Long Case Volume 3

• Hematuira with clots - malignancy, without clots - might be due to UTI only 
• BPH should always be diagnosis of exclusion in DD unless you do investigations 
• Urine cytology - there is no harm in sending cytology, send cyctology if suspected anything

• Duration of symptoms 
• Nocturia - times 
• Frequency - times/ day 
• Incontinence or not
• Waxing and waning of symptoms
• Which symptom is bothering the most - predominant storage or voiding symptoms
• is there sudden stoppage of urine stream - bladder stone, strangury is typical of bladder stone  
• h/o of urinary incontinence, retention, dysuria, hematuria
• Abdominal pain, flank pain 
• History of HTN - if using diuretics ? 
• For nocturnal polyuria - ask history of diuretic intake, congestive heart failure, FV charting to know about nocturnal polyuria 
• Alchohol hhistory - causes diuresis, increased intake of fluid 
• Think, if decompression is required - cr raised, hydro

• Generalized weakness, weight loss, bony pain, hemopthysis 
• Talk as less as possible, do not give unnecessary explanations
• History of erectile function - 
• History of instrumentation - to rule out stricture 
• History of DM, HTN 
• Taking any medicine - anticholinergic, sympathomimetics,  role of diuretics in polyuria, nocturia,
• Dysuria not present with OAB

History of catherization - normal size passage of catheter rules out stricture 

Dont forget IPSS in BEP 

• External genitalia 
• - meatal stenosis, urethral mass 

Palpable or percussable bladder 

• DRE 
• - anal tone
• - grade of enlargement
• - firm/hard/soft 
• - tenderness 
• - median sulcus 
• - Rectal mucosa free or not 

• Focussed neurological examination 
• - tone 

• Keep D/d as 
• - Bladder outflow obstruction due to BEP 
• - Carcinoma prostate 
• - Overactive bladder secondary to BOO 
• -

Volume of urine - In GUTB , always low volume urine, in OAB, the volume may be variable

Interval - the interval is also variable in OAB, and is constant in GUTB

Pain - no pain in OAB, pain in GUTB

GUTB - frequency is more in night, storage symptom is predominant 

In GUTB, if seminal vesical is involved, then DRE - we can find the nodular prostate

• - Nocturnal polyuria 
• - BEP 
• - Ca P 
• - OAB 
• - Urethral stricture 
• - Bladder stone 
• - Bladder TB - dysuria, Hematuria are common in bladder TB, Bladder TB have frequency without urgency 
• - Diabetic cystopathy (if history of DM)

Localized carcinoma prostate - DRE based, no other advanced features 

Manifestations of locally advanced prostate cancer - obstructive urinary symptoms, ureteral obstruction causing renal failure, flank pain,  hematospermia or decreased ejaculate volume, and, rarely, impotence.

Manifestations of metastatic disease - bone pain, pathologic fractures, anemia, and lower extremity edema; less common are malignant retroperitoneal fibrosis,  paraneoplastic syndromes, disseminated intravascular coagulation (DIC), and paralysis.

focal neurological deficit - leg weakness, sensory levels, change in bladder habit - for cord compression, in advanced CaP back ache family history in past

• Direct action of tumor on bone
• Interactions of the tumor and its secreted factors with nerves in the periosteum
• Action of inflammatory cells in the local bone metastasis environment

• Ca prostate 
• Previous BCG therapy 
• Granulomatous prostatitis 
• Prostate calculi

• Detail about the surgery - indication of hysterectoy, how long did it take, any blood transfusion, counselling regarding the surgery by the doctors,
• Post operative events in detail - pain in flank, postoperative ileus, drain placement - if foleys decreased the amount of leak 
• Foleys catheter removal day, drain removal, 
• Hematuria after surgery
• HPE reports 

History of stress incontinence - that is necessary in further follow up management if there is resisual incontinence - ? 

How many pads changed per day 

• Presence of anemia, nutritional status 
• Scar 
• Inspection of external genitalia - local skin excoriation 
• Per speculum examinaiton -
• Bimanual pelvic examination 
• Vaginal length and diameter - you can explain the diameter in how may fingers does it admit 

Other causes of leak like peritoneal fluid, vaginal cuff infection can cause leak - these needs to be ruled out

• LUTS - FUN, WISE
• Incontinence 
• Bed wetting
• Limb weakness 
• Constipation 
• Gait 

• Childhood surgery 
• Examination of back - scars, lumps 
• DRE - anal sphincter tone

• FV chart 
• Uroflowmetry 
• USG
• Urodynamic study 

• d/d
• - Tethered cord syndrome

In young women, take history of how much fluid does she take, History of caffeine use,