staff round 25 8-2012

Case 1

Complaint:

HPI:

The condition started 2 months ago when ptstarted to complain of lt. dull aching loin pain, not accompained with fever or rigors, not accompained with nausea or vomiting.2 months earlier pt. used to experience severe pain in the area of both upper thighs with no improvement on med. ttt.

• Irritative symptoms:• BM, Frequency

• No Obstructive Symptoms:• No History of PN, hematuria or SP.

• +ve History of Bilhariziasis.

Past History:

Medical:• Free

Surgical• Free

MRI Abdomen

Bone Scan

MRA Abdomen

Labs. :

S. Creat. : 1.9 mg dl

Urine Analysis :

Case 2

Complaint:

HPI:

The condition started 4 months ago when ptstarted to complain of bilateral dull aching loin pain, more on the left side not accompainedwith fever or rigors, not accompained with nausea or vomiting

• No Irritative symptoms • No Obstructive Symptoms:• No History of PN, hematuria, Bilhariziasis.• +ve history of stone passage once 2 years ago.

Past History:

Medical:• HTN on inderal

Surgical• Tonsillectomy when she was 18

years old • Cholecystectomy 4 years ago

Pelvi-Abd U/S

PACT without contrast

Labs. :


Urine Analysis :

Case 3

Complaint:

HPI:

The condition started 7 months ago when ptstarted to complain of right dull aching loin pain, not accompained with fever or rigors, not accompained with nausea or vomiting

• Irritative symptoms : BM, Frequency.

• No Obstructive Symptoms:• No History of PN, hematuria or Bilhariziasis.• +ve History of Stone passage

Past History:

Medical:• Free

Surgical• Free

Pelvi-Abd U/S

Labs. :


Urine Analysis :

Case 4

Complaint:

HPI:

The condition started 1 yr ago when ptstarted to complain of right dull aching loin pain, not accompained with fever or rigors, nausea or vomiting, releived with analgesics

• Irritative symptoms : BM, Frequency

• No Obstructive Symptoms:• No History of PN, hematuria, Bilhariziasis or SP.

Past History:

Medical:• Free

Surgical Lt. Varicocelectomy 3 yrs ago . Homorroidectomy 2 yrs ago . One session of ESWL at 7-8-2012 .

Pelvi-Abd U/S

Post-ESWLPre-ESWL

Labs. :


Urine Analysis :

Case 5

Complaint:

HPI:

The condition started one monthes ago when ptfirst experienced a sudden red discolourationof urine followed by acute retention of urine in the same day. Pt. had a urethral catheter applicated since then and received med. ttt. for haematuria with significant improvement.


• No Obstructive Symptoms• No History of PN, Bilhariziasis or SP.• +ve History of haematuria ( single attack )

Past History:

Medical:• Hypertensive on Concor Plus 1x1

Surgical• Free

Pelvi-Abd U/S

PA-CT with cont.

CT Cystogram

Labs. :


Case 6

Complaint:

HPI:

The condition started one month ago when ptfirst experienced a sudden red discolourationof urine. Pt. had a urethral catheter applicated since then and received med. ttt. for haematuria with significant improvement.


• No Obstructive Symptoms• No History of PN, Bilhariziasis or SP.• +ve History of haematuria ( single attack )

Pelvi-Abd U/S

PA-CT without cont.

Renal Scan

Labs. :


PSA : 1.25 ng ml (total)

Urine Analysis :

Case 7

Complaint:

HPI:

The condition started one month ago when ptfirst experienced difficult painful micturation.


• Obstructive symptoms : Weak intermittent stream, hesitancy,PMD

• No History of PN or haematuria.• +ve History of Bilhariziasis & SP.

Past History:

Medical:• Free.

Surgical Cystolithotomy 1991 . VIU 5 times starting from 2000. ESWL 5 times for bilateral renal stones. ??

Pelvi-Abd U/S

Labs. :


Urine Analysis :

Case 8

Complaint:

HPI:

The condition started 6 months ago when ptfirst experienced painless swelling of both scrotal compartments.

• Irritative symptoms : -ve• Obstructive symptoms : -ve• No History of PN ,Bilhariziasis, SP or

haematuria.

Past History:

Medical:• Free.

Surgical• Free.

Scrotal Duplex

Case 9

Complaint:

Pre-KUB

Post-KUB

Case 10

Complaint:

Pre-KUB

Post-KUB

S. Creat. : 9.7 mg dl.

Total GFR : 13 ml min.(before &

after).

Pt. now is on regular dialysis.

Case 11

Complaint:

HPI:

At age of 4yrs old ,MCA fr. Pelvis ( conserv. Management ) & diff. during mict. multiple VIU .

At age of 7yrs old uretheroplasty pt micturate through urethra

till age of 22 yrs old .

At age of 22 yrs old pt developed weak stream of mict. VIU

3 m later pt developed weak stream of mict D CX post-

operative pt had supra-pubic cath & complained of bl/rectum & micturation through rectum (fistula ) . 2 days later , pt underwent repositioning of supra-pubic cath .

2 yrs later, pt underwent fistula repair . Suprapubic cath was removed with app of ureth cath 15 d after ureth cath was obstructed & wrongly removed with false app of ureth cath stool was coming from urethra ( fistula reformation ) suprapubic cath

was applied

6m later transient colostomy was done .

6m laterpt underwent uretheroplasty . Colostomy was closed after

6ms .

1y later pt complained of diff in mict pt underwent D CX with uretheral stent app . Pt did not come for follow up for 7 yrs sever infection around stent obstructing urethra supra-pubic cath was

app ( in 2009).

In 2010, uretheral stent is removed surgically after failure of endoscopic removal with formation of fistula bet urethra & perinealskin . Pt is micturating through this fistula but now stream of mictbecame weak.

3 months ago, Diagnostic urethrocystoscopy revealed an opening proximal to the vero, with no definitive fistilous tract, urethral dilatation starting from the opening of the perineal fistula up to 26 FrenchAnd application of a urethral catheter 22 FR.

Last urethral dilatation was done at 15-7-2012.

HPI:

Past History:

Medical:• Free.

Surgical• As mentioned before.

Case 1

Complaint:

Pre-KUB

Post-KUB

Case 2

Complaint:

Combined Study (Pre)

Combined Study (Post)

staff round 25 8-2012

Health & Medicine