Complete urological examination of men. How a urologist examines a woman. Why should you contact the “Clinic of Modern Medicine”

During the examination of a man by a urologist, it is important to inform him about previous diseases and operations. The problem must be described from the moment the first complaints appear. The patient must also report any medications taken medicines. This is due to the fact that some drugs can cause diseases of the urinary organs. A thorough questioning of a patient who comes to see a urologist allows one to draw conclusions about the possible presence of any diseases or predisposition to them.

After the consultation, the doctor conducts an examination. The urologist pays attention to the structure of the external genitalia, the size, shape and condition of the testicles, and also conducts a rectal examination of the prostate gland through the anus.

Remember! Regular examination and consultation with a urologist are periodically necessary for all representatives of the stronger sex. This is due to the fact that many diseases in the first stage are asymptomatic. Only a thorough examination can identify them. It makes it possible to make an accurate diagnosis and begin treatment.

Comprehensive diagnostics: stages

Consultation and urological examination. A specialist can assess your condition at your first appointment.

Laboratory urological studies:

general urine and blood tests;
tests for tumor markers: PSA, alpha-fetoprotein, Beta HCG, CEA, UBC, Cifra 21-1 (cancer tumor markers Bladder);
blood chemistry;
hormone tests: T3, T4 total and free, GS PG, LH, FSH, estradiol, prolactin;
study of prostate secretions: microscopy, bacteriological examination, PCR diagnosis of STIs (10 positions).

Ultrasound of the kidneys and bladder.

TRUS of the prostate. This urological examination is as informative as possible.

Ultrasound of the bladder to determine the volume of residual urine.

For additional indications, urological studies of men can be carried out, such as ultrasound of the scrotum, hormonal profile (LH, FSH, prolactin, estradiol), tests for RV, HIV, hepatitis B and C.

Remember! Only a complete urological examination allows the doctor to obtain a complete picture of the diseases present in men. It is necessary to undergo research in large clinics.

Why should you contact the “Clinic of Modern Medicine”?

We have everything necessary to conduct various urological studies.
We cooperate with large laboratories. Thanks to this, you can receive accurate research results.
By contacting us, you do not just undergo an examination, but receive adequate, competent treatment from experienced specialists! We know how to relieve men from many of the urological problems that bother them.

Make an appointment!

Many male patients are embarrassed to seek advice from specialists due to the sensitivity of the examination. At an appointment with a urologist, you can identify the main inflammatory diseases that threaten your health. How to prepare for the examination and why annual prostate checks are needed - read our article.

Subspecialists help to most accurately diagnose the cause of the patient’s anxiety. If you have problems with hormones, you should visit an andrologist or endocrinologist; women turn to a gynecologist, men - to a urologist.

However, you should not refer the specialist only to a male doctor. A urologist is a universal doctor who helps to identify and cope with urinary tract pathologies for men and women. When contacting a general practitioner, he will refer a patient with symptoms of pain in the penis, appendages and problems with urination to a urologist.

A special mention can be made of a pediatrician. There is a urologist for adults and for children. This division is due to physiological and anatomical differences in the structure of organisms.

The science of urology belongs to the category of surgical specializations. Therefore, you can receive emergency surgical care directly at an appointment with such a specialist. The urologist also performs some types of physiotherapeutic procedures directly during the examination.

Scheduled inspections

To maintain the health of the pelvic organs, it is recommended to undergo annual preventive examinations. Women without need and without visible symptoms of the disease do not need to visit a urologist.

In men, most diseases occur in a latent form. This is the first reason why you should visit a specialist regularly. Such a check will help detect the development of the disease at the initial stage and stop it.

What is included in the scheduled annual inspection:

taking urine and blood tests;
rectal examination of the prostate;
additionally: checking the kidneys, bladder, lymph nodes.

Most urological diseases are early stages does not show any visible symptoms, and very often the time for their timely treatment is missed. Therefore, we recommend that healthy men without complaints contact a urologist for an examination for the first time at the age of 14 and then annually.

According to indications

If a man or woman has previously been diagnosed with developmental pathologies of the urinary tract, then they will have to visit the urology office more often. To control the development of the disease and prolong the stage of remission of the disease, strictly follow the doctor’s recommendations.

Indications for visiting a doctor:

chronic diseases of the genitourinary system;
secondary manifestation of prostatitis in men;
problems with urination of any form;
neoplasms on the prostate gland, bladder, kidneys;
cancer diseases;
congenital structural defects and developmental anomalies.

In this case, you will have to contact a urologist more often than once a year. It is recommended to undergo verification, including laboratory diagnostics, at least once every 3-4 months.

What complaints do people go to a urologist with?

If men need to undergo an examination of the genitourinary system by a urologist, then women more often turn to a gynecologist with such a problem. But there are complaints common to both boys and girls. In this case, you should not risk your health and urgently need to make an appointment.

The main complaints with which people seek advice and treatment from a urologist:

Suspicious in men. If a woman detects similar symptoms, she will seek help from a gynecologist. Discharge from the urethra can be either within normal limits or a sign of sexually transmitted diseases. They may be associated with inflammation in the excretory canal and prostate after hypothermia. It may also be a complication of any disease in other organs. The urologist will prescribe bacteriological culture, PCR tests and ultrasound of the prostate.
Itching and burning in the urethra. This is an almost universal symptom that can indicate the presence of many diseases. However, with periodic manifestations, one can suspect an allergic reaction to latex, lubricant, or a manifestation of prostatitis or infection. Specify the reason discomfort Only a doctor can.
The appearance of pain syndrome. The pain can be felt in the groin area, in the testicles, on the head of the penis, around the anus, and even radiate to the lower back. There are many reasons for such pain: from yesterday’s cycling workout to the development of a benign or malignant tumor.
Problems with urination. Both women and men turn to a urologist regarding this issue. This sign indicates problems with the kidneys, a slowdown in metabolism, or age-related changes in the body. In men, this is how the initial stage of prostatitis manifests itself, which, if left untreated, can become chronic.
The presence of blood in urine or semen, as well as other impurities. This is a dangerous sign indicating the presence of an advanced inflammatory or infectious process. The appearance of pus or blood is a symptom of a chronic disease, benign hyperplasia of impressive size, or even cancer.
The appearance of rashes, sores, erosions or spots. In this case, the man should take care of genital hygiene and urgently contact a urologist to check for infection. Rashes, redness and the appearance of strange spots are signs of STDs (sexually transmitted diseases).
Development of erectile dysfunction. When libido decreases, men are often embarrassed to see a doctor. But in vain, because impotence develops rapidly and, if measures are not taken, becomes irreversible. In this case, the specialist looks for the cause of sluggish potency or its absence. The problem may also be deeper, associated with a violation of the hormonal system, diseases of the blood vessels, internal organs or the genitourinary system. Even psychological problems cause dysfunction.
Astheno-vegetative syndrome in men. With such a problem, you can also go for a urological examination. This syndrome is manifested by increased fatigue, decreased performance, irritability, psychological instability, sweating, tachycardia and general apathy.
Suspicion of the presence of a disease. You can ask the urologist any delicate questions that concern you: small penis size, lack of ejaculation, complaints of pain, or... Even if the pathology turns out to be far-fetched, it is worth checking your suspicions.

It is important to take care of your health, even if open problems no with urinary organs. Sometimes, due to age-related changes, issues with potency and urination appear. In this case, the urologist will help you choose maintenance therapy.

List of urological diseases

Among the diseases of the excretory system there are exclusively male pathologies and general diseases. Universal ones include cystitis and urethritis, which also occur in women. Due to the anatomical differences in the structure of the genital organs, specific pathologies arise in men.

List of the most common urological diseases in men:

Erectile disfunction. These are problems with penile hardness, when the area of the cavernous penis is not filled with arterial blood to the extent to ensure a full erection. Most often, the disease appears in men over 45 years of age, smokers and patients with diabetes.
. Problems with the prostate gland are observed in 70% of older men on the planet. This can cause the glandular tissue to enlarge, interfering with normal urination and, in some cases, causing decreased fertility.
Phimosis. This is a narrowing of the foreskin. In boys under 3 years of age, the head is hidden behind the fold of the penis; it begins to emerge by the age of six. At the initial stage, the patient feels pain due to the inability to freely retract the foreskin. The latter will require surgery to free the head.
Balanoposthitis. This is an inflammatory process on the head of the genital organ. Suspicious rashes and ulcers appear on the mucous membrane and skin. The disease can be either a consequence of an untreated infection or a cause of the development of phimosis (narrowing of the foreskin).

This list can be continued for a long time. Developmental defects are less common; in some cases, priapism occurs - a prolonged erection. Often, diseases of the urinary organs become a consequence of drug treatment.

Common diseases that occur in men and women:

Enuresis. This is urinary incontinence, which can be partial or complete. It occurs in both sexes and can occur at any age. In women, it often occurs after childbirth and goes away without treatment after a few days. The cause in most cases is nervous tension or defects in the anatomical structure.
Cystitis. This is an inflammation of the bladder, which is manifested by a burning sensation in the urethra when urinating. In its acute form it can cause severe pain. This pathology especially often worries girls of preschool and primary school age.
. An inflammatory process occurring on the mucous membrane of the urinary tract. The symptoms are similar to cystitis, the treatment regimen is also practically the same.
Pyelonephritis. This is a bacterial disease caused by microorganisms entering the kidneys, which causes an inflammatory process. The danger of this disease is that the infection can spread through the urinary tract.

Do not self-medicate. Therapy is prescribed only based on the results of laboratory tests and depending on the identified pathogen. Antibacterial agents are selected depending on the sensitivity of microorganisms to drugs.

Independent experiments on the body can only worsen the situation. Remember that most urological diseases are sexually transmitted. It is recommended to use a condom during sexual intercourse to avoid infection.

Preparing for your appointment

An examination of a man or woman by a urologist usually takes no more than 15-20 minutes. During this time, the doctor will question the patient, examine the organs of the urinary system, and possibly perform an ultrasound.

General requirements before examination by a urologist:

avoiding sexual intercourse 24 hours before visiting a urologist;
refusal to take painkillers for an accurate diagnosis;
refusal to pre-use antibacterial agents.

The use of analgesics may interfere with localization of pain. The doctor will not be able to make the correct diagnosis. For a similar reason, you cannot perform genital hygiene before examination using disinfectants (Chlorhexidine, Furacilin). The result of bacteriological culture in this case will be incorrect.

In some cases, a gynecological chair is used to examine women. Therefore, do not forget to bring a diaper with you for examination. The day before your visit to the doctor, you should avoid sexual intercourse to avoid extraneous lubricant secretions.

The man needs to cleanse his rectum so that the doctor can perform a digital examination of the prostate. Do not be scared or embarrassed by the erection that occurs during such an examination - this is normal. It's worse if an erection does not occur. A cleansing enema can be replaced by taking a laxative the day before.

How is an examination by a urologist performed?

Many patients are concerned about what they do at an appointment with a urologist. Many men avoid prostate testing because rectal palpation hurts their masculinity and degrades their dignity.

Examination of the prostate gland is purely a medical matter. Patients experience more problems with tightness adolescence. Some experts recommend taking a few drops of an herbal valerian-based sedative before a routine examination.

Nothing terrible happens in the urologist's office. The examination begins with a normal conversation. Answer the doctor's questions in detail, this will help with an accurate diagnosis. If there are chronic diseases, the doctor needs to know what medications the patient takes on a regular basis.

At the same time, the doctor studies your outpatient card, looks at tests, the results of which should be pasted into it. If the appointment is primary, the urologist will definitely prescribe, some of which can be taken directly in the office.

Men

Examination of men differs from palpation of internal organs of women. Follow the requests of the doctors; you can inform them in advance that the examination is primary.

How a man is received:

Palpation. The patient lies down on the couch, the doctor manually examines the internal organs abdominal cavity and kidneys. Severely enlarged organs can be found on at this stage palpation examination. The specialist also examines the condition of the internal and external genital organs. These are the scrotum, penis, prostate gland and inguinal lymph nodes.
Rectal examination of the prostate gland. Can be performed standing or in a knee-elbow position. The doctor inserts a finger into the rectal area to feel the condition of the prostate; in some cases, an ultrasound probe is used for this.
Collection of tests. If a bacterial infection is suspected, a urologist can take a general smear from the urethra, which will help identify the presence of microorganisms. A sample of the prostate is also taken during the examination, if necessary.

Examination of the prostate in men can cause pain only in the presence of acute prostatitis. In other cases, the procedure is painless. Put aside your embarrassment, since preserving your health is more important than your damaged male honor.

Women

In some cases, in the urologist’s office you may notice the presence of a gynecological chair. But in very rare cases, a specialist examines a woman’s genital organs. The appointment is a little different from a men's health check.

Stages of urological examination of women:

Conversation. The patient reports her problems, describes the symptoms that bother her. The doctor also examines the woman’s medical history and the presence of other diseases. You should tell your urologist about all suspicious manifestations of abnormalities in the urinary system.
Palpation. The doctor will ask you to lie down or conduct an examination in a standing position. Palpation of the pelvic organs occurs: bladder, kidneys. The condition of the lymph nodes is also examined.
Instrumental research. If necessary, the urologist uses modern diagnostic tools such as ultrasound, laboratory tests, instrumental and endoscopic methods.

In the same way as in men, urethral secretions are collected. The main difference is the lack of examination of the female genital organs and prostate gland, since women do not have a prostate. Instrumental diagnostics are carried out only in case of obvious manifestation of symptoms and medical suspicion of the presence of a pathogenic development of the disease.

Sometimes, at an appointment with a urologist, men become isolated and cannot talk about sensitive problems. One of the most common reasons for this is when a man is examined by a woman's urologist.

Even though medical issues are being resolved in the specialist’s office, the man is seized with panic. From a psychological point of view, the patient does not want to show his weaknesses.

Advice for a man if the urologist is a woman:

Think about your health. First of all, you did not come to flirt, get acquainted or start a family in the urology office, but to solve your problem.
The doctor saw something different. Remember that a urologist examines a huge number of patients every day, and in 20 minutes another shy man will see her.
Medical ethics. A doctor does not have the right to talk about small penis size and disseminate information about the presence of diseases.

Calm down and go into the doctor's office with confidence. If a urologist is a woman, this does not mean that she is a bad specialist. Trust her medical instincts, do not discriminate based on gender, and follow your doctor's instructions.

Knowing what a urologist checks for men, you can prepare both physically and psychologically in advance. Also at the appointment, the urologist may use additional instrumental diagnostic methods. The most common types are described in the table.

Additional urological procedures	Description and types
Endoscopic methods	A method that allows you to examine the urethra. Methods such as urethroscopy, fiber optics, cystoscopy, nephroscopy, pyeloscopy are used
Physical research	Methods that help to most accurately determine the condition of internal organs. These include ultrasound, plain radiography, excretory urography, infusion urography, retrograde ureteropyelography, antegrade pyeloureterography
Instrumental diagnostics	Method for diagnosing diseases of the urethra in men and women. Examination of the bladder using a catheter, bougienage of the urethra, puncture biopsy - removal of a piece of tissue for examination

The list of diagnostic methods does not end here. If it is impossible to examine part of the internal organs, surgery is prescribed. Surgical intervention will help make a diagnosis and even become a method of emergency treatment.

How to choose a specialist

The choice of a specialist depends not only on the availability of a urologist in a free clinic, but also on the financial situation of the patient. You can make an appointment at a private center to get faster lab test results.

Not all types of diagnostics can be performed free of charge at a local clinic. You can make an appointment with a local urologist, and additionally undergo a urinary tract examination at a medical center for a fee.

The cost of seeing a urologist will cost from 500 rubles, and testing will cost from 1,500 rubles. In the central regions of Russia, the cost of doctor’s services is even higher.

Find good doctor It’s not difficult, you can just find information about a specialist on the Internet. Each private center has its own website, which describes the achievements of its employees, and there are pages with reviews.

Some tips to choose the best doctor:

Choose a specialized medical center. It is better if it is a urological clinic or a private medical office, in which every corner is collected for the diagnosis and treatment of urinary tract diseases.
Research reviews. Ask a neighbor or friend for advice, find a page on the forum dedicated to seeing a specific specialist.
Estimate the percentage of recovered patients. The higher the effectiveness of treatment, the more responsible the urologist is in performing his work.
Novelty of the medical institution. With new equipment, the chance to accurately diagnose the presence of certain diseases increases.

Some men choose doctors only of the stronger sex, embarrassed by a female examination. Others prefer older, experienced professionals. The choice also depends on personal preference. The main thing is to take the first step by asking for help.

Video

How an examination by a urologist takes place - learn more from the video.

A urological examination is carried out to diagnose diseases of the urinary system and genital organs, as well as for prevention. Urology is a field of medicine that studies diseases of the urinary system, and in men, the genital organs, and develops methods for their treatment and prevention. The vulnerability of the excretory (excretory) system is explained by the complex structure of the kidneys, as well as the fact that it communicates with the external environment through the external genitalia. A urologist treats inflammation, infections, tissue injuries, cancer of the urinary system, etc. The diagnosis is made based on urine analysis and the results of various methods of examining the patient.

Analysis of urine

Urine collection for urological examinations can be done in different ways. Most often, the patient collects urine in a glass container, from which it is then poured into a small test tube and examined. Analysis is usually done chemical composition urine. In order to detect pathogens or pathological cells, the doctor prescribes a bacteriological urine test. However, when collecting urine for this study(culture for sterility) some requirements must be met: the external genitalia should be washed with boiled water, because the presence of antiseptic solutions in the urine may give false negative results. For bacteriological examination, urine from the middle portion is collected in a sterile container.

If you suspect a disease of the prostate gland, some diseases of the bladder, as well as transverse paralysis, the doctor must determine the so-called residual amount of urine: normally, during urination, the bladder is completely emptied, while in some diseases there is always some amount of urine left in it. To determine the residual amount of urine, scintigraphy or bladder catheterization is used.

Endoscopic diagnostic methods

Typically, your doctor will examine your ureters, bladder, and urethra using a cystoscope. The cystoscope consists of a metal cylinder surrounding the telescope, lighting and optical systems, and an irrigation device. During the procedure, it is inserted into the urethra. Various instruments can be inserted into the metal cylinder to perform microsurgical operations. Using these instruments, the surgeon can perform a biopsy, remove stones from the kidneys or bladder, and cauterize small bleeding wounds.

The urethra is an elastic tube that starts from the bladder and ends at the external opening. It is shorter in women than in men, which is why women suffer from urethral infections 20 times more often than men.

X-ray urological examination

Endoscopic examinations and catheterization are carried out only if certain diseases are suspected, because these procedures are unpleasant and very painful. Therefore, in urology, X-ray examinations of the kidneys and bladder are more often used. During an x-ray examination, the patient is given a small amount of radiopaque contrast agent intravenously and x-rays are taken. From the images, the doctor can determine the following:

The time it takes for the contrast agent to reach the kidneys from the blood allows us to evaluate their function.
Based on the distribution of contrast in the kidneys, the doctor can determine whether there are pockets of inflammation, stones, or any other abnormalities in the kidneys.
In addition, the ureters and bladder are clearly visible on the images. Scintigraphy and radiological studies, during which substances with slight radioactivity are used, make it possible to assess the condition of the kidneys and urinary tract even more accurately.
Usually radioactive substances are administered intravenously. The patient is placed on a special table, above which there is a detector. This device detects the slightest radiation. The information received is processed by a computer, which transmits an image of the distribution of the radioactive substance in the kidneys and urinary tract.

An apparatus for ultrasound urological examination (echoscope) is indispensable for a urologist. Its use allows for a quick examination of the kidneys, urinary tract and bladder.

Examinations by a urologist are not pleasant; moreover, they are painful. However, diseases of the kidneys and other organs of the urinary system can be accompanied by severe pain and be deadly. Therefore, when the first symptoms of diseases of the urinary system occur, for example, pain, burning, frequent urge to urinate, you must immediately contact a urologist.

Currently, in order to effectively diagnose diseases of the genitourinary system in urology, various studies using modern methods, as well as the latest devices and tools.

There are the following diagnostic methods in urology:

laboratory diagnostics

instrumental research methods

endoscopic diagnostics

X-ray diagnostics.

Laboratory diagnostics.

Blood analysis.

General blood analysis identifies signs of a possible infectious process in the body, a decrease in the amount of hemoglobin in the blood, which can also happen with kidney diseases.

During a biochemical blood test determine blood levels various substances, kidney diseases are related to the level of uric acid and creatinine (nitrogenous waste), the increase of which in the blood directly indicates insufficient kidney function. In severe renal failure, the amount of urea and creatinine in the blood can increase 5-10 times. Based on a biochemical blood test, one can judge other changes in the body that may be related to the urinary system.

For a more detailed study of the urinary system, other complex biochemical tests:

acid-base state of blood

the amount of various enzymes in the blood and urine

excretion of amino acids and sugars by the kidneys.

One of the more accurate studies of kidney function is the determination of creatinine clearance. Creatinine clearance is calculated using a formula and represents the volume of blood that is cleared of creatinine in one minute. Using this indicator, the degree of renal failure is more accurately determined.

Analysis of urine.

A healthy adult produces from one to one and a half liters of urine per day. With various diseases, the amount of urine may increase or decrease.

When performing a urine test, measure:

quantity

determine physical properties

The contents of urine sediment are examined under a microscope.

Urine should be collected in a clean container. In this case, the patient should not touch the inner walls of the dish with parts of his body. Collect a medium portion of urine. To do this, the patient must toilet the perineum, then begin urinating into the toilet, then into the test vessel, and finish urinating into the toilet. Sometimes, usually in infants, in order to exclude impurities in the analysis, urine is taken from the bladder using a catheter or using a bladder puncture.

Researched in general analysis urine:

Relative density of urine. It depends on the concentration of substances dissolved in the urine: uric acid, urea, creatinine, salts and other substances. Normally, the relative density of urine can fluctuate from 1005 to 1026 during the day. The density of urine reflects the ability of the kidneys to concentrate this urine.

Hyposthenuria is a decrease in urine concentration, in which the osmotic concentration of urine is equal to the osmotic concentration of blood plasma. In other words, the concentrating ability of the kidneys decreases and a lot of low-concentration urine is released more often. Observed in renal failure.

Hypersthenuria is an increase in the osmotic concentration of urine, which is often not associated with kidney disease, but occurs, for example, with a high content of sugar in the urine in diabetes mellitus and in some diseases of the thyroid gland or salt poisoning heavy metals. Then the relative density of urine can reach 1040-1050.

Since the density of urine varies throughout the day, one study is not enough. Then a urine test is performed according to Zimnitsky. The density of urine is measured in eight three-hour portions taken during the day.

Urine color. The normal color of urine is straw yellow. This color is formed by pigments that are excreted from the blood in the urine: urobilin, hepatoporphyrin, etc. Normally, urine is transparent. Cloudy urine occurs when there is salt, bacteria, mucus or pus in it. Changes in urine color may be affected by diet or use medicines. Eating blueberries, beets, and rhubarb can color the urine red-brown; the same color of urine appears when treated with rifampicin, phenolphthalein, nitrofurantoin; a brown-black color occurs when using metronidazole, methyldopa.

Be sure to examine the presence of sugar and protein in the urine. A healthy person can excrete up to 50 mg of protein in urine per day. This is a small amount and this amount of protein can only be determined by a more subtle immunochemical method. At inflammatory diseases kidneys, the amount of protein can increase to 1 g/l.

An increase in protein excretion in the urine is called proteinuria. This indicates a violation of the permeability of the kidney membranes, which normally should retain protein in the blood and not allow it to pass into the urine. The excretion of protein in the urine due to impaired renal function is called true proteinuria. False proteinuria is an increase in protein due to a large number of leukocytes or red blood cells in the urine. With severe inflammatory processes in the kidneys, there may even be pyuria (pus in the urine). If there is pus in the urine, a so-called three-glass test is often performed. The patient is asked to urinate in turn into three vessels. This test makes it possible to roughly establish the localization of the inflammatory process. If most of the pus occurs in the first portion of urine, more often the infectious process occurs in the urethra, in the middle portion in the bladder, and in the last portion the pus occurs due to a process in the kidneys or prostate gland.

Blood in the urine is called hematuria. Hematuria can be microscopic, when red blood cells in the urine can only be detected under a microscope, and macroscopic, when the color of the urine changes from the color of meat slop to red with noticeable blood clots. Gross hematuria is more common in blood diseases, injuries, malignant tumors of the kidneys and urinary tract. A three-glass test is also used to determine the source of hematuria.

If necessary, it is possible to determine the presence of acetone, bilirubin, urobilin and urobilinogen in the urine.

Urine sediment examined under a microscope. At the same time, it is determined which cellular elements are present in the urine. Epithelial cells, leukocytes, erythrocytes, and casts are counted using special techniques. The sediment may contain salt crystals and bacteria. To determine the type of bacteria, urine is cultured on nutrient media. Normally, one milliliter of urine contains 2x10 - 4x10 leukocytes, 1x10-2x10 erythrocytes, up to 20x10 cylinders. Now more complex immunochemical methods are being produced that make it possible to study the qualitative composition of proteins in urine.

Instrumental research methods.

Bladder catheterization.

It is performed using a catheter for catheterization of the bladder. Catheters are available for men, women and children. Women's are shorter and do not have much curvature like men's. Children's are smaller than adults'. Catheters can also be soft, semi-soft and hard or metal. The use of catheters is carried out in compliance with all rules of asepsis and antisepsis. Catheterization is not performed in case of acute inflammatory processes in the urinary tract in order to avoid the spread of infection higher up the urinary tract. Most often, bladder catheterization is performed in patients with benign prostatic hyperplasia (enlargement) due to urine retention in the bladder. Sometimes catheterization is done to measure the volume of residual urine in the bladder, but this is currently done using ultrasound. In some patients, catheterization has to be carried out systematically, then a Foley balloon catheter is used, which is left for some time in the urethra.

Bougienage of the urethra.

It is carried out to expand the narrowed areas of the urethra, to identify the degree of narrowing, to clarify the location of the stone in the canal. Bougies of increasing sizes are used, starting with the thinnest thread-like one, which is introduced at the beginning of the procedure. Before the procedure begins, lidocaine gel is injected into the urethra for local anesthesia.

Needle biopsy.

There is an open puncture biopsy of the kidney during surgery and a closed one, which refers to instrumental methods for studying the kidneys. Closed percutaneous kidney biopsy is required when other methods do not provide reliable results and is performed only in a hospital setting under supervision ultrasound examination. With the patient lying on his stomach at a point 10-12 cm lateral to the midline, just below the 12th rib, a special biopsy needle is inserted through a small skin incision. The needle consists of an outer cylinder and an inner rod. When the tip of the needle pierces the outer membrane of the kidney, an internal rod is inserted and the needle is advanced into the kidney to a depth of 1.5 cm. There is a recess on the rod into which a piece of kidney tissue falls. The outer cylinder is pushed onto the rod and the needle is removed. A piece of kidney tissue is examined under a microscope. If prostate cancer is suspected or the diagnosis is unclear, a needle biopsy of the prostate gland is performed. It is carried out through the rectum or through the skin of the perineum. For testicular diseases of unknown nature, a puncture testicular biopsy may be performed. A small puncture needle is used under ultrasound control.

Cystomanometry.

This test is done to measure the pressure in your bladder. It allows you to determine the condition of the muscular wall of the bladder and its function. After it has been emptied, warm liquid in 50 ml portions or gas of a certain volume is injected into the bladder through a catheter. Through the same catheter, the pressure in the bladder is measured at the first urge to urinate. Normally, in a healthy person, the first urge to urinate appears when there is 100-150 ml of liquid in the bladder. The pressure in the bladder is 8-10 cm of water column. A pronounced urge occurs when the amount of liquid is about 300 ml and the pressure is 20-35 cm of water column. Measurement of pressure in the bladder is also carried out during urination, this makes it possible to judge the patency of the urethra and its sphincters.

Uroflowmetry.

This test is done to determine the function of the muscle that expels urine from the bladder. In this case, the volumetric velocity of urine flow through the urethra is measured and recorded on a graph depending on time. To measure the volumetric velocity of urine, special devices, uroflowmeters, are used. Normally, the highest urine flow rate in men is 15-20 ml/s, in women 20-25 ml/s. A decrease in the volumetric velocity of urine is observed when the urethra is narrowed or when the contractility of the muscle that expels urine from the bladder is impaired. The average volumetric flow rate of urination is sometimes determined in a simple way: divide the volume of urine released by the rate of urination. When examining patients with urinary incontinence and urinary disorders, the intraurethral pressure profile is sometimes determined. In this case, using a special device, the resistance of the bladder closure apparatus (internal and external sphincters, prostate gland) to the pressure of the fluid leaving the bladder is measured. The obtained figures are marked on the graph. In patients with urinary incontinence, maximum pressure is reduced compared to normal.

Endoscopic diagnostics.

An endoscope allows you to view the surface of the organ being examined from the inside. Endoscopes come in hard and soft types. Currently, with the help of endoscopes, not only the examination of the internal surfaces of various organs is carried out, but also small surgical interventions, the scope of which is constantly expanding as endoscopic technology develops and becomes more complex. Endoscopic examination in urology is used to examine the urethra, bladder and pyelocaliceal system kidney

Urethroscopy.

This is a study of the surface of the mucous membrane of the urethra along its entire length. The study allows you to examine in detail the mucous membrane of the canal, its changes and sometimes perform therapeutic actions. The manipulation is performed using a urethrocystoscope, which is used to examine the bladder and urethra while slowly removing the device from the bladder. Sometimes only an examination of the urethra is performed. In case of inflammatory diseases of the canal, manipulation is contraindicated.

Cystoscopy.

It is produced more often than other methods. This is an examination of the inner surface of the bladder using a cystoscope or urethrocystoscope. In some diseases of the urinary canal, accompanied by narrowing, cystoscopy may not be available. The urethrocystoscope consists of an optical system that allows inspection of the bladder, a system for catheterization of the ureters that allows the kidneys to be examined separately, and systems for minor surgical interventions. For children, special children's urethrocystoscopes, smaller in size, have been created. Manipulation is not performed for inflammatory diseases of the urethra. Before the examination, the patient is given an intravenous painkiller, and the examination is occasionally carried out under general anesthesia. Before the examination, the patient is asked to urinate. Cystoskipia is performed with the patient in the supine position in a special urological chair. The urethrocystoscope is lubricated with sterile glycerin and inserted into the bladder, the remaining urine is released and the bladder is washed with furacillin solution and the same solution is injected into the bladder until the urge to urinate, simultaneously checking the capacity of the bladder. Then the entire surface of the bladder is examined in detail. Examine the walls of the bladder and the exit site of the ureters. Normally, the color of the inner surface of the bladder is pale pink, smooth, with a pale network of blood vessels. If purulent deposits are found on the surface of the wall, they are washed off. Often, examination of the inner wall of the bladder is combined with chromocystoscopy.

Chromocystoscopy

It is performed to determine the excretory function of each kidney separately. In this case, the patient is injected intravenously with 2-3 ml of a 0.4% solution of the dye indigo carmine, which is excreted in the urine. Through a cystoscope, the release of this substance from the ureters is observed. Normally, a stream of greenish-blue, indigo carmine-stained urine should be released from each ureter 3-5 minutes after intravenous administration. If it is impossible to administer indigo carmine intravenously, it is administered intramuscularly, then the interval is 15-20 minutes. If the release of a dye by one of the ureters is delayed, it is assumed that the excretory function of one of the kidneys is impaired or that there is an obstruction to the outflow of urine from the kidney in the form of a stone, narrowing of the ureter, compression of the ureter, etc. A delay in the release of indigo carmine from the two ureters of more than 10-12 minutes suggests a disruption in the functioning of both kidneys. If necessary, catheterization of the ureters is performed. A catheter is inserted into each ureter separately. The procedure is performed to determine the patency of the ureters, the presence of obstacles to the flow of urine in the ureters, to collect urine for analysis separately from each ureter, i.e. separately from each kidney. The procedure is carried out carefully so as not to damage the ureter. Sometimes pressure in the ureters is also measured.

Pyeloscopy.

This is a method for studying the renal collecting system. It is performed using a special ureteral catheter with a fiber optic system. First, cystoscopy is performed to examine the bladder and ureteral openings, then the ureteral catheter is carefully inserted into the renal pelvis and the inner walls of the pelvis and calyces are examined. During this study, contrast agents are introduced into the pelvicaliceal system, followed by an X-ray examination. X-ray photographs determine the size of the cups and pelvis, the presence of pathological formations in them.

X-ray diagnostics.

X-ray research methods in urology are important, sometimes decisive. To conduct an x-ray examination, the patient must be prepared. It is necessary to empty the intestines thoroughly. Before the examination, a diet with a decrease in the amount of carbohydrates is prescribed for 2-3 days. A cleansing enema is performed the evening before the examination and in the morning on the day of the examination. Another appointment is possible activated carbon during the day and a laxative the night before. Thus, the patient must appear for examination on an empty stomach. To prevent excess gas formation, the patient is allowed to drink some strong tea with a cracker in the morning. Gases formed in the intestines do not allow you to see the clear contours of the kidneys and other organs.

Survey radiography.

This is usually the first X-ray examination performed on a urology patient. A survey X-ray image covers almost the entire urinary tract and allows one to judge the anatomical structure of the kidney and suggest the nature of the processes occurring in it and determine further research tactics. On an x-ray you can see shadows of stones in the kidneys, urinary tract, and bladder.

Excretory urography.

With this research method, the patient is intravenously injected with a contrast agent (Ultravist, Urografin, Hypek, Triambrast), which is then excreted by the kidneys. At certain points in time, images are taken that make it possible to obtain an image of the kidneys and urinary tract and evaluate their functional state.

Infusion urography.

This is the same excretory urography, but a larger amount of contrast agent is introduced using an intravenous drip. It allows you to get a clearer image of the renal collecting system.

Retrograde ureteropyelography.

In this case, the urinary tract is filled with a contrast agent through a catheter through the ureter. Ultravist and urografin are used. This study reveals even minor changes in the calyces, papillae, pelvis and ureters.

Antegrade pyeloureterography.

In this study, the contrast agent is administered by percutaneous lumbar puncture. It is used if other methods do not allow diagnosing kidney and urinary tract diseases. It allows you to clarify the condition of the upper urinary tract and its function.

A urologist is a specialist in diseases in the genitourinary area: kidneys and adrenal glands, bladder, genitals.

His responsibilities include diagnostic operations, treatment and further preventive measures to prevent the occurrence of urological diseases.

Diseases treated by a urologist

The following ailments are within the competence of the specialist:

ailments of the genital organs;
problems and diseases of the kidneys and adrenal glands;
inflammation of the urinary system – , ;
infertility;
neoplasms in the urinary tract and bladder;
injuries of the genitourinary system.

Classification

is a fairly broad area of medicine, which is divided into several narrower categories:

Andrology– treatment of pathologies of the reproductive system in men: inflammatory processes, congenital defects of the reproductive system.
Phthisiourology- treatment .
Urogenicology– treatment of urogynecological pathologies in women.
Gyriatric– one of the most complex and extensive areas in urology, the contingent of which are elderly patients.
Oncourology– treatment of oncological processes occurring in genitourinary system patient.
Pediatric urology. Specialists in this category consider problems in children with congenital diseases of the genitourinary system.
Emergency urology. Doctors of this group provide immediate surgical assistance to patients with problems of the genitourinary organs who contact him.

When to see a doctor

There are two types of urinary tract infections:

affecting the upper urinary tract: ureters and kidneys;
inflammatory processes developing in the lower urinary tract: bladder and.

Symptoms of infectious diseases in the upper urinary tract, for which a visit to a specialist is mandatory:

chills;
vomit;
elevated temperature;
nausea;
pain in the back or one side;
an increase in the size of the kidneys (it is difficult to determine this on your own).

Symptoms of infection in the lower urinary tract:

strong ;
prolonged discomfort in the abdominal area;
partial loss of urinary control;
the presence of blood in the urine, a strong change in its color;
strong sharp pains in the abdominal area;
fatigue.

The only way to determine the presence of an infection in the urinary tract is to be examined by a doctor.

After conducting a series of tests, he will be able to diagnose the disease and prescribe the necessary course of treatment.

Getting ready for the visit

Preparing for a visit to the urology department does not take much time. The process of preparing women is slightly different from the process of preparing men.

Preparing a man for examination

Before visiting a doctor, a man needs to have a hygienic toilet.

In addition, two days before visiting the doctor, refrain from sexual intercourse.

Since during the appointment the doctor examines the man's prostate gland by inserting fingers into the colon, it will be necessary to clean it with a cleansing enema.

It can be replaced by taking laxatives.

Woman preparing

A woman should prepare for a urological examination in the same way as before visiting a gynecologist. Women are examined on a gynecological chair.

When going to the appointment, you must take a diaper or sheet with you. One day before your appointment with a specialist, sexual intercourse should be excluded.

Douching should not be done immediately before the examination. Also, you cannot perform hygiene of the external genitalia using furatsilin, chlorhexyl or another disinfectant, since a medical specialist will need to take tests.

The use of disinfectant solutions will negatively affect the reliability of the results.

What does a child need?

Parents should understand that the child’s preparation depends on his age category, namely:

Appointment with a specialist

It should be understood that visiting a urologist is an ordinary matter. No terrible things happen; the procedure is absolutely painless. If you still have some anxiety before the visit, you can take soothing drops.

For all patients, the examination begins with a conversation. The specialist’s questions must be answered in detail. This will help make a more accurate diagnosis. If you have chronic diseases, you should tell your doctor about it.

The doctor examines the patient’s tests and outpatient card. If tests have not been taken beforehand, the doctor will definitely prescribe them.

The patient will undergo a number of tests directly in the doctor’s office. After the conversation, the doctor begins the examination.

Examination of men

In men, a specialist examines the skin around the penis, testicles, scrotum, and prostate. Since the prostate gland is located in the pelvis, it is examined through the man's rectum.

Women's Study

Urological examination of women is carried out on a gynecological chair. The purpose of such an examination is to examine the skin of the groin area, determine the condition of the urinary tract, kidneys and dryness of the vaginal mucosa. This can play an important role in determining the correct diagnosis.

Examination of the child

Just like with adults, an appointment with a pediatric urologist begins with collecting information. The child’s parents talk about his illnesses and health in general. Next, the doctor examines the genitals and examines the abdomen. The presence of parents during the examination is mandatory.

Additional procedures

After the examination, the doctor and patient discuss the further course of treatment, including a series of additional tests. They can be carried out on the day of the visit, or at the next visit. Additional tests include:

ultrasound diagnostics of the prostate, bladder and kidneys;
Analysis of urine;
blood analysis;

These procedures will help the doctor choose the appropriate course of treatment.

Finally

In order to promptly diagnose diseases in the genitourinary area, you should undergo examination at least twice a year. Initial stages any disease in urology is treated very successfully in a short time and does not cause serious complications.

For men over forty years old, visiting a urologist is simply a necessity. There is no need to be embarrassed or ashamed, because taking care of your health is a real adult act.

To prevent the occurrence of urological diseases, it is recommended to follow a number of basic rules:

exercise;
Healthy food;
exclude casual sexual contacts;
wear underwear that matches your size, give preference to underwear made from natural materials that provide good air exchange;
wear clothes appropriate for the weather, do not sit on a cold surface for a long time;
maintain personal hygiene;
be periodically examined by a urologist.

During an examination by a doctor, you should not feel discomfort, awkwardness, worry or fear. It’s better to endure everything for 15-20 minutes than to treat the disease in a more advanced stage in the future.