Ix in urology
Terms in this set (18)
- urine analysis
. renal cast
. dec in the sp gravity of the urine (indicating renal failure)
- plain xray film (KUB): inc renal shadow on both sides
- IV urogram (IVU): compressed & stretched calyces w elongated narrowed calcyeal necks (spider leg apperance)
- US: diffuse small echo lucent cysts on both kidneys
a) medical hx:
- diabetes, htn
- previous pelvic surgery
- drug hx
b) sexual hx
- libido status (sexual desire)
- morning erection status
- onset of ED
- previous sexual relationship
- arousal status
- BP, peripheral pulsation (femoral pulse the nearest pulse to genital organs), hair distribution, gynecomastia(hormonal imbalance ,inc est)
b) local (genital)
- penis : size, scars
- testis: size, consistency
- DRE: for older pt gp
- glycemic status (DM)
- lipid profile
- hormonal assay (hypogonadal)
- penile duplex study: erectile vascular status (venous leakage)
- cavernosometry: rare
- arteriography: rare (traumatic causes only)
- regiscan: detection of erection during sleep ; REM (can EX organic ED)
- intracavernosal injection of vasoactive substances: official based dx ***
- IVU : pelvic position of the kidney w short ureter (DD: nephroptosis have long tortuous ureter)
depends on IVU or asceding pyelography
- w cryptorchidism the scrotum on affected side is empty & atrophic
- undescended testis mb palpable (at the ext inguinal ring or neck of scrotum or intra abdominal)
- ectopic testis is eaaily palpable, M/C in the supf inguinal pouch.
- if testis is not palpable, US and /or CT are indicated to identify the cryptorchoid testis.
hypospadiasfor complicated cases
- genetic karyotyping (in perineal hypospadius)
- investigate for undescend testis
- IVP for anomalus kidney
ix of PUV
- lab ix:
. urine analysis : UTI, low sp gravity, proteins
. renal function test
- US: HUN, full bladder , key hole sign of dilated post urethra
- VCUG (voiding cystourethrogram)
the m/i dx radiological ix for PUV is VCUG
dx findings are the presence of dilated post urethra w hypertrophied bladder neck
ix of VUR
- using a radio-opaque medium in the UB. gives precise grading of the degree of reflux
2. US: gives an idea about the degree of hydronephrosis & echogenecity
3. excretory urography (IVP)
rough measure of function & assessment of the renal size
4. renal isotope study
99m Tc labeled DMSA is the best study to detect pyelonephritis & the cortical renal scarring
5. studies of urodynamics are indicated for any child w a suspected 2ry cause for reflux
1. urine analysis may show haematuria
2. pyruria & bacteruria are frequent
3. the type of crystals present in the urine may pedict the composition of the stone
4. bl urea & serum creatinine give an estimate of the total renal function
b) xray findings
- radio-opaque calculi (80-90% of all stones
- confusing shadows include phleboli, calcified LN, fecolith, calcified ovaries, or fibroids, FB & gall stones
- rt lateral view is essential when radio-opaque shadows is shown in the rt renal area. a renal calculus overlies the vertebral bodies whereas gallstones are far ant.
- kidney f(x) roughly assesed (tansient dearangement in cases of acute renal colic) . lucent stones are outlined; opaque stones can be assesed w certainty. a post-voiding film is essential to show ureterovesical & intramural calculi
- US during pregnancy, in anuric pt, if the pt allergic to contrast material. shows acoustic shadow of stone, stasis or hydronephrosis are also shown.
- non contrast spiral CT used in radiolucent stones or ureamic pts to show the site, size +- type of stone (not miss any stone)
-urine analysis: pyuria, bacteriuria, hematuria.
-urine culture: often not necessary.
-CBC: leucocytosis with predominance of
neutrophils, inc.ESR & C- reactive ptn.
U.A: WBCs in clumps, bacterial rods.
Specific casts (bacteria in ptn matrix).
-IVU: renal enlargement (1.5 cm greater in length). focal" (focal bacterial nephritis) disappear with treatment. calyceal & ureteral dilatation (endotoxins)
-U/S & CT: to diagnose complicated PN to reevaluate pts not responding after 72 hours treatment.
-Plain KUB: crescentic gas shaddow (in renal space) & loculated "gas shaddow" (in parench.)
-IVU: rare of value (NF or poorly functioning K.)
CT: procedure of choice.
-Leucocytosis, pyuria, bacteriuria (if communicat).
-Urine culture: no or different organism (bld borne).
-Renal enlargement & distortion of renal contour.
-Renal fixation on insp. & exp. films.
-Obliteration of psoas shadow & scoliosis.
-CT is the procedure of choice
Renal enlargement & area of low attenuation.
Thickening of perinephric fascia.
Infected Hydronephrosis & Pyonephrosis:
Radiology: internal ecchoes in dilated pelvicalyceal (PC) P.C system.
-Absent psoas shaddow, elevated or immobile
-U/S & CT: ecchogenic collection.
1- Physical examination:
-Important but not helpful for diagnosis or classificat
ABP: prostate is hot, boggy, very tender
Other types: prostate is normal.
2- Cytology & culture:
- Stamey 4 glass urine collection
ACUTE FLANK PAIN—URETERIC OR RENAL COLIC
Work Up :
Examination: patient want to move around, in an attempt to find a comfortable position.
Radiological investigation :
KUB / Abdominal US
advantages over IVP:
greater specificity (95%) and sensitivity (97%) for diagnosing ureteric stones
Can identify other, non-stone causes of flank pain.
No need for contrast administration.
Faster, taking just a few minutes
the cost of CTU is equivalent to that of IVU
very accurate way of determining whether or not a stone is present in the ureter
very high cost
Torsion of the Spermatic Cord (Intravaginal)
The affected testis is high-riding Transverse orientation.
Acute hydrocele or massive scrotal edema
Cremasteric reflex is absent.
Tender larger than other side.
To aid in differential diagnosis of the acute scrotum.
To confirm the absence of torsion of the cord.
Doppler examination of the cord and testis :High false-positive and false-negative results
Color Doppler ultrasound:
Assessment of anatomy and determining the presence or absence of blood flow.
Sensitivity: 88.9% specificity of 98.8%
Radionuclide imaging :
Assessment of testicular blood flow.
PPV of 75%, a sensitivity of 90%, and a specificity of 89%.
False impression from hyperemia of scrotal wall.
Not helpful in Hydrocele and Hematoma