W1L2 History & Examination in Urology

Question 1

Steps For Diagnosis?

Answer 1

➢History (Patient centered)
➢Physical Examination (Focused)
➢Necessary Investigations (lab, rad, histopathological, endoscopic, others)

Question 2

History taking component?

Answer 2

1) Personal history/ social history
2) Chief complaint
3) Present history
• Analysis complaint.
• Other symptoms related same system
• Symptom other system (GIT, neurological)
• Previous investigations, treatment
4- Past history
5- Family history
6- Gynecological and obstetric history

Question 3

Urological Symptoms?

Answer 3

1. Upper urinary tract symptoms
  • Flank/ loin pain
2. Lower urinary tract symptoms (LUTS)
  • Obstructive  • Irritative
3. Incontinence
4. Change of urine character
5. Hematuria
6. Masses
7. Genital symptoms
8. Constitutional (Fever, malaise, weight loss, loss of appetite)

Question 4

PAIN?

Answer 4

➢ANALYSIS OF PAIN
➢PAIN ACCORDING TO THE ORIGIN:
- RENAL - URETERIC - BLADDER
- PROSTATIC - TESTICULAR

Question 5

Flank Pain/ Renal Colic?

Answer 5

1) Acute/ chronic.
2) Renal colic = ureteral obstruction
– Acute/sudden(minutes)
– Intermittent
– Colicky
– Radiating to the groin
– Patient uncomfortable
– Pain xrelate (posture, eating/bowel move)

Question 6

Differential diagnosis?

Answer 6

1) Urological:
- Obstruction (Stone)
- Infection (pyelonephritis)
2) GIT (appendicitis,bowel obstruction)
3) Gynecological (ectopic pregnancy)
4) Musculoskeletal (disc prolapse)
5) Vascular (dissecting/leaking aortic aneurysm)

Question 7

Bladder Pain?

Answer 7

1) Full bladder/acute retention(common cause)
2) Criteria?
- Referred to distal urethra
- Chronic urine retention: SP discomfort

Question 8

Prostate Pain?

Answer 8

➢Acute prostatitis.
▪ Pain is perineal, rectal and may be referred to lower back
▪ Pain associated with:
- Irritative &/ obstructive voiding symptoms
- Rectal tenesmus
- Fever

➢Chronic prostatitis:
▪ vague discomfort, UTI

Question 9

Testicular Pain?

Answer 9

1) Causes:
- Testicular torsion
- Testicular trauma
- Tumors usually painless
2) Referred pain from other sites
3) Testicular pain can referred to other sites

Question 10

Lower Urinary Tract Symptoms?

Answer 10

1) Obstructive voiding symptoms (ISIS)
• Difficulty(hesitancy, intermittency, post-micturition dribbling)
• Sense incomplete evacuation
• Straining
• Stream abnormalities (weak, narrow, bifid urinary stream)

2) Irritative voiding symptoms (FUN)
• Frequency.
• Urgency
• Nocturia

Question 11

Types Urinary Incontinence?

Answer 11

1. Stress urine incontinence
2. Urge incontinence
3. Overflow incontinence
4. Continuous urine incontinence
5. Paradoxical incontinence
6. Nocturnal enuresis

Question 12

Changes in the Physical Characters of Urine?

Answer 12

1) Volume(N=.5-1ml/min/kg)
- Oliguria(< 400)
- Anuria(0/12H or <100/day)
- Polyuria(>2500 ml/day)

2) Color(Amber yellow)
- Pale: polyuria
- Red: hematuria
- Dark brown: cholestatic jaundice

3) Odor(urinferous)
- Offensive: infection
- Acetone: ketonuria

4) Aspect(clear)
- Turbid(3P2C)

5) Pneumaturia

Question 13

Masses?

Answer 13

• Renal: hydronephrosis, tumors
• Bladder: Urine retention
• Scrotal/inguino-scrotal
• Interlabial mass

Question 14

Symptoms related to sexual function?

Answer 14

➢ Males:
• Libido • Erection • Ejaculation
• Orgasm • Infertility
➢ Females
• Vesico-vaginal fistula: total incontinence
• Vesico-uterine fistula: cyclic hematuria
• Uretero-vaginal fistula: continuous urine leakage with a normal voiding pattern

Question 15

Examination?

Answer 15

• General.
• Abdominal.
  – + inguinoscrotal examination.
  – +Digital rectal examination (DRE) 
  – +Back examination.
• Targeted neurological examination