PHYSICAL EXAMINATION &

DIAGNOSTIC PROCEDURE
IN URINARY TRACT SYSTEM
Budi Himawan
Urology Department
Soetomo General Hospital/ Airlangga
University

Determining Diagnostic
Anamnesis
Physical Examination
Adjunctive Procedure
Laboratorium
Radiologis

PHYSICAL EXAMINATION

General state
Head/Neck
Anemic
Icterus
Cyanosis
Dyspneu
Enlargment of Lymph Node

Cont...
Thorax
Simetric
Retraction
Cor
Pulmo

Cont...
Abdomen
Inspection
Palpation
Auscultation

Extremity
Inspection
Palpation

Urologic State

Flank mass
CVA Knocking Pain
Bladder
External Genetalia
Rectal Toucher

LABORATORY
EXAMINATION

Pathology Clinic
Basic Lab

Urinalysis

Macroscopies
Chemical
Microscopies

Complete Blood Count

Other Lab
RFT
Electrolyte

Adjunctive Lab
Tumor Marker

Prostate Tumor: PSA (Prostate Spesific Antigen)

Testicle Tumor: LDH, AFP, BHCG
Bladder Tumor:BTA, NMP-22

Mycrobiology
Urinary Tract Infetion
Urine Culture

Midstream Urine
Suprapubic Puncture
Via Catheter
Type of Culture: Aerob, Anaerob, BTA

Prostatitis Meares Examination (VB1, VB2,

EPS, VB 3)

Pathology Anatomy

Urine Cytology
VC
FNAB
Excisional/Incisional Biopsy
Endoscopic Biopsy
Routine Post Operation PA

RADIOLOGIC
EXAMINATION

Abdominal Plain Photo

Other Names: BOF, KUB
Evaluation 4S (Side, Skeleton, Soft
Tissue, Stone)
Examinating Preparation Lavement

IVP
(Intravenous Pyelography)
Indications :
Hematuria
Recurrent UTI
S. Urinary Stone
S. Urinary System Anatomy Anomaly

Requirements :
Normal RFT
No Allergy due to Contrast

 Preparations
Fasting
Lavage

How to Read

Minute 5
Minute 15
Minute 30
Minute 60
Post Mictie

: Nephrogram
: Contrast decent to Bladder
: All Anatomy of Urinary System
: Prone/Erect position
: Urinary Emptying

Ultrasonography (USG)
Safe Procedure
No contrast needed
Good for Initial Assessment
Hydronephrosis= anatomic diagnosis
Can have caliectasis or pelviectasis in an unobstructed
system

Doppler- measures renal resistive index (RI), an

assessment of obstruction
RI= (PSV-EDV)/PSV
RI > 0.7 is suggestive elevated resistance to blood flow
suggesting obstructive uropathy

Disadvantages:
Operator Dependent
May have false negative in acute obstruction (35%)
Need Additional Imaging to determine the Obstruction

CT SCAN
Most accurate study to diagnose ureteral calculi
More sensitive to identify cause of obstruction
Helpful in surgical planning
Explaining another organs
Gold Standard for Urinary Trauma

Disadvantages:
Expensive

X-ray exposure and contrast needed (except CT

Stonography)
Limited use in patients with renal insufficiency,
pregnancy, and pediatric

Increased risk of contrast-induced nephropathy

Cannot use in patients with contrast allergy

MRI
Can identify hydro but unable to identify calculi
and ureteral anatomy of unobstructed systems
Diuretic MRU can demonstrate obstruction
Especially accurate with strictures or congential
abnormalities

IV gadopentetate-DTPA allows functional

assessment of collecting system while providing
anatomic detail
GFR assessment
Renal clearance

Still several limitations in its use

Vesicula Seminalis stone

PEMERIKSAAN PENUNJANG
LAINNYA

 Lower Urinary Tract Symptoms

(LUTS) Evaluation
Uroflowmetri
Urodinamic Study
Cystoscopy

Uroflowmetry
Indication :
Micturition Disturbance
Post Op Evaluation

Abnormality :
BPH
Partial Urethral Stricture

Value :

0 10 ml/s : Obstruction
10-15 ml/s : Border line
>15 ml/s
: Normal
Minimal Urine : 100 cc

Urodinamic Study
Indoication
Neurological Disturbance
Luts Patient with age < 40 or > 80
Years
Pelvic Operation History
PVRU > 300cc
Twice of Uroflowmetry Examination with
VV < 100 cc

Kidney Function Evaluation

eGFR
Creatinine Clearance
Withaker test
Nuclear Renography

eGFR

Klirens Kreatinin

Whitaker Test
True pressure within the pelvis = Collecting system

pressure intravesicle presure

Saline or contrast though a percutaneous needle or
nephrostomy tube at a rate of 10mL/ min
Serial pressure recording in pelvis renalis and bladder.

Disadvantage:
Invasiveness and discordant results limit clinical usefulness

Nuclear Renography
Provides functional assessment without
contrast
Obstruction is measured by the clearance curves

Tc 99m DTPA- glomerular agent

Tc 99m MAG3 tubular agent
Diuretic renogram- maximizes flow and
distinguishes true obstruction from dilated and
unobstructed

THANK YOU