Introduction to urology by sayed eleweedy
- 1. Introduction To Urology SAYED M ELEWEEDY PROF. OF UROLOGY UROLOGY DEPARTMENT AL-AZHAR UNIVERSITY CAIRO, EGYPT
- 2. Urology A surgical specialty devoted to the study and treatment of disorders of the genitourinary tract of the male and urinary tract of the female.
- 3. Urology 15 % of patients presenting to a physician have a urologic complaint or abnormality.
- 4. Urology Urologists have a unique position in medicine Their patients encompass all age groups Prenatal Pediatric Adolescent Adult Geriatric. Their patients comprised both gender
- 5. Urology Urology combines management of: – Medical problems Urinary tract infections Benign prostatic hyperplasia – Surgical problems The surgical management of urolithiasis The surgical management of cancers The correction of congenital abnormalities Correcting certain types of incontinence.
- 6. Urology Wide overlap of urology with other specialties 1. Nephrology 2. Andrology 3. Pediatric surgery 4. The medical fields of oncology 5. Endocrinology.
- 7. The organs covered by urology – Adrenal glands – Kidneys – Ureters – Urinary bladder – Urethra – The male reproductive organs Testes Epididymis Vas deferens Seminal vesicles Prostate Penis
- 10. UROLOGIC MANIFESTATIONS OF DISEASE 1. Direct • Signs and symptoms that are directly related to the GUT: • Hematuria • Scrotal swelling 2. Indirect • Manifestation Referred to or from Other Organ Systems: • A stone in the kidney or upper ureter • Symptoms of nausea and vomiting. • Ipsilateral testicular pain
- 11. 3.Primary urologic disorders may be hidden and manifested in different organ or systems. • Bone pain and pathologic fracture • Secondary to metastatic carcinoma arising in the genito-urinary tract . UROLOGIC MANIFESTATIONS OF DISEASE
- 12. 4. Primary disease in other organ systems may result in secondary urologic signs and symptoms that initially lead the patient to the urologist. • D.M : • Frequency, polyurea and nocturia. • ED • Glucosuria • D.I • Other signs and symptoms mimicking urologic disease are related to inflammatory or neoplastic processes arising in other organs: 1. Lower lobes of the lungs 2. Gastrointestinal tract 3. Female internal genitalia UROLOGIC MANIFESTATIONS OF DISEASE
- 13. 5. Systemic constitutional manifestations • Fever, weight loss, and malaise May be present in: • Acute and chronic inflammatory disorders • Renal failure • Genitourinary carcinoma with or without metastases. UROLOGIC MANIFESTATIONS OF DISEASE
- 14. 6. Asymptomatic presentation Extensive disease may exist within the genitourinary tract without any signs or symptoms • Large renal calculi • Neoplasms may only be found incidentally during other examination. • Far-advanced renal deterioration may occur prior to the detection of silent reflux or obstruction. UROLOGIC MANIFESTATIONS OF DISEASE
- 15. HISTORY Urologic symptoms A. Pain and discomfort B. Alterations of micturition C. Changes in the gross appearance of the urine D. Abnormal appearance and/or function of the external genitalia
- 16. Pain 1. Pain within the genitourinary tract generally arises from Distention or inflammation 2. Pain can be experienced directly or referred 3. Referred pain is a relatively common symptom of GU disease.
- 17. Renal pain A. The kidney and its capsule are innervated by Sensory fibers traveling to the TI0-LI B. The etiology of renal pain may be due either to Distention Capsular Renal collecting system. Inflammation C. Renal pain characters: A dull, aching sensation felt in area of the costovertebral angle A sharp colicky nature felt in the area of the flank, with radiation around the abdomen into the groin and ipsilateral scrotum or labium.
- 18. Ureteral pain • The upper ureter is innervated in a similar fashion to the kidney. • Upper Ureteral pain has a similar distribution to that of renal pain. • The lower ureter sends sensory fibers to the cord through ganglia subserving the major pelvic organs. • Pain derived from the lower ureter is generally felt in the suprapubic area, bladder, penis, or urethra.
- 19. Ureteral pain • Etiologic mechanism for Ureteral pain is • Sudden obstruction and Ureteral distention. • Acute renal and Ureteral colic are among the most severe types of pain known to humankind.
- 21. Other urologic pains Cystalgia (vesical pain) Persistent pain localized behind pubic bone Urethralgia Pain along the urethra Prostatic pain Sharp pain promoting to the perineum Orchalgia Pain localized to the testes, often propagating along the spermatic cord
- 22. Changes in urine volume Polyuria- Diuresis > 1500-2000 ml/24h Oliguria - Diuresis < 500 ml/24h Anuria - Diuresis < 100 ml/24h
- 23. Changes in urine appearance Hematuria: Blood in urine Cloudy urine Pyuria (presence of pus in urine) Chyluria (presence of fatty lymph in the urine) Bacteriuria : Presence of bacteria in urine
- 24. Changes in urine appearance Proteinuria-: Proteins in urine Pneumaturia : Passage of gas with urine Necroturia : Necrotic tissues in the urine
- 25. Voiding Disorders Frequency : Voiding too often (>8/day) Nocturia: Frequent voiding at night (after sleep) Urine retention: Inability to void Acute chronic Strangury: Painful voiding
- 26. Voiding disorders Urinary incontinence - Urgency - A sudden, compelling and powerful need to urinate. - Precipitancy - Inability to stop urine midway - Stress incontinence - Involuntary loss of urine with sudden increase of intraabdominal pressure - Overflow incontinence - Involuntary loss of urine associated with overdistention of the bladder, with or without a detrusor contraction. - Total incontinence - Continuous and total loss of urinary control and is the severest type of incontinence - Nocturnal Enuresis - Involuntary urination while asleep after the age at which bladder control usually begins.
- 27. Voiding Disorders Obstructive symptoms - Hesitancy: - Voiding initiation delay - Interrupted voiding - Weak urine stream - Incomplete voiding - Necessity of abdominal pressure during voiding - Retention
- 28. Voiding Disorders Irritative Symptoms - Frequency - Urgency - Dysuria
- 29. History of Other urological diseases – Corective operations in childhood – Urolithiasis – Urogenital infection – Blood in urine – Sexually transmitted diseases – Catheterizations, endoscopy, trauma /biking, riding horses/ → strictures
- 30. History of other diseases DM Systemic neurological Disasters operations in pelvic region Obstetric and gynecologic history Abuse of analgetic medication Risk jobs, exposition of carcenogenic substances Allergic history
- 31. Examination Of Urologic Patient
- 32. Examination – General examination – Abdominal – Local DRE External genitalia examination Basic neurological examination
- 37. Investigations
- 38. Diagnostic Lab Tests Urinalysis 1. Physical Characteristics & Measurements – appearance – color – odor – specific gravity 2. Chemical Measurements – pH – protein; glucose – ketones – bilirubin; urobilinogen – leukocytes; nitrite – blood 3. Microscopic – cells (wbc, RBCs, sperm) – casts – crystals – bacteria 4. Detection of Bacteriuria – nitrite test qualitative or screening test – C & S Colony Count Organism Antibiotics sensitivity
- 39. Other Diagnostic Lab Tests Blood tests Blood urea / creatinine Blood glucose CBC ------ anemia if decreased EPO production Urine culture & sensitivity (C&S) Include colony count
- 40. Imaging studies Imaging U/S IVP including KUB Retrograde pyelography Ascending and micturating cystourethrography CT scan MRI Renal isotopic study
- 42. Ultrasound Diagnostic – Transabdominal – Pelvic – Scrotal – Transrectal Intervention Tru-cut needle, biopty gun Percutaneous nephrostomy
- 44. Dilatation of collecting system
- 47. Ultrasound TRUS
- 48. Plain film of abdomen KUB
- 49. Plain film of abdomen
- 50. Plain film of abdomen
- 51. Plain film of abdomen
- 52. Plain film of abdomen Disadvantages Preparation Radiolucent stones
- 57. IVU Disadvantages Needs normal renal function Patient preparation Contrast disorders
- 58. Computed tomography (CT) scan With or without contrast medium Indications: – Stones – Trauma – Tumours – Scaring of retroperitoneum – Lymphadenopathy in genitourinary tumors – Metastatic dissease
- 59. CT Scan
- 60. CT scan
- 61. CT scan
- 62. CT scan
- 63. Magnetic resonant imaging (MRI) MRU – urography MRA – angiography Contrast contraindication Radiation contraindication
- 64. Retrograde pyelography Cystoscopy and ureteric catheter Contrast injection Indications: – Non-functional kidney – Non-conclusive IVU – Examination in trauma of ureter – Urothelial tumors of upper urinary tract
- 65. Retrograde pyelography Advanteges: – History of contrast allergy . – Non-functional or non-visualized kidney in IVU Disadvanteges: – Invasive examination – Needing anesthesia
- 68. Ascending And Micturating Cystourethrography Catheter in the urethra and fill it with contrast medium Catheter in the bladder and fill it with contrast medium Indications: – Trauma – Vesicoureteral reflux – Posterior urethral valve – Stricture urethra – Stress incontinence – Fistula
- 69. Cystography
- 70. Cystography
- 76. Renogram
- 77. Urodynamic study
- 78. Different types of urodynamic tests Uroflowmetry Cystometry Pressure flow study Video urodynamics Urethral pressure profile Electromyography