The document discusses diagnostic tests used to evaluate urinary tract function. It describes various urine tests including urinalysis, urine culture and sensitivity, urine osmolality, 24-hour urine collections for creatinine clearance and catecholamines. Imaging tests are also summarized such as abdominal ultrasound, intravenous pyelogram, renal scan, cystoscopy and renal biopsy. The goals are to identify parameters for assessing upper and lower urinary tract status and describe studies used to determine urinary tract function.

1. Objectives
 Identify the assessment parameters used for
determining the status of upper and lower urinary tract
function
 Describe the diagnostic studies used to determine
urinary tract function
 Initiate education and preparation for patients
undergoing assessment

2.  Obtaining a urologic health
history requires excellent
communication skills
because many patients are
embarrassed or
uncomfortable discussing
genitourinary function or
symptoms.

3.  Px’s chief concern or reason for seeking health
care, the onset of the problem & it’s effect on the
px’s quality of life
 Location, character & duration of pain (if present)
& its relationship t voiding; factors that precipitate
pain and those that relieve it
 Hx of UTI, including past tx or hospitalization for
UTI

4.  Fever or chills
 Previous renal or urinary dx tests or use of
indwelling catheters
 Dysuria & when it occurs during voiding (at
initiation or termination of voiding)
 Hesitancy, straining, or pain during, after
urination

5.  Urinary Incontinence (stress intolerance, urge
incontinence, overflow incontinence or
functional incontinence)
 Hematuria or change in color, volume of urine
 Nocturia and its date of onset
 Renal calculi (kidney stones), passage of
stones or gravel in urine

6.  Female px: number & type (vaginal or
cesarean) of deliveries; use of forceps; vaginal
infxn, discharge or irritation; contraceptive
practices
 Presence or history of genital lesions or STD’s
 Habits: use of tobacco, alcohol, or recreational
drugs
 Any prescription & over-the-counter
medications (including those prescribed for
renal or urinary problems

7.  Gradual kidney dysfunction can be insidious in its
presentation, although fatigue is a common
symptom. Fatigue, shortness of breath, and
exercise intolerance all result from the condition
known as “anemia of chronic dse”
 Hgb / Hct are quantified to detect anemia however
Hgb level is more significant it’s the one responsible
for circulating oxygen

9. Problems Associated with Changes in Voiding
Problem Definition Possible Etiology
Frequency Frequent voiding – more than Infection, obstruction of lower urinary tract leading to residual urine and
every 3 hours overflow, anxiety diuretics, BPH, urethral stricture, diabetic neuropathy
Urgency Strong desire to void Infection, chronic prostatitis, urethritis, obstruction of lower urinary tract
leading to residual urine and overflow, anxiety, diuretics, BPH, urethral
stricture, diabetic neuropathy
Dysuria Painful or difficult voiding Lower urinary tract infection, inflammation of bladder or urethra, acute
prostatitis, stones, foreign bodies, tumors in bladder
Hesitancy Delay, difficulty in initiating BPH, compression of urethra, outlet obstruction, neurogenic bladder
voiding
Nocturia Excessive urination at night Decreased renal concentrating ability, ♥ failure, diabetis mellitus,
incomplete bladder emptying, excessive fluid intake at bedtime,
nephritic syndrome, cirrhosis with ascites
Incontinence Involuntary loss of urine External urinary sphincter injury, obstetric injury, lesions of bladder neck,
detrusor dysfunction, infection, neurogenic bladde, medications
neurologic abnormalities
Enuresis Involuntary voiding during sleep Delay in functional maturation of central NVS (bladder control usually
achieved by 5 years of age) obstructive dse of lower urinary tract, genetic
factors, failure to concentrate urine, UTI, psychological stress
Polyuria Increased volume of urine voided DM, diabetes insipidus, use of of diuretics, excess fluid intake, lithium
toxicity, some forms of kidney dse (hypercalmemic and hypokalemia
nephropathy)
Oliguria Urine output less than Acute or chronic renal failure, complete obstruction
400mL/day
Anuria Urine output less than 50mL/day Acute or chronic renal failure, complete obstruction
Hematuria Red blood cells in the urine Cancer of genitourinary tract, acute glomerulonephritis, renal stones,
renal tuberculosis, blood dyscrasia, trauma, extreme exercise, rheumatic
fever, hemophilia, leukemia, sickle cell trait or disease
Proteinuria Abnormal amounts of protein in Acute and chronic renal disease, mephrotic syndrome, vigorous exercise,
the urine heat stroke, severe ♥ failure, diabetic neuropathy, multiple myeloma

10.  Gastrointestinal symptoms may occur with
urologic conditions because of shared
autonomic and sensory innervation and
renointestinal reflexes.
 Common s/sx: N/V, diarrhea, abdominal
discomfort, abd distention,. Urologic symptoms
can mimic appendicits, PUD, cholecystitis, thus
making diagnosis difficult especially in elderly
because of decreased neurologic innervation to
this area.

11. Identifying Characteristics of Genitourinary Pain
TYPE LOCATION CHARACTER ASSOCIATED S/SX POSSIBLE ETIOLOGY
KIDNEY Costovertebral angle, may Dull constant ache; if n/v, diaphoresis, pallor, Acute obstruction, kidney
extend to umbilicus sudden distention of signs of shock stone, blood clot, acute
capsule, pain is severe, pyelonepritis, trauma
sharp, stabbing and colicky
in nature
BLADDER Suprapubic area Dull, continous pain, may Urgency, pain at the end Overdistended bladder,
be intense with voiding, of voiding, painful infection, interstitial
may be severe if bladder is straining cystitis; tumor
full
URETERAL Costovertebral angle, Severe, sharp, stabbing n/v, paralytic ileus Ureteral stone, edema or
flank, lower abdominal pain, colicky in nature stricture, blood clot
area, testis or labium
PROSTATIC Perineum and rectum Vague discomfort, feeling Suprapubic tenderness, Prostatic cancer, acute or
of fullness in perineum, obstruction to urine flow, chronic prsotatitis
vague back pain frequency, urgency,
dysuria, nocturia
URETHRAL Male: along penis to Pain variable, most severe Frequency, urgency, Irritation of bladder neck,
meatus; female: urethra to during and immediately dysuria, nocturia, urethral infection of urethra,
meatus after voiding discharge trauma, foreign body in
lower urinary tract

12.  Aging affects the way the body absorbs,
metabolizes, and excretes drugs thus
placing the elderly patient at risk for
adverse reactions, including
compromised renal function
 Structural or functional abnormalities
that occur with aging may prevent
complete emptying of the bladder. This
may be due to decrease bladder wall
contractility due to myogenic or
neurogenic causes or structurally related
to bladder outlet obstrcution as in BPH.

13.  URINALYSIS – a urine test for evaluation of the
renal system and for determining renal disease

14. Changes in Urine Color and possible Causes
Urine Color Possible Cause
Colorless to pale yellow Dilute urine due to diuretics, alcohol consumption,
diabetes insipidus, glycosuria, excess fluid intake,
renal dse
Yellow to milky white Pyuria, infection, vaginal cream
Bright yellow Multiple vitamin preparation
Pink to red Hgb breakdown, RBC, gross blood, menses, bladder or
prostate surgery, beets, blackberries, medications
(phenyton, rifampicin, phenothiazine, cascara, senna
products)
Blue, blue green Dyes, methylene blue, pseudmona species organisms,
medications
Orange to amber Concentrated urine due to dehydration, fever, bile,
excess bilirubin or carotene, medications
Brown to black Old RBC, urobilirogen, bilirubin, melanin, porphyrin,
extremely concentrated urine due to dehydration,
medications

15.  A urine test that measures the ability of the
kidneys to concentrate urine
 NV: 1.016 to 1.022 (may vary depending on the
lab)
 An increase in the result may indicate
insufficient fluid intake, decreased renal
perfusion or increased ADH
 A decrease in result (less concentrated urine)
occurs with increased fluid intake or DI.

16.  Urine test that identifies the presence of
microorganisms and determines the specific
antibiotics to treat the existing microorganisms
appropriately.

17.  Evaluates how well the kidneys remove
creatinine from the blood
 The urine specimen for the creatinine
clearance is usually collected for 24 hours, but
shorter periods such as 8 to 12 hours could be
prescribed.

18.  A 24 hour urine collection sample is tested to
diagnose gout and kidney dse

19.  The test is a 24 hour urine collection to
diagnose pheocromocytoma, a tumor of the
adrenal gland
 The test determines urinary catecholamine
levels in the urine

20.  May be performed for evaluating urinary
frequency, inability to urinate or amount of
residual urine (the amount of urine remaining
in the bladder after voiding)

21.  Performed to delienate the
size, shape and position of
the kidneys and to reveal
any abnormalities such as
calculi in the kidneys or
urinary tract,
hydronephrosis (distention
of the pelvis of the kidney)
cysts, tumors, or kidney
displacement by
abnormalities in
surrounding tissues

22.  Used in evaluating
genitourinary
masses,
neprhrolithiasis,
chronic renal infxn,
renal or urinary tract
trauma, metastatic
disease and soft
tissue abnormalities

23.  Requires injection of
isotope into the circulatory
system.
 Hypersensitivity to the
isotope is rare
 Nuclear scans are used to
evaluate acute and
chronic renal failure, renal
masses and blood flow
before and after kidney
transplantation.

24.  Intravenous urography
includes test includes tests
such as excretory
urography, intravenous
pyelography (IVP) and
infusion drip pyelography.
 Used as the initial
assessment of any
suspected urologic
problem, especially lesions
in the kidneys and ureters.
It also provide a rough
estimate of renal function.

25.  Catheters are advanced into renal pelvis by
means of cystoscopy. It is usually performed if
Intravenous urography provides inadequate
visualization of the collecting systems.
 It may also be used before extracorporeal
shock wave lithotripsy or in px with urologic
cancer who need to follow up and are allergic
to intravenous contrast.

26.  Aids in evaluating vesicoureteral reflux
(backflow of urine from the bladder into one or
both ureters) and assessing the px for bladder
injury

27.  Uses fluoroscopy to visualize the lower urinary
tract and assess urine storage in the bladder.
 A urethral catheter is inserted and a contrast
agent in instilled into the bladder. When the
bladder is full and the patient feels the urge to
void, the catheter is removed and the px voids.

28.  Renal angiogram/renal arteriogram provides an
image of the renal arteries.
 The femoral or axillary are the preferred sites.
 Use to evaluate renal blood flow in suspected
renal trauma, to differentiate renal cysts from
tumors and to evaluate hypertension.
 It is used for preoperatively for tyransplantaion.

29.  Endourology or urologic endoscopic procedures
can be performed in one of two ways; using a
cystoscope inserted into the urethra, or
percutaneously through an incision.
 Used to directly visualize the urethra and
bladder.
 The cystoscope also permits the urologist to
obtain a urine specimen from each kidney to
evaluate its function.

30.  Cup forceps can be inserted through the
cystoscope for biopsy.
 Calculi may be removed from the urethra,
bladder and ureter using cystoscopy.

31.  Brush biopsy techniques provide specific
information when abnormal x-ray findings of
the ureter or renal pelvis raise questions about
whether the defect is a tumor, a stone, a blood
clot, or an artifact.
 First a cystoscopic exam, then a ureteral
catheter is introduced, follwed bya biopsy brush
that is passed through the catheter.

32.  Used in diagnosing and evaluating the extent of
kidney dse. Indications for biopsy include
unexplained acute renal failure, persistent
proteinuria or hematruria, transplant rejection
and glomerulonephritis .
 Obtained either percutaneously (needle biopsy)
or by open incision through a small flank
incision.

33. Uroflowmetry – is the record of the volume of
urine passing through the urethra per time unit
(milliliter per second).
 The px is advised to arrive for the test with a
strong urge to void but not have an overly full
bladder.
 It is combined with electromyographic
measurement of the external urethral sphincter
via surface wire or needle electrodes placed at
th level of the sphincter, on eother side of the
urethra.

34.  Cystometrography – graphic recording of the
pressures in the bladder filling and emptying.
 It is the major dx portion of urodynamic testing.

35.  Involves placement of
electrodes in the pelvic
floor musculature or over
the area of the anal
sphincter to evaluate the
neuromuscular function of
the lower tract.
 It is performed
simultaneously with CMG

36.  Consideres optimal urodynamic evaluation.
 This test combines a study of the filling and
voiding phases of the CMG and EMG with a
simultaneous visualization of the lower urinary
tract via a radiopaque filling and detailed
assessment of the voiding dysfunction which
may be due in part to anatomic dysfunction.

38.  For some patients, contrast agents are
neprhotoxic and allergenic. The following
guidelines can help the nurse and other care
givers respond quickly in the event of a
problem.

39.  Have emergency equipment and medications
available in case of the patient has an
anaphylactic reaction to the contrast agent.
Emergency supplies include epinephrine,
corticosteroids, and vasopressors, oxygen and
airway and suction equipment

40.  Thank you 