Urology
! Diagnostic Tests for the Urological Patient
!
Investigation:
- History
o History of presenting complaint: duration, severity, chronicity, periodicity, degree of disability
o Past medical history
o Family history
- Physical examination
- Investigations
o Urinalysis/ blood tests (Start with basic, non-invasive mechanisms)
o Radiological imaging
o Endoscopy (invasive)
o Biopsy (invasive)
! o Urodynamic studies
Urolongical History- Pain
Pain from inflammation = constant
Pain from obstruction = fluctuating intensity
Renal pain may be confused with abdominal pain
- Peritonitis: patient lies motionless
- Renal colic: on and off pain; patient rolls around in agony
!
Back pain may be altered by a change in posture
Hamaturia
More than 2 RBC per hpf (high power field)
Frank or microscopic: should never be ignored
Microscopic; may be completely asymptomatic; if see blood in urine (macroscopic), more likely to have serious
pathology
Where in the urinary stream? Initial/ total/ terminal
Associated with pain?
!
Are there any clots?
Lower Urinary Tract Symptoms
Obstructive symptoms: hesitancy, poor flow (do you ever pee with a good flow? Everyone will experience poor flow at
some point), terminal dribbling
Irritative symptoms: frequency, urgency, urge incontinence
Nocturnal frequency = multifactorial; common with prostate disease and with age
Other important symptoms:
Haematospermia: blood-stained semen
Ohenumoturia: passage of flatus per urethram (passing wind from front)
!
Urethral discharge: venereal disease; urethral carcinoma
Past Medical History
Prior surgery; Medical conditions; Medications; Allergies; Remember patients may require anaesthesia for urological
!
surgery
Family/Environmental history
Familial prostate cancer
Cystine stones
Polycystic kidneys
Smoking, alcohol, occupation (e.g. cook in hot kitchen perspiring may become dehydrated/ air line pilot who doesn’t
!
drink becomes dehydrated)
Examination
General physical examination: jaccol (jaundice, anaemia, clubbing, cyanosis, oedema, lymphedema/lymphadenopathy),
cachexia
Specific examination of: kidneys (probably will not feel a tumour unless really large), bladder (may not be able to palpate
a filled bladder with abdominal examination even if can percuss), genitalia, rectal examination (palpate prostate, pick up
!!
low rectal tumour) +/- vaginal exam
!
UROLOGY - SIOBHAN PAGE 1
! Diagnostic Tests for the Urological Patient
!
Investigation:
- History
o History of presenting complaint: duration, severity, chronicity, periodicity, degree of disability
o Past medical history
o Family history
- Physical examination
- Investigations
o Urinalysis/ blood tests (Start with basic, non-invasive mechanisms)
o Radiological imaging
o Endoscopy (invasive)
o Biopsy (invasive)
! o Urodynamic studies
Urolongical History- Pain
Pain from inflammation = constant
Pain from obstruction = fluctuating intensity
Renal pain may be confused with abdominal pain
- Peritonitis: patient lies motionless
- Renal colic: on and off pain; patient rolls around in agony
!
Back pain may be altered by a change in posture
Hamaturia
More than 2 RBC per hpf (high power field)
Frank or microscopic: should never be ignored
Microscopic; may be completely asymptomatic; if see blood in urine (macroscopic), more likely to have serious
pathology
Where in the urinary stream? Initial/ total/ terminal
Associated with pain?
!
Are there any clots?
Lower Urinary Tract Symptoms
Obstructive symptoms: hesitancy, poor flow (do you ever pee with a good flow? Everyone will experience poor flow at
some point), terminal dribbling
Irritative symptoms: frequency, urgency, urge incontinence
Nocturnal frequency = multifactorial; common with prostate disease and with age
Other important symptoms:
Haematospermia: blood-stained semen
Ohenumoturia: passage of flatus per urethram (passing wind from front)
!
Urethral discharge: venereal disease; urethral carcinoma
Past Medical History
Prior surgery; Medical conditions; Medications; Allergies; Remember patients may require anaesthesia for urological
!
surgery
Family/Environmental history
Familial prostate cancer
Cystine stones
Polycystic kidneys
Smoking, alcohol, occupation (e.g. cook in hot kitchen perspiring may become dehydrated/ air line pilot who doesn’t
!
drink becomes dehydrated)
Examination
General physical examination: jaccol (jaundice, anaemia, clubbing, cyanosis, oedema, lymphedema/lymphadenopathy),
cachexia
Specific examination of: kidneys (probably will not feel a tumour unless really large), bladder (may not be able to palpate
a filled bladder with abdominal examination even if can percuss), genitalia, rectal examination (palpate prostate, pick up
!!
low rectal tumour) +/- vaginal exam
!
UROLOGY - SIOBHAN PAGE 1
