1. Hematuria Hx Personal data: name, age, occupation, residency, place of birth and marital status CC: hematuria, for how long? HPI: 1. Microscopic/macroscopic? 2. Associated with pain? (flank, suprapubic,…etc) [you have to take a full Hx of pain!] 3. Appearance (shape & color): - clots (thread  kidney; round  bladder) –fresh 4. Timing: 1. At the beginning: 2. Midstream 3. At the end 4. Continuous 5. frequency. 6. Bleeding from other sites: e.g. menstruation. 7. Did the patient suffer from the same condition before?

2. 8.Other urinary symptoms: 1. Storage (irritative): 1. Frequency 2. Urgency 3. Noctoria 4. Urge incontinence 5. Dysuria 2. Voiding (obstructive): hesitancy: delay in starting micturation. Intermittent folw Weak stream: diminished force and caliber with prolonged voiding time. Double voiding Straining to void Terminal dribbling 9. Constitutional symptoms: Fever Anorexia Malaise Weight loss Bone pain

3. Risk factors: Risk factors: PRE-RENAL: Coagulation disorder, Sickle-cell, Vasculitis RENAL: Stones, TB, Glomerular disease, Carcinoma, Cystic disease, Trauma, A-V malformations, Emboli POST RENAL: Stones, stricture, Infection [Bladder (schistosomiasis)/ Prostate / Urethra], Carcinoma (Bladder / Prostate), Traumatic bladder catheterisation, Inflammatory Cystitis Drugs: rifampicin (color), warfarin (blood) Past Hx: sotnes, schistosomiasis, trauma, HTN, DM, TB Family Hx: stones, tumors Social Hx: smoking Occupation (painting, dry cleaning, dental technician!)

4. Investigation: Painless haematuria is carcinoma until proven otherwise Investigations: PR full history and examination (don’t forget PR!) Blood Investigations FBP – Anaemic? White cell count raise indicative of infection?, Enough platelets? U&E – Are their kidneys working? (Crude test) Coagulation screen – Haemophilia?, Warfarin? In Men … PSA (prostate specific antigen) MSU REMEMBER MSU – Direct microscopy and culture. Urinary Cytology: Not very sensitive, but an unequivocally positive cytology is quite specific for TCC bladder. RADIOLOGY: Ultrasound IVP Both are very sensitive and specific, but USS better for small peripheral renal lesions, and IVP better for renal pelvis and ureters. FLEXIBLE CYSTOSCOPY

5. nephrostomy NEPHROSTOMY

6. Nephrostomy Nephrostomy Q1- Describe what you see. (previous slide) Q2- What are the indications for nephrostomy? 1.To provide urinary drainage when the ureter is obstructed by kidney stone or tumor 2.To remove or dissolve renal calculi 3.To deliver chemotherapeutic agents to the renal collecting system 4.If there is a hole in the ureter or bladder and urine is leaking into the body. 5.As a diagnostic procedure to assess kidney anatomy. 6.As a diagnostic procedure to assess kidney function. Q3- What are the complications of nephrostomy? 1.injury to surrounding organs, including bowel perforation, splenic injury, and liver injury 2.infection, leading to septicemia 3.significant loss of functioning kidney tissue (<1%) 4.delayed bleeding, or hemorrhage(<0.5%) 5.blocking of a kidney artery(<0.5%) Q4- When you will remove it? ? (a doctor told us that it depends! Some cases 2 days and some can stay there until the patient dies!!) ?

7. Hx of nocturia Personal data: name, age, occupation HPI: Onset Frequency Volume changes: oliguria, polyuria Urine color Painful/painless groin, suprapubic or loin pain Obstructive symptoms: Retention Poor stream Intermittent stream Hesitancy Drippling Incomplete emptying

8. Irritative symptoms: Frequency Urgency Dysuria Incontinence External genitalia: rash, discharge or ulceration Constitutional symptoms: fever, loss of appetite, loss of weight, bone pain Chronic illness: DM, HTN, renal failure,heart failure, gout Risk factors: smoking and alcohol(BPH), UTI, trauma, stones, catheterization Past Hx: UTI, stones, surgery Drugs: e.g. PGE2, lithium, tetracycline, hypercalcemia, hypokalemia. Family Hx: malignancy, stricture, stones Social Hx: smoking, occupation, travel,

10. Lamees alashykh Lulu alolayt