عدد المساهمات : 2397نقاط : 4183السٌّمعَة : 9الجنس : علم بلدك : تاريخ الميلاد : 03/04/1950تاريخ التسجيل : 30/07/2012العمر : 74 الموقع : السودان - سنارالعمل/الترفيه : طبيب عمومى وموجات صوتيةالساعة الان : دعائي :
موضوع: ABCs of UROLOGY-- الأحد مارس 24, 2019 3:49 pm
Urological evaluation
The most common urological complaints that need referral to a primary care doctor or urological surgeon can be divided into those referable to # the lower urinary tract and those referable to # the upper urinary tract.
Although a careful history may be diagnostic in patients with, for example, renal colic or testicular torsion, often non-specific features are more difficult to unravel. .
Symptoms The bladder has been described as an unreliable witness. Sensory innervation is mediated largely through parasympathetic nerves, with pain from overdistension mediated through the sympathetic nervous system.
The precision with which the site and cause of symptoms in the lower and upper urinary tracts can be identified from this autonomic innervation is limited. Similar symptoms may occur as the result of different pathology. Urological evaluation on the basis of symptoms depends on understanding how much reliance can be placed on the patient's account of symptoms, and on the doctor phrasing questions so that the patient is clear about their meaning .
Obstructive symptoms # Hesitancy of micturition can be a reliable symptom. The patient can quantify accurately a delay in initiation of the urinary stream. Most men can describe whether their urinary stream is fast or slow—that is, strong or weak. Patients can confirm if their urinary stream is intermittent, and this is a good indicator of obstruction. A feeling of incomplete bladder emptying correlates poorly with objective findings on ultrasound examination.
Irritative symptoms # A burning sensation on micturition is common in patients with a lower urinary tract infection. A similar sensation can occur in the absence of infection, however, and infection can occur in the absence of any discomfort.discomfort.
Table 3 Irritative symptoms # • Burning on micturition • Urgency • Daytime frequency • Nocturia • Urge incontinence
The term “dysuria” is often applied to a burning sensation on micturition, but it means different things to people and is best avoided. Urgency of micturition may be sensory or motor in origin, but when a history is taken, it is hard to distinguish between the two—although the underlying pathologies are very different. Patients with urgency feel as if they may leak urine if they are not able to reach a lavatory imminently. The sensation of needing to pass urine again just after micturition—strangury—is the urological equivalent of tenesmus. In the urinary tract, the symptom is not diagnostic for any one pathology.
Frequency of micturition When patients are asked to describe their urinary frequency, they have every opportunity for an unhelpful and lengthy reply. The number of times a patient wakes to pass urine at night is a value that most people can identify accurately. A single episode of nocturia is within normal limits. **** More than this number becomes increasingly important.
Differentiation between urological and non-urological causes of non-specific symptoms can be made only after basic urological investigation
Daytime urinary frequency is subject to so many variables that it is almost unhelpful—except to know whether such frequency provokes an adverse effect on the patient's lifestyle.
Urinary incontinence To establish the circumstances under which urine loss occurs is important. Neither men nor women are entirely continent. In men, a small urinary leakage at the end of the stream (also known as “post-micturition dribble”) is so common that it does not constitute an abnormality. Many women—young and old—leak a little urine on coughing. .
[وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط]
[rtl]تم تحجيم الصورة إلى : 99 % من الحجم الطبيعي لها [ 502 x 362 ][/rtl]
[وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط] [rtl][وحدهم المديرون لديهم صلاحيات معاينة هذه الصورة][/rtl]
[وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط]
Male genitalia including scrotal contents. Reproduced from Adler M, et al. ABC of sexually transmitted infections. 5th edition. Oxford: Blackwell Publishing, 2004, and adapted from the Sexually transmitted infections: history taking and examination CD published by the Wellcome Trust, 2003.
[وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط] [rtl][وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط]
[وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط]
NEXT
[وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط]
عدل سابقا من قبل د.كمال سيد في الأحد مارس 24, 2019 4:03 pm عدل 1 مرات
د.كمال سيد Admin
عدد المساهمات : 2397نقاط : 4183السٌّمعَة : 9الجنس : علم بلدك : تاريخ الميلاد : 03/04/1950تاريخ التسجيل : 30/07/2012العمر : 74 الموقع : السودان - سنارالعمل/الترفيه : طبيب عمومى وموجات صوتيةالساعة الان : دعائي :
موضوع: رد: ABCs of UROLOGY-- الأحد مارس 24, 2019 3:51 pm
Urinary leakage
The most important question to follow a complaint of urinary incontinence is “What protection do you need to cope with the leakage?” If the loss of urine needs no more than a change of underwear, further investigation is unlikely to be worthwhile, but referral for consideration of pelvic floor exercises may be beneficial to the patient. .
Table 4 Urinary leakage
• Urinary leakage is more common in women than in men • A severe degree of urge incontinence will probably cause a larger volume of urine loss than the most severe stress incontinence • Some women are unable to identify how they leak • Urinary leakage during sexual intercourse occurs in some women
Renal and ureteric colic The pain from a stone that is moving within the urinary tract is among the most severe pains that patients may experience. The site of the pain, however, is not a very reliable indicator of the site of the stone. [وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط]
[rtl]تم تحجيم الصورة إلى : 96 % من الحجم الطبيعي لها [ 519 x 390 ][/rtl]
[size] [وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط] Renal ultrasound scan showing pelvi-caliceal and upper ureteric dilatation
Fever Lower urinary tract infections do not cause a fever, which occurs only when a urinary infection is in a solid organ or if the patient has an obstructed and infected urinary tract.
Sexual dysfunction Erectile dysfunction presents as an inability to initiate or sustain an erection sufficient to enable vaginal penetration and subsequent orgasm. The presence of nocturnal or early morning erections makes an organic cause of erectile dysfunction less likely.
Retrograde ejaculation occurs commonly in men after transurethral resection of the prostate and sometimes in those who have taken α adrenergic blockers. Failure of ejaculation may occur after sympathectomy or retroperitoneal surgery, as the sympathetic pathways to the prostate and seminal vesicles are interrupted. Premature ejaculation occurs most often as a functional problem.
Go to : Examination Much of the genitourinary tract is hidden from view. This dictates that many decisions on management are usually possible only at a second outpatient visit, when the results of baseline investigations are available.
External genitalia If a lax scrotum lies between the thighs, the scrotal contents can be delivered painlessly for examination by taking and pulling on a fold of scrotal skin. The testes appear without discomfort. The testes and epididymes can be identified separately.
If epididymal infection is present or testicular torsion is suspected, the examination must be gentle. Observation of the colour of the scrotal wall may reveal hyperaemia. The absence of a cremasteric reflex contraction when the scrotum, or the area close to the scrotum, is touched is also an important sign to elicit. The loss of this reflex is not diagnostic of one pathology, but its presence is strongly against a diagnosis of torsion.
Examination of the penis should include assessment of the degree to which the prepuce can be retracted. : The external urethral meatus must be identified in patients with hypospadias and epispadias, the meatus will be sited abnormally. If an attempt is made to pull the sides of the meatus apart, the presence of meatal stenosis can be identified. The shaft of the penis is palpated to identify fibrous plaques of Peyronie's disease, which usually are found dorsally.
When a stone enters the intramural ureter, patients often describe strangury, and, in men, discomfort may be felt at the tip of the penis
If a urinary tract infection is suspected the presence of nitrites and red cells on dipstick testing can be useful, although not unequivocal (leaving no doubt), confirmatory evidence
Ideally, antibiotics should not be prescribed until a urine culture has been taken
The patient's external genitalia should be examined with the patient in the supine and erect positions to identify pathologies such as hernia and varicocele
Rectal examination Rectal examination is performed best with the patient in the left lateral position. The examiner's finger should be inserted while the patient exhales to encourage maximum relaxation of the anal sphincter. The tone of the anal sphincter is noted. Perianal sensation can be tested in the distribution of the S2, S3, and S4 segments—the spinal segments responsible for the main motor and sensory innervation of the bladder. .
[وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط] [/size]
[rtl]تم تحجيم الصورة إلى : 99 % من الحجم الطبيعي لها [ 502 x 526 ][/rtl]
[size] [وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط] S2, S3, and S4 segments are responsible for the main motor and sensory innervation of the bladder
Table 5 Rectal examination
• Anal sphincter tone • Anal sphincter contractility • Perianal sensation • Prostate—size, surface, symmetry, and consistency
: Examination of the prostate per rectum provides only a rough estimate of the size : the prostate can be categorised as small, medium, or large. The consistency of the prostate can be described as soft, firm, or hard; the surface as smooth or irregular; and the lateral lobes as symmetrical or asymmetrical. No precise correlation exists between any of the features described and a specific pathology. .
Dipstick urine testing Although it is readily available and often used, dipstick testing of urine is an inaccurate investigation. The presence of white cells and nitrites is a rough guide to the presence of infection, although the absence of nitrites in the urine normally is enough to rule out an infection and the need for urine microscopy. Microscopic haematuria may be intermittent, but the presence of blood cells in the urine should normally prompt referral for further investigation, and it is considered unnecessary to confirm the presence of red cells by urine microscopy.
Urine culture Many laboratories now use an automated method to identify red and white cells in the urine. The numbers of each that can be considered normal are considerably higher than the numbers regarded as normal when urine microscopy is used. These values must be recognised, particularly for red cells, to prevent inappropriate referrals.
Urine cytology Although some automation is used for the analysis of urine cytology, the final arbiter is microscopy—the accuracy of which depends on the expertise of the cytopathologist.
Biochemistry Renal function is measured better by serum creatinine than by blood urea, the latter being influenced by the degree of hydration and rate of metabolism. [size=34]The extent of reserve renal function means there must be a loss of two thirds of overall renal function before levels of serum creatinine increase. [/size]Measurements of sodium, potassium, and chloride electrolytes are the other baseline biochemical tests of relevance.
Ultrasonography Ultrasound examinations are used in the investigation of renal, ureteric, bladder, prostatic, and scrotal pathology. They may be regarded as an extension of examination. The person who undertakes the examination has the advantage of seeing the images in real time, whereas the doctor has only a few still images. The report thus is of prime importance. Limitations of ultrasonography vary in different situations.
Kidney In the kidney, ultrasound is better than computed tomography at identifying renal cysts, but it may fail to distinguish between parapelvic cysts and hydronephrosis. Ultrasound is a poor way of screening for renal stones. Assessment of the size of a stone using ultrasound is not very accurate.
Culture of a midstream specimen of urine is the only way to identify patients whose symptoms truly result from infection
Ureter Ureteric dilatation can be identified, but the cause is much more difficult to define. A stone at the lower end of the ureter may be identified by using the full bladder as an acoustic window. . [وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط] [/size]
[rtl]تم تحجيم الصورة إلى : 96 % من الحجم الطبيعي لها [ 519 x 392 ][/rtl]
[size] [وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط] Ultrasound scan showing dilated ureter
[وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط]
next[/size]
[وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط]
د.كمال سيد Admin
عدد المساهمات : 2397نقاط : 4183السٌّمعَة : 9الجنس : علم بلدك : تاريخ الميلاد : 03/04/1950تاريخ التسجيل : 30/07/2012العمر : 74 الموقع : السودان - سنارالعمل/الترفيه : طبيب عمومى وموجات صوتيةالساعة الان : دعائي :
موضوع: رد: ABCs of UROLOGY-- الأحد مارس 24, 2019 3:54 pm
Bladder The bladder is seen easily on transabdominal ultrasound, and volume measurements are simple and accurate. Intravesical pathology, such as tumours and stones, can be seen best when the bladder is full. . [وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط]
[rtl]تم تحجيم الصورة إلى : 96 % من الحجم الطبيعي لها [ 519 x 369 ][/rtl]
[وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط] [rtl][وحدهم المديرون لديهم صلاحيات معاينة هذه الصورة][/rtl]
[وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط] Axial coloured magnetic resonance image scan of a patient with prostate cancer.
Prostate Transrectal ultrasonography of the prostate has transformed the understanding of prostatic anatomy and pathology. Biopsies of the prostate and placement of radioactive seeds in brachytherapy are always undertaken with ultrasound imaging. .
Table 7 Radiological investigations
• Plain abdominal x ray • Intravenous urogram • Urethrogram • Retrograde ureterogram • Antegrade ureterogram • Computed tomography • Magnetic resonance imaging • Isotope renogram • Isotopic glomerular filtration rate • Isotope bone scan
Scrotum The scrotal contents are one of the few sites in urological practice where examination is easy. Differentiation between the normal epididymis and testis is accurate, and the vas can be palpated. In the presence of a tense hydrocele or inflammation, examination becomes more difficult and ultrasound may be worthwhile.
: Urodynamics Urodynamic investigations of the upper urinary tract are not often performed. Assessment of the function of the lower urinary tract can be made by a number of investigations:
Urinary flow rate Assessment of bladder capacity and the size of the residual urine volume Measurement of bladder pressures with a urethral catheter during bladder filling and emptying Pressure or flow assessment under fluoroscopic imaging.
: Radiological investigation The methods of radiological investigation include those listed in the box above and each are used in different situations. Intravenous # urography (combined with renal ultrasonography) is the investigation of choice for patients with painless haematuria. New low osmolarity contrast media causes severe allergic reactions in < 0.02% of patients. Computed # tomography is the investigation of choice for identifying renal masses. The speed of the investigation has advantages, but interpreting the images needs a considerable investment in time at a sophisticated workstation that can format the images. Magnetic # resonance imaging has been adopted as the investigation of choice in the staging of prostate cancer. The same investigation can be helpful if used on bone settings to interpret areas of increased isotope uptake on a bones scan. Dynamic # isotope renography that uses mercaptoacetylglycine (MAG3) as the radiopharmaceutical is the most accurate method of identifying upper urinary tract obstruction and also shows differential renal function. Static # renography with dimercaptosuccinic acid (DMSA) will identify renal scarring and differential renal function. The most accurate measurement of glomerular filtration rate is obtained by using an ethylenediamine tetra-acetic acid (EDTA) clearance technique. Isotope # bone scans are used in uro-oncology to identify bony metastatic disease.
Notes The ABC of urology is edited by Hugh N Whitfield, consultant urological surgeon, Royal Berkshire Hospital, Reading, and Chris Dawson, consultant urologist, Edith Cavell Hospital, Peterborough. The book will be published in September 2006. [وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط] [rtl] [وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط][/rtl] [وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط]
[وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط]
د.كمال سيد Admin
عدد المساهمات : 2397نقاط : 4183السٌّمعَة : 9الجنس : علم بلدك : تاريخ الميلاد : 03/04/1950تاريخ التسجيل : 30/07/2012العمر : 74 الموقع : السودان - سنارالعمل/الترفيه : طبيب عمومى وموجات صوتيةالساعة الان : دعائي :
موضوع: رد: ABCs of UROLOGY-- الأحد مارس 24, 2019 4:05 pm
The Urinary Tract System
[وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط] Urology is a part of health care that deals with a lot of different body parts. This includes body parts that form the Urinary System and Male Reproductive System. If you have a problem with a body part in these two systems, you may need to see a urologist.
The Urinary System Many of your body parts work with each other to form the Urinary System. Urine is taken out of the body if these parts work with each other in the right order. This allows normal urination to happen. For both men and women, the main parts of the system are Kidneys, Ureters, Bladder and Urethra. Urine is produced in the kidneys. It flows through tubes called ureters, and into the bladder. Urine leaves the body through the urethra.
How the Kidneys Work The kidneys are fist-size organs that make urine. They are found on both sides of the spine behind the liver, stomach, pancreas and bowels. Healthy kidneys work like clockwork to turn extra water and waste into urine.
How the Ureters Work Urine flows out of the kidneys and into the ureters. Ureters are thin tubes of muscle that connect the kidneys to the bladder. Ureters carry urine from the kidneys to the bladder.
How the Bladder Works The bladder is a hollow, balloon-shaped organ. It is mostly made of muscle. It stores urine until you are ready to go to the bathroom to release it. The bladder helps you urinate. The brain tells it to tighten and force the urine out.
How the Urethra Works Urine leaves the body through a hollow tube connected to the bladder. This tube is called a urethra.
The Male Reproductive System Many body parts work with each other to form the Male Reproductive System. The purpose is for each part to work in the right order so a male can have sex. During sex, you may be able to fertilize a woman's ovum (egg) and make a baby. Not all men are able to have sex, even if their Male Reproductive System works right.
How the Testicles Work The testicles (also known as testes) are two golf ball size glands held in a sac (scrotum) below the penis. The testicles have a firm, slightly spongy feel. At the top and outside edge is a rubbery, tube-like structure called the epididymis. The firmness of the teste should be the same throughout. The size of the testicles should be about the same.
The testicles make male hormones. The most common hormone is testosterone, which controls the sex drive (libido). It also triggers the development of male traits, such as facial hair. The testicles also make sperm, the male reproductive cells, which travel through a group of tube-like structures to the epididymis. Sperm cells are then carried from the testicles by the vas deferens to the seminal vesicles, where they are mixed with fluid from the prostate gland.
How the Prostate Works The prostate is a walnut-shaped gland inside the male body. The prostate sits under the bladder and in front of the rectum. The prostate's main job is to help make fluid for semen to help protect and energize the sperm as they travel to the female egg.
How the Urethra Works During ejaculation the sperm cells, seminal vesicle fluid and prostate fluid enter the urethra (the tube in the penis through which urine and seminal fluid leave the body).
How the Penis Works The penis carries sperm out of the body. There are three tubes inside the penis. One is called the urethra. It is hollow and carries urine from the bladder through the penis to the outside. The other two tubes are called the corpora cavernosa. These are spongy tubes that are soft until filled with blood during an erection. The three tubes are wrapped together by a very tough fibrous sheath called the tunica albuginea.
During sex, the stiffness of the penis makes it hard enough to be inserted into the woman's vagina. In this case, the urethra acts as a tube for semen to be ejaculated into the vagina. When you ejaculate, seminal fluid and seminal vesicles mix with sperm to form semen. The semen travels through the urethra and comes out the end of your penis.
[وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط]
د.كمال سيد Admin
عدد المساهمات : 2397نقاط : 4183السٌّمعَة : 9الجنس : علم بلدك : تاريخ الميلاد : 03/04/1950تاريخ التسجيل : 30/07/2012العمر : 74 الموقع : السودان - سنارالعمل/الترفيه : طبيب عمومى وموجات صوتيةالساعة الان : دعائي :
موضوع: رد: ABCs of UROLOGY-- الأحد مارس 24, 2019 4:11 pm
[وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط]
Renal | Micturition Reflex
micturition reflex part 1
micturition reflex part 2
[وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط]
د.كمال سيد Admin
عدد المساهمات : 2397نقاط : 4183السٌّمعَة : 9الجنس : علم بلدك : تاريخ الميلاد : 03/04/1950تاريخ التسجيل : 30/07/2012العمر : 74 الموقع : السودان - سنارالعمل/الترفيه : طبيب عمومى وموجات صوتيةالساعة الان : دعائي :
موضوع: رد: ABCs of UROLOGY-- الأحد مارس 24, 2019 4:16 pm
Physiology of the Renal System: Introduction [وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط]
Urine Concentration The mechanisms of urine concentration and the action of ADH
"The Kidney & the Counter Current Multiplier" Animation
Concentration of Urine
next
[وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط]
د.كمال سيد Admin
عدد المساهمات : 2397نقاط : 4183السٌّمعَة : 9الجنس : علم بلدك : تاريخ الميلاد : 03/04/1950تاريخ التسجيل : 30/07/2012العمر : 74 الموقع : السودان - سنارالعمل/الترفيه : طبيب عمومى وموجات صوتيةالساعة الان : دعائي :
موضوع: رد: ABCs of UROLOGY-- الأحد مارس 24, 2019 4:32 pm
موضوع: ABCs of UROLOGY-- 
الأحد مارس 24, 2019 3:49 pm
