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UROLOGIC PATIENTS
IRFAN
FIRMANSYAH
Pembimbing: dr. Kuncoro Adi, SpU(K)
INTRODUCTION
UROLOGIS
T The patients encompass all age groups
The urologist has the ability to make the initial evaluation and
diagnosis and to provide medical and surgical therapy for all
diseases of the GU systems
HISTORY TAKING
Chief Complaint and present illness
Pain is an unpleasant
sensory and emotional
experience associated
with actual or potential
tissue damage, or
described in terms of
such damage
HISTORY TAKING
Chief Complaint and present illness
Obstructi
on
Pain in
GU tract
HISTORY TAKING
Chief Complaint and present illness
Secondary to Inflammation
Inflammation Obstruction Produce intermittent
suprapubic discomfort
Hyperperistalsis
and spasm of
smooth muscle
Obstruction
May be
associated with
GI symptoms
HISTORY TAKING
Chief Complaint and present illness
>3
RBC/HPF
Gross
Types
Microscopic
Initial Urethra
Bladder or upper
Timing Total
urinary tract
Hematuria
Bladder neck or
Terminal
prostatic urethra
Vermiform
Clots
(wormlike) clots
HISTORY TAKING
Chief Complaint and present illness
Frequency
Irritative Nocturia
Dysuria
Lower urinary
Weakstream
tract symptoms
Hesitancy
Obstructive Intermittency
Postvoid
dribbling
Straining
HISTORY TAKING
Chief Complaint and present illness
Incontinence
Psychogenic
Impotence
Organic
Androgen deficiency
Sexual dysfunction
Sympathetic denervation
Failure to ejaculate
Pharmacologic agents
Psychogenic
Anorgasmia
Medications
Diabetes Mellitus
Tuberculosis
Hypertension
Neurologic disease
Jaundice
Skin Pallor
Cachexia
Nutritional status Obesity
Palpation
Bimanual examination
Transillumination
Children < 1 y.o with a palpable flank
mass
Percussion of CVA
Localizes pain in renal inflammation
Percussion
Better for diagnosing a distended
bladder
Palpation
Bimanual examination
PHYSICAL EXAMINATION
PENIS
Urethral meatus
Position hypospadias or epispadias
Inspection neoplastic or inflammatory lesions within fossa
navicularis
Penile skin
Superficial vesicle herpes simplex
Ulcers venereal infection or tumor
Venereal warts (condylomata acuminata)
Shaft
Dorsal: fibrotic plaques or ridges typical of Peyronie disease
Ventral: tenderness periurethritis, urethral stricture
PHYSICAL EXAMINATION
SCROTUM AND CONTENTS
Inspection
Lesions
Palpation
Testes
Epididymis
Hernia
Spermatic cord
Transillumination
Solid tumor
Cystic hydrocele,
spermatocele
PHYSICAL EXAMINATION
RECTAL AND PROSTATE EXAMINATION IN MALE
Indication Procedure
Men of
any age
who
Male > 40 Anal Guaiac
present Prostate Rectum
y.o sphincter test
for
urologic
evaluation
PHYSICAL EXAMINATION
PELVIC EXAMINATION IN FEMALE
Cystocele
Valsava
Rectocele
maneuver
Sensory Reflexes
examination examination
Sensory deficits Bulbocavernosus
in penis, labia, reflex
scrotum, vagina, Cremasteric
and perianal reflex
area damage
or injury to
sacral roots or
nerves
URINALYSIS
Specimen collection
Males
Females
Urine dipsticks
Hematuria
Proteinuria
Cells
Erythrocyte
Leukocyte
Epithelial cells: Squamous cells, Transitional cells, Renal tubular cells
Casts
Tamm-Horsfall mucoprotein
RBC casts
WBC casts
Cellular casts
Granular and waxy casts
Fat casts
Crystals
Bacteria
5 bacteria/HPF UTI
Yeast
Parasites
Trichomonas vaginalis
Schistosoma hematobium