1. Dr mohammad alshahwani
بسم الله الرحمن الرحيم
Dr mohammad alshahwani

2. URINARY SYMTOMS&INVESTIGATIONS dr.mohamed fawzi alshahwani
LECTURE ONE
URINARY SYMTOMS&INVESTIGATIONS dr.mohamed fawzi alshahwani
Dr mohammad alshahwani

3. Dr mohammad alshahwani
URINARY SYSTEM
US is extra peritoneal system composed of two kidneys located in the upper abdomen protected by thoracic cage, each weighs about 150 g. Each kidney supplied by main renal artery from aorta, divided into 5 segmental branches and drained by renal vein to the inferior vena cava.
Dr mohammad alshahwani

4. Normal capacity about 350-400 cc
URINARY BLADDER
Muscular organ located in the pelvis, acts as urine reservoir during resting time and discarding urine via urethra during the process of urination by the action of detruser muscles contraction.
Normal capacity about cc
Dr mohammad alshahwani

5. Dr mohammad alshahwani

6. Dr mohammad alshahwani
urethra
Dr mohammad alshahwani

7. Dr mohammad alshahwani
URINARY SYMTOMS
HAEMATURIA
PAIN
ALTERED BLADDER FUNCTION
INCONTINENCE
Nocturnal enuresis
ASSOCIATED SYMTOMS
Dr mohammad alshahwani

8. Dr mohammad alshahwani
HAEMATURIA
MACROSCOPICAL
MICROSCOPICAL
TERMINAL
TOTAL
EARLY
INTERMITANT
PERSISTANT
Dr mohammad alshahwani

9. Dr mohammad alshahwani
pain
Renal pain
Ureteric colic
Bladder pain
Perineal pain
Urethral pain
Dr mohammad alshahwani

10. Incontinence involuntary loss of urine
Continuous incontinence
Stress incontinence
Urge incontinence.
Overflow urinary incontinence
Dr mohammad alshahwani

11. Associated symptoms&sign
GIT
Autonomic
Organ relationship
Peritoneal irritation
Mass or swelling
Failure to thrive
Uremia
Dr mohammad alshahwani

12. INVESTIGATION urine examination
DIPSTIC…RBC,,,protein,,,nitrite,,,,screenig
GUE
CYTOLOGICAL
BACTERIOLOGICAL
BIOCHEMICAL
HAEMOGLOBIN;MYIGLOBIN;BILIRUBIN;GLUCOSE;ELECTROLYTE protein
24h urine for calcium; uric acid; oxalate,protein
Dr mohammad alshahwani

13. Dr mohammad alshahwani
INVESTIGATION
Renal function test
MORE THAN 70%OF RENAL FUNCTION MUST BE LOST BEFOR RENAL FAILURE BECOME EVIDENT
BLOOD UREA& SERUM CRIATININ
Isotope study
(EDTA),(DMSA)
Dr mohammad alshahwani

14. INVESTIGATION radiological
KUB
BONES
SOFT TISSUE
STONES
IVU
RETROGRADE URETERPYELOGRAPHY
ANTEGRADE PYELGRAPGY
CYSTOGRAPHY (MCUG)
URETHROGRAPHY
Dr mohammad alshahwani

15. Dr mohammad alshahwani
INVESTIGATION
ULTRASONOGRAPHY
Color Doppler uls
TRANSRECTAL ULTRASONOGRAPHY
CT SCAN
TUMOR SIZE;SITE;INVATION
LYMPH NODE
INVATION OF THE RENAL VEIN&VENA CAVA
STAGING&FOLLOW UP OF TESTICULAR TUMOR
MRI
Dr mohammad alshahwani

16. Dr mohammad alshahwani
INVESTIGATION
RADIOISOTOP SCANNING
FUNCTION OF INDIVIDUAL RENAL UNIT
DTPA LABELLED WITH TECHNETIUM-99
ISOTOP BONE SCANING
FOR STAGING KIDNEY&PROSTATE CANCER
Urodynamic study
ENDOSOPY
Dr mohammad alshahwani

17. URINARY TRACT IMAGING KUB (kidneys, ureters, and bladder)
A plain radiograph of the abdomen and pelvis includes the area above both adrenal glands and extends to 2 cm below the symphysis pubis \
Dr mohammad alshahwani

18. Dr mohammad alshahwani/
KUB: site, skin, sex, stones, psoas shadow, skeleton, and soft tissue shadow.
Dr mohammad alshahwani

19. Dr mohammad alshahwani
3-IVU:
No., size, site, function of the kidneys, anatomy of the collecting system, hydronephrosis, and filling defects.
C.I.: allergy and renal failure.
Dr mohammad alshahwani

20. Dr mohammad alshahwani

21. Dr mohammad alshahwani

22. Dr mohammad alshahwani

23. RETROGRADE URETERPYELOGRAPHY invasive
Dr mohammad alshahwani

24. Dr mohammad alshahwani
CYSTOURETHROGRAPYH
Contrast-enhanced imaging of the lower urinary tract provides valuable information on the function and anatomy of the bladder and urethra
Voiding Cystourethrography
Dr mohammad alshahwani

25. Dr mohammad alshahwani
ANGIOGRAPHY
Currently, CT, MRI, and ultrasonography have supplanted angiography for most diagnostic indications, providing equivalent and at times greater information with markedly decreased morbidity and risk.
Dr mohammad alshahwani

26. Dr mohammad alshahwani
NUCLEAR IMAGING \.
Technetium Tc 99m Diethylenetriaminepenta-acetic Acid 99mTc-DTPA Technetium Tc 99m Mercaptoacetyltriglycine 99mTc-MAG3
Technetium Tc 99m Dimercaptosuccinic Acid 99mTc-DMSA
It gives the split function of
each kidney
Dr mohammad alshahwani

27. Dr mohammad alshahwani

28. Dr mohammad alshahwani

29. Dr mohammad alshahwani
Color doppler ult
Dr mohammad alshahwani

30. MAGNETIC RESONANCE IMAGING\
Dr mohammad alshahwani

31. Dr mohammad alshahwani
COMPUTED TOMOGRAPHY
Non Contrasted
Oral Contrast Agents
Intravenous Contrast Agents
CT can accurately characterize the nature of tissue in the lesion.
CT is useful in the preoperative evaluation and staging of tumors.
CT has replaced IV urography as the primary modality for the assessment of suspected renal injuries and their complications
For the evaluation of patients with acute flank pain, unenhanced spiral CT is more sensitive in detecting calculi than EXU
Dr mohammad alshahwani

32. Urethroscope, cystoscope ureteroscope and renoscope.
Endoscope…invasive
Urethroscope, cystoscope ureteroscope and renoscope.
Dr mohammad alshahwani

33. Dr mohammad alshahwani

34. Dr mohammad alshahwani

35. Dr mohammad alshahwani

36. Dr mohammad alshahwani
nephroscopy :
Dr mohammad alshahwani

37. Dr mohammad alshahwani:
Urodynamic studies:
To study the function of the vesico-urethral unit. Include cystometry, flow rate and EMG of pelvic floor.
Dr mohammad alshahwani