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UROLOGY Lecture Course for Students of Medical Universities A.A. Zebentaev, P.V. Plotnikov UROLOGY Lecture course for students of medical Universities Vitebsk, 2017 Ministry of Health Care of the Republic of Belarus Higher Educational Establishment “Vitebsk State Medical University” A.A. Zebentaev, P.V. Plotnikov UROLOGY Lecture course for students of medical Universities Рекомендовано учебно-методическим объединением по высшему медицинскому, фармацевтическому образованию Республики Беларусь в качестве учебно-методического пособия для студентов учреждений высшего образования, обучающихся по специальности 1-79 01 01 “Лечебное дело” Vitebsk, 2017 УДК 616.6(042.3/.4)=111 ББК 56.9я73 Z 42 Reviewed by: N.A. Nechiporenko, MD, PhD Grodno State Medical University Urology Dpt., Belarusian State Medical University, Minsk Zebentaev A.A. Z42 Urology: Lecture course for students of medical universities/ А.А. Zebentaev, P.V. Plotnikov. – Vitebsk: VSMU. - 2017. - 188p. ISBN-978-985-466-862-8 The content of this lecture course “Urology” for students of medical Univer- sities corresponds with basic educational plan and program, approved by Minis- try of Health Care of the Republic of Belarus. This book corresponds to the typ- ical educational program on specialty Urology and suitable for foreign students. This edition accumulates in a chort form the data covering the most of essential areas and all basic topics of urology. УДК 616.6(042.3/.4)=111 ББК 56.9я73 Confirmed and recommended for edition by the Central educational - methodi- cal Council of Vitebsk State Medical University in 16 November 2016, the protocol № 10. ISBN-978-985-466-862-8 © Zebentaev A.A., Plotnikov P.V., 2017 © VSMU Press, 2017 • CONTENTS CONTENTS . 3 ABBREVIATIONS .LIST . 7 1 .SYMPTOMS, .PHYSICAL .EXAMINATION AND. .INVESTIGATIONS .OF .THE . UROLOGICAL .PATIENTS . 11 1.1. Symptoms . 11 1.1.1. Systemic manifestations . 11 1.1.2. Flank pain . 13 1.1.3. Scrotal symptoms . 14 1.1.4. Penile and urethral symptoms . 15 1.1.5. Urinary incontinence . 16 1.1.6. Nocturia and nicturia . 17 1.2. Physical examination of the urological patient . 17 1.2.1. Abdominal examination of the patient with urological disease . 17 1.2.2. Digital rectal examination . 18 1.3. Urine examination . 18 1.3.1. Dipstick testing . 18 1.3.2. Urine microscopy . 19 1.3.3. Urine cytology . 20 1.4. Endoscopy . 20 1.4.1. Urethroscopy. 20 1.4.2. Cystoscopy. 20 1.4.3. Ureterorenoscopy . 21 1.5. Ultrasound. 21 1.6. Radiological imaging . 24 1.6.1. A plain film . 24 1.6.2. Intravenous urography . 24 1.6.3. Retrograde urography . 25 1.6.4. Antegrade urography . 25 1.6.5. Cystography . 25 1.6.6. Urethrography . 25 1.7. Computed tomography . 26 1.8. Magnetic resonance tomography . 27 1.9. Radioisotope imaging and renal function assessement . 28 1.10. Uroflowmetry. 30 1.11. Cystometry, pressure flow studies and videocystometry . 30 1.12. PSA . 31 4 CONTENTS 2 .STONE .DISEASE . 32 2.1. Kidney stones . 32 2.2. Ureteric stones . 37 2.3. Bladder stones . 39 3 .BENIGN .PROSTATIC .HYPERPLASIA . 41 4 ANOMALIES. .OF .THE .GENITOURINARY .TRACT . 47 4.1. Renal and ureteral anomalies . 47 4.1.1. Horseshoe kidney . 47 4.1.2. Ectopic kidney . 47 4.1.3. Renal agenesis. 47 4.1.4. Cystic kidney disease . 48 4.1.5. Upper urinary tract duplication . 49 4.1.6. Pelviureteric junction obstruction . 50 4.1.7. Vesicoureteric reflux . 51 4.1.8. Ectopic ureter . 51 4.1.9. Ureterocele. 52 4.2. Urethral anomalies . 53 4.2.1. Hypospadias . 53 4.2.2. Posterior urethral valves . 54 4.3. Bladder exstrophy and epispadias . 54 4.3.1. Bladder exstrophy . 54 4.3.2. Primary epispadias. 55 4.4. Bladder abnormalities . 56 4.4.1. Persistent urachus . 56 4.4.2. Contracture of the bladder neck . 56 4.4.3. Dilated fetal bladder . 57 4.4.4. Congenital megacystis . 57 4.4.5. Bladder hypoplasia . 58 4.4.6. Bladder agenesis. 58 4.4.7. Bladder diverticulum . 58 4.4.8. Bladder duplication. 59 4.5. Penile abnormalities. 59 4.5.1. Phimosis . 59 4.5.2. Aphallia . 60 4.5.3. Diphallia . 60 4.5.4. Inconspicuous penis . 61 4.5.5. Micropenis . 62 4.5.6. Penile curvature . 63 4.6. Testicular abnormalities . 64 4.6.1. Cryptorchidism . 64 UROLOGY 5 5 .ONCOUROLOGY . 65 5.1. Prostate cancer . 65 5.2. Bladder cancer . 77 5.3. Renal pelvic and ureteral cancers . 85 5.4. Renal tumors . 87 5.4.1. Benign renal masses. 87 5.4.2. Renal cell carcinoma. 88 5.5. Testicular cancer . 93 5.6. Penile neoplasms . 97 5.6.1. Viral-related and premalignant lesions. 97 5.6.2. Penile cancer. 98 5.7. Urethral cancer . 100 6 .TRAUMA .TO .THE .URINARY .TRACT . 103 6.1. Renal injuries . 103 6.2. Ureteric injuries . 106 6.3. Bladder and ureteric injuries associated with pelvic fractures . 108 6.4. Bladder injuries . 109 6.5. Urethral injuries . 110 6.5.1. Posterior urethral injuries in males. 110 6.5.2. Anterior urethral injuries in males . 111 6.5.3. Urethral injuries in females. 112 6.6. Testicular injuries . 113 6.7. Penile injuries . 113 6.7.1. Penile amputation . 113 6.7.2. Penile fracture . 114 7 .EMERGENCIES . 115 7.1. Acute urinary retention . 115 7.1.1. Aсute urinary retention in male . 115 7.1.2. Bladder outlet obstruction and retention in women . 117 7.2. Torsion of the testis and testicular appendages . 118 7.3. Paraphimosis . 118 7.4. Malignant ureteric obstruction. 119 8 .URINARY .TRACT .INFECTIONS . 120 8.1. Cystitis. 122 8.2. Urethritis. 123 8.3. Recurrent urinary tract infection . 124 8.4. Pyelonephritis . 125 8.4.1. Acute pyelonephritis . 125 8.4.2. Emphysematous pyelonephritis . 127 8.4.3. Purulent forms of pyelonephritis . ..
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