Fractionated urine samples

In males, although MSUs are adequate, in certain clinical conditions it might be appropriate to take different aliquots of urine to aid localization of the UTI (e.g., diagnosis of prostatitis). Voided bladder 1 (VB1) first 5-10 mL of voided urine and represents urethral flora Voided bladder 2 (VB2) mid-stream urine and best correlates with bladder urine Voided bladder 3 (VB3) initial 2-3 mL of urine, containing expressed prostatic secretions (EPS), collected following prostate massage In...

Interpretation

The principles of analysis of the traces is similar to those used in conventional cystometry. However, certain notable differences have been noted between measurements obtained from conventional and ambulatory UDS. 1. Detrusor overactivity (see Fig 5.5) AUDS is significantly more sensitive in the detection of involuntary detrusor contraction during the filling phase compared to conventional UDS The more prolonged and physiological nature of AUDS may well account for this seeming superiority....

Cysto Rpg Nephrostogram

Ultrasound scanning (USS), 80-87 advantages and disadvantages of, 86-87 in children, 83 contrast-enhanced, 82-83 Doppler-assisted, 117-118 color, 81-82, 117 duplex, 117 duplex penile, 127 for erectile dysfunction evaluation, 85 of hydroceles, 225 penile, 127, 261, 262 of testicular torsion, 225 indications for, 80-81 bladder outlet obstruction, 227 epididymitis, 224 penile cancer, 247 renal calculi, 235 testicular tumors, 249 interpretation of, 83-86 intraoperative, 86 for residual bladder...

Technique and radiation

Filling Defect Ureter

This procedure is performed in conjunction with cystoscopy and will therefore require either sedation or general regional anes- FIGURE 3.9. RPG TCC lower ureter seen as a filling defect with caliber change (Courtesy of Dr A Bradley, Wythenshawe, Manchester) FIGURE 3.9. RPG TCC lower ureter seen as a filling defect with caliber change (Courtesy of Dr A Bradley, Wythenshawe, Manchester) thesia. Improved quality images are acquired if measures have been taken to minimise bowel related artifacts...

E Urethral Pressure Profile Overview

Sufficient urethral pressure is mandatory for the maintenance of urinary incontinence. Urethral profile measurement (or urethral profilometry) is a technique used to record the intraluminal pressure changes within the entire length of the urethra. A satisfactory evaluation of urethral function can be made by a standard filling voiding bladder urodynamic study, such that urethral closure mechanism is considered adequate if no incontinence is demonstrated and inadequate if there is obvious stress...

Common abnormalities on cystometry

Abnormal results do not necessarily indicate pathology as inconsistent values may occasionally be noted in normal, asymptomatic patients and are of little clinical significance. Abnormalities noted in symptomatic patients are more consequential. Some characteristic findings associated with common abnormalities are described below. 1. Detrusor overactivity (see Fig 5.3) Characterized by phasic elevations of detrusor pressure over baseline during the filling phase, irrespective of the magnitude,...

Technique and interpretation

Cavernosography Penis

This study is usually performed as an outpatient procedure and no specific patient preparation is required. The only absolute contraindication is a previous history of contrast allergy. Two 19-22 G butterfly needles are inserted into the corpora. Care must be taken to avoid perforation of the urethra An erection is induced by an intracorporeal injection of 1020 g of prostaglandin Ej One of the needles is used to record intracavernosal pressures. A record is made of any increase in pressure up...

Mag3 Renal Scan Interpretation

The shape of the renogram curve (following subtraction of background activity) is dependent on 1. MAG3 uptake from blood into kidney 2. MAG3 elimination from kidney into bladder Classically, the normal MAG3 renogram curve has three phases (see figure 4.1) The first phase steep upward rise following intravenous contrast injection this is indicative of the speed of tracer injection and its delivery to the kidneys (i.e., renal vascular supply) The second phase a more gradual slope which represents...

Indications

Possible upper tract obstruction (Fig. 3.3a) Suspected renal adrenal mass (Fig. 3.3b) Investigation of renal failure Monitor renal cystic disease Diagnosis of urinary stone disease Aids access to kidneys for interventional procedures FIGURE 3.3. USS showing (a) mild hydronephrosis and dilated upper ureter, (b) 4-cm solid RCC interpolar region of kidney (Courtesy of Dr A Bradley, Wythenshawe, Manchester) FIGURE 3.3. USS showing (a) mild hydronephrosis and dilated upper ureter, (b) 4-cm solid...

Urinary Acidification

A urinary pH that never falls below 5.8 is suggestive of renal tubular acidosis RTA The normal renal response to acidemia is to Reabsorb all filtered bicarbonate Increase hydrogen excretion primarily by enhancing the excretion of ammonium ions in urine Any inability of the renal tubules to perform these functions leads to a metabolic acidosis which typically Is a normal anion gap hyperchloremic metabolic acidosis Occurs as a consequence of either net retention of hydrogen chloride or its...

A Ureteropelvic junction obstruction UPJO

Classically identified in young women age 20-40 Type, severity, and location of the pain may vary Usually present with a dull ache in the loin worsened after drinking fluids Loin pain may be atypical in nature often mistaken for other non-renal pain Associated nausea and emesis Costovertebral angle tenderness on examination 1. Urine dipstick usually will be normal 3. USS to assess hydronephrosis but not accurate for diagnosing UPJO 4. IVU may help determine degree of obstruction and suggests...

Info

Addition, combining FCM with the morphonuclear score an image analysis-based nuclear grading system recurrence versus non-recurrence is predicted in 91 of low-grade disease. Treatment monitoring Patients treated with radiotherapy for muscle-invasive TCC have a clinical response in 100 , 54 , and 30 of cases for tumor that are DNA diploid, aneuploid, and multiploid, respectively. About 70 of patients with an S-phase fraction lt 11 survive 10 years in contrast to only 30 of patients with a...

Fbc

Often a lymphocytosis and oesinophilia Hyperkalemia, hyponatremia due to l mineralocorticoid T Urea, T calcium, T LFTs Hypoglycemia Cortisol levels low lt 100 nmol L random measurements of little use Aldosterone may be low normal range 111-860pmol L ACTH level gt 80 ng L Tetracosactide 250 g given im or iv at time 0 Measure plasma cortisol at time 0, 20, and 60 min A normal response should show cortisol increase to gt 550 nmol L Depot tetracosactide 1 mg at time 0 Plasma cortisol measurement at...

Kub

Helpful in documenting the number, size, and location of stones Radiopacity may provide information regording stones type Will identify calcium stones gt 1-2 mm in diameter Will miss most uric acid and some cystine calculi Will identify nephrocalcinosis seen in hyperparathyroidism, primary hyperoxaluria, renal tubular acidosis, or sarcoidosis Useful as a screening tool for hydronephrosis or stones within the kidney or renal pelvis Provides information on renal parenchyma in an obstructed...