Methodological Instructions for Students
Theme: concluding lesson
Aim: To determine the level of knowledges of urology and the main methods of diagnostic of urological diseases symptoms.
1. To collect anamnesis, determine the symptoms of urological diseases.
2. X-ray,functional,instrumental,laboratory,endoscopic methods of examination in diagnostic of urologic diseases.
3. Etiological, pathogenetic, symptomatical, operative methods of treatment.
Students' Independent Study Program.
Clinical Assessment of Urological Symptoms.
Instrumental Methods of Examination in Urology
X-rays and radioisotopic diagnostics of urological diseases.
Pyonephros and paranephritis.
Tuberculosis of kidneys.
Tumors of kidneys and urinary tract.
Tumors of urinary bladder.
Benign prostatic hyperplasia and cancer of prostata
Urine stones (urolithiasis)
Injuries of urine system
Nephrogenic arterial hypertension.
Acute renal failure.
Acute diseases of scrotum.
Tumors of genitals.
Tuberculosis of genitals.
Chronic renal failure.
One has to master the followings methods of diagnostic of urological diseases:
General and descending urography.
Compression, infusion, orthostatic excretion urography.
Cystography (descending, ascending, combinative, sedimentary, polycystography)
Visual aids and material tools:
1. X-ray pictures:
1. 1. General urograms – stones of the kidney, ureter, bladder, descending of the stone with loop.
1. 2. Excretory urograms – stones of the kidney and ureter, hydronephros of I-II degree, cancer of the kidney, cancer of the bladder, tuberculosis of the kidney.
Ascending ureteropyelography – hydronephrosis III degree, coral-like stone of the kidney, tumors of the kidney, abnormalities of the urinary system.
Ascending pneumopyelography – stone of the kidney.
Ascending pneumoureteropyelography – stone of the ureter.
Ascending cystography – cancer of the urinary bladder.
Students Practical Activities:
The main symptoms of diseases.
Characteristics of the pain at the urological diseases. Reasons and mechanism of the renal colic.
Disorders of the urination: pollakiuria (night and day), imperative feeling of urination, hard urination: acute and chronic urine retention, ischuria paradoxa.
Common and distinctive features of true enuresis and ischuria paradoxa, acute urine retention and anuria.
Quantive and qualitive changes of urine (specific weight, daily diuresis, pathological additions).
Cystoscopy and chromocystoscopy. Indications and contraindications,diagnostic value.
Descending (excretory) and ascending urography. Indications and contraindications diagnostic value.
Pyelonephritis. Ethiology, pathogenesis, classification.
Primary pyelonephritis. Clinics, diagnosis, treatment.
Secondary pyelonephritis. Clinics, diagnosis, treatment.
Pyelonephritis of pregnant women. Clinics, diagnosis, treatment.
Acute purulent pyelonephritis. Clinics, diagnosis, treatment.
Pyonephros. Clinics, diagnosis, treatment.
Paranephritis. Classification, clinics, diagnosis, treatment.
Nephroptosis. Classification, clinics, diagnosis, treatment.
Cystitis. Classification, clinics, diagnosis, treatment.
Acute orchoepididymitis. Clinics, diagnosis, treatment.
Spermatic cord torsion. Clinics, diagnosis, treatment.
Varicocele. Ethiology, mechanism. Clinics, diagnosis, treatment.
Renal tuberculosis. Ethiology, pathogenesis. Clinic-roentgenologycal classification.
Renal tuberculosis. Clinics, diagnosis.
Treatment and prognosis of the renal tuberculosis.
Prostatic tuberculosis. Clinics, diagnosis, treatment.
Epididymis tuberculosis. Clinics, diagnosis, treatment.
Urine stones. Clinics, diagnosis, treatment.
Differential diagnosis of the renal colic and acute diseases of abdominal organs. Treatment of the renal colic.
Hydronephrosis. Clinics, diagnosis, treatment.
Complications of the urinary stones. Treatment.
Tumors of the kidney. Classification, metastasis.
Symptoms and clinic of renal tumors.
Diagnosis and treatment of the renal tumors.
Classification, symptoms and clinical course of cystic tumors.
Diagnosis and treatment of cystic tumors.
Penis tumors. Classification, clinics, diagnosis, treatment.
Testes tumors. Classification, clinics, diagnosis, treatment.
Symptoms and clinical course of the prostatic adenoma.
Diagnosis and treatment of prostatic adenoma.
Symptoms and clinical course of the prostatic carcinoma.
Diagnosis and treatment of prostatic carcinoma.
Closed injury to the kidney. Classification, clinics, diagnosis, treatment.
Closed injury to the urinary bladder. Classification, clinics, diagnosis, treatment.
Treatment of the closed injury to the bladder and its complications.
Injury to the urethra. Classification, clinical course and diagnosis.
Treatment of the urethra injuries. Urgent aid at the total rupture of the urethra.
Classification and pathogenesis of the nephrogenic arterial hypertension.
Etiology, pathogenesis, and classification of the prostatic cancer.
Real-life situations to be solved
Patient S., at the age of 69; was admited to the urology department, his complaints are urinary difficulty, urinary frequency, bloody urine. Was noted after urination dullness of the percussion sound under symphisis. Pastematzkiy's symptom is negative. The urination is 4 times during the night. How is the urinary difficulty and the urinary frequency called? How is the blood in urine called? Name of the diseases that these symptoms are typical. What does the dullness of the percussion sound mean?
Answer: Stranguria. Hematuria. These symptoms are typical for nonmalignant hyperplasia of prostate. Chronic urinary retention.
Patient P., 36 years complains on intensive pain in the left abdominal and right below the rib cage, a frequent urinatory. She feals sick a day ago after a very tired some travel (vibrations). On examination stomach normal soft, in accordance to the left part under the rib cage. Symptom Pasternatskiy’s positive on the left part. Approximate diagnosis? What should be done to give exact diagnosis?
Answer: Left sided Renal colic. Chromocystoscopy should be done.
Patient S., 28 years. During intravenous infusion of 76% urographine (3 ml), troubles on voumiting, headache, and apnoe. What does it mean? Your tactics?
Answer: Alergical reaction on iodcontent preparation. To stopped inffusion of urographyne, it is necessary to inffuse Natrium Thyosulfate.
Patient K., at the age of 67, complaints of pain at the right lumbar with raising of temperature 39 °С and chill, the fact from her anamnesis (life history) is that she is suffering with stone in right kidney during 12 years. From chromocystoscopy, it is noted that thick pus is coming from right ureteric orifice. Objective: right kidney is bulged, painful. Symptom of Pastematzkiy is positive. What is a diagnosis? What is a tactics of treatment?
Answer: Stone in right kidney. Right pyelonephros. Nephrectomy should be done for the patient.
Patient C., at the age of 54, complaints on periodical dysuria which brings pain and problem during urine excretion. Usage of uroseptics didn't bring any improvement. What type of disease gives this type of symptoms? What should we do for absolute diagnosis for this patient?
Answer: Tuberculosis; normal ulcer, cancer of urinary bladder. We must do cystoscopy.
Patient K., at the age of 54, complaints on pain left side back in the region of kidney, urine with blood since a week. Examination. of left side it is noted thick round structure 10*14 cm with out pain when it is touched. What is the diagnosis? What methods should be used to put a correct diagnosis?
Answer: Tumour of left kidney. Patient should be done ultrasound screening. Excretory urography.
Patient M., at the. age of 44; during cystoscopy investigation-tumour 1,5/2 cm is noted with elements of necrosis, diameter of tumour is large. What is a diagnosis? What is a tactics of doctor in polyclinic, treatment of this patient?
Answer: Tumour of urinary bladder. Patient should be sent to special urological department, necessary to provide transvasical resection of urinary bladder and next we should do radiational therapy.
Patient K., at the age of 74, admitted with complaints of excretion of urine in drops, with out sensation of urinary secretion, thirst and weakness. Objective: above the lap when the percussive sound is dumb and when touched it is painful. Symptom of. Pastematzkiy is doubling in two sides, prostate is bulged 6/6,5 cm, elastic, between two doles it is smooth. What is your diagnosis? What should we have to do to the patient to confirm diagnosis and tactics in treatment?
Answer: bening prostatic hyperplasia we should put a permanent catheter if the patient is doing well, we should do prostatectomy.
Patient K., at the age of 74, admitted with complaints of excretion of urine in drops, with out sensation of urinary secretion, blood of urine, thirst and weakness. Objective: above the lap when the percussive sound is dumb and when touched it is painful. Symptom of Pasternatzkiy is doubling in two sides, prostate is bulged 6/6,5 cm, bumpy. What is your diagnosis? What should we have to do to the patient to confirm diagnosis and tactics in treatment?
Answer: cancer of prostate, we should keep permanent catheter if the patient is doing well, we should do orchepididimectomy and hormones. X-ray treatment.
Patient S., 52 years old, complains on intensive pain in right iliac and lumbal regions, painful excretion of urine. Region of right ureter is tenderness, Pasternatski’y symptom present on the right side. No shades was found on urogram. What is the preliminary diagnosis? What i| the differential diagnosis? What method is necessary to held to specify the diagnosis?
Answer: renal colic on the right side; appendicite; chromocystoscopy, ultrasonography, retrograde pneumoweteropyelography.
The patient was brought to the hospital with multiply traumas. In the left lumbar region hematoma may be found. Hematuria. Pulse 94/min, blood pressure 105/70 mm Hg. What is the previous diagnosis? What methods of examination are necessary in this case
Answer: closed renal rupture; urography and excretory urography are useful.
Patient K., 34 years old, crashed by car. At the causality ward fracture of the pelvis was found. Urethrorrhage. What is the previous diagnosis? What methods of examination is indicated in this case?
Answer: Urethrorhagia. suspicion on the rupture of urethra. Ascending urethrocystography is needed.
The young person after therapeutic deprivation left 14 kg. Now he complains of weak, dull pain in the right hypogasfrium and in the lumbar region after physical work. What do you think about this clinical case? What methods of examination are useful in this situation?
Answer: nephroptosis of the right kidney, excretory orthostatic urography.
The patients P. 24 years old, often has complaints on headaches, lumbar pain, increased arterial pressure 180 and 120 mm/Hg, that cannot be corrected by hypertensive medicaments. What is your predective diagnosis-
The answer: nephrogenic hypertension. Intravenous urography, USR and angiopgraphy. must be done to the patient.
In the patient on the 2nd: day after extirpation of the uterus is the anuria, pain in the lumbar region. What diagnostic measures are necessary to held in this situation to form the diagnosis? What is the surgical tactics?
Ansewer: Yatrogenic defect of the ureters, postrenal anuria, it is necessary to find the organic reason of the obstruction by catheterization of the ureters, if it is impossible the ureterocystoneostomy is indicated.
Boy of 8 years old was brought to hospital with complaints on acute pain in right part of scrotum that appeared urgent (after physical training lesson). On examination right orchis enlarged on 4 cm, is very painful. What is the diagnosis? What is the tactics?
Answer: torsion of right orchis, urgent operation.
The patients P. 42 years old, troubles on sudden pain in the right part of the stomach localization in the right suboostal in the right limb. Objectivelly: a solf stomach, sensible in the right kidney’s projection. Pastemazkyiy's symptoms is positive in the right. Often urination. The shadows of the suspect are not present on the urogram. What is your predective diagnosis? What should you do to confirm the diagnosis.
The answer: Right side kidney's pain. Chromocystoscopia must be done to the patient
Causes of renal anuria.
A. Incompatible blood transfusion.
B. Shock, collapse.
C. Gall-stones in ureters.
D. Ureters'bandaging during gynaecologic operations.
E. Nephrectomy of solitary kidney.
What is the physiological capacity of urinary bladder?
A. 100-150 ml.
B. 400-450 ml
C. 200-250 ml.
D. 300-400 ml.
E. 500-600 ml.
What of this preparation must be used for excretory urography?
First change in urine which will prove acute hematogenic first pyelonephritis:
E. Hyaline casts.
Cystoscopic signs of pyelonephros are:
A. Hyperemia of left ureteric orifice.
B. Secretion of blood of the ureteric orifice.
C. Suppuration of the ureteric orifice.
D. Deformation of the ureteric orifice.
Symptom of tuberculosis in urine-excretory system which is noted in urography is:
A: deposits of calcium in kidney.
B: shadow in renal pelvis projection.
C: increase of kidney in size.
D: smoothing of transverse muscle.
E: decrease of kidney's size.
What is the main character of tumour of Williams?
B. Embrional adenocarcinoma of kidney.
C. Metastasis of kidney's tumour.
D. Angiosarcoma of kidney.
E. Dermoid of kidney.
Main symptom of urinary tract's tumour in retrograde cystography is:
A. Deffect wall of urinary bladder.
B. Calcium deposits.
C. Diverticulum of urinary bladder.
E. Before bladder.
Main characteristic symptom of benign prostatic hyperplasia in excretory urography is:
A. Chain shaped urinary canal
B. Structure of ureter.
C. Bent urinary tract in 1/3 part
D. Symptom «fishhook».
E. Symptom «lion's face».
What method of examination gives the complete information of carcinoma prostatic glands?
A. -Function of prostate.
B. Doppler graphy.
C. Retrograde cystography.
The method to confirm renal colic is:
E. Retrograde pyelography.
In patient with closed renal rupture and shock the emergency measures are:
C. Treat shock and hemorrhage.
D. Infusion of the opiates.
E. Treatment of the secondery infection.
What disease may be found by Zeidovich test?
A. Rupture of the bladder.
B. Rupture of the liver.
C. Rupture of the urethra.
D. Rupture of the kidney.
E. Rupture of the ureter.
The sign of the 1 stage of hydronephrosis on excretory urogram is:
A. Dilatation of the upper calix.
B. Enlargement of the pyelos and calix.
C. Enlargement of the pyelos.
D. Amputation of the calix.
What is necessury to provide at 3rd stage of diagnosis of vasorenal hypertension:
A. Howards and Rappoport's test
B. Zymnytskyiy's test
C. Zeidovych' test
D. Excretory urography
E. Kidney's angiography
The cause of prerenal acute renal failure is:
A. Stone of the only kidney.
C. Intoxication by heavy metals.
D. Nephrectomy of the only kidney.
E. Obstruction of the both ureters.
In case of purative epididymitis is indicated:
A. Suspensorium wearing.
B. Urgent operation.
C. Planned operation.
E. Winkelmann's operation.
Urgent help in case of trauma of uretra is:
A Hemostatic therapy.
В Antebacteiial therapy.
C. Kidney's catheterezation.
Student should be able to:
To find main symptoms of urological diseases.
To make diagnosis and differential diagnosis.
To determine treatment tactics at urological diseases.
To know the methodic and to give interpretation ofdiagnostical methods.
a) basic literature:
1. Donald R. Smith, M. D. General Urology, 11-th edition, 1984.
2. Official Journal of the European Association of Urology /2002-2005/.
3. Urological Guidelines (European Assosiation of Urology) Health Care Office /august 2004 edition/.
4. Scientific Foundations of Urology. Third Edition 1990. Edited by Geoffrey D. Chisholm and William R. Fair, MD. Heinemann Medical Books, Oxford.
5. O. F. Vozianov, O. V. Lyulko. Urology. – Kyiv: Vischa shkola, 1993.
6. Urology edited by N. A. Lopatkin, Moscow, 1982.
b) supplementary literature:
1. Urinary Tract Infection and Inflamation / Jackson E. Fowler, JR. MD. Year Book Medical Publishers, Chicago 1989.
2. European Urology Supplements /2002-2005/.
3. Urological Oncology. Editors J. Lorens, J. Dembowski, R. Zdrojowy /Dolnoslaskie wydawnictwo edukacyyne, Wroclaw 2002, 2003/.
4. European Urology via www. eropeanurology. com
5. Urology The Gold Jounal /www. goldjournal/net/.