#2. Methods in Urological Practice - Physical Examination, Lab Tests, X-Ray

Question 1

What Part of the Kidney can be Palpated?

Answer 1

• The LOWER Pole of the RIGHT Kidney can ONLY be Palpated
• In THIN Patients with a Relatively RELAXED Abdominal Wall

Question 2

How is Succussio Renalis Performed?

Answer 2

{AKA Costovertebral Angle Tenderness}

• By GENTLY tapping on the HYPOTHENAR EMINENCE of the RIGHT Hand
• IF Patient Reacts with Pain, it’s suspected of:
  – Pyelonephritis / Renal Colic / Hydronephrosis / Pyelonephrosis

Question 3

What are the Indications for Performing a Digital Rectal Examination (DRE)?

Answer 3

• Any man with Symptoms of LOWER UT
• It’s a Basic Screening Method for Detecting CARCINOMA of the Prostate Gland

Question 4

What are the Conditions for a Proper Physical Examination of the Scrotum?

Answer 4

{Scrotum = Sac of Skin + Muscles, a CONTINUATION of the ANTERIOR Abdominal Wall where Testicles, Epididymis + Initial Parts of the SEMINAL CORDS are Located}

• Patient has to be in UPRIGHT / SUPINE Position
• In a WELL-WARMED Room

Question 5

What will be found in a Physical Examination of a Patient with Testicular Torsion?

Answer 5

{Testicular Torsion = Absolute Urological Emergency DUE to Interrupted Blood Circulation}

• The Testes are HIGH + TRANSVERSE

Question 6

What are the Diagnostic Capabilities of the Non-Contrast Overview Examination of the Urinary System?

Question 7

When are Nitrates Detected in Urine?

Answer 7

They’re found in Urinary Tract Infections (UTIs)

Question 8

What Instructions must be given to the patient before Microbiological Examination of Urine?

Answer 8

• Midstream of 1st Morning Urine is Used
• This happens AFTER cleaning the External Genital Organs
• And AFTER Repositioning the Foreskin BEHIND the Glans Penis (Uncircumcised Men)

Question 9

What are Antegrade Pyelography AND Retrograde Ureterography?

Answer 9

= Antegrade Pyelography = PERCUTANEOUS Access via Nephrostomy Tube / Needle Puncture in Cavity System where Contrast Materials are instilled into Cavities of Kidney

• Retrograde Ureterography = A Minimally Invasive Procedure, which requires Cystoscopy / Urethral Catheterisation, by introducing a Radiopaque Contrasting Agent into the Ureters

Question 10

By Which method can information be obtained about the function of each kidney separately?

Answer 10

Dynamic Radioisotope Renography aka Renal Scintigraphy

• Allows the degree of Obstruction / Kidney function to be assessed in detail
• After IV Injection, the Radiopharmaceuticals are SELECTIVELY Secreted from PT of Kidney, entering the LUMENS of the Tubules / Pyelocalyceal System / Ureters / Bladder + Radiation is EMITTED from the RFs TO PENETRATE the tissues, which are RECORDED by GAMMA CAMERA
• The RENOGRAM is used to observe the changes in activity curve over time for EACH KIDNEY SEPARATELY

Question 11

What are the Indications for Cystography?

Answer 11

{Cystography = Direct Injection of Contrast Material into the BLADDER}

• Indications are for SUSPECTED Bladder Trauma / Congenital Anomalies (VESICOURETERAL REFLEX)

Question 12

What Information is Obtained from a Urine pH Test?

Answer 12

The Concentration of FREE H+ Ions are used:

• Healthy Person = 4.5 - 8
• ALKALISING Factors = Hyperparathyroidism / Renal Tubular Acidosis / Urinary Infection / Fruit / Diet / Citrates / NaHCO3
• ACIDIFYING Factors = Metabolic Acidosis / Protein Diet / Vitamin C