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History and Physical Exam For The Urologic Patient

The document provides guidance on performing a history and physical exam for urologic patients. It discusses taking a thorough history, including chief complaints, symptoms like pain, hematuria, and urinary symptoms. It also details examining different parts of the genitourinary system like the kidneys, bladder, penis, scrotum, and prostate. The goal is to obtain all relevant information to make an accurate diagnosis.

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Nendy Oktari
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72 views39 pages

History and Physical Exam For The Urologic Patient

The document provides guidance on performing a history and physical exam for urologic patients. It discusses taking a thorough history, including chief complaints, symptoms like pain, hematuria, and urinary symptoms. It also details examining different parts of the genitourinary system like the kidneys, bladder, penis, scrotum, and prostate. The goal is to obtain all relevant information to make an accurate diagnosis.

Uploaded by

Nendy Oktari
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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History and Physical exam

for the urologic patient


Introduction
 Most diagnosis can be reached by a complete
history, and a thorough physical examination
 Challenges in History
 Communication (anxiety, language, educational
background )
 Make the patient feel comfortable
 calm, caring, and competent image
 Family member
Introduction
 Time
 sufficient to express their problems and the reasons
for seeking your care
 Listen carefully
 without distractions in order to obtain and interpret
the clinical information provided by the patient
History
 Major components
 Chief complaint
 History of the present illness
 Past medical history
 Family history
 Review of systems
 Medications
 Allergies
 Social History
Chief Complaint and Present Illness
 The chief complaint is a constant reminder as
to why the patient initially sought care.
 This issue must be addressed even if
subsequent evaluation reveals a more serious
or significant condition that requires
 Duration
 Severity

 Chronicity

 Periodicity

 Degree of disability
Pain

 Can be severe
 urinary tract obstruction
 inflammation
 Inflammation of the GU tract is most severe when it
involves the parenchyma of a GU organ
 Pyelonephritis
 Prostatitis
 Epididymitis
 Inflammation of the mucosa of a hollow viscus usually
produces discomfort
 Cystitis
 Urethritis
Pain

 Tumors:
 No pain unless
 obstruction
 extend beyond the primary organ to involve adjacent
nerves
Pain

 Renal Pain
 Site: ipsilateral
costovertebral angle just
lateral to the
sacrospinalis muscle and
beneath the 12th rib

 Acute distention of the


renal capsule
Pain
 Associated symptoms
 Gastrointestinal symptoms
 Nausea
 Vomiting

 Ileus
Pain

 Renal pain may also be confused with pain


resulting from irritation of the costal nerves,
most commonly T10–T12 which is:
 not colicky in nature.
 Severity of radicular pain may be altered by
changing position
Ureteral pain
 Usually acute and secondary to obstruction

 Midureter ( Rt side): referred to the right lower quadrant


(McBurney's point) and simulate appendicitis
 Midureter (Lt side) :referred over the left lower quadrant
and resembles diverticulitis.
 Scrotum in the male or the labium in the female.
 Lower ureteral obstruction frequently produces symptoms
of bladder irritability( frequency, urgency, and suprapubic
discomfort)
Vesical Pain
 Vesical pain is due

 Overdistention

 inflammation
Prostatic Pain
 Inflammation with secondary edema and
distention of the prostatic capsule
 poorly localized
 lower abdominal
 Inguinal
 Perineal
 Lumbosacral
 rectal pain.
 irritative urinary symptoms ( frequency and dysuria)
 acute urinary retention.
Penile Pain
 Pain in the erect penis is usually due to
Peyronie's disease or priapism
 Pain in the flaccid penis
 usually secondary to inflammation in the bladder
or urethra
 referred pain that is maximally at the urethral
meatus
 paraphimosis
Testicular Pain
 Acute pain
 epididymitis
 torsion of the testicle

 Chronic scrotal pain


 hydrocele
 varicocele,

 dull, heavy sensation that does not radiate

 Referred pain: kidneys or retroperitoneum


Hematuria
 Hematuria : the presence of blood in the urine

 In adults, should be regarded as a symptom of


urologic malignancy until proved otherwise
 Is the hematuria gross or microscopic?
 Timing: (beginning or end of stream or during entire
stream)?
 Is it associated with pain?
 Is the patient passing clots?
 If the patient is passing clots, do the clots have a specific
shape?
Hematuria
 Initial hematuria:
 usually arises from the urethra
 least common
 usually secondary to inflammation.
 Total hematuria
 most common
 bladder or upper urinary tracts.
 Terminal hematuria
 the end of micturition
 secondary to inflammation bladder neck or prostatic
urethra.
Lower Urinary Tract Symptoms
 Irritative Symptoms
 Urinary frequency
 Nocturia

 Frequency

 Dysuria: painful urination

 Incontinence
 Stress
 Urge
Obstructive Symptoms
 Decreased force of urination
 Urinary hesitancy
 Intermittency
 Post void dribbling
 Straining
Enuresis
 Urinary incontinence that occurs during sleep
 Mostly in children up to 5 years
Urethral Discharge

 Urethral discharge is the most common


symptom of venereal infection.
Fever and Chills
 Usually in
 Pyelonephritis
 Prostatitis

 Epididymitis
Past Medical History
 Systemic diseases that may affect the GU
system
 diabetes mellitus.
 multiple sclerosis

 TB

 Schistosomiasis
Family History
 prostate cancer
 Stones( cystine)
 Renal tumors (some types)
Previous Surgical Procedures
 it is worthwhile obtaining as much
information as possible before any intended
surgery, because most surprises that occur
in the operating room are unhappy ones.
Smoking and Alcohol Use
 Cigarette smoking
 urothelial carcinoma, mostly bladder cancer
 Erectile dysfunction.

 Chronic alcoholism
 impaired urinary function
 Sexual dysfunction.

 testicular atrophy, and decreased libido.


PHYSICAL EXAMINATION
 General Observations
 visual inspection of the patient
 Cachexia
 Malignancy, TB
 Jaundice or pallor
 Gynecomastia
 endocrinologic disease
 alcoholism

 hormonal therapy for prostate cancer


Kidneys
 Palpation of the kidneys
 supine position
 The kidney is lifted from behind with one hand
in the costovertebral angle
 In neonates, palpating of the flank between the
thumb anteriorly and the fingers over the
costovertebral angle posteriorly
Kidneys
 Auscultation : epigastrium for bruit
 renal artery stenosis
 aneurysm.

 renal arteriovenous fistula.


Abnormal Physical Examination
Findings—Kidneys
 The most common abnormality detected on
examination of the kidneys is a mass
 In neonates and younger children, the
transillumination helps to distinction between
cystic and solid
Bladder
 at least 150 ml of urine in it to be felt.
 Percussion is better than palpation
 A bimanual examination, best done under
anesthesia, is very valuable to asses bladder
tumor extension
Bladder
Penis
 The position of the urethral meatus
 Priapism: sickle cell disease
Hypospadias
Scrotum and Contents
 Painful
 Torsion
 Epididymitis firm or hard area within the testis should be considered a
malignant tumor until proved otherwise
 Painless
 Spermatocele
 Hydrocele
 Varicocele

 Transillumination : Cystic vs. solid


 Painless solid testicular mass is tumor until proven otherwise
Rectal and Prostate Examination in the
Male
 Digital rectal
examination (DRE) :
 every male after age 40
years
 Men of any age who
present for urologic
evaluation
Prostate Examination
 Acute Prostatitis
 Benign Prostatic Hyperplasia
 Carcinoma of the Prostate

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