EVALUATION OF THE

UROLOGICAL PATIENTS
Dr. Sanjay Kumar Mahapatra
Associate Professor & HOD
Department of Urology
VIMSAR, Bura
The Symptoms
Pain
Hematuria
LUTS
Incontinence
Sexual Dysfunction
Hematospermia
Pneumaturia
Origin of Pain
Kidney
Ureter
Bladder
Prostate
Penis
Testicular
Pain
Can be severe
◦ Urinary tract obstruction
◦ Inflammation
Inflammation of the GU tract is most severe when it
involves the parenchyma of a GU organ
◦ Pyelonephritis
◦ Prostatitis
◦ Epididymitis
Inflammation of the mucosa of a hollow viscus usually
produces discomfort
◦ Cystitis
◦ Urethritis
Pain
Tumors:
◦ No pain unless
● obstruction
● extend beyond the primary organ to
involve adjacent nerves
Renal Pain
location
Nature – Constant or Floctuating
Radiation
Association
Gastrointestinal symptoms
Hematuria
Pain
Renal Pain
◦ Ipsilateral costovertebral
angle just lateral to the
sacrospinalis muscle and
beneath the 12th rib

Acute distention of the

renal capsule
Pain
Associated symptoms
◦ Gastrointestinal symptoms
● Nausea
● Vomiting
● Ileus
Pain
Renal pain may also be confused with pain
resulting from irritation of the costal nerves,
most commonly T10–T12 which is:
◦ Not colicky in nature.
◦ Severity of radicular pain may be altered by
changing position
Ureteral Pain
Upper Ureter

Mid- Ureter

Lower Ureter
Ureteral pain
Usually acute and secondary to obstruction
◦ Midureter ( Rt side): referred to the right lower
quadrant (McBurney's point) and simulate appendicitis
◦ Midureter (Lt side) :referred over the left lower
quadrant and resembles diverticulitis.
◦ Scrotum in the male or the labium in the female.
◦ Lower ureteral obstruction frequently produces
symptoms of bladder irritability( frequency, urgency,
and suprapubic discomfort)
Vesical Pain
Vesical pain is due
◦ Overdistention

◦ Inflammation
Vesical pain
Constant suprapubic pain that is unrelated
to urinary retention is seldom of urologic origin.

Inflammatory conditions of the bladder usually

produce intermittent suprapubic discomfort
Prostatic Pain
Inflammation with secondary edema and
distention of the prostatic capsule
Poorly localized
◦ lower abdominal
◦ Inguinal
◦ Perineal
◦ Lumbosacral
◦ rectal pain.
◦ irritative urinary symptoms ( frequency and dysuria)
◦ acute urinary retention.
Penile Pain
Pain in the erect penis is usually due to Peyronie's
disease or priapism
Pain in the flaccid penis
◦ Usually secondary to inflammation in the bladder or
urethra
◦ referred pain that is maximally at the urethral meatus
Paraphimosis
Testicular Pain
Acute pain
◦ Epididymitis
◦ Torsion of the testicle
Chronic scrotal pain
◦ Hydrocele
◦ Varicocele,
◦ Dull, heavy sensation that does not radiate
◦ Referred pain: kidneys or retroperitoneum
Hematuria
Hematuria : the presence of blood in the urine

In adults, should be regarded as a symptom of

urologic malignancy until proved otherwise
◦ Is the hematuria gross or microscopic?
◦ Timing: (beginning or end of stream or during entire
stream)?
◦ Is it associated with pain?
◦ Is the patient passing clots?
◦ If the patient is passing clots, do the clots have a specific
shape?
Hematuria
Initial hematuria:
◦ Usually arises from the urethra
◦ least common
◦ Usually secondary to inflammation.
Total hematuria
◦ Most common
◦ Bladder or upper urinary tracts.
Terminal hematuria
◦ The end of micturition
◦ Secondary to inflammation bladder neck or prostatic
urethra.
Lower Urinary Tract Symptoms
Irritative symptoms

Obstructive symptoms
IPSS Score
Frequency
Weak urinary stream
Hesitancy
Intermittency
Incomplete bladder emptying
Urgency
Nocturia
IPSS
The total symptom score ranges from 0 to 35
0 to 7- Mild
8 to 19- Moderate
20 to 35 - severe
 LUTS
BPH

Sricture Urethra

Neurogenic Bladder

GUTB

UTI
Enuresis
Urinary incontinence that occurs during sleep
Mostly in children up to 5 years

No urologial evaluation upto 6 yrs of age

Incontinence
Urinary incontinence is the involuntary
loss of urine.

Stress urinary incontinence

Continuous Incontinence

Urge incontinence

Overflow incontinence
Stress Urinary Incontinence
Female -Loss of anterior vaginal support and
weakening of pelvic tissues

Child bearing
Post menopausal

Male- Injury to external urethral sphincter

Prostatic surgery
Continuous Incontinence
Vesico –vaginal Fistula

Urtero Vaginal fistula

Ectopic Ureter
Sexual dysfunction
Impotency

Loss of Libido

Failure to ejaculate

Premature ejaculation
Erectile Dysfunction
Organic
Psychogenic
Anejaculation
Androgen Deficiency
Sympathetic denervation
Pharmacologic agents
Bladder neck &Prostatic surgery
Hematospermia
Presence of blood in the Seminal fluids.
Inflammation of Prostate and Seminal vesicles
Tuberculosis
Prostate cancer
Pneumaturia
Passage of gas in the Urine.
Divericulitis
Ca Colon
Chrohn disease
THANK YOU