Urology: Diagnostic Tests in Urology Flashcards
what are the 3 key things to do to get a diagnosis?
- history
- physical examination
- investigations
what do urine cultures do?
- incubation to grow the offending microbe
- testing for sensitivity to antibiotics, if bacterial
which tests are included in a urine dipstick?
- RBC
- WBC
- protein
- glucose
- pH
- nitrites
- specific gravity
- ketones
- bilirubin
- urobilinogen
what is a 24-hr urine collection used for?
check for hormone levels in the urine, apart from levels of electrolytes
what type of investigations are used in urology?
- urinalysis/blood tests
- radiological imaging
- endoscopy
- biopsy
- urodynamic studies
what should you delve into in the history?
- duration, severity, chronicity, periodicity and degree of disability of the presenting complaint
- past medical history (surgery, conditions, drugs, allergies, anaesthesia)
- family history (familial prostate cancer, cystine stones, polycystic kidneys, smoking, alcohol, occupation)
- drug history
what does pain signify in urology?
- inflammatory pain is constant
- obstructive pain fluctuates in intensity
- in renal colic, the patient cannot get comfortable and thus, they roll around in agony
what should you ask in haematuria?
- is it frank or microscopic?
- when does it occur in the urinary stream - initial, total, terminal
- is it associated with pain
- are there any clots passed in the urine
what are the lower urinary tract symptoms?
- obstructive: hesistancy, poor flow, terminal dribbling
- irritative: frequency, urgency, urge incontinence
- noctural
other symptoms which are important to ask about
- haematospermia
- pneumaturia
- urethral discharge
what does urethral discharge signify?
- venereal disease
- urethral carcinoma
what is JACCOL?
jaundice, anaemia, clubbing, cyanosis, oedema, lymphadenopathy
physical examination in urology
- JACCOL
- cachexia
- kidney, bladder, genitalia, rectal and vaginal exam
blood investigations for calculous disease
serum Ca, uric acid etc
blood investigations for prostate conditions
PSA level
blood investigations for testicular disease
AFP, bHCG, LDH
what is PSA?
- prostate specific antigen
- single chain glycoprotein
- only produced by prostatic epithelial cells
- can be elevated in both benign and malignant conditions
PSA assays
- age-specific reference ranges
- PSA density
- PSA velocity
- free and bound PSA (in cancer cases, there is a higher proportion of bound PSA whilst in benign disease, there is a higher proportion of free PSA)
what do they take into consideration for prostatic cancer diagnosis?
- PSA
- tumour volume
- radiological investigations
pros of ultrasound examinations
- non-invasive, quick, cost-effective
- good assessmnet of kidneys, bladder residuals, testes and prostate
- differentiates solid from cystic lesions
type of endoscopy done in urology
- rigid, flexible cystoscopy
- retrograde pyelography
- antagrade pyelography
- rigid, flexible ureterorenoscopy
how is a retrograde pyelogram done?
dye is injected into the urethra which then, goes up. xrays are taken to monitor the flow of the dye
which radionuclear studies are done in urology?
renography
- DTPA (dynamic scanning) - functional, obstruction and reflux
- DMSA (static scanning) gives information about scarring and anatomy of the kidneys
- PET/CT scanning
everything about prostate biopsies
- done to confirm the diagnosis of prostate cancer
- can be approached transrectally
- the affected part of the prostate can be identified using a MRI
what are urodynamic studies?
investigates the function and the dysfunction of the lower urinary tract during the storage and voiding phases of the micturition cycle
what does a uroflowmetry measure?
the amount of urine passed
symptoms of sexual dysfunction
- loss of desire/arousal
- erectile problems - absent, weak or short-lasting
- ejaculation problems - premature, absent, delayed
- psychological factors
how can prostatic pain manifest?
- can be referred to the perineum, testes, groin, pain sitting down
how can testicular pain manifest?
- can be primary or referred
- primary: trauma, torsion, hydrocoele, varicocoele infection
- referred: kidney, ureter, retroperitoneum, indirect inguinal hernia
causes of bladder pain
- bladder distension
- inflammation
- chronic retention is usually painless
causes of urinary incontinence
- fistula: ureterovaginal/vesicovaginal/ectopic ureter
- sphincter weakness (genuine stress incontinence)
- detrusor instability
- bladder outflow obstruction
- atonic bladder (last 2 due to overflow incontinence)
how is ultrasound frequency related to image quality
- image quality is higher in higher frequency scans
- greater penetrance of waves in lower frequenecy scans
what type of situation is an obstruction and infected kidney
EMERGENCY
what do you when there is a case of obstructed/infected kidney?
- early relief of obstruction
- antegrade nephrostomy
- cystoscopic placement of stent
why are urethral catheters used?
- collect urine specimens
- assess a degree of retention
- exclude a urethral stricture
- as permanent indwelling damage
- as intermittent self-catheterisation
