Urology

UROLOGIC SEMIOLOGY
UROLOGY
 Definition: surgical discipline that studies and

treats affections of:
 Female urinary tract
 Male uro-genital tract
 Retroperitoneal space
 Suprarenal glands
RENAL COLIC
 Definition
 Localization
 Intensity
 Irradiation
 Debut
 Duration
 Evolution
 Antialgic position
 Signs and symptoms
 Differential diagnosis
 Treatment
RENAL COLIC
 Definition
 Paroxysmal pain syndrome due to upper urinary
tract distension.
 Most commonly caused by stones
RENAL COLIC
 Localization
 Lumbar
 Unilateral
 Intensity
 Very great in intensity
 Irradiation
 Antero-inferior, along the ureter to external genital
organs
 Never on the dorsal face of the thigh
RENAL COLIC
 Debut
 Sudden
 Duration
 Variable (up to a few hours)
 Evolution
 Undulating
 Antalgic position
 It does not exist
RENAL COLIC
SIGNS AND SYMPTOMS
 Urinary
 Polakiuria (frequent urination)
 Oliguria
 Hematuria
 Extra urinary
 Digestive(nausea, vomiting)
 Cardio vascular
 Respiratory
 Neuro-psychiatric
RENAL COLIC
DIFFERENTIAL DIAGNOSIS
 Abdominal pain
 Biliar
 Apendicular
 Pancreatic
 Ovarian
 Acute surgical abdomen
 Entero-mezenteric infarct, perforated ulcer, bowel obstruction
 Acute medical abdomen
 Saturnism
 Intercostal shingles
 Back pain: lombosciatica, herniated disk
 Tabet crisis
RENAL COLIC
TREATMENT
 Decreased liquid intake

 Antispasmodic
 Pain killers
 Anti-inflammatory
 Alfa-blockers
NORMAL URINATION
 3 main characteristics
 Voluntary
 Comfortable
 Efficient
POLAKIURIA
 Definition
 Polakyuria ≠ Polyuria
 Classification
POLAKIURIA
 Definition: disorder of comfortable urination,

characterized by urinary frequency, with
reduced urinary volume (<250ml)
POLAKIURIA
 Classification
 Diurnal/Nocturnal/Mixed
 With clear/cloudy urine

POLAKIURIA
 Extra-urinary causes
 neurological – post stroke sequelae , Parkinson’s
disease, tabes, chronic alcoholism or diabetic
peripheral neuropathy
 Proximity : Pericystitis, pelviperineale diseases -
infections and tumors of the female genital , rectal
cancer , hemorrhoids , hemorrhoidal thrombosis ,
anal fissure , appendicitis , vaginitis
POLAKIURIA
 Urinary causes
 1.Reduced functional bladder capacity
 overactive bladder
 UTI
 Bladder stones/foreign body in bladder
 Bladder tumor
 Pelvin ureteral stone
 2.Reduced anatomic bladder capacity
 After surgery (partial cystectomy)
 Bladder TB
 Rx therapy
 Ureterocele
 3.Chronic urinary retention – subvesical obstacle – urinating loses
characteristic of being efficient – bladder is not emptied completly –
postmictional residue that causes faster bladder filling
POLAKIURIA
 Rare couses
 Stress – caused by hypertony of sympathetic
nervous system
 Hormonal – hyperfoliculinemia
 Very acidic urinary PH
 Voluntary polakiuria
DYSURIA
 Urinating with effort
 The term “dysuria” contains several allegations
that he patient can relate:
 Delay of urination start
 Urine flow force decreases
 Abdominal muscles contracture to raise additional
bladder pressure
 Urine flow interruption followed by urine flow
reinstatment
DYSURIA
 COUSES
 Neurological – myasthenia, bladder denervation after
surgery (rectal amputation), peripheral neuropathy
(chronic alcoholism, diabetes), vesicoureteral sphincter
dyssynergia
 Bladder – bladder neck disectazia, bladder stones,
bladder foreign body, bladder tumors(near bladder
neck), bladder neck tumors, irreversible
decompensated detrusor
 Urethral – (urethro-prostatic) – prostate tumors
(benign/malignant), urethral tumors, urethral stricture,
urethral meatus stenosis, phimosis, urethral stone,
urethral foreign body
HEMATURIA
 Definition: presence of red blood cells in urine
 Circumstances of discovery
 Anamnestic hematuria
 Hematuria in progress
 Accidental discovery
HEMATURIA
 CLASSIFICATION
 Microscopic/macroscopic
 Permanent/intermittent
 Isolated/accompanied by other urological

symptoms
 Initial/terminal/total
HEMATURIA
 Initial hematuria – urethral/prostatic bleeding

source
 Terminal hematuria – bladder is the source
 Total hematuria – bleeding occurs in bladder or
upper urinary tract
 Any heavy bleeding (hematuria) will cause total

hematuria
HEMATURIA
 Differential diagnosis
 Red coloration of urine by ingestion of food or
drugs (eg.: Beet, rifampicin, furazolidone, laxatives
containing phenolphthalein)
 Hemoglobinuria and myoglobinuria
 Porfirinuria – urine has a normal color at emission ,

but subsequently changes color
 Blood in urine after bladder catheterisation
 Blood originating from vulvo-vaginal area

HEMATURIA
 Independent of:
 Circumstances of discovery
 Type of hematuria (micro/macroscopic)
 Presence or absence of other urological symptoms
 Initial/final/terminal hematuria
You must find the source of hematuria because

there is no hematuria without a cause!!!
HEMATURIA
 First intention
 Patient history and clinical exam

 Biological exam (urine and blood)
 Ultrasound and I.V. urography

HEMATURIA
 History of patient
 Personal pathological history
 Recent infection in oral area
 Pulmonary TB
 Anticoagulant medication
 Blood dyscrasias
 Familial pathological history
 Uropathies/nephropathies
 Hematuria
 First episode
 Characters
 Home medication
 Circumstances of appearance (trauma/effort)
 Other symptoms (disuria/polakiuria/fever/pain(lumbar/hypograstric)/urinary
retention
HEMATURIA
 Local clinical exam

 Lumbar – search of a potentially palpable kidney
 Hypogastrium – search for bladder globe or palpable
mass
 Gynecological exam needed for female with hematuria
 General clinical exam

 Blood pressure value
 Existence of edema
 Weight gain
HEMATURIA
 Biological exam
 Urine – urinalysis exam
 Blood - glucose / urea nitrogen / creatinine serum /
blood count / hemostasis and coagulation tests
 Ultrasound and I.V. urography

HEMATURIA
 If balance sheet is normal, cystoscopy is

required, cytology (systematic) and other
investigations – CT, UPR (urea production
rate?)
 If trauma is the context – treatment will apply

specially for this type of pathology
HEMATURIA
 Nephrological cause of hematuria

 Clinical:edema, hypertension, personal
pathological history (recent oral infection, diabetes,
painkiller medication)
 Biological: presence of hematite cylinders,
proteinuria
 RX: normal aspect of I.V urography
 Patient must be examined by Nephrology

HEMATURIA
 Urological causes:
 Urine culture shows urinary infection
 Ultrasound and I.V. urography show lesions that
explain bleeding
 Ultrasound and I.V. urography are normal or show
atypical causes of hematuria

Urology

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UROLOGIC SEMIOLOGY

 Definition: surgical discipline that studies and

 Decreased liquid intake

 Definition: disorder of comfortable urination,

 With clear/cloudy urine

 Very acidic urinary PH

 Definition: presence of red blood cells in urine

 Isolated/accompanied by other urological

 Initial hematuria – urethral/prostatic bleeding

 Any heavy bleeding (hematuria) will cause total

 Porfirinuria – urine has a normal color at emission ,

 Blood originating from vulvo-vaginal area

 Presence or absence of other urological symptoms

You must find the source of hematuria because

 Patient history and clinical exam

 Ultrasound and I.V. urography

 Local clinical exam

 General clinical exam

 Ultrasound and I.V. urography

 If balance sheet is normal, cystoscopy is

 If trauma is the context – treatment will apply

 Nephrological cause of hematuria

 Patient must be examined by Nephrology

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