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Evaluation of the Urologic Patient

By

Geetha Maddukuri

, MD, Saint Louis University

Last full review/revision Nov 2020| Content last modified Nov 2020
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History in the Urologic Patient

Pain originating in the kidneys or ureters is usually vaguely localized to the flanks or lower back and may radiate into the ipsilateral iliac fossa, upper thigh, testis, or labium. Typically, pain caused by calculi Urinary Calculi Urinary calculi are solid particles in the urinary system. They may cause pain, nausea, vomiting, hematuria, and, possibly, chills and fever due to secondary infection. Diagnosis is based on... read more is colicky and may be prostrating; it is more constant if caused by infection. Acute urinary retention Urinary Retention Urinary retention is incomplete emptying of the bladder or cessation of urination. Urinary retention may be Acute Chronic Causes include impaired bladder contractility, bladder outlet obstruction... read more distal to the bladder causes agonizing suprapubic pain; chronic urinary retention causes less pain and may be asymptomatic. Dysuria Dysuria Dysuria is painful or uncomfortable urination, typically a sharp, burning sensation. Some disorders cause a painful ache over the bladder or perineum. Dysuria is an extremely common symptom... read more is a symptom of bladder or urethral irritation. Prostatic pain manifests as vague discomfort or fullness in the perineal, rectal, or suprapubic regions.

Symptoms of bladder obstruction in men include urinary hesitancy, straining, decrease in force and caliber of the urinary stream, and terminal dribbling. Incontinence Urinary Incontinence in Adults Urinary incontinence is involuntary loss of urine; some experts consider it present only when a patient thinks it is a problem. The disorder is greatly underrecognized and underreported. Many... read more has various forms. Enuresis after age 3 to 4 years may be a symptom of urethral stenosis in girls, posterior urethral valves in boys, psychologic distress, or, if onset is new, infection.

Pneumaturia (air passed with urine) suggests a vesicovaginal, vesicoenteric, or ureteroenteric fistula; the last 2 may be caused by diverticulitis, Crohn’s disease, abscess, or colon cancer. Pneumaturia could also be due to emphysematous pyelonephritis.

Physical Examination of the Urologic Patient

Physical examination focuses on the costovertebral angle, abdomen, rectum, groin, and genitals. In women with urinary symptoms, pelvic examination is usually done.

Costovertebral angle

Abdomen

Visual fullness of the upper abdomen is an extremely rare and nonspecific finding of hydronephrosis or a kidney or abdominal mass. Dullness to percussion in the lower abdomen suggests bladder distention; normally, even a full bladder cannot be percussed above the symphysis pubis. Bladder palpation can be used to confirm distention and urinary retention.

Rectum

Groin and genitals

Inguinal and genital examination should be done with patients standing. Inguinal hernia or adenopathy may explain scrotal or groin pain. Gross asymmetry, swelling, erythema, or discoloration of the testes may indicate infection, torsion, tumor, or other mass. Horizontal testicular lie (bell-clapper deformity) indicates increased risk of testicular torsion. Elevation of one testis (normally the left is lower) may be a sign of testicular torsion Testicular Torsion Testicular torsion is an emergency condition due to rotation of the testis and consequent strangulation of its blood supply. Symptoms are acute scrotal pain and swelling, nausea, and vomiting... read more . The penis is examined with and without retracting the foreskin. Inspection of the penis can detect

Testing of the Urologic Patient

Bladder tumor antigen testing for transitional cell cancer of the urinary tract is more sensitive than urinary cytology in detecting low-grade cancer; it is not sensitive enough to replace endoscopic examination. Urine cytology is the best test to detect high-grade cancer.

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