This document provides an introduction and overview of the field of urology. It discusses that urology is the surgical specialty focused on disorders of the genitourinary tract. It also outlines some key points about urology, including that 15% of patients seen by physicians have a urologic complaint, urologists treat patients of all ages and both genders, and the organs and systems within the scope of urology. The document then discusses common urologic symptoms, examinations, investigations including various imaging studies and endoscopic procedures, and diagnostic tests used in urology evaluations and diagnoses.

1. Introduction To Urology
SAYED M ELEWEEDY
PROF. OF UROLOGY
UROLOGY DEPARTMENT
AL-AZHAR UNIVERSITY
CAIRO, EGYPT

2. Urology
A surgical specialty devoted to the study and
treatment of disorders of the genitourinary tract of
the male and urinary tract of the female.

3. Urology
 15 % of patients presenting to a physician have a
urologic complaint or abnormality.

4. Urology
 Urologists have a unique position in medicine
 Their patients encompass all age groups
 Prenatal
 Pediatric
 Adolescent
 Adult
 Geriatric.
 Their patients comprised both gender

5. Urology
Urology combines management of:
– Medical problems
Urinary tract infections
Benign prostatic hyperplasia
– Surgical problems
The surgical management of urolithiasis
The surgical management of cancers
The correction of congenital abnormalities
Correcting certain types of incontinence.

6. Urology
Wide overlap of urology with other specialties
1. Nephrology
2. Andrology
3. Pediatric surgery
4. The medical fields of oncology
5. Endocrinology.

7. The organs covered by urology
– Adrenal glands
– Kidneys
– Ureters
– Urinary bladder
– Urethra
– The male reproductive organs
Testes
Epididymis
Vas deferens
Seminal vesicles
Prostate
Penis

9. Symptoms of urological
diseases

10. UROLOGIC MANIFESTATIONS OF
DISEASE
1. Direct
• Signs and symptoms that are directly related to the GUT:
• Hematuria
• Scrotal swelling
2. Indirect
• Manifestation Referred to or from Other Organ Systems:
• A stone in the kidney or upper ureter
• Symptoms of nausea and vomiting.
• Ipsilateral testicular pain

11. 3.Primary urologic disorders may be hidden and
manifested in different organ or systems.
• Bone pain and pathologic fracture
• Secondary to metastatic carcinoma arising in the genito-urinary tract .
UROLOGIC MANIFESTATIONS OF DISEASE

12. 4. Primary disease in other organ systems may result in
secondary urologic signs and symptoms that initially lead the
patient to the urologist.
• D.M :
• Frequency, polyurea and nocturia.
• ED
• Glucosuria
• D.I
• Other signs and symptoms mimicking urologic disease are related to
inflammatory or neoplastic processes arising in other organs:
1. Lower lobes of the lungs
2. Gastrointestinal tract
3. Female internal genitalia
UROLOGIC MANIFESTATIONS OF DISEASE

13. 5. Systemic constitutional manifestations
• Fever, weight loss, and malaise
May be present in:
• Acute and chronic inflammatory disorders
• Renal failure
• Genitourinary carcinoma with or without metastases.
UROLOGIC MANIFESTATIONS OF DISEASE

14. 6. Asymptomatic presentation
Extensive disease may exist within the genitourinary tract without
any signs or symptoms
• Large renal calculi
• Neoplasms may only be found incidentally during other examination.
• Far-advanced renal deterioration may occur prior to the detection of
silent reflux or obstruction.
UROLOGIC MANIFESTATIONS OF DISEASE

15. HISTORY
Urologic symptoms
A. Pain and discomfort
B. Alterations of micturition
C. Changes in the gross appearance of the urine
D. Abnormal appearance and/or function of the external
genitalia

16. Pain
1. Pain within the genitourinary tract generally arises from
 Distention or inflammation
2. Pain can be experienced directly or referred
3. Referred pain is a relatively common symptom of GU disease.

17. Renal pain
A. The kidney and its capsule are innervated by
 Sensory fibers traveling to the TI0-LI
B. The etiology of renal pain may be due either to
 Distention
 Capsular
 Renal collecting system.
 Inflammation
C. Renal pain characters:
 A dull, aching sensation felt in area of the costovertebral angle
 A sharp colicky nature felt in the area of the flank, with radiation around
the abdomen into the groin and ipsilateral scrotum or labium.

18. Ureteral pain
• The upper ureter is innervated in a similar fashion to
the kidney.
• Upper Ureteral pain has a similar distribution to that of renal pain.
• The lower ureter sends sensory fibers to the cord
through ganglia subserving the major pelvic organs.
• Pain derived from the lower ureter is generally felt in the suprapubic
area, bladder, penis, or urethra.

19. Ureteral pain
• Etiologic mechanism for Ureteral pain is
• Sudden obstruction and Ureteral distention.
• Acute renal and Ureteral colic are among the most severe types
of pain known to humankind.

21. Other urologic pains
 Cystalgia (vesical pain)
 Persistent pain localized behind pubic bone
 Urethralgia
 Pain along the urethra
 Prostatic pain
 Sharp pain promoting to the perineum
 Orchalgia
 Pain localized to the testes, often propagating along the spermatic
cord

22. Changes in urine volume
 Polyuria-
 Diuresis > 1500-2000 ml/24h
 Oliguria -
 Diuresis < 500 ml/24h
 Anuria -
 Diuresis < 100 ml/24h

23. Changes in urine appearance
 Hematuria:
 Blood in urine
 Cloudy urine
 Pyuria (presence of pus in urine)
 Chyluria (presence of fatty lymph in the urine)
 Bacteriuria :
 Presence of bacteria in urine

24. Changes in urine appearance
 Proteinuria-:
 Proteins in urine
 Pneumaturia :
 Passage of gas with urine
 Necroturia :
 Necrotic tissues in the urine

25. Voiding Disorders
 Frequency :
 Voiding too often (>8/day)
 Nocturia:
 Frequent voiding at night (after sleep)
 Urine retention:
 Inability to void
 Acute
 chronic
 Strangury:
 Painful voiding

26. Voiding disorders
Urinary incontinence
- Urgency
- A sudden, compelling and powerful need to urinate.
- Precipitancy
- Inability to stop urine midway
- Stress incontinence
- Involuntary loss of urine with sudden increase of intraabdominal pressure
- Overflow incontinence
- Involuntary loss of urine associated with overdistention of the bladder, with or without
a detrusor contraction.
- Total incontinence
- Continuous and total loss of urinary control and is the severest type of incontinence
- Nocturnal Enuresis
- Involuntary urination while asleep after the age at which bladder control usually
begins.

27. Voiding Disorders
Obstructive symptoms
- Hesitancy:
- Voiding initiation delay
- Interrupted voiding
- Weak urine stream
- Incomplete voiding
- Necessity of abdominal pressure during voiding
- Retention

28. Voiding Disorders
Irritative Symptoms
- Frequency
- Urgency
- Dysuria

29. History of Other urological
diseases
– Corective operations in childhood
– Urolithiasis
– Urogenital infection
– Blood in urine
– Sexually transmitted diseases
– Catheterizations, endoscopy, trauma /biking,
riding horses/ → strictures

30. History of other diseases
 DM
 Systemic neurological Disasters
 operations in pelvic region
 Obstetric and gynecologic history
 Abuse of analgetic medication
 Risk jobs, exposition of carcenogenic substances
 Allergic history

31. Examination Of Urologic Patient

32. Examination
– General examination
– Abdominal
– Local
DRE
External genitalia examination
Basic neurological examination

37. Investigations

38. Diagnostic Lab Tests
Urinalysis
1. Physical Characteristics &
Measurements
– appearance
– color
– odor
– specific gravity
2. Chemical Measurements
– pH
– protein; glucose
– ketones
– bilirubin; urobilinogen
– leukocytes; nitrite
– blood
3. Microscopic
– cells (wbc, RBCs, sperm)
– casts
– crystals
– bacteria
4. Detection of Bacteriuria
– nitrite test
qualitative or screening test
– C & S
Colony Count
Organism
Antibiotics sensitivity

39. Other Diagnostic Lab Tests
Blood tests
Blood urea / creatinine
Blood glucose
CBC ------ anemia if decreased EPO production
Urine culture & sensitivity (C&S)
Include colony count

40. Imaging studies
Imaging
U/S
IVP including KUB
Retrograde pyelography
Ascending and micturating cystourethrography
CT scan
MRI
Renal isotopic study

41. Interventional studies
Surgical procedures
Cystoscopy
Ureteroscopy
Biopsy

42. Ultrasound
Diagnostic
– Transabdominal
– Pelvic
– Scrotal
– Transrectal
Intervention
Tru-cut needle, biopty gun
Percutaneous nephrostomy

43. Ultrasound
Stones

44. Dilatation of collecting system

45. Ultrasound
Tumours

46. Ultrasound
Tumours

47. Ultrasound
TRUS

48. Plain film of abdomen
KUB

49. Plain film of abdomen

50. Plain film of abdomen

51. Plain film of abdomen

52. Plain film of abdomen
Disadvantages
Preparation
Radiolucent stones

53. INTRAVENOUS UROGRAPHY
IVU

57. IVU
Disadvantages
Needs normal renal function
Patient preparation
Contrast disorders

58. Computed tomography (CT) scan
With or without contrast medium
Indications:
– Stones
– Trauma
– Tumours
– Scaring of retroperitoneum
– Lymphadenopathy in genitourinary tumors
– Metastatic dissease

59. CT Scan

60. CT scan

61. CT scan

62. CT scan

63. Magnetic resonant imaging
(MRI)
MRU – urography
MRA – angiography
Contrast contraindication
Radiation contraindication

64. Retrograde pyelography
Cystoscopy and ureteric catheter
Contrast injection
Indications:
– Non-functional kidney
– Non-conclusive IVU
– Examination in trauma of ureter
– Urothelial tumors of upper urinary tract

65. Retrograde pyelography
Advanteges:
– History of contrast allergy .
– Non-functional or non-visualized kidney in IVU
Disadvanteges:
– Invasive examination
– Needing anesthesia

66. Retrograde pyelography

67. Retrograde pyelography

68. Ascending And Micturating
Cystourethrography
Catheter in the urethra and fill it with contrast medium
Catheter in the bladder and fill it with contrast medium
Indications:
– Trauma
– Vesicoureteral reflux
– Posterior urethral valve
– Stricture urethra
– Stress incontinence
– Fistula

69. Cystography

70. Cystography

71. Voiding cystourethrography

72. Voiding cystourethrography

73. Voiding cystourethrography

74. Voiding cystourethrography

75. Renal isotopic study

76. Renogram

77. Urodynamic study

78. Different types of urodynamic tests
Uroflowmetry
Cystometry
Pressure flow study
Video urodynamics
Urethral pressure profile
Electromyography

83. Endoscopic Diagnostic study
Cystoscopy
Uretroscopy
Ureterorenoscopy
Percutaneous nephrostomy