IN THE NAME OF GOD. HISTORY AND PHYSICAL EXAMINATION IN UROLOGY.

IN THE NAME OF GODIN THE NAME OF GOD

HISTORY AND PHYSICAL HISTORY AND PHYSICAL EXAMINATION IN EXAMINATION IN

UROLOGYUROLOGY

HISTORYHISTORY

C.C & P.IC.C & P.I

Past medical historyPast medical history

Family historyFamily history

PAINPAIN

PAINPAIN

Sever pain : distention of hollow viscus Sever pain : distention of hollow viscus e.g ureteral obstruction, urinary retentione.g ureteral obstruction, urinary retention

Tumor : usually do not pain unless Tumor : usually do not pain unless produce: produce:

ObstructionObstructionExtend beyond the primary organ Extend beyond the primary organ

Pain in Pain in urogenital cancer urogenital cancer is late is late presentationpresentation

RENAL PAINRENAL PAIN

Location (CVA)Location (CVA) RadiationRadiation Associated Associated

symptomssymptoms Inflamatory pain Inflamatory pain

(steady)(steady) Obstructive pain Obstructive pain

(colic)(colic)

URETERAL PAINURETERAL PAIN

AcuteAcute Obstruction Obstruction

acute ureteral dilatation acute ureteral dilatation

Ureteral spasm and hyperperistaltismUreteral spasm and hyperperistaltism

painpain

URETERAL PAINURETERAL PAINRadiation:Radiation:1/3 upper: testis1/3 upper: testis1/3 middle: scrotom – labia1/3 middle: scrotom – labia1/3 lower: penis –meatus-irritative 1/3 lower: penis –meatus-irritative . . bladder symptomsbladder symptomsChronicChronic ureteral pathology no pain ureteral pathology no pain

Bladder painBladder pain

AcuteAcute pain: acute urinary retention pain: acute urinary retention

IntermittentIntermittent suprapubic pain: suprapubic pain: inflammation(cystitis- IC) inflammation(cystitis- IC)

ContiniousContinious suprapubic pain: non urologic suprapubic pain: non urologic

Aute urinary retentionAute urinary retention

PROSTATE PAINPROSTATE PAIN

Secondary to inflammationSecondary to inflammation

Edema –distention of the prostatic capsuleEdema –distention of the prostatic capsule

Localized in perineoum Localized in perineoum

Refer to lombosacral- inguinal –lower Refer to lombosacral- inguinal –lower extremityextremity

PENILE PAINPENILE PAIN

Flaccid: Flaccid: STDSTD

paraphimosisparaphimosis Erection: Erection:

priapism—priapism—peyronie diseasepeyronie disease

TESTIS PAINTESTIS PAIN

Primary Primary : : Acute : Acute :

torsiontorsion Hematoma(trauma)Hematoma(trauma)

orchiepididimitisorchiepididimitis Chronic : Chronic :

hydrocele hydrocele varicocelevaricocele

spermatocelespermatocele ReferralReferral : :

kidneykidney retroperitoneoumretroperitoneoum

indirect inguinal herniaindirect inguinal hernia

HEMATURIAHEMATURIA

Definition : macroscopic– microscopic Definition : macroscopic– microscopic RBC> 2 hpfRBC> 2 hpf Initial : UrethraInitial : Urethra total : bladder and upper tract total : bladder and upper tract terminal : bladder neck & prostatic terminal : bladder neck & prostatic

urethraurethra

HEMATURIAHEMATURIA

Painless hematuria :Painless hematuria : malignancymalignancy( bladder- kidney) ( bladder- kidney)

Hematuria+ flank pain :Hematuria+ flank pain : stonestone

Hematuria+ irritative symptoms :Hematuria+ irritative symptoms : cystitiscystitis( bacterial- hemorragic)( bacterial- hemorragic)

LOWER URINARY TRACT LOWER URINARY TRACT SYMPTOMS(LUTS)SYMPTOMS(LUTS)

IRRITATIVE SYMPTOMSIRRITATIVE SYMPTOMS

FrequencyFrequency : : Polyuria (DM-DI-excessive fluid intake)Polyuria (DM-DI-excessive fluid intake) Decreased bladder compliance :Decreased bladder compliance :

Bladder outlet obstruction & residual urineBladder outlet obstruction & residual urine Decreased functional capacityDecreased functional capacity

External pressureExternal pressure AnxietyAnxiety


UrgencyUrgency : strong ,sudden impulse to : strong ,sudden impulse to voidvoid

Causes: Causes: Inflammation: e.g Acute cystitisInflammation: e.g Acute cystitis

Hyperreflexive neurogenic bladderHyperreflexive neurogenic bladderAdvanced urinary outlet obstructionAdvanced urinary outlet obstruction

Anxiety Anxiety


DysuriaDysuria : painful urination : painful urination Usually by inflammationUsually by inflammation Initial : urethral pathologyInitial : urethral pathology Terminal(strangury) : bladderTerminal(strangury) : bladder


NocturiaNocturia : nocturnal frequency : nocturnal frequency Frequency without nocturia : psychogenicFrequency without nocturia : psychogenic Nocturia without frequency : CHFNocturia without frequency : CHF Normal nocturia :Normal nocturia :

old ageold ageExcessive fluid drink in night : caffeinated Excessive fluid drink in night : caffeinated

& alcoholic beverages & alcoholic beverages

OBSTRUCTIVE SYMPTOMSOBSTRUCTIVE SYMPTOMS

HesitencyHesitency IntermittencyIntermittency Decreased force & caliberDecreased force & caliber Post void dribblingPost void dribbling StrainingStraining Incomplete emptyingIncomplete emptying

OBSTRUCTIVE SYMPTOMSOBSTRUCTIVE SYMPTOMS

Common causeCommon cause: : BPHBPH Urethral strictureUrethral stricture Neurogenic bladderNeurogenic bladder Uncommon causeUncommon cause : : Prostate cancerProstate cancer Urethral cancerUrethral cancer Foreign bodyForeign body

URINARY INCONTINENCYURINARY INCONTINENCY

True(continous)True(continous) :involuntay loss of :involuntay loss of urine at all times & all position urine at all times & all position

Common cause:Common cause:

Fistula(VVF-UVF)Fistula(VVF-UVF)Sphincter destruction Sphincter destruction

Ectopic ureterEctopic ureter


Stress urinary incontinency(SUI):Stress urinary incontinency(SUI): Sudden leakage of urine with coughing, Sudden leakage of urine with coughing,

sneezing, and exercise that increased sneezing, and exercise that increased intravesical pressureintravesical pressure

Cause: Cause: multipar women multipar women after menopauseafter menopause

men after prostate surgerymen after prostate surgery


Urge incontinence (UI):Urge incontinence (UI): Loss of urine preceded by a strong urge Loss of urine preceded by a strong urge

to voidto void Cause:Cause:

cystitiscystitisNeurogenic bladderNeurogenic bladder

Advanced bladder outlet obstructionAdvanced bladder outlet obstruction


Overflow incontinencyOverflow incontinency (paradoxical (paradoxical inc): inc):

Secondary to advanced urinary retention Secondary to advanced urinary retention and high residual urine volumeand high residual urine volume

ENURESISENURESIS

ENURESISENURESIS

PRIMARYPRIMARY SECONDARYSECONDARY Everybody with enuresis should be Everybody with enuresis should be

evaluatedevaluated

Sexual dysfunction in Sexual dysfunction in malemale

Decreased libidoDecreased libido

Endocrine Endocrine PsychologicPsychologic

ERECTILE DYSFUNCTIONERECTILE DYSFUNCTION

PsychogenicPsychogenic NeurogenicNeurogenic VasculogenicVasculogenic

ABSENCE OF EMMISSIONABSENCE OF EMMISSION

Retrograde ejaculationRetrograde ejaculation Sympathetic denervationSympathetic denervation Androgen disturbanceAndrogen disturbance DrugsDrugs Bladder neck & prostate surgeryBladder neck & prostate surgery

ABSENCE OF ORGASMABSENCE OF ORGASM

PsychogenicPsychogenic Medications used to treat psychiatric Medications used to treat psychiatric

diseasesdiseases

PREMATURE PREMATURE EJACULATIONEJACULATION

Subjective symptomSubjective symptomOrgasm within less than 1 minute after Orgasm within less than 1 minute after initiation of intercourseinitiation of intercourseCause:Cause:

PsychogenicPsychogenicAnxiety Anxiety

HEMATOSPERMIAHEMATOSPERMIA

Causes:Causes:Nonspecific inflammation in prostate & Nonspecific inflammation in prostate &

s.vs.vProstate and s.v cancersProstate and s.v cancers

Initial prostateInitial prostate Terminal s.v Terminal s.v Evaluation: DRE- urine cytology-TRUS-Evaluation: DRE- urine cytology-TRUS-

spermogramspermogram

PNEUMATURIAPNEUMATURIA

Cause:Cause: Fistula between bladder and intestineFistula between bladder and intestine CommonCommon cause: cause:

diverticulitisdiverticulitis sigmoid cancersigmoid cancer

regional enteritis(croh,n disease)regional enteritis(croh,n disease) UncommonUncommon cause: cause:

diabetes & gas forming infectiondiabetes & gas forming infection

URETHRAL DISCHARGEURETHRAL DISCHARGE

The most common symptom of veneral The most common symptom of veneral infectioninfection

Gonococal urethritisGonococal urethritis Nongonococal urethritisNongonococal urethritis Bloody discharge: urethral carcinomaBloody discharge: urethral carcinoma

FEVERFEVER

Urogenital infection associated with Urogenital infection associated with fever:fever:

Acute ProstatitisAcute ProstatitisAcute pyelonephritisAcute pyelonephritis

Acute epididimo-orchitisAcute epididimo-orchitis

Infection+ obstruction+ fever & chills= Infection+ obstruction+ fever & chills= sepsissepsis

PHYSICAL EXAMINATIONPHYSICAL EXAMINATION

RENAL EXAMINATIONRENAL EXAMINATION

Bimanual kidney Bimanual kidney palpationpalpation

CVA percussionCVA percussion RUQ or LUQ RUQ or LUQ

ascultation : cystolic ascultation : cystolic bruitbruit

transillumination : transillumination : cystic- solidcystic- solid

BLADDER BLADDER EXAMINATIONEXAMINATION

Volume required for percussion or Volume required for percussion or palpation: palpation: 150150cccc

Volume required for vision :Volume required for vision : 500 500cccc

Bimanual bladder examination during Bimanual bladder examination during anesthesiaanesthesia: evaluation of regional : evaluation of regional extension of bladder tumorextension of bladder tumor

PENILE EXAMINATIONPENILE EXAMINATION

Retraction of prepus and exam of glans penisRetraction of prepus and exam of glans penis Meatus position:Meatus position:

hypospadiasis-hypospadiasis- epispadiasisepispadiasis

Penile skin: Penile skin: vesicle genital herpesvesicle genital herpes

Ulcer sexually transmited- tumorsUlcer sexually transmited- tumors Stiffness : peyronie plaque Stiffness : peyronie plaque

hypospadiasishypospadiasis

EpispadiasisEpispadiasis

phimosisphimosis

ParaphimosisParaphimosis

Genital herpesGenital herpes

Syphlis ulcerSyphlis ulcer

Peyronie diseasePeyronie disease

SCROTOM EXAMINATIONSCROTOM EXAMINATION

Testises: bimanual examTestises: bimanual exam Normal: 4-6 cm in adultsNormal: 4-6 cm in adults Firm area within the testis : Firm area within the testis : malignancy malignancy Epididym Epididym Vas deferenceVas deference Scrotal skinScrotal skin Spermatic chordSpermatic chord Upright examUpright exam is mandatory is mandatory

RECTAL RECTAL EXAMINATION(DRE)EXAMINATION(DRE)

Indication : Indication : Every male after age Every male after age

40 who present for 40 who present for urologic evaluationurologic evaluation

Importance is for Importance is for prostate cancer , the prostate cancer , the most common most common cancer in malecancer in male


Patient position knee chestPatient position knee chest Inspection : hemorroid – fissure- fistula- Inspection : hemorroid – fissure- fistula-

polyp- cancerpolyp- cancer EAS( external anal sphincter) tonicityEAS( external anal sphincter) tonicity Prostate : size – consistency- median Prostate : size – consistency- median

sulcussulcus Bulbocavernous reflexBulbocavernous reflex

COMMON ABNORMAL COMMON ABNORMAL PHYSICAL FINDINGPHYSICAL FINDING

KIDNEYSKIDNEYS

MassMass : common abnormal finding in examination : common abnormal finding in examination AdultsAdults : cyst – tumor : cyst – tumor ChildrenChildren : : cyst & benign:cyst & benign:

Hydronephrosis-Hydronephrosis- MCDK- MCDK-

RPKRPK Malignant :Malignant :

Wilm,s tumor- Wilm,s tumor- NeuroblastomaNeuroblastoma

PENISPENIS

PhimosisPhimosis ParaphimosisParaphimosis Peyronie disease Peyronie disease PriapismPriapism HypospadiasisHypospadiasis EpispadiasisEpispadiasis Penile carcinomaPenile carcinoma

SCROTOM & CONTENTSSCROTOM & CONTENTS

MassMass : : testis masses : commonly malignanttestis masses : commonly malignant Epididym & spermatic chord mass : Epididym & spermatic chord mass :

commonly benign commonly benign TorsionTorsion HydroceleHydrocele SpermatoceleSpermatocele Trauma( hematoma)Trauma( hematoma)

SCROTOM & CONTENTSSCROTOM & CONTENTS

VaricoceleVaricocele : enlarged , tortuous : enlarged , tortuous spermatic vein above the testis , almost spermatic vein above the testis , almost always in left side always in left side

Grading : Grading : I palpable only with valsalvaI palpable only with valsalva II palpable without valsalvaII palpable without valsalva III visible without valsalvaIII visible without valsalva

spermatocelespermatocele

hydrocelehydrocele

varicocelevaricocele

Testis torsion(R)Testis torsion(R)

Testis torsionTestis torsion

Scrotal hematomaScrotal hematoma

Inguinal herniaInguinal hernia

PROSTATEPROSTATE

Acute bacterial prostatitisAcute bacterial prostatitis BPHBPH Prostate cancerProstate cancer

THE ENDTHE END

IN THE NAME OF GOD. HISTORY AND PHYSICAL EXAMINATION IN UROLOGY.

Documents

Transcript of IN THE NAME OF GOD. HISTORY AND PHYSICAL EXAMINATION IN UROLOGY.