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Published byLeslie Benson Modified over 9 years ago
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IN THE NAME OF GOD
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HISTORY AND PHYSICAL EXAMINATION IN UROLOGY
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HISTORY C.C & P.I Past medical history Family history
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PAIN
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PAIN Sever pain : distention of hollow viscus e.g ureteral obstruction, urinary retention Tumor : usually do not pain unless produce: Obstruction Extend beyond the primary organ Pain in urogenital cancer is late presentation Pain in urogenital cancer is late presentation
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RENAL PAIN Location (CVA) Radiation Associated symptoms Inflamatory pain (steady) Obstructive pain (colic)
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URETERAL PAIN Acute Obstruction acute ureteral dilatation Ureteral spasm and hyperperistaltism pain
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URETERAL PAIN Radiation: 1/3 upper: testis 1/3 middle: scrotom – labia 1/3 lower: penis –meatus-irritative. bladder symptoms Chronic ureteral pathology no pain
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Bladder pain Acute pain: acute urinary retention Intermittent suprapubic pain: inflammation(cystitis- IC) Continious suprapubic pain: non urologic
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Aute urinary retention
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PROSTATE PAIN Secondary to inflammation Edema –distention of the prostatic capsule Localized in perineoum Refer to lombosacral- inguinal –lower extremity
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PENILE PAIN Flaccid: STD paraphimosis Erection: priapism— peyronie disease
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TESTIS PAIN Primary : Acute : torsion Hematoma(trauma) orchiepididimitis Chronic : hydrocele varicocele spermatocele Referral : kidney retroperitoneoum indirect inguinal hernia
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HEMATURIA Definition : macroscopic– microscopic RBC> 2 hpf Initial : Urethra total : bladder and upper tract terminal : bladder neck & prostatic urethra
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HEMATURIA Painless hematuria : malignancy( bladder- kidney) Hematuria+ flank pain : stone Hematuria+ irritative symptoms : cystitis( bacterial- hemorragic)
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LOWER URINARY TRACT SYMPTOMS(LUTS)
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IRRITATIVE SYMPTOMS Frequency : Polyuria (DM-DI-excessive fluid intake) Decreased bladder compliance : Bladder outlet obstruction & residual urine Decreased functional capacity External pressure Anxiety
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IRRITATIVE SYMPTOMS Urgency : strong,sudden impulse to void Causes: Inflammation: e.g Acute cystitis Hyperreflexive neurogenic bladder Advanced urinary outlet obstruction Anxiety
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IRRITATIVE SYMPTOMS Dysuria : painful urination Usually by inflammation Initial : urethral pathology Terminal(strangury) : bladder
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IRRITATIVE SYMPTOMS Nocturia : nocturnal frequency Frequency without nocturia : psychogenic Nocturia without frequency : CHF Normal nocturia : old age Excessive fluid drink in night : caffeinated & alcoholic beverages
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OBSTRUCTIVE SYMPTOMS Hesitency Intermittency Decreased force & caliber Post void dribbling Straining Incomplete emptying
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OBSTRUCTIVE SYMPTOMS Common cause : BPH Urethral stricture Neurogenic bladder Uncommon cause : Prostate cancer Urethral cancer Foreign body
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URINARY INCONTINENCY True(continous) :involuntay loss of urine at all times & all position Common cause: Fistula(VVF-UVF) Sphincter destruction Ectopic ureter
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URINARY INCONTINENCY Stress urinary incontinency(SUI): Sudden leakage of urine with coughing, sneezing, and exercise that increased intravesical pressure Cause: multipar women after menopause men after prostate surgery
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URINARY INCONTINENCY Urge incontinence (UI): Loss of urine preceded by a strong urge to void Cause: cystitis Neurogenic bladder Advanced bladder outlet obstruction
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URINARY INCONTINENCY Overflow incontinency (paradoxical inc): Secondary to advanced urinary retention and high residual urine volume
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ENURESIS
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ENURESIS PRIMARY SECONDARY Everybody with enuresis should be evaluated
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Sexual dysfunction in male
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Decreased libido Endocrine Psychologic
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ERECTILE DYSFUNCTION Psychogenic Neurogenic Vasculogenic
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ABSENCE OF EMMISSION Retrograde ejaculation Sympathetic denervation Androgen disturbance Drugs Bladder neck & prostate surgery
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ABSENCE OF ORGASM Psychogenic Medications used to treat psychiatric diseases
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PREMATURE EJACULATION Subjective symptom Orgasm within less than 1 minute after initiation of intercourse Cause: Psychogenic Anxiety
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HEMATOSPERMIA Causes: Nonspecific inflammation in prostate & s.v Prostate and s.v cancers Initial prostate Terminal s.v Evaluation: DRE- urine cytology-TRUS- spermogram
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PNEUMATURIA Cause: Fistula between bladder and intestine Common cause: diverticulitis sigmoid cancer regional enteritis(croh,n disease) Uncommon cause: diabetes & gas forming infection
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URETHRAL DISCHARGE The most common symptom of veneral infection Gonococal urethritis Nongonococal urethritis Bloody discharge: urethral carcinoma
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FEVER Urogenital infection associated with fever: Acute Prostatitis Acute pyelonephritis Acute epididimo-orchitis Infection+ obstruction+ fever & chills= sepsis
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PHYSICAL EXAMINATION
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RENAL EXAMINATION Bimanual kidney palpation CVA percussion RUQ or LUQ ascultation : cystolic bruit transillumination : cystic- solid
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BLADDER EXAMINATION BLADDER EXAMINATION Volume required for percussion or palpation: 150cc Volume required for vision : 500cc Bimanual bladder examination during anesthesia: evaluation of regional extension of bladder tumor
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PENILE EXAMINATION Retraction of prepus and exam of glans penis Meatus position: hypospadiasis- epispadiasis Penile skin: vesicle genital herpes Ulcer sexually transmited- tumors Stiffness : peyronie plaque
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hypospadiasis
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Epispadiasis
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phimosis
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Paraphimosis
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Genital herpes
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Syphlis ulcer
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Peyronie disease
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SCROTOM EXAMINATION Testises: bimanual exam Normal: 4-6 cm in adults Firm area within the testis : malignancy Epididym Vas deference Scrotal skin Spermatic chord Upright exam is mandatory
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RECTAL EXAMINATION(DRE) Indication : Every male after age 40 who present for urologic evaluation Importance is for prostate cancer, the most common cancer in male
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RECTAL EXAMINATION(DRE) Patient position knee chest Inspection : hemorroid – fissure- fistula- polyp- cancer EAS( external anal sphincter) tonicity Prostate : size – consistency- median sulcus Bulbocavernous reflex
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RECTAL EXAMINATION(DRE)
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COMMON ABNORMAL PHYSICAL FINDING
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KIDNEYS Mass : common abnormal finding in examination Adults : cyst – tumor Children : cyst & benign: Hydronephrosis- MCDK- RPK Malignant : Wilm,s tumor- Neuroblastoma
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PENIS Phimosis Paraphimosis Peyronie disease Priapism Hypospadiasis Epispadiasis Penile carcinoma
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SCROTOM & CONTENTS Mass : testis masses : commonly malignant Epididym & spermatic chord mass : commonly benign Torsion Hydrocele Spermatocele Trauma( hematoma)
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SCROTOM & CONTENTS Varicocele : enlarged, tortuous spermatic vein above the testis, almost always in left side Grading : I palpable only with valsalva II palpable without valsalva III visible without valsalva
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spermatocele
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spermatocele
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hydrocele
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hydrocele
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hydrocele
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varicocele
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varicocele
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Testis torsion(R)
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Testis torsion
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Scrotal hematoma
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Inguinal hernia
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PROSTATE Acute bacterial prostatitis BPH Prostate cancer
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THE END
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