Surgery 5 (Trauma Surgery, Urology) [ChK/S-GM5/18]

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.

Trauma is defined as a physical injury or a wound to living tissue caused by an extrinsic agent. Trauma is the sixth leading cause of death worldwide, accounting for 10% of all mortalities. It accounts for approximately 5 million deaths each year worldwide and causes disability to millions more. About half of all deaths due to trauma are in people aged 15–45 years and in this age it is the leading cause of death.

Urology is the branch of medicine that focuses on surgical and medical diseases of the male and female urinary-tract system and the male reproductive organs. Organs under the domain of urology include the kidneys, adrenal glands, ureters, urinary bladder, urethra, and the male reproductive organs (testes, epididymis, vas deferens, seminal vesicles, prostate, and penis).

The incidence of urolithiasis is 0.1-0.5-1%.The prevalence of of urolithiasis nearby 4%, in children 5,8/100, 000 children/year, M: F ratio 2:1. Recurency only once in a lifetime in about 50%. Different urolithiasis composition and metabolic changes in 50-75% pts. Etiology is unknown. There are multifactorial nature, endogenous, exogenous causes, intranefrotic, extranefrotic creation, metabolic disorders, local factors in the urinary tract as a small diuresis, immobilization, genetic factors-polygenic effect (RTAs and cystinuria), familial clustering, the impact of welfare (climate, social factors, physical activity, occupation, gender, age, ethnic and genetic influences, food, water, pregnancy, lactation, etc.).

Infections of the urogenital system (UTI) are the second most common site of infection. They are non-specific / specific, potentially life-threatening, frequent site of hospital acquired infection. Etiology of UTI are 90% bacterial / non-specific, Gram-negative, e.g. E. coli 85%, - other enteral bact. (Klebsiella, Proteus, Pseudomonas, Enterococci), rare Gram- bacilli (Acinetobacter, Alcaligenes, etc.), anaerobic inf. (abscess), atypical bacteria (chlamydia, ureaplasma, mycoplasma), Fungal (Candida, Mycosis), Parasitic (Schistosomiasis, Trichomonas vag.), Viral (HPV, HSV 1 ,2; Herpes zoster-bladder).

Developmental anomalies of the kidneys and ureters are numerous and not only potentially render image interpretation confusing but also, in many instances, make the kidneys more prone to pathology. Most frequent in human population (66%). High morbidity resulting from obstruction, infection, secondary urolithiasis, functional impairment (renal failure, hypertension, infertility).

The lecture provides information on the basic aspects of urological examination. It discusses the history of urological diseases, examinations and symptomatology, which are important in the examination of a urological patient. It deals with urinary disorders, changes in urine quality, urological causes of hematuria, endoscopic examination methods, USG and CT with a presentation of some typical findings.