2. Introduction
• The evaluation of a patient must always begin with a thorough and appropriate
history and physical examination. By using an organized system of information
accrual, the doctor/clinician/surgeon can gather information pertinent to the
cause.
• Contrary to popular believe, the urological patient spans from a day old with
congenital anomalies of the genitourinal system renal hypoplasia, polycystic
kidney disease,hypospadias,neurogenic bladder,posterior urethral valves,etc
through adolescent, adult and the aged( male infertility,urethral,prostate ,
bladder disorder )
3. COMMON CHIEF COMPLIANTS
PAIN
•SOCRATES: SITE,
ONSET,CHARACTER,RADIATION,ASSOCIATION,TIME/DURATION,EXACERBATION, SEVERITY
• Severity of pain : Must be assessed to monitor and intervene appropriately. Most accepted
is the WONG & BAKER 10 point scale system
• Penile Pain: The differential for penile pain includes paraphimosis,ulcerative penile lesions
(e.g., cancer or herpes), or referred pain from cystitis/prostatitis in the flaccid penis. In the
rigid penis, Peyronie disease or priapism may be the cause.
4. • Scrotal Pain:
Pain within the scrotum may be due to irritation of the scrotal skin, such as
an inflamed pustule from an ingrown hair or from the testicles and cord within.
Epididymitis and orchitis are typified by testicular pain that may be relieved by
maneuvers that elevate or support the testis.
Torsion of the testicle or its appendages result in acute vascular congestion
and pain (and in the case of testicular torsion is a surgical emergency).
Varicoceles may result in a dull ache particularly toward the end of the day from
accumulated vascular congestion. Again, because of common embryologic
origins and therefore neurologic pathways, pain within the kidney or ureter
may be referred to the ipsilateral scrotum.
5. • Prostatic Pain
Inflammation of the prostate, prostatitis, can result in pain that is
located deep within the pelvis. It can be difficult to localize and
sometimes is confused with rectal pain. Irrigative voiding symptoms
(urinary frequency, urgency, and dysuria) are often associated with
irritation of the prostate.
6. • Vesicle Pain:
If the bladder is inflamed (as in cystitis) or distended because of obstruction
(as in acute urinary retention), suprapubic pain may be present. Inflammation of
the bladder caused by infection or interstitial cystitis is worst when the bladder
is distended, so patients may report improvement in suprapubic pain with
voiding.
Patients also may describe strangury, a sharp and stabbing pain at the end of
urination (presumably resulting from final contraction
of the inflamed detrusor).
In sensate bladders, acute urinary retention can be easily identified from
the history: profound desire to urinate without ability to do so. However, in
patients with flaccid atonic bladders, large volumes of urine can be retained
without any symptoms.
7. Ureteral Pain.
Ureteral pain typically is due to ureteral obstruction is acute in onset, and
is located to the ipsilateral lower quadrant.
The acute distention of the ureter and hyperperistalsis result in pain as
prostaglandins accumulate, causing ureteral spasm, which in turn causes
increased lactic acid production, which in turn irritates type A and C nerve
fibers in the ureteral wall.
These nerve fibers conduct signal toward T11-L1 dorsal root ganglia,
and this irritation is perceived as pain. Ureteral obstruction are of a gradual or
partial nature may not cause pain. The point of ureteral obstruction may result
in referred pain to the ipsilateral scrotum or penis. Obstruction at the
ureterovesical junction also may result in irritative voiding symptoms (urinary
urgency, frequency, nocturia, painful voiding, bladder discomfort)
8. HEMATURIA
Hematuria simply means blood in urine.
• It can be microscopic or macroscopic
• According to urine flow , it can be: initial, total and terminal (urethral
damage ,infections, bleed from bladder
• Can also be painful/painless
One must ask, is this true hematuria. This is because dyes and certain
vegetables may color urine red.
9. LUTS(lower urine tract symptoms)
These can be due to irritative or obstructive causes.
Causes of lower urinary tract obstruction include benign prostatic hyperplasia
(BPH), obstructive prostate cancer, urethral stricture disease, dysfunctional
voiding, detrusor external sphincter dyssynergia, severe phimosis, and severe
meatal stenosis
Irritative LUTS include urinary frequency, urgency, and dysuria. Causes of
irritative voiding symptoms, other than chronic bladder outlet obstruction,
include overactive bladder, cystitis, prostatitis, bladder stones, or bladder
cancer
10. • FREQUENCY
• URGENCY
• NOCTURIA
• FEELING INCOMPLETE VOIDING
• HESITANCY
• URINE INCONTINENCE( STRESS OR URGE)
14. • FAMILY HISTORY
• MEDICAL AND SURGICAL HISTORY(STI, TRAUMA, SURGERY,
• BIRTH/NEONATAL HISTORY
• DRUG HISTORY
• ALLERGIC
15. GENERAL PHYSICAL EXAM
• Patient’s habitus
• Palor, jaundice, hydration status,respiratory,
• Signs of wasting, or malnutrition
• Any catheter in situ, supra pubic or urethral
17. IPSS SCORE
• The International Prostate Symptom Score (IPSS) is a scoring system
used to screen for and diagnose benign prostatic hyperplasia (BPH) as
well as to monitor symptoms and guide decisions about how to
manage the disease
• With the mneumonic FUNWISE(frequency,urgency,nocturia,weak
stream,intermittency,straining,emptying(feeling incomplete empty)
• Minimal score 0-
18.
19. DIAGNOSIS
PLAN OF MANAGEMENT OUTLINE CLEARLY ACCORDING TO DIAGNOSIS
INVESTIGATION: BLOOD AND IMAGING
APPROPIRATE EXCLUSIVE CURATIVE/MANAGING TREATMENT
Editor's Notes
Pelvic abscess my give rectal pain
We must not forget about shistosomiasis
This is often a symptom of severe overactive bladder, cystitis,
or neurogenic bladder or may occur in patients with poorly compliant
bladders
