MUDr. Ľubomír Lachváč, lubomir.lachvac(at)upjs.sk

Acute scrotum is a urological emergency characterized by sudden onset of scrotal pain, swelling, and tenderness. It encompasses a spectrum of conditions affecting the testis, epididymis, and surrounding structures. Testicular torsion is the most critical cause of acute scrotum and requires immediate surgical intervention. Other common etiologies include epididymitis, orchitis, torsion of the testicular appendages, and scrotal trauma. Rapid and accurate differential diagnosis is essential to preserve testicular viability. Clinical evaluation includes detailed history taking and focused physical examination. Color Doppler ultrasonography is the imaging modality of choice for assessment of testicular perfusion. Laboratory investigations may assist in identifying infectious or inflammatory causes. Delayed diagnosis or management can result in testicular infarction and loss of reproductive function. Prompt recognition and appropriate treatment are crucial to achieve favorable clinical outcomes in patients with acute scrotum.

Renal colic is a severe, acute pain syndrome most commonly caused by obstruction of the urinary tract by urolithiasis. The pain typically originates in the flank and may radiate to the lower abdomen, groin, or genital region. Renal colic results from increased intraluminal pressure and ureteral smooth muscle spasm proximal to the obstruction. Nausea, vomiting, and haematuria are frequently associated symptoms. Non-contrast computed tomography is considered the imaging modality of choice for the diagnosis of renal colic. Ultrasonography may be used as an initial imaging tool, particularly in pregnant patients or those requiring radiation avoidance. Laboratory evaluation includes urinalysis to detect haematuria and blood tests to assess renal function and infection. Differential diagnosis includes other causes of acute abdominal or flank pain. Initial management focuses on pain control, hydration, and exclusion of complications such as infection or renal impairment. Definitive treatment depends on stone size, location, composition, and patient-related factors.

Haematuria is defined as the presence of red blood cells in the urine and represents a common urological symptom. It may be classified as microscopic or macroscopic, depending on whether it is detectable only by laboratory analysis or visible to the naked eye. Haematuria can originate from any part of the urinary tract, including the kidneys, ureters, bladder, prostate, and urethra. The etiology of haematuria ranges from benign conditions to malignant urological diseases. Urinary tract infections, urolithiasis, and trauma are frequent non-malignant causes of haematuria. Painless macroscopic haematuria is considered a hallmark symptom of urothelial carcinoma until proven otherwise. A structured diagnostic evaluation is essential to identify the underlying cause of haematuria. Laboratory investigations, including urinalysis and urine cytology, play a key role in the diagnostic process. Imaging modalities such as ultrasonography and computed tomography are used to assess the upper urinary tract. Cystoscopy remains the gold standard for evaluation of the lower urinary tract in patients with haematuria.

Laboratory examinations in urology play a crucial role in the assessment of diseases of the urinary tract and male reproductive system. Urinalysis is a fundamental diagnostic tool used to detect infection, hematuria, proteinuria, and metabolic abnormalities. Blood laboratory tests provide essential information about renal function, electrolyte balance, and systemic inflammation. Measurement of prostate-specific antigen (PSA) is widely used in the evaluation of prostatic diseases. Imaging examinations are indispensable for the anatomical and functional assessment of the urogenital system. Ultrasonography is frequently employed as a first-line imaging modality due to its availability and non-invasive nature. Computed tomography offers high-resolution visualization of the urinary tract and is particularly valuable in the detection of urolithiasis. Magnetic resonance imaging provides superior soft-tissue contrast and is especially important in prostate imaging. Conventional radiographic examinations retain a role in the evaluation of selected urological conditions. The integration of laboratory and imaging examinations enables accurate diagnosis, risk stratification, and therapeutic decision-making in urology.

Article about basic examination in Urology, how to take history, how to perform physical examination. History taking is very important part of any medical investigation. How to take general informations about patient (family history, occupational informations, previous surgery, labours and current medication) is well known. Also, groups of specific urological symptoms are listed here. Much of the genitourinary tract is hidden from view. The testes and epididymes can be identified separately. If epididymal infection is present or testicular torsion is suspected, the examination must be gentle. Observation of the colour of the scrotal wall may reveal hyperaemia. The absence of a cremasteric reflex contraction when the scrotum, or the area close to the scrotum, is touched is also an important sign to elicit. The loss of this reflex is not diagnostic of one pathology, but its presence is strongly against a diagnosis of torsion.

Selected lectures from Urology are devoted to the students of General medicine in the fifth and sixth study years. The students can find here the supporting materials to study Urology topics in the form of lecture notes that should be used in combination with recommended literature. The slides offered here describe particular topics according to the syllabus.