Symptomatology of Genitourinary System Dept. of Medicine Introductory Lecture Series III Term
Jul 16, 2015
Learning Objectives
• Learn definitions of some specific terms associated with genitourinary system
• Learn to localize disease from symptoms related to genitourinary disease
Symptoms- 1. Pain
• Obstruction- stricture, calculus
• Infection
• Tumour
• Immunological injury
• Trauma
Symptoms- 1. Pain
Organ Site
Upper UT Renal Flank/ Loin
Ureter Loin to Groin
Lower UT Bladder Supra-Pubic
Urethra Urethral
Pain related terms with localisation
• Loin Pain: Acute and Chronic
• Colics: Renal, Ureteral, Urethral
Pain related terms with localisation
• Loin Pain: Acute and Chronic
• Colics: Renal, Ureteral, Urethral
• Dysuria: Burning pain before, during or after
Pain related terms with localisation
• Loin Pain: Acute and Chronic
• Colics: Renal, Ureteral, Urethral
• Dysuria: Burning pain before, during or after
• Strangury: Extreme pain when bladder is empty
2. Micturition Abnormalities
• Urgency: Inability to postpone
• Frequency: Increased number of times
2. Micturition Abnormalities
• Urgency: Inability to postpone
• Frequency: Increased number of times
• Polyuria: Above + increased volume
2. Micturition Abnormalities
• Urgency: Inability to postpone
• Frequency: Increased number of times
• Polyuria: Above + increased volume
• Oliguria: Reduced volume (<500 ml)
2. Micturition Abnormalities
• Urgency: Inability to postpone
• Frequency: Increased number of times
• Polyuria: Above + increased volume
• Oliguria: Reduced volume (<500 ml)
• Anuria: No urine production
2. …Micturition Abnormalities• Retention: Inability to pass/ No urine flow
• Slow Stream: Decreased flow
2. …Micturition Abnormalities• Retention: Inability to pass/ No urine flow
• Slow Stream: Decreased flow
• Hesitancy: Difficulty in initiating
2. …Micturition Abnormalities• Retention: Inability to pass/ No urine flow
• Slow Stream: Decreased flow
• Hesitancy: Difficulty in initiating
• Precipitancy: Inability to stop midway
2. …Micturition Abnormalities• Retention: Inability to pass/ No urine flow
• Slow Stream: Decreased flow
• Hesitancy: Difficulty in initiating
• Precipitancy: Inability to stop midway
• Dribbling : Leak of small amounts after
2. …Micturition Abnormalities• Retention: Inability to pass/ No urine flow
• Slow Stream: Decreased flow
• Hesitancy: Difficulty in initiating
• Precipitancy: Inability to stop midway
• Dribbling : Leak of small amounts after
• Incontinence: Involuntary passage of urine
– Stress Incontinence
– Urge Incontinence
3. Urethral Discharge, Blistering and Ulceration
• In Males
• Infection (Urethritis, genital Herpes, Syphilis, Gonorrhea)
• Females?
4. Hematuria
Definition: More than three RBCs in centrifuged urine per high-power field on microscopy
( > 3 RBC/HPF)
Normal urine:
No red blood cell or less than 3RBCs/ HPF
Types of Hematuria
• Microscopic Hematuria: normal colour on naked-
eye examination
• Gross Hematuria: tea/ cola-colored, pink/red
Hematuria with Associated Symptoms
• Hematuria with renal colic: renal calculus or
ureteric calculus
Hematuria with Associated Symptoms
• Hematuria with renal colic: renal calculus or
ureteric calculus
• With dysuria, straining to void and strangury:
bladder or urethra stone
Hematuria with Associated Symptoms
• Hematuria with renal colic: renal calculus or
ureteric calculus
• With dysuria, straining to void and strangury:
bladder or urethra stone
• Hematuria with urinary frequency, urgency
and dysuria bladder or lower urinary tract
infection or (tuberculosis or tumor)
Hematuria with Associated Symptoms
• Hematuria with renal colic: renal calculus or
ureteric calculus
• With dysuria, straining to void and strangury:
bladder or urethra stone
• Hematuria with urinary frequency, urgency
and dysuria bladder or lower urinary tract
infection or (tuberculosis or tumor)
• If accompanied by high fever, chills and loin
pain: pyelonephritis
Hematuria Associations• Hematuria with edema and hypertension
glomerulonephritis
hypertensive nephropathy
Hematuria Associations• Hematuria with edema and hypertension
glomerulonephritis
hypertensive nephropathy
• Hematuria with mass in the kidney
neoplasm
hereditary polycystic kidney
Hematuria Associations• Hematuria with edema and hypertension
glomerulonephritis
hypertensive nephropathy
• Hematuria with mass in the kidney
neoplasm
hereditary polycystic kidney
• Hematuria with hemorrhage in skin and mucosa
hematological disorders
infectious diseases
Hematuria Associations• Hematuria with edema and hypertension
glomerulonephritis
hypertensive nephropathy
• Hematuria with mass in the kidney
neoplasm
hereditary polycystic kidney
• Hematuria with hemorrhage in skin and mucosa
hematological disorders
infectious diseases
• Hematuria with chyluria
filariasis
Other Genitourinary Symptoms• Females:
–Menstrual abnormalities
–Vaginal Discharge
– Fertility disturbances
Other Genitourinary Symptoms• Females:
– Menstrual abnormalities– Vaginal Discharge– Fertility disturbances
• Males– Impotence (erectile dysfunction)– Loss of libido (decreased interest)– Premature ejaculation (early seminal emission)– Retrograde ejaculation (reverse into bladder)
– Fertility disturbances
General Symptoms in Nephrology
• Fatigue and breathlessness
• Nausea & Vomiting
• Peri- orbital and leg swelling
General Symptoms in Nephrology
• Fatigue and breathlessness
• Nausea & Vomiting
• Peri- orbital and leg swelling
• Itching
General Symptoms in Nephrology
• Fatigue and breathlessness
• Nausea & Vomiting
• Peri- orbital and leg swelling
• Itching
• Easy bruising and bleeding
General Symptoms in Nephrology
• Fatigue and breathlessness
• Nausea & Vomiting
• Peri- orbital and leg swelling
• Itching
• Easy bruising and bleeding
• Bone pains, fractures and tetany
General Symptoms in Nephrology
• Fatigue and breathlessness
• Nausea & Vomiting
• Peri- orbital and leg swelling
• Itching
• Easy bruising and bleeding
• Bone pains, fractures and tetany
• Headache sleep disturbances, altered consciousness and seizures
General Symptoms in Nephrology
• Fatigue and breathlessness
• Nausea & Vomiting
• Peri- orbital and leg swelling
• Itching
• Easy bruising and bleeding
• Bone pains, fractures and tetany
• Headache sleep disturbances, altered consciousness and seizures
• Chest pain (HT, Pericarditis, Lipid abnormalities)
Case 1: 24 year female, Newly Married
• Fever and Pain lower abdomen
• Burning while passing urine
• Needing to go frequently to the toilet
• Cannot wait once she feels like passing urine
Case 2: 22 year old soldier2 days after unprotected sex
• Pus like discharge from urethra
• Burning pain while passing urine
• Frequent visits to the toilet
• Intense pain lower abdomen and in the urinary passage after urination
Case 3: 50 year old multipara
• Distressed by the smell of urine accompanying her all the time
• Does not go outdoors; Depressed
• Passage of small amounts of urine during coughing, sneezing or lifting weights
65 year old retired manager
• Reduced stream of urine X 1 year
• Difficulty in initial passing of urine once bladder is full
• If he has to stop while passing, he cannot stop- ‘it all comes out’
• Had an episode of inability to pass urine requiring catheterization -1 month ago
40 year old male
• Backache & continuous pain left loin X 1 M
• Painless, red colored urine last week- stopped on its own
• Painless passage of blood today
55 yr old male; After lifting a heavy weight
• Backache since
• weakness of lower limbs X 2 days
• Pain lower abdomen and Inability to pass urine X 1 day
• Leaking of urine almost all the time X 1 day
• Fever with chills right now
5 Y old child; sore throat 3 weeks ago
• Swelling whole body, started around eyes X 4
• Reduced urine X 3 days
• Pinkish opaque urine X 2 Days
• No urine X 1 day
• Drowsy
• Breathless
35 year old housewife• 6 months earlier had night time urination 3 to
4 times for few weeks
• Reduced urine output X 2 months
• Progressive breathlessness and fatigue X 1 month
• Swelling of face and feet X 2 months
• Cramps in hands and feet X 1 month