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Special investigations A successful outcome after fistula surgery requires careful assessment of the fistula tract, sphincter integrity and func tion and patient expectations (especially in terms of risk to continence). Clinical examination will give some indi...

The epithelium and subepithelial structures The pink columnar epithelium lining the rectum extends through the anorectal ring into the upper anal canal. Passing downwards the columnar mucosa becomes a cuboidal ‘transi - tional zone’ characterised by 8–12 verti...

Treatment of complications Strangulation and thrombosis are relatively uncommon. The patient presents in severe discomfort with often circumferential haemorrhoidal prolapse with impending mucosal necrosis. Distinction must be made from rectal prolapse and exte...

Treatment After confirmation of the diagnosis and exclusion of secondary causes of anal ulceration, conservative management should result in the healing of almost all acute and the majority of chronic fissures. Emphasis must be placed on normalisation of bowe...

Venous drainage The anal veins are distributed in a similar fashion to the arterial supply . The upper half of the anal canal is drained by the superior rectal veins, tributaries of the inferior mesenteric vein and thus the portomesenteric venous system, an...

coccygea) A dimple in the skin beneath the tip of the coccyx, sometimes amounting to a short blind pit, is noticed from time to time in the course of a clinical examination and is of no consequence.

Bladder function assessment Flow rate and ultrasound scan residual urine Men with LUTS and women with recurrent UTIs or LUTS are frequently investigated with a flow rate and a USS residual urine at the first clinic appointment ( Figures 81.30–81.32 A peak flow ra...

Endoscopy Cystoscopy To further evaluate urinary symptoms, the entire lining of the urinary tract can be directly visualised from the urethra - - ). and bladder (using a cystoscope) to the ureter and renal pelvis (using a semirigid ureteroscope), and finally th...

Epididymis Epididymal pathology is rare in prepubertal males. In sexually active males, acute epididymitis (often due to Chlamydia ) with significant pain and swelling needs to be distinguished from acute testicular torsion. A Doppler USS may help di ff eren - t...

FURTHER READING Dalkin BL, Ahmann FR, Kopp JB. Prostate specific antigen levels in men older than 50 years without clinical evidence of prostatic carcinoma. J Urol 1993; 150 (6): 1837–9. DeAntoni EP , Crawford ED, Oesterling JE et al. Age- and race - specific r...

Glans penis In the younger male, genitourinary warts due to human papillomavirus (HPV) infection may be observed. In the older male, red raised patches on the glans penis or the inner aspect of the prepuce due to Zoon’s balanitis or CIS (also known as erythro...

HAEMATURIA Haematuria occurs when there is blood in the urine. This is now classified as visible haematuria (VH) or non-visible haematuria (NVH). Enquiry should be made about the timing of the blood in relation to the urinary stream – initial (urethral patholo...

INVESTIGATION OF URINARY SYMPTOMS Blood tests Blood counts and chemistry Initial blood tests in suspected urological pathologies include a full blood count, urea, creatinine and electrolytes. Creatinine, a surrogate marker for renal function (glomerular filtrat...

Introduction No content extracted automatically.

LESS COMMON URINARY SYMPTOMS Haematospermia This refers to blood, which can be bright red or a brown colour, in semen. It is most commonly due to benign inflammatory change in the prostate or TB. A digital rectal examination (DRE) should be performed alongside ...

LOWER URINARY TRACT SYMPTOMS A normal micturition cycle consists of two phases: storage and voiding. During the storage phase, the bladder holds urine at low pressures and the urethral sphincter is closed. During voiding, the bladder contracts to expel urine ...

Learning objectives To understand: The signi /f_i cance of pain relating to urinary tract pathology • The difference between renal pain and ureteric colic • The de /f_i nitions of common lower urinary tract symptoms •

PAIN Pain is a common urological symptom. Pain while passing urine is called dysuria and refers to discomfort experienced during voiding – typically described as a sensation akin to passing razor blades or glass. Most commonly , dysuria is due to an infection ...