Urology n n n n n n n n KÚCH FN Brno Urology | Best Urology Hospital in Hyderabad | India Obrázek nUrology – medical discipline treating urinary system disorders, retroperitoneal disorders, male genital n+ male andrology, children urology n n nInflammatory diseases nOncology nInjuries n n n n nUUT n kidneys and ureters n low-pressure and low capacity system n (10cm H2O, max. 7 ml) n nLUT n urinary bladder and urethra n high pressure and high capacity n system (40 cm H2O a 400ml ) n ngenitals n 40km/hour n communication with LUS n n n n n Urol atlas 035 n History: n nFH: oncological disorders, urolithiasis, polycystic kidneys nPH: injuries, infections, DM, neurological disorders, … nPH: character of complaints – character of urination, pain, fever n n nThe entire urogenital system should always be examined for every symptom of urological disease nurine examination chemically, microscopically and biochemically, measuring micturition frequency and volume n n n Appearance of urine nmacroscopic hematuria (due to color- intensity and age of hematuria) nuretrorrhagia (blood flow out of urethra meatus), npyuria (pus in urine, odor), n n n n nhemoglobinuria (free hemoglobin in urine, no RBC) npneumaturia (air in the urine when fistula between intestine and urinary), nCholurie - bilirubinuria n Paroxysmal Nocturnal Hemoglobinuria | Concise Medical Knowledge Milky white urine due to pseudomonas pyuria. | Download Scientific Diagram C:\Users\Martin\Desktop\obr. orthobull\qawer.jpg n Edgar V. Lerma 🇵🇭 on Twitter: "MT @md_comics Choose your 🍺🍻#Nephrology @weddellite @ben_a_goldfarb @DrDanMO @Nephro_Sparks @HecmagsMD… " Pathology of the volume of urine nPolyuria - diuresis > 2,5l n n nAnuria – stop of urine production, diuresis 50-0 ml/24h n nOliguria – decreased urination, 500-50 ml/24 hour n nKidney failure, acute tubular necrosis, shock condition severe dehydration, n n Urological symptomatology nDysuria – unpleasant difficult urination – postponed start, discontinued urination, prolonged, sensation of incomplete evacuation nUrothelial irritation– subvesical obstruction , urethritis, cystitis, vesico-lithiais, chemical irritation n nPolakisuria – frequent urination with small amount of urine volume, in short intervals nEmotional instability, cystitis, urethritis, lithiasis n nStranguria – painful cutting sensation during urination n nNycturia – frequent awakening in night due to repeated need to urinate nPolyuria, CHHF, secretion disorder of ADH, disorder of capacity of bladder n nRetention – urinary retention in the bladder nIncontinence - failure to retain urine nResidue - urine residue after urination nHematuria – RBC in urine ( >10/ml, 2-3 in visual field) n nMacroscopic nMicroscopic n nRenal nPost-renal n n Hematuria (Blood in the Urine) - ASUI Hematuria or Blood in the Urine - Causes, Symptoms, Treatment, Risk Factors, Prognosis & Prevention C:\Users\Martin\Desktop\obr. orthobull\qawer.jpg Pain of urinary tract nKidney – n - nephralgia n - Colic pain n n nBladder – retro pubic, associated with urination nUrethra – cutting sensation n nProstate and seminal vesicles – dull pain of perineum , around rectum nTesticles and epididymis - testalgia n n n n n Nephrolithiasis: Practice Essentials, Background, Anatomy Examination in urology nHistory nPhysical exam nLab exam nImaging methods – SONO, X-ray/CT, radioisotopes nEndoscopic exam nFunctional exam Physical examination in urology nAspects - View – antalgic posture n - tumors, cysts, contraction of abdominal wall nPalpation – kidney exam – bimanual palpation n - larger tumors n - movement of kidney when kidney ptosis, n - filled bladder, n nExamination of outer genitals, digital rectal exam n nPercussion – tapottement, n(auscultation – aneurysm) n Digital rectal exam with labels | Media Asset | NIDDK Palpation of the Bladder - Biology Forums Gallery Palpate for Kidneys C:\Obrazy\kopie 95\dOPLNĚNÍ OBRÁZKŮ\per rectum palp.jpg n Digital rectal examination for prostate cancer screening performed with colonoscopy for colon cancer screening: 2 for the price of 1 - Gastrointestinal Endoscopy n C:\Users\Martin\Desktop\obr. orthobull\ran\Figure-62-1.jpg C:\Users\Martin\Desktop\obr. orthobull\ran\Figure-57.jpg C:\Users\Martin\Desktop\obr. orthobull\ran\Figure-60.jpg nhydrocele Hydrocele - Eversion of Sac Hydrocele | Boston Children's Hospital Differential diagnosis of pain ØSciatic syndrome Herpes Biliary colic Abdominal colic Perinephric abscess Appendicitis Pancreatitis Gynecological diseases C:\Obrazy\kopie 95\dOPLNĚNÍ OBRÁZKŮ\kostovert.úhel.jpg Lab examination nBlood – BCH, WBC, Coagulation nUrea, creatinine, urine acid, ABL, ion's, osmolality, CRP n nUrine examination- necessary at all urological examinations Biochemical exam, microscopy exam n nFirst current– in urethra nMedium current– significant (bladder, kidney) nFinal current n n/glu, ketone, proteins, pH, Hbg/ nCentrifuge, microscopy n Urinalysis (Urine) Test Results, Interpretation, Types, Definition nMicroscopy: normal - 0-2 ery/field, 0-5 leu/field, n rarely - crystals, epithelia's, 0 bacteria n nMicroscopic exam n n Urine sample: nMedium current nSingle catheterizing nSuprapubic aspiration n nPositive cultures- > 10*5 bacteria's in 1ml, sterile fashion > 10*3 n n Imaging methods nSONO – echo of high frequency (MHz) sound waves from different tissues n nB-mode n n3D SONO n nDoppler Kidney - Sonography | Medicína, nemoci, studium na 1. LF UK nX-ray n nIntravenous urography n scans qh 5 min n nCAVE – creatinine > 175 umol/l PICT0056 ncystography PICT0062 nAscendant pyelogram n (retrograde pyelogram ) n nContrast via catheter to the ureters Retrograde pyelography | Radiology Reference Article | Radiopaedia.org nRetrograde urethrocystography – assessment of urethra and bladder, quality of urination nVoiding cystourethrography (VCUG) – during urination n nNative CT 143 nCT - i.v. contrast Kidney tumor - CT scan: MedlinePlus Medical Encyclopedia Image nKidney scintigraphy Childhood Kidney Diseases Functional examination nUroflowmetry (UFM) nMeasurement of amount of urine in time unit, depends on quality of detrusor muscle n nCystometry nMeasurement of intravesical pressure doe to the volume of filling. n nMeasurement of urethral pressure nMeasurement of intraurethral pressure with special probe catheter n Types of catheters nsize – Chariere/ French – circumference C:\Obrazy\Díl 4 skripta,Olomouc,operace\kATETRY,MATERIÁL\katetry.jpg C:\Obrazy\Díl 4 skripta,Olomouc,operace\kATETRY,MATERIÁL\char_mmtab.jpg Single use catheters nNelaton Thiemann C:\Obrazy\Díl 4 skripta,Olomouc,operace\kATETRY,MATERIÁL\thieman.jpg C:\Obrazy\Díl 4 skripta,Olomouc,operace\kATETRY,MATERIÁL\nelaton.jpg Long term catheters - Foley nfixation C:\Obrazy\Díl 4 skripta,Olomouc,operace\kATETRY,MATERIÁL\malecot.jpg C:\Obrazy\Díl 4 skripta,Olomouc,operace\kATETRY,MATERIÁL\katetrves.jpg C:\Obrazy\Díl 4 skripta,Olomouc,operace\kATETRY,MATERIÁL\foleykat.jpg Urinary tract catheterizing nDisinfection of outer orifice nApply lubrication agent/wait 2min/ nInstilagel, Mesocain n - disinfection, lubrication, anesthesia nInsert catheter nSterile fashion of connection of bag n P1010144 Female catheterizing n C:\Obrazy\kopie 95\dOPLNĚNÍ OBRÁZKŮ\cevkovaní ženy.jpg Male catheterizing n two angles of male urethra C:\Obrazy\kopie 95\dOPLNĚNÍ OBRÁZKŮ\katetrizace.jpg C:\Prezentace PowerPoint\semináře PRO MEDIKY\definitivní 5 ročník 1.den\A_Pondělí\Medici\katetrizace muže.jpg The main problem of urology – drainage od urinary tract nUUT nstones nOuter pressure nstenosis nRarely tumor n nLUT nBenign hypertrophy of prostate ntumors nstones nstenosis n C:\Obrazy\Descscan\kameny.tif Drainage of ureter nureteral catheter nureteral double (pigtail) nNephrostomy nStent C:\Obrazy\Descscan\doublepigobr.tif C:\Obrazy\Díl 4 skripta,Olomouc,operace\kATETRY,MATERIÁL\cevky.jpg JJ stent - „Double pigtail“ n C:\Obrazy\Díl 4 skripta,Olomouc,operace\kATETRY,MATERIÁL\dobpigt.jpg C:\Obrazy\Díl 4 skripta,Olomouc,operace\kATETRY,MATERIÁL\doublepig.jpg Ureteral Stenting - an overview | ScienceDirect Topics Wall stent n C:\Obrazy\Díl 4 skripta,Olomouc,operace\kATETRY,MATERIÁL\stentmodel.jpg C:\Obrazy\Díl 4 skripta,Olomouc,operace\kATETRY,MATERIÁL\stenty.jpg Percutaneous nephrostomy nAcute and long term drainage nMinimally invasive procedure nOpen pathway to kidney nGood control of function n nDilation of kidney pelvis C:\Dokumenty\Publikace knihy\obrázky\obr.19 schéma perkutánní nefrostomie.jpg Nephrostomy Complications - YouTube nefrostomy tube care - YouTube epicystostomy C:\Dokumenty\PowerPoint pásma\Chudobín\PUNKČNÍ EPICYSTOSTOMIE.jpg n PB120108 Endoscopy in urology nCystoscopy nUreteroscopy nPyeloscopy nRetroperitoneoscopy (laparoscopy) n cystoscopy nRigid nFlexible n C:\Obrazy\Díl 4 skripta,Olomouc,operace\ENDOSKOPIE\cystosch.jpg Flexible cystoscopy (male) | healthdirect Cystoscopy in Iran at Erfan Hospital - irantreatments - Plastic Surgery in Iran Urethrorenoscopy n C:\Obrazy\kopie 95\dOPLNĚNÍ OBRÁZKŮ\ureteroskopie schema.jpg cystoscopy n C:\Obrazy\Díl 4 skripta,Olomouc,operace\ENDOSKOPIE\Cystoskopie obrazy\USTÍ DX.jpg C:\Obrazy\Díl 4 skripta,Olomouc,operace\ENDOSKOPIE\Cystoskopie obrazy\evicevka.jpg Infections of urinary tract nsimple n (simple acute pyelonephritis, cystitis) n - no disorder in anatomy and function n ncomplicated -Deviation in anatomy and function, predisposing factors -More severe, longer, recurrence rate n ncommunity x nosocomial n nILUT x IUUT n n95 % of infection begins ascending – bacterial from perianal region - urethra, bladder, ureter, kidney nMore common female, - short, wide, urethra, male > 65 y/o n nHematogenous – S. aureus – abscesses formation pyelonephritis n nPer continuitatem – vesico-intestinal / vesico-vaginal fistula, intraperitoneal abscess, necrotic tumor n Acute pyelonephritis nIUUT nChills, fever, flank pain, lumbgia nHematogenous x ascending nPyuria, bacteriuria nKidney parenchama inflammation, abscess even scarring n nRule out obstruction – Sono n n nObstruction pyelonephritis – double pigtail, nephrostomy, ATB n n Pyelonephritis Images, Stock Photos & Vectors | Shutterstock Acute cystitis nMore common females nCystalgia, dysuria, stranguria, polakisuria, hematuria nATB, symptomatic therapy – painkillers, fluid intake – wash out bacteria's, drainage when obstruction presented 654 Cystitis Illustrations & Clip Art - iStock Acute prostatitis nPerineal pain ana d suprepubic, pelvalgia, fever, urethra discharge, generalized fatigue nEven septic condition nATB n n RMRH on Twitter: "Symptoms of Prostatitis #symptoms #Prostatitis… " Chronic Prostatitis Guide: Causes, Symptoms and Treatment Options Urolithiasis – kidney stone disease n7% population nPrecipitation of salts in urinary tract– nefro/uretero/cystolithiasa nMicroscopic exam of crystals nWater income, diet, genetic factors n nRenal colic, nephralgia - in obstruction UUS nConcernments can settle chronic infection n nSONO, X-ray/ CT n nConcernments up to 5mm – conservative therapy https://www.wikiskripta.eu/images/thumb/2/2e/Nefrolithiaza.png/800px-Nefrolithiaza.png nExtracorporal lithotrypsy nUreteroscopy, surgical extraction Urolife Stone Hospital - Book Appointment, Contact No, Address, Reviews & More C:\Obrazy\Díl 4 skripta,Olomouc,operace\Operace schemata a obrázky\Atlas operací\126-2.jpg Benign hyperplasia of prostate nNon-malignant enlargement of prostate – increase in volume of stromal cells nIncidence rises with age - effect of androgens - testosterone nIn periurethral area- hypertrophic nodes n beginning of obstruction: nMechanic - urethra compression nDynamic tone of prostatic and smooth muscles n frequency of urination n Nycturia n strength of urination current n delayed beginning of urination, n discontinuation of urination n urgency Srovnání normální a hyperplastické prostaty nDRE – prostate enlarged, smooth surface, elastic, well bordered, painless; nAssessment of post-urination residuum nUSG – suprapubic or rectal tube prostate examination nUrine exam - urinary tract infection – ncystouretrography, IVU, uroflowmetry n n Therapy: n nMedication : α-blockers , Inhibitors of 5-α reductase n nTURP – transurethral resection of prostate n nPartial prostatectomy – enucleation of periurethral prostatic tissue n Transurethral resection of the prostate (TURP) - Mayo Clinic Transurethral Resection of Prostate (TURP) – Ricardo Gonzalez, M.D. Testicle torsion nTorsion of spermatic cord vessels nSudden onset mainly children and adolescents nSevere pain , nausea vomiting nNo signs of infection in urine nTesticle in painful, enlarged, elevation doesn´t release pain nSonography of hydrocele, Doppler imaging of vascularization of testicle nHemorrhagic infarction , tissue necrosis n nSurgical therapy up to 6 hours nVital testicle derotation, orchiectomy necrotic testicle remove n Testicular Torsion – Core EM Neonatal testicular torsion | Radiology Case | Radiopaedia.org Paraphimosis nDue to phimosis – tight foreskin nTight foreskin retracted over base of glans nGlans induration and swelling due to lymphatic and venous stasis - ischemia n nAnesthesia of penis (field, emla) nManual compression of glans edema than reduction nWhen unsuccessful - sharp discision of strangulation ncircumcision n n n HD - Paraphimosis Reduction | EM:RAP Paraphimosis Reduction & Circumcision Surgery || Dr. Jayanta Bain - YouTube Kidney cancer nAdenocarcinoma – Grawitz tumor nMicro/macroscopic hematuria nNephralgie, lumbalgia, palpable resistance nBone pains, pathologic fr., anemia n nCommon incidental findings when SONO nMetastasis – lungs, bones, brain, liver nNon-sensitive to RT/CHT – only INF alfa, targeted terapy n n Kidney Cancer Treatment in India - Cost and Procedure - India EHS nRadical nephrectomy n nParcial – tumor up to5 cm Nephrectomy (nephro = kidney,... - The Kidney Club of Western | Facebook Urinary bladder carcinoma nIncreasing incidence n5. - 7. decennium, (2nd. Most common male malignancy) nRisk factors – smoking, aromatic amines n nUrotelium of bladder nHematuria, polakisuria n nDiagnostics: cystoscopy nTUR transurethral resection - biopsy from base of tumor – nTNM classification n Bladder Cancer - Types, Symptoms, Diagnosis & Treatment | MD Anderson Cancer Center n Transurethral Resection of Bladder Tumors | Abdominal Key Bladder Cancer: Symptoms and Treatment | Live Science nTherapy: n nTUR + intravesical CHT, BCG vaccination nPartial, radical cystectomy – affection of muscle layers n - Ileal conduit - ostomy n - Ileal neovesica – new bladder pouch n nChemotherapy nLocal x systemic + RT Total Cystectomy with Incontinent Urinary Diversion in Women | Saint Luke's Health System n Ileal Conduit as the Standard for Urinary Diversion After Radical Cystectomy for Bladder Cancer - European Urology Supplements Ileal conduit urinary diversion after cystectomy - Stock Image - C038/1707 - Science Photo Library Modified Studer pouch (A) and T-pouch (B). Reprinted with permission... | Download Scientific Diagram Carcinoma of prostate nThe most common urological malignity of male, 3rd common cause of male cancer disease n7. – 8. decennium nBone metastasis, lung metastasis n n n nWell bordered tumor– asymptomatic nLocally advanced tumor – urination disorders, hematuria, hemosperma, ED ngeneralized – skeletal pain, anemia, fatigue, DIC n n n n n n Prostate Gland Removal | Health Plus nDiagnostics: n nDRE nPSA nTRUS biopsy n n n n n nImaging – CT/ MRI of pelvis, scintigraphy of bones n n prostata dg 002 trus2 prostata dg 003 nlocalized CaP nlocally advanced CaP nGeneralized with metastasis CaP n nTNM classification – T1-T4 n n ca_pr1 ca_pr2 Radical prostatectomy nComplete removal of tumor tissue while preserved continence of urine even in suitable condition erection functions nOpen, laparoscopic, robot n n rad_prost n AhleringFigure1 Otevřená prostatektomie - PI CZ > ngeneralized – metastasis formation n nUp to 50% of patients are generalized in time of diagnosing nHormonally dependent tumor - testosterone n nAntiandrogens, castration – apoptosis of tumor cells –temporary improvement n nRadiotherapy n n Orchid | Radiotherapy New gel reduces side effects of prostate cancer treatment • healthcare-in-europe.com Kidney injuries nHigh incidence at high energy injuries - 80% nblunt x penetrating injury of abdomen, flank, back n nHematuria nSONO + Doppler nCT + iv. contrast n C:\Users\Martin\Desktop\obr. orthobull\kidney aast.jpg F:\adbin surgery\obr\Ct-abdomen-showed-subcapsular-renal-hematoma-around-left-kidney-see-black-arrows.png F:\adbin surgery\obr\image24.jpeg C:\Users\Martin\Desktop\obr. orthobull\qawer.jpg n85% mild and moderate injuries– contusion - bruising, sub- capsular hematoma, superficial cortical lacerations n nSevere injuries15% - hilar injury - vessels, cortico-medullar injury – pyramid, hollow system – pelvis – urine extravasation n n n nCritical injuries – life threatening – surgery n Shattering of kidney – partial resection, nephrectomy n Hilum avulsion / vascular thrombosis - nephrectomy revascularization n Rupture of pelviureteral junction – suture with stent n n n n C:\Users\Martin\Desktop\obr. orthobull\m_atl_ch7_f022.png PPT - Fibrous capsule PowerPoint Presentation, free download - ID:5250861 nInjury of calyx – renal pelvis (collecting) system with urine extravasation – ATB coverage nUrine drainage with stent/catheter, nephrostomy – excessive urine extravasation – tissue scarring C:\Users\Martin\Desktop\obr. orthobull\151192_1_En_46_Fig3_HTML.png Diagnosis and management of urinary extravasation after high-grade renal trauma | Nature Reviews Urology Urinary bladder injury nBlunt impact on hypogastrium with full bladder nLaceration by dislocated pelvic fracture n n nCatheter – anuria / gross hematuria nCT + iv contrast, retrograde cystography n nIntraperitoneal X extraperitoneal rupture n n n C:\Users\Martin\Desktop\obr. orthobull\B9781416037729500341_f26-02-9781416037729.jpg C:\Users\Martin\Desktop\obr. orthobull\Urinary System_Page_217.jpg C:\Users\Martin\Desktop\obr. orthobull\Extraperitoneal Bladder Rupture-ann.jpg C:\Users\Martin\Desktop\obr. orthobull\intra.jpg nIntraperitoneal rupt. – acute surgery n two-layer suture n temporary catheter / epicystostomy - week n n nExtraperitoneal rupt. n non dislocated fx – conservative treatment. + catheter n surgery – dislocated fx – ORIF –of pelvic fx + suture of bladder wall + bladder drainage C:\Users\Martin\Desktop\obr. orthobull\00450.jpeg Injury of urethra nPredominantly at male - longer, double angled n nanterior urethra -penile- direct hit to perineum nposterior urethra - dislocated pelvic fx with fixed bladder distraction / rupture of posterior urethra n n perineal hematoma nPelvic fx, DRE – proximal dislocation of prostate „high riding“ nUrethrorrhagia – blood at outer orifice, unable of urination, unable catheterizing n Retrograde urethrocystography nepicystostomy n C:\Users\Martin\Desktop\obr. orthobull\urethral-trauma-12-638.jpg C:\Users\Martin\Desktop\obr. orthobull\retrograde-urethrogram-and-cystogram-in-patient-with-pelvic-fracture.jpg Perineal hematoma. | Download Scientific Diagram nUrethra: complete x incomplete rupture n nPartial rupture – conservative management 3-4weeks with catheter n subsequently voiding urethrocystopraphy to rule out stenosis of urethra n n n nComplete rupture nanterior urethra – suture on catheter nposterior urethra – primary surgical repair only at monotrauma due to severe condition of multiple injured nMainly approximation on catheter + epicystostomy, postponed secondary urethroplasty after healing soft tissues n C:\Users\Martin\Desktop\obr. orthobull\bju_8883_f2.gif C:\Users\Martin\Desktop\obr. orthobull\bju_10340_f16.gif n