Urology

Urology，内容有 Acute pyelonephritis or protatitis、Symptoms related to the act of urination，欢迎交流。

• Acute pyelonephritis or protatitis
  • fever 40C + chill
    • chronic pyelonephritis does not cause fever.
      • renal carcinoma causes fever- reach 39℃ or more.
    • Infants and children- acute pyelonephritis- high temperatures without other localizing symptoms or signs
• Symptoms related to the act of urination
  • General malaise
    • tumors, chronic pyelonephritis, or renal failure
  • Weight loss
    • advanced stage of cancer, renal insufficiency due to obstruction or infection.
  • gastrointestinal symptoms of urologic diseases
    • typical renal or ureteral colic, hematuria - severe nausea and vomitin, abdominal distention.
  • local and referred pain
    • Local pain
      • felt in or near the involved organ
        • pain - diseased kidney(T10～12, L1)- costovertebral angle& near the 12th ribs. Pain from an inflamed testicle- gonad
    • Referred pain
      • felt at some distance from that organ.
        • ureteral colic -stone( upper ureter) -severe pain ipsilateral testicle (T11~12).
        • stone in the lower ureter - pain referred to scrotal wall
        • burning pain with voiding -- acute cystitis - distal urethra (female) the glandular urethra in males.
  • Frequency
    • times of micturition - increased.
      • physiological or psychological (high fluid intake)
      • residual urine, inflammation of the mucosa, submucosa, eg, infection, foreign body, stones & tumor.
  • dysuria
    • Painful urination
      • caused by acute inflammation of the bladder, urethra, or prostate.
  • urgency
    • a strong, sudden desire to urinate.
      • caused by hyperactivity and irritability of bladder, resulting from obstruction, inflammation, or neuopathic bladder.
  • Enuresis
    • bedwetting at night
      • physiologic during the first 2 or 3 years of life.
      • functional or secondary to delayed neuromuscular maturation of the urethrovesical component.
      • symptom of organic disease (eg, infection, distal urethral stenosis in girls, posterior urethral valves in boys, neurogenic bladder).
  • Hematuria (bloody urine)
    • Gross
      • 1000ml urine - 1 ml blood, becomes visible
    • Microscopic
      • number of erythrocyte (red blood cell) more than 3 per high power field.
  • Gross hematuria
    • Total hematuria
      • erythrocytes in all urine indicate a source above the bladder neck(bladder, ureters or kidneys)
    • Initial hematuria
      • erythrocytes predominate in the initial portion of urine,( from the anterior urethra)
    • Terminal hematuria
      • erythrocytes in terminal portion (from the bladder neck, trigone, or posterior urethra)
  • urination is painful or not(If not, may indicate cancer
  • Pyuria
    • the number of leukocyte (white blood cell) in the centrifuged urine is more than 3 per high power field,
      • urinary tract infection or lithiasis.
  • Chyluria
    • passage of milky white urine
      • lymphatic-urinary system fistula. cause is obstruction of renal lymphatics.
  • Pneumaturia
    • The passage of gas in urine strongly suggests a fistula between the urinary tract and the bowel.
  • Crystalluria
    • Urine organic or non organic substances deposit and crystallization.
  • Oliguria and anuria
    • urine output is less than 400ml per day,
      • acute renal failure, fluid-ion imbalance, or bilateral ureteral obstruction.
    • anuria means urine output less than 100ml per day.
• 改编创意的3个套路
  • Symptoms of bladder outlet obstruction
    • Hesitancy degree of obstruction increases, prolonged strains to force urine through the obstruction. Prostate obstruction, urethral stricture
    • Loss of force and decrease of caliber of the stream
    • Terminal dribbling Terminal dribbling become more and more noticeable as obstruction progresses.
    • Interruption of the urinary stream, severe pain radiating down the urethra. complication of vesical calculus.
    • Acute urinary retention Sudden inability to urinate may supervene. experiences increasingly agonizing suprapubic pain associated with severe urgency and may dribble only small amounts of urine.
    • Chronic urinary retention Chronic urinary retention may cause little discomfort to the patient even though there is great hesitancy in starting the stream and marked reduction of its force and caliber.
  • Incontinence patient loses urine without control.
    • True incontinence or total incontinence
      • constant diurnal and nocturnal incontinence without normal voiding. exstrophy of the bladder, epispadias, vesicovaginal fistula and ectopic ureteral orifice. Injury to the urethral smooth muscle sphincters may occur during prostatectomy or child birth. Congenital or acquired neurogenic diseases may lead to dysfunction of the bladder and incontinence.
    • Stress incontinence
      • TypeⅠ stress incontinence result from a defect in the pelvic support of the bladder neck or urethra
      • TypeⅡ stress incontinence result from a defect in the pelvic support of both the bladder neck and urethra
      • TypeⅢ it may be caused by trauma, denervation, multiple surgical procedure, radiation therapy, or postmenopausal atrophy （绝经后萎缩）.
    • Urge incontinence loss of urine associated with marked urinary urgency.
      • detrusor instability: idiopathic involuntary bladder contraction
      • detrusor hyperreflexia: involuntary bladder contraction occur in conjunction with a known neurologic disease (eg. Stroke, multiple sclerosis, spinal cord injury)
    • Paradoxic(Overflow) incontinence
      • loss of urine due to chronic urinary retention or secondary to a flaccid bladder. neurogenic impairment of bladder contractility or by outflow obstruction, especially in men.
• Symptoms related to the urine
• Urology