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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 ...

Penis Peyronie’s disease is an idiopathic condition in which fibrosis develops in the corpora cavernosa of the penis. The ‘plaque’ of Peyronie’s fibrosis is usually palpable in the midline anywhere from the base of the penis to just behind the corona. It gives ...

Pneumaturia This is gas in the urine. Patients typically describe frothy urine, bubbles in the urine or a stream that intermittently stops and starts. The commonest cause is an underlying colovesical fistula, usually due to primary pathology in the rectum or si...

Prepuce (foreskin) Phimosis occurs when the distal foreskin is tight and will not retract. Paraphimosis occurs when a poorly retractile foreskin becomes trapped in the retracted state and cannot be replaced. Significant oedema of the foreskin results, making r...

Radiology Urinary tract ultrasound scan USS ( Figure 81.14 ) can characterise pathologies of the kidney , bladder, prostate and testis very well but is not very good for assessing the ureters unless they are significantly dilated or have sizeable pathology . T...

SPECT/CT and PET/CT Single photon emission computed tomography (SPECT) and positron emission tomography (PET) are nuclear medicine imaging techniques that provide metabolic and functional information, unlike CT and MRI. They have both been combined with CT and...

SYMPTOMS RELATED TO THE EXTERNAL GENITALIA Testis A testis may be absent from the scrotum in patients with unde - scended or ectopic testes. In boys <5 years, a common cause of testicular pain and swelling is torsion of a hydatid of Morgagni (appendix testi...

Spermatic cord Ten per cent of males have a left-sided varicocele and a smaller left testis. Masses are occasionally found associated with the spermatic cord, which on removal are found to be lipomas, mesotheliomas or sarcomas.

Uraemia Rarely , the initial symptoms of urological disease may be those of severe renal dysfunction or uraemia. In infants and children, this may manifest as failure to thrive as well as anorexia, vomit ing and altered sensorium due to encephalopathy .

Urethra Hypospadias occurs when there is failure of the urethra to completely close on the ventral aspect and epispadias occurs when there is failure of closure on the dorsal surface. A urethral diverticulum in a female can be a cause for recurrent UTIs and ...

Urine-based tests Urinalysis In a urine dipstick test, used to screen for significant disease, urine is dipped with a stick on which there is a series of small chemical-containing pads designed to detect, typically , glucose, bilirubin, ketones, the specific gr...

Acquired renal cystic disease Most patients on haemodialysis develop bilateral renal cysts - after 10 years. On follow-up one-fifth of these patients with - acquired renal cystic disease (ARCD) develop renal cancers. -

Antenatal hydronephrosis The prevalence of antenatal hydronephrosis (ANH) ranges from 0.6% to 5.4%. The majority of cases of ANH are transient and resolve after birth. The optimal timing of postnatal US in patients with ANH is at least 48 hours after birth....

Autosomal dominant polycystic kidney disease Autosomal dominant polycystic kidney disease (ADPKD) is the most common autosomal dominant genetic cystic renal disease causing chronic renal failure requiring dialysis and renal trans plantation. It occurs as a res...

Benign renal tumours Incidental detection of renal lesions has increased owing to - the widespread use of abdominal imaging. The lesions may be cystic or solid. Solid renal tumours should be considered - malignant unless proven otherwise. Renal oncocytoma - ...

CONGENITAL DISEASES Renal agenesis Complete absence of one kidney occurs in 1 in 3000 live births. The other formed kidney is usually hypertrophic. Reproductive tract anomalies are common in females with unilateral renal agenesis. Bilateral renal agenesis is ...

Children See also Chapter 20 . Stones are rare in children. Childhood urolithiasis is more common in males in the first decade and in young adolescent females. Calcium oxalate stones are the most common vari - ety . Genetic disorders are seen in 17% of childre...