Urology

UROLOGY Zhang Xue-pei

MD

Anatomy

Symptoms

Frequency, Nocturia and Urgency • Increased bladder residual urine • Decreased bladder capacity • Urinary tract inflamed

odynuria (pain in urination) • Always with the voiding. • Acute inflammation of bladder, urethra and prostate.

• Often associated with urinary frequency and urgency

Enuresis • Before 3 years : physiology • Infection. Distal urethra stenosis, posterior urethra valve, neurogenic bladder

Difficult Urination • Hesitancy, loss of force and decreased of caliber of the stream, terminal dribling

• Due to lower urinary tract obstruction • Such as BPH, Pca, urethra stricture, urethra stone et al.

Acute and Chronic Urinary Retention • Boo (bladder outlet obstruction) • Such as BPH, Pca, urethra stricture, urethra stone et al.

• Neurogenic bladder

Incontinence • True incontinence: constant urine

leakage due to ectopic ureter orifice, injury to the sphincter of the urethra and neurogenic bladder • Stress incontinence: in multiparous women loss the muscle support to the bladder neck and urethra

• Urge incontinence : due to overactive bladder ---infection; Upper motor neuron lesions; It is often seen in anxious , tense women even without infection • False incontinence: bladder pressure equals the urethra resistance then the constant dribbling occures

Bloody Urine • Hematuria associated with flank pain

radiates to lower anterior abdominal quadrant , also to scrotum testis and vulva---ureter stone. Due to spasm of ureter muscle . • Painless hematuria throughout the urination ----urinary tract tumor.

Physical Examination • Kidney

Non-invasive Examination

Ultrasound • The most common use in urology • Cheap, get quick result, noninvasive • Valuable in renal cyst disease, renal

tumors, stones, urinary tract obstruction • The accuracy of the result depended on the experience of the operators • It is always as a screening methods.

KUB+IVP • What is KUB? • What is IVP? • Shape • Function • Common used as ultrasound

Retrograde pyelography • Use the cystoscope to insert the

catheter into the ureter then inject contrast medium. • Invasive operation • Used when IVP can not show the lesions clearly or renal function is severely damaged

Voiding cystourethrograms • To invest the LUT • Machinical or dynamic disease

Computed tomography Scanning(CT) • Transverse section of the body • Applied to any urinary tract tumors, adrenal tumors, renal injury

• More accurate than ultrasound

Magnetic Resonance Imaging (MRI) • Applied in kidney, retroperitoneum lesions, bladder and prostate

• More expensive than CT • Less common use than CT

Catheter

Invasive Examination

Cystoscope • Can see the urethra and bladder • Simultaneously biopsy or treatment of the lesions

• Most accuracy examination of the diseases

• Invasive can cause hematuria and retrograde infection

Ureteroscope • To invest ureter and pelvic • When the noninvasive examination can not make a defined dignosis

• Can also do the treatment

Laparoscopy • It is a revolution to the traditional surgery • Minimal invasive • Short hospital time • Economic • Most open operation can be done by lap