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Investigations of Urology
- 1. Professor/ Abdellatif Zayed Graduated 1987 Urologic investigations
- 3. Urinalysis 1-Laboratory • First morning voiding (most concentrated) • Record collection time • Type of specimen (e.g. “clean catch”) • Analyzed within 2 hours of collection • Free of debris or vaginal secretions
- 4. Clean Catch
- 6. 1. Macroscopic Examination 1. Chemical Analysis (Urine Dipstick) 1. Microscopic Examination 1. Culture Types of Analysis
- 7. Macroscopic Examination • Odor: − Ammonia-like: (Urea-splitting bacteria) − Foul, offensive: Old specimen, pus or inflammation − Fruity: Ketones • Color: normally amber yellow − Colorless B Diluted urine − Deep YellowConcentrated Urine, Riboflavin
- 8. Chemical Analysis Glucose Bilirubin Ketones Specific Gravity Blood pH Protein Urobilinogen Nitrite Leukocyte Esterase
- 9. Negative Trace (100 mg/dL) + (250 mg/dL) ++ (500 mg/dL) +++ (1000 mg/dL) ++++ (2000+ mg/dL) The Urine Dipstick: Glucose
- 10. 1.000 1.005 1.010 1.015 1.020 1.025 1.030 The Urine Dipstick: Specific Gravity Significance Diabetes insipidus chronic renal failure
- 11. Negative Trace (non-hemolyzed) Moderate (non-hemolyzed) Trace (hemolyzed) + (weak) ++ (moderate) +++ (strong) Blood Significance 1. - Hematuria 1. - Hemoglobinuria 1. - Myoglobinuria
- 12. 5.0 6.0 6.5 7.0 7.5 8.0 8.5 pH Significance - Acidic (less than 4.5): metabolic acidosis, high-protein diet - Alkaline (greater than 8.0): renal tubular acidosis (>5.5), U T I
- 13. Negative Trace + (30 mg/dL) ++ (100 mg/dL) +++ (300 mg/dL) ++++ (2000 mg/dL) Protein
- 14. Functional Renal - Severe muscular exertion - Glomerulonephritis - Pregnancy - Nephrotic syndrome - Orthostatic proteinuria - Renal tumor or infection Pre-Renal Post-Renal Causes of Proteinuria
- 16. Negative Trace + (weak) ++ (moderate) +++ (strong) Leukocyte Esterase Significance - Pyuria - Acute inflammation - Renal calculus
- 17. Preservation - Cells and casts begin to disintegrate in 1 - 3 hrs. at room temp. - Refrigeration for up to 48 hours Types of microscopy - Phase contrast microscopy Microscopic Examination General Aspects
- 18. Abnormal Findings Per High Power Field (HPF) (400x) > 3 erythrocytes > 5 leukocytes > 10 bacteria
- 19. RBCs
- 20. WBCs
- 21. Bacteria
- 22. Yeasts
- 23. Erythrocyte Casts: Glomerular diseases Leukocyte Casts: Pyuria, glomerular disease Casts
- 24. RBCs Cast WBCs Cast
- 25. Urate Uric acid Calcium Oxalate Triple Phosphate Amino Acids Crystals
- 28. Urate Crystals
- 29. Cystine Crystals
- 30. Increased Increased Microscopic: • Erythrocytes (dysmorphic) • Erythrocyte casts • Mixed cellular casts Common Findings in: Acute Glomerulonephritis Glucose Bilirubin Ketones S.G. Blood pH Protein Nitrite L.E. Urobilinogen
- 31. Decreased Increased Increased Common Findings in: Chronic Glomerulonephritis Glucose Bilirubin Ketones S.G. Blood pH Protein Nitrite L.E. Urobilinogen Microscopic: • Pathological casts (broad waxy casts, RBCs)
- 32. Trace Positive Positive Microscopic: • Bacteria • Leukocytes • Leukocyte, granular, and waxy casts • Renal tubular epithelial cell casts Common Findings in: Acute Pyelonephritis Glucose Bilirubin Ketones S.G. Blood pH Protein Nitrite L.E. Urobilinogen
- 33. ++++ Microscopic: • Oval fat bodies • Fatty casts • Waxy casts Common Findings in: Nephrotic Syndrome Glucose Bilirubin Ketones S.G. Blood pH Protein Nitrite L.E. Urobilinogen
- 34. Common Findings in: Urothelial Carcinoma Microscopic: • Malignant cells on urine cytology (urine sample should be submitted separately to cytology Glucose Bilirubin Ketones S.G. Blood pH Protein Nitrite L.E. Urobilinogen +
- 35. - Normal creatinine (0.4-1.4) PSA Normally < 4 ng If > 4 ng CA PROST is suspected
- 36. Radiologic Investigations 1- plain KUB 2- ultrasonography 3- urography a- excretory (IVU) b- antegrade (nephrostogram) c- retrograde (ascending urogram) d- cystogram e- VCUG
- 37. PLAIN KUB
- 38. 1- PLAIN KUB Skeleton Soft tissue shadow Stones NO URINARY TRACT ANATOMY RADIOLUCENT STONES(25%) RADIATION
- 39. radio-opaque shadow in the left hypochondrium left renal stone
- 40. radio-opaque shadow in the left hypochondrium stone upper left Ureter
- 41. a large radio- opaque shadow central in the pelvis bladder stone
- 42. ULTASONOGRAPHY
- 43. cheap widely available no radiation no contrast operator dependent did not show the ureter
- 44. U/S bladder mass
- 47. AN IVU SHOWING GOOD EXCRETORY FUNCTION OF BOTH KIDNEYS AND NORMAL URINARY TRACTS
- 48. AN IVU SHOWING GOOD EXCRETORY FUNCTION OF BOTH KIDNEYS AND NORMAL URINARY TRACTS
- 49. IVU SHOWING GOOD EXCRETORY FUNCTION OF BOTH KIDNEYS HORSE-SHOE KIDNEY
- 50. IVP SHOWING GOOD EXCRETORY FUNCTION OF BOTH KIDNEYS CROSSED RENAL ECTOPIA
- 51. IVU SHOWING GOOD EXCRETORY FUNCTION OF BOTH KIDNEYS SPIDER-SHAPED COLLECTING SYSTEM POLYCYSTIC KIDNEY DISEASE
- 52. IVP GOOD EXCRETORY FUNCTION OF THE LEFT KIDNEY NON-VISUALIZED RIGHT KIDNEY THE LEFT KIDNEY SHOWS HYDRONEPHROSIS UPJ OBSTRUCTION
- 53. IVU SHOWING GOOD EXCRETORY FUNCTION OF BOTH KIDNEYS A SPACE OCCUPYING LESION IN THE MIDZONE OF THE RT KIDNEY
- 54. AN IVU SHOWING GOOD EXCRETORY FUNCTION OF BOTH KIDNEYS COBRA HEAD BILATERAL URETROCELE
- 58. CYSTOGRAM FILLING-DEFECT IN THE BLADDER -BLADDER MASS -BLOOD CLOT -ENLARGED MEDIAN LOBE OF THE PROSTATE
- 59. IVP GOOD EXCRETORY FUNCTION OF THE LEFT KIDNEY NON-VISUALIZED RIGHT KIDNEY PELVIC MASS COMPRESSING THE BLADDER
- 60. AN IVU SHOWING GOOD EXCRETORY FUNCTION OF BOTH KIDNEYS FILLING DEFECT IN THE RT-SIDE OF THE BLADDER CANCER BLADDER
- 64. ASCENDING PYELOGRAPHY FILLING-DEFECT IN THE URETER URETRAL TUMOR
- 65. C.T.
- 66. CT DETAILED ANATOMY RENAL FUNCTION EXPENSIVE NEEDS CONTRAST IRRADIATION USED IN TUMORS TRAUMA STONES CT SHOWING RENAL MASS
- 68. CONTRAST ENHANCED CT LARGE HYPODENSE MASS IN THE LEFT KIDNEY
- 69. Endoscopic - urethroscopy - cystoscopy - uretroscopy - nephroscopy
- 71. Thank you