Showing posts from June, 2010

Scrotal pain

Scrotal pain Pathology within the scrotum Torsion of the testicles  Torsion of testicular appendages Epididymo-orchitis Testicular tumour Referred pain Ureteric colic Testicular torsion: ischaemic pain is severe (e.g. myocardial infarction, ischaemic leg, ischaemic testis). Torsion presents with sudden onset of pain in the hemiscrotum , sometimes waking the patient from sleep. May radiate to the groin and/or loin. There is sometimes a history of mild trauma to the testis in the hours before the acute onset of pain. Similar episodes may have occurred in the past, with spontaneous resolution of the pain (suggesting torsion/spontaneous detorsion). The testis is very tender. It may be high-riding (lying at a higher than normal position in the testis) and may lie horizontally due to twisting of the cord. There may be scrotal erythema. Epididymo-orchitis: similar presenting symptoms as testicular torsion. Tenderness is usually localized to the epididymis (a

Urinary incontinence - Wetting your pants and bed? involuntary leakage of urine

Definitions Urinary incontinence (UI):    the complaint of any involuntary leakage of urine. Stress urinary incontinence (SUI): the complaint of involuntary leakage of urine on effort or exertion or sneezing or coughing. SUI can also be a sign, the observation of involuntary leakage of urine from the urethra that occurs synchronously with exertion, coughing, etc. A diagnosis of urodynamic SUI is made during filling cystometry when there is involuntary leakage of urine during a rise in abdominal pressure (induced by coughing), in the absence of a detrusor contraction. Urge urinary incontinence (UUI): the complaint of any involuntary leakage of urine accompanied by or immediately preceded by urgency. Mixed urinary incontinence (MUI): a combination of SUI and UUI. Both UUI and MUI cannot be a sign as they both require a perception of urgency by the patient. 25% of women aged >20 years have UI of whom 50% have SUI, 10 to 20% pure UUI, and 30 to 40% MUI. UI i

Loin (flank) pain

This can present suddenly as severe pain in the flank reaching a peak within minutes or hours ( acute loin pain ).  Alternatively, it may have a slower course of onset (chronic loin pain), developing over weeks or months.  Loin pain is frequently presumed to be urological in origin on the simplistic basis that the kidneys are located in the loins. However, other organs are located in this region, pathology within which may be the source of the pain, and pain arising from extra-abdominal organs may radiate to the loins (referred pain). So, when faced with a patient with loin pain think laterally the list of differential diagnoses is long! The speed of onset of loin pain gives some, though not an absolute, indication of the cause of urological loin pain. Acute loin pain is more likely to be due to something obstructing the ureter, such as a stone. Loin pain of more chronic onset suggests disease within the kidney or renal pelvis. Acute loin pain The most common cause of su

Nocturia and nocturnal polyuria (Peeing at night)

Nocturia is common and bothersome (sleep disturbance). Please review where I review this in detail. Prevalence of nocturia:  men:  40% aged 60 to 70yrs,  55% aged >70yrs;  women 10% aged 20 to 40yrs,  50% aged >80yrs. Nocturia is associated with a 2-fold increased risk of falls and injury in the ambulant elderly. If you dont sleep you can expect to fall. Men who void more than twice at night have a 2-fold increased risk of death (possibly due to the associations of nocturia with endocrine and cardiovascular disease). Please review McKeigue P, Reynard J (2000) Relation of nocturnal polyuria of the elderly to essential hypertension. Lancet 355 :486-88. The diagnostic approach to the patient with nocturia Nocturia can be due to urological disease, but more often than not is non-urological in origin. Therefore approach the lower urinary tract last. Causes of nocturia Urological: benign prostatic obstruction, overactive bladder, i

Lower urinary tract symptoms (LUTS)

A plethora of terms have been coined to describe the symptom complex traditionally associated with prostatic obstruction due to BPH.  The classic prostatic symptoms of hesitancy, poor flow, frequency, urgency, nocturia, and terminal dribbling have, in the past, been termed prostatism or simply BPH symptoms. One sometimes hears these symptoms being described as due to BPO (benign prostatic obstruction) or BPE (benign prostatic enlargement) or, more recently, LUTS/BPH. However, these classic symptoms of prostatic disease bear little relationship to prostate size, urinary flow rate, residual urine volume or indeed uro-dynamic evidence of bladder outlet obstruction.  Furthermore, age-matched men and women have similar prostate symptom scores, but women obviously have no prostate. We therefore no longer use the expression prostatism to describe the symptom complex of hesitancy, poor flow, etc. Instead we call such symptoms lower urinary tract symptoms (LUTS) which is purely a de

Haemospermia - blood in the sperm

Definition of Haemospermia:  the presence of blood in the semen. Usually intermittent, benign, self-limiting and no cause identified. Causes: Age <40 years : usually inflammatory (e.g. prostatitis, epididymo-orchitis, urethritis, urethral warts) or idiopathic (though to an extent this reflects the limited investigation that is usually carried out in this age group). Rarely testicular tumour; perineal or testicular trauma. Age >40 years : as for men aged <40 prostate cancer; bladder cancer; BPH; dilated veins in the prostatic urethra; prostatic or seminal vesicle calculi; hypertension; carcinoma of the seminal vesicles. Rare causes at any age: bleeding diathesis; utricular cysts; Mallerian cysts; TB; schistosomiasis; amyloid of prostate or seminal vesicles; post-injection of haemorrhoids. Examination:  Examine the testes, epididymis, prostate, and seminal vesicles. Measure blood pressure. Investigation:  Send urine for culture. If the haemospermia resolves, an


Definition of Haematuria: the presence of blood in the urine. Macroscopic (gross) haematuria:  the patient has seen blood. Microscopic or dipstick haematuria:  blood identified by urine microscopy or by dipstick testing, either in association with other urological symptoms - symptomatic microscopic haematuria - or during a routine medical examination (e.g. for insurance purposes) - asymptomatic microscopic haematuria. Microscopic haematuria has been variably defined as 3 or more, 5 or more, or 10 or more red blood cells (RBCs) per high-power field. Urine dipsticks test for heme (i.e. they test for the presence of haemoglobin and myoglobin in urine). Heme catalyses the oxidation of orthotolidine by an organic peroxidase, producing a blue coloured compound. Dipsticks are capable of detecting the presence of haemoglobin from 1 or 2 RBCs. False +ve urine dipstick:  occurs in the presence of myoglobinuria, bacterial peroxidases, povidone, hypochlorite. False -ve urine dipstick (rare)

Obstetrics - Pregnancy

Obstetrics - Pregnancy