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Voiding Dysfunction .. ! 1. Symptomatology and terminology of voiding dysfunction 2. International prostatic symptom scores (IPSS) 3. Hematuria : definition and causes 4. Investigation for patient with hematuria Voiding Dysfunction AB CDE E (Sign & Symptom) GH AB GHI J ! JADK KLLCJ G MNOHEDED LUTS (Lower Urinary Tract Symptom) CDE LUTS G Terminology ISGH B TLUIVNE J UMNMNA NE M J B LD W N D LUTS (lower urinary tract symptom Irritative symptom Obstructive symptom Frequency Weak stream Nocturia Urinary hesitancy Urgency Intermittency Dysuria Postvoid dribbling Straining Acute and chronic urinary Retention Interruption of the stream Sense of residual urine 1 Symptomatology and terminology of voiding dysfunction Frequency KJDE IVE GHJJDEGHC ED BH MNaJJ I K NMbD LK 5-6 f DE g D f LG 300-400 cc. KJDEGIC W N D - Polyuria !E K !Bf ID D 2000 ./ LGICL IJGH WDW N J TOEWDHUIE OEIJLO (Diabetes Insipidus) OE ELI L GH OHfUM I jW N - Decreased bladder capacity GgGHUMN IKG ID D IKEE J D (Partial cystectomy), g Neurogenic bladder - Decreased functional capacity ! !E IKELLIDI D GH GJ M IK (irritation) ID M cystitis OENDIG jELUMNI KJDEW N Nocturia KJDEGHI !BfME O L GHI!NEWN J f MNUD Nocturnal frequency LOHE!BfKJN WDI 2 f DEO M l Na LUIVNE l I GH J frequency E NIE U - Frequency GHI !BfISE g WDG nocturia GICGHI GHIOHE J psychogenic IG - Nocturia without frequency ELI MNaGHIV congestive heart failure G peripheral edema IOHE L ED supine UMN intravascular volume I H!Bf - Nocturia MN EC renal concentrating ability ECGHI H!Bf MNa ECLG KI H!BfE OIOHE L renal blood flow I H!BfMDE Noctruia ELI MGHEJfU m DEE IOHE OHE EnE o IOHEl WDJIC DIJOfE NN nocturia LI L GHG bladder outlet obstruction W N D gDE g (BPH) 2 Urgency E KED C LJL fWDED LGICL E IJGHI !BfM IK ID bacterial cystitis UMNIOHEJC !E IKGWDE JGJ !Bf ELI L Neurogenic bladder hyperreflexic urinary urgency ELI L anxiety ED I G g WDGgMJJ I KED EOHI jW N MNaJ GHGE IVI m LUMNI urgency incontinence OE urinary dribbling IrsE I EDIV f Na ECGHG urgency ELLJ NIOHE K GHE (enuresis) IOHE L C L GHE OIOHEI!NNE fUWD Dysuria E MD ! JADK I MDEK (urethra) IVE MNa - initial dysuria EI HNADK GICL J IDE I K - terminal dysuria M!ADKM NC GICL IK DE E dysuria GICL E IJMDEK (urethritis) DE (prostatitis) HM IK (vesicle calculi) Weak stream IVL bladder outlet obstruction ID gDE g NaDMbD LWDW N I DG IGH ! !E UK OE !E K IOHE L IGH DI ED N m ELMNIIVt m LB GED IL ID UMNKWD frequency I !Bf DEKGJ (strictured urethra) jIVICBH GHUMNI KbGfW N Hesitancy WDAI HN KW N G MNIE D u IOHE !E NKLEE W NM G (NE D 1 Gg ) DLN MNaGHGKb bladder outlet obstruction ADKM!GH IKG WDAB LC OENGHGJC GHG E IELIVIC!E hesitancy W N 3 Intermittency KEE IVN m IOHE L NaMN NIOfENNE IJD GHI !BfIE M I KM ADK JJDEMNa bladder outlet obstruction Postvoid dribbling IOHE fC KD f KGHELL IOEMDEK D bulbous OE prostatic urethra LA G JI!NWM IK MNaGHIV bladder outlet obstruction KGHEDJ IDE bulbous LIj EE It I DGHLA G JI!NWM I K KIjLNDMbD LI!DIJ m MNKEE DJ f jELLWD W N G IJ m J IvtIjJ UD DEK bulbous MNKEE meatus ELLD NKb dribbling W N Gf WDGU bM LI HI Urinary Retention KWDEE LNE I!N J K LGICD m W N D 1. Acute Urinary Retention (AUR) ICGHJJDEGHC OE gDE g (BPH,BPO) Na GE KUJ BH N DWDW N J TED I IOHE D JG E IJ IOfE J!E DE (prostatic congession) ED KLLCJ UWD ADWD KWDEE MGHC Na CDGf LW J T IOHEKEE ME OGNE SC IS K NI GHA NE L NKbMNNaW N H UMNNaI!N J TISg N (definitive treatment) IOHE L GfIVlfUW NIj KGHW NM GGfL D !E IK ( D 400 .) fM GGH !E KGHW NNE DELWDAOEIV AUR 2. Chronic Urinary Retention JW N f Ib JD JgIOfE GHUMNNa ! J WDW NOEWD ID gE gE y (paraplegia, paraparesis, CVA), Neurogenic bladder, DM with peripheral neuropathy NaELLg J NIOHE E IJ!E I K WE IJ GKIGH IOHE L G overflow incontinence TNa CDGfNE MN U J Neurogenic bladder 4 3. Postoperative Acute Urinary Retention ELJW NMNab LI acute overdistended bladder ID D GI D MI OE D GHNE MN spinal anesthesia 4. Idiopathic acute urinary retention J MNab WDJICD ELJM NaGHGI M fKWN m T N MN intermittent catheterization UMNNa JKW N IjGHC 5. Post Traumatic urinary retention IOHE L ECJ ICI GHDEK (ruptured urethra) ELJ ECJ IC G OEM GGH J ILjJWDC NaELg J ECJ IC m NIOHE KWDEE IOHE L Strictured urethra NaDMbD AMN W N G UMN LS gWD Strictured urethra ELI IOfEMDEKg ISg IOfE I u (Sexual transmitted disease) M E G!E NaW N NaM CDGfIOHEW N J LS gGHNE SC IS N J KbM MDK IOHE L DEKGHGJJ ELNE NKb N U Cystostomy IOHEMNKEE H DEGHLD MNJJ I KU TDEW urinary retention WDIOE J anuria lBH I L EC !E E WM J D IK!BfW NaELLg J NE N OE }KWDEE ~ MN LS gMNW N IOHE L SC IS !E gD LD MNa AUR J full bladder lBH WDJMNa anuria MJ f NE G KIOHEDM LS g LJD Na anuria LWDGKM IK Incontinence HW!E Kg WDN OEJ JWDW N JD IV D m W N D 1. Continuous incontinence W!E KGHJ JWDW NIICDMbDIV iatrogenic I D MI (Pelvic surgery) OE D DE N NE (Transurethral Resection of Prostate gland : TUR-P) IOHE L ND U MNI J ILjJDE External sphincter AOEIV!N IG GHN DEMNI C ! 5 DNa ECJ DE!N HU WDAOEDIVKbM D TUR-P M J NaJ g ID Na high spinal cord paralysis, Quadriplegia GHNE JC K D endoscopic external sphincterotomy IV UMNI continuous incontinence lBH LUMNWDGK N JC IOfEMNaW N G!Bf ANU KMNaGHIV continuous incontinence WDDIM j LJDWDGKM IKI AOEIV A GHD L incontinence EOH 2. Stress incontinence G Ij !E KM!GHG I H IJD MDE NE ID M! WE L !BfJ W H MGHC L HM!I N JJDEMNab ECGHG DE!E pelvic diaphragm lBH IVMNDEK DEK (sphincter unit) IOHE HUUMNWDAN I H!E GHI !BfW NE LGHU bOE U stress test GfELJW NM f m D DE NE MNa 3. Overflow incontinence LD MNa CDGfLJ full bladder lBH ELL LAB J OE NaJ NKbIOHE KIGH E I WDAJCW N J f D J persistent bacteriuria and pyuria J NE MNNENEI j DEWNE I I L neurogenic bladder hyporeflexia UMNWDG propioceptive sensation WDE J IOHE CNMN IKJGJ JMNa paraplegia GHI L sacral cord lesion lBH IVUD !E micturition center ELJMNaIJGHG sensorineuropathy OEI j GHIVg myelomeningocoel LS gGHU bOE continuous incontinence g KIOHE !E KGH N 4. Urgency incontinence JW NJDEGHC NaGE WDC IV H J f IG UbID f GD m GHUMNI urgency incontinence W N D cystitis, CVA with hemiparesis, parkinsonism, post operative TUR-P, overactive bladder, bladder stone etc. LS DMbDMN l LD LK NaJ GHGl JlNEELNE MN L N urodynamics N 6 Enuresis AB K GHE L E JWN Enuresis MI j I OEJ f I L delay maturation !E JJ JC K I j GHG LJC ADKW NIE ME IOHEEC 1-2 !J E O 2-3 !J OJN (investigation) WDGLUIVMI j ECNE D 7 !J LS TUJD Wg INGH behavioral change ID fU DEE C MN!BfADKJN v MNI!NNE fU DEEC O IOHE DIG !E I j L EE M IOHE enuresis W NJDE m ID Wg IG A DED GHIOHENEIGMIOHE K GHE MN U ML DI j g DED UMNI j I KbNE WMGHC M J I j GHGKbGfWDW N J MDMLIDGH L WDJC GHI jJ G NEM!I!ND CD Enuresis MNMbD IVL gMGHW N J L LS ED IEG Pneumaturia G HEE M!K AB GE H DE JJJ I EOE UWN MbD ELIV!N IG D I OE C !E Ij L UWNMbD E HGfELJGH E W OE IK GHU bOE IOfEED IOfE !E JJ I K NE m ELEE AE K OE L DE NE !E JJ K (cystoscope) W N lBH IV f m WDI 48 Hg International prostatic symptom scores (IPSS) IOHE L E DED GH DELGfU M GH D LB GN N MNDGHIG D International Prostate Symptom Score (IPSS) lBH MKLLCJ E L LMN JNaDE gN UMNMNa LUTS EG g KLLCJ MN symptom score LB IVGHE J ED N ! M MN LS g I T U JNa LUTS 7 IPSS 0 1 2 3 4 5 WDGE GE m GE JDE GE JDE GE JDE GE I f NE D DNE D E D 5 JDE 2 f MAD 5 f M 5 f M I OEJC f K 10 ADK f M ADK f 10 f ADK 10 f 10 f 1. NB ADKWDC OEIOEN 0 1 2 3 4 5 L ADIjLN 2. ADKJDE m D WDAB 0 1 2 3 4 5 2 Hg 3. ADK J EOE ADm 0 1 2 3 4 5 C m f 4. IOHE KN fWDW NNE GJ 0 1 2 3 4 5 I!NNE fU 5. KWDCD UKEDE 0 1 2 3 4 5 6. NE IJD OEE DELAD 0 1 2 3 4 5 KEE W N 7. IOHEE JNNE C !BfAD -----0 -----1 -----2 -----3 -----4 -----5 K B GH f DEOHE f f f f f f EIN 0 7 AB E NE 8 19 AB I HGE !Bf 20 35 AB E C I H T Hematuria : definition and causes Definition Microscopic hematuria Macroscopic hematuria (gross hematuria) Initial hematuria Terminal hematuria Homogeneous hematuria Painful or painless hematuria Pseudohematuria 8 Microhematuria When will be considered abnormal? Microhematuria Reference 1.
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    Urology 2002

    UROLOGY Dr. S. Herschorn Ryan Groll, Alexandra Nevin and David Rebuck, chapter editors Gilbert Tang, associate editor HISTORY AND PHYSICAL . 2 PENIS AND URETHRA . .26 Peyronie's Disease KIDNEY AND URETER . 2 Priapism Renal Stone Disease Phimosis Stone Types Paraphimosis Benign Renal Tumours Penile Tumours Malignant Renal Tumours Erectile Dysfunction Carcinoma of the Renal Pelvis and Ureter Urethritis Renal Trauma Urethral Syndrome Urethral Stricture BLADDER . 9 Urethral Trauma Bladder Carcinoma Neurogenic Bladder HEMATURIA . .30 Incontinence Urinary Tract Infections (UTI) INFERTILITY . .31 Recurrent/Chronic Cystitis Interstitial Cystitis PEDIATRIC UROLOGY . .32 Bladder Stones Congenital Abnormalities Urinary Retention Hypospadias Bladder Trauma Epispadias-Exstrophy Bladder Catheterization Antenatal Hydronephrosis Posterior Urethral Valves PROSTATE . 16 UPJ Obstruction Benign Prostatic Hyperplasia (BPH) Vesicoureteral Reflux (VUR) Prostate Specific Antigen (PSA) Urinary Tract Infection (UTI) Prostatic Carcinoma Enuresis Prostatitis/Prostatodynia Nephroblastoma Cryptorchidism / Ectopic Testes SCROTUM AND CONTENTS . .21 Ectopic Testes Epididymitis Ambiguous Genitalia Orchitis Torsion SURGICAL PROCEDURES . .35 Testicular Tumours Hematocele REFERENCES . .36 Hydrocele Spermatocele/Epididymal Cyst Varicocele Hernia MCCQE 2002 Review Notes Urology – U1 HISTORY AND PHYSICAL HISTORY ❏ pain: location (CVA, genitals, suprapubic), onset, quality (colicky, burning), severity, radiation ❏ associated symptoms: fever, chills, weight loss, nausea, vomiting
  • Assessment of the Urological Patient : History and Examination

    Assessment of the Urological Patient : History and Examination

    1 Assessment of the urological patient : History and examination Assessment of the urological patient involves initial assessment of the patient’s age, built, taking a complete and detailed history, a thor- demeanour, intelligence and socio‐economic ough physical examination and analysis of a group and adapt your consultation style accord- urine sample. As with all history taking the ingly, based on your experience, in an attempt enquiry should include details of the presenting to make the patient feel comfortable. An ice- complaint and its history, the relevant past breaker such as ‘I hope you haven’t been medical history and a family and drug history. waiting too long’ or ‘Did you manage to park Th e examination should include the abdomen, easily?’ can help the patient to relax. Aim to external genitals and a digital rectal examination project a caring, experienced and open but in men and a vaginal examination in women, if professional image that will put the patient at clinically indicated. Th e urinalysis is most readily ease and facilitate communication. performed by dipstick testing; a formal micro- Then begin with, ‘How old is your patient scopic analysis may be required to investigate and what is his/her occupation? How can any abnormality. I help’, or ‘Your GP has written to us saying you have a problem with…please tell me about it’, which are good open questions to start the consultation. Look out for signs that the patient H istory may not be able to describe the problem due to anxiety or embarrassment or a language bar- Communication skills rier.