Urinary symptom and investigation
Urology is the science dealing with a surgical
management of urinary system.
Urinary symptom:
1. Hematuria:
Presence of blood in urine, tiny amount of blood are insufficient to stain
the urine (microscopic haematuria), significant amount in urine
(macroscopic haematuria) give the urine red tinge even pass clot.
False positive and discolored urine:
Beetroot, drug (phenindion), pyridium, furadantin (absence of RBC) in
urine.
May be: intermittent or persistent
May be in the beginning of stream as in lower urinary tract cause.
Uniform staining throughout the stream may point higher up.
Terminal heamaturia typical irritation by stone or infection.
If pain with haematuria help to identify the source of bleeding.
Malignant cause usually painless.
Each hematuria should investigate even the patient taking anti-
coagulant drugs
.
Also it may caused by occult nephropathy so it is important to check for
significant proteinuria and hypertension.
So haematuria is
*always abnormal.
*may caused by lesion anywhere in urinary system. exam. For infection
by C\S, cytology, IVU, Ultrasound, cystoscopy.
*commonly caused by UTI
.
2.PAIN:
Renal pain:
Due to inflammation, obstruction, acute obstruction felt as deep seated,
ache in loin, May due to stretching of renal capsule .may colic or dull
aching.
Tumor or cyst are usually not painful unless very large or complicated.
Also renal trauma causing pain.
Ureteric colic:
Acute pain felt in loin and radiating to ipsilateral iliac fossa and genitalia.
The patient rolls around. While in peritoneal pain the patient lies still to
ovoid exacerbation by movement.
Caused by passage of stone clot or sloughed papilla.
Local tenderness is much less than would be expected from the severity
of the pain.
Bladder pain:
suprapubic discomfort made worse by bladder filling
, referred to the tip of penis may result from irritation of trigon, can
cause extreme discomfort at the end of micturition may sever
(strangury
).
Perineal pain:
Penetrating pain in perineum may associate with inguinal discomfort.
Named
pelvic pain
may due to chronic prostatitis may name
prostadynia, but it occurs both in man and women.
Urethral pain:
Is scalding or burning in vulva or penis during voiding
3. Symptom due to altered bladder function
:
The urinary bladder has two functions:
filling phase, and voiding phase
:
Symptom due to filling phase
.
a
Urgency
: inapropperiate contraction of the bladder detruser muscle
Frequency
(in day time),
nacturia
(at night).
Urge incontinence
(involuntary leakage of urine due un inhibited desire
to void).
b. Symptom due to impaired emptying:
Mostly due to bladder outlet obstruction:
Hesitancy
: difficulty initiating voiding.
Weak or slow stream
.
Incomplete emptying
: the patient feel the urine remain in bladder after
voiding, with time the bladder become chronically overfull lead to spill of
urine (
overflow incontinence
).
Post voiding drippling(
mean stream of drops ).
INVESTIGATION OF THE URINARY TRACT:
URINE
:
Dipstick test to detect the presence of: Blood, protein, nitrite.this is
convenient way to screen urine. This is simple test if fined positive result
we can proceed for farther chemical and microscopic examination.
Example if positive for protein and nitrite may indicate the presence of
infection.
Also my give indication for urine PH, and specific gravity.
Microscopic examination.
To find: RBC, WBC, bacteria, protein cast (mostly renal pranchymal
disease), RBC dysmorphya, schistosoms ova, vegitable and meat fiber
(indicate presence of fistula with bowel.
Cytological examination.
Especially in case of malignant tumors of urinary system.
Bacteriological culture:
Using midstream urine sample for culture to identify urinary pathogen
(especially bacteria).
If there are pus cell in urine but there is no growth of bacteria on culture
media named STERILE PYURIAR
.
In case of TB we take multiple early morning urine specimens for culture
on Lowenstein-Jensen medium.
Chlamydia not detected on routine culture.
Biochemical examination of urine:
For electrolyte, glucose, bilirubin, haemoglobin, myoglobin.
24 hours urine specimen of urine for investigation for calculus disease.
(Test for calcium, oxalate uric acid).
Test of renal function
:
MORE THAN 70% OF KIDNEY FUNCTION MUST BE LOST BEFORE RENAL
FAILURE BECOMES EVIDENT.
Renal damage that causes renal impairment is of three types:
*Reduction of renal plasma flow: hypertension, renal artery stenosis.
*destruction of glomeruli: glomeriolonephritis, acute cortical necrosis.
*impairment of tubular function. pyelonephritis.
In obstructive uropathy back pressure on the renal parenchyma causes
all three types of damage.
Level of blood
urea
and serum
creatinine
can affect by various factors.
*
creatinine clearance test
will give an approximate value for glomerular
filtration rate (this mean that each minute that persons kidneys clear
95-120 ml of blood free of creatinine.) that is approximate to glomerular
filtration rate (which is the best overall index of kidney function, normal
GFR varies with age, sex, and body size).
*clearance of chromium-51- labeled: more accurate for GFR.
*specific gravity of the urine is fixed at low level when the kidney loses
the power to concentration , because of renal tubular dysfunction
*estimation of urinary lose of Na, beta 2 microglobulin, or N-
acetylglucosamin (NAG) will farther define the nature of any functional
impairment.
Dr. Muhammad redah Judi
Assist. Professor
Urology