Papillary tip

PHYSIOLOGY OF VOIDING

Increase in volume at a pressure lower than that of the

bladder neck and urethra.
Emptying is dependent on the integrity of a complex
neuromuscular network that causes relaxation of the
urethral sphincter a few milliseconds before the onset of
the detrusor (bladder muscle) contraction.
The voluntary control of micturition depends on the neural
connections between the cerebral cortex and the
brainstem.
DYSURIA
Pain, tingling or burning in the perineum during urination
or just after urination (terminal dysuria).

Dysuria is caused by :

Inflammation involving the urethra and bladder trigone, in which pain

receptors are triggered by the passage of urine through the urethra
(urethritis, cystitis)

Inflammation involving the vaginal labia, in which pain receptors are

triggered when a stream of urine strikes the inflamed labia during
urination (vaginitis)

Inflammation or irritative condition involving the prostate (prostatitis)

URINARY FREQUENCY (POLAKISURIA)

Frequent urination of small volume

Polyuria : frequent urination of large volume
( > 3 L/day).

1. Urethritis
2. Cystitis
3. Prostatitis
ENURESIS
The involuntary leakage of urine (diurnal = daytime
or nocturnal = nighttime)

1. Primary : Who have never achieved a satisfactory period of

dryness.

2. Secondary : Who have had a period of dryness for at least six

months.
Important causes of secondary nocturnal enuresis include
emotional disturbances, urinary tract infections or malformations,
cauda equina lesions, epilepsy, sleep apnea, and certain
medications.
INCONTINENCE
Incontinence is a condition where involuntary loss of urine is
objectively demonstrated.
I. Transient urinary incontinence

1. Effecting the lower urinary tract

2. Drug side effects
3. Increased urine production
4. Impaired ability to reach a toilet

II. Established urinary incontinence :

1. Stress incontinence, denotes involuntary loss of urine with physical exercise (coughing,
sneezing, sports, sexual activity).
2. Urge incontinence is an involuntary loss of urine associated with a strong desire to void.
3. Overflow incontinence is an involuntary loss of urine when the elevation of intravesical
pressure with bladder overfilling or distention exceeds the maximal urethral pressure.
Oliguria

Refers to a 24-h urine output of <500 mL

Accompany any cause of acute renal failure

Anuria is the complete absence of urine formation.
Can be caused by

1. Total urinary tract obstruction

2. Total renal artery or vein occlusion
3. Shock (manifested by severe hypotension and intense
renal vasoconstriction).
4. Cortical necrosis
5. ATN
6. Rapidly progressive glomerulonephritis
Polyuria
Is defined as a urine output exceeding 3 L/day.
Caused by :
1. Glucose-induced osmotic diuresis in uncontrolled diabetes mellitus.
2. Primary polydipsia (psychogenic polydipsia) is characterized by a primary increase in
water intake. This disorder is most often seen in anxious, middle-aged women and in
patients with psychiatric illnesses, including those taking a phenothiazine which can
lead to the sensation of a dry mouth.
3. Central diabetes insipidus (DI) is associated with deficient secretion of antidiuretic
hormone (ADH). This condition is most often idiopathic (possibly due to autoimmune
injury to the ADH-producing cells) or induced by trauma, pituitary surgery, or hypoxic or
ischemic encephalopathy.
4. Nephrogenic diabetes insipidus is characterized by normal ADH secretion but varying
degrees of renal resistance to its water-retaining effect (chronic lithium use,
hypercalcemia).
NOCTURIA
Frequent urination at night.
1. Benign prostate hyperplasia (BPH) due to decreased sensation
of bladder fullness leads to incomplete emptying and
overdistention of the bladder.
2. Interstitial cystitis : Chronic bladder disorder.
3. Tubulointerstitial diseases : Affecting predominantly medullary
and papillary structures may exhibit concentrating defects.
4. Diabetes insipidus, diabetes mellitus.
5. Chronic Renal Failure
 HEMATURIA

I. GROSS HEMATURIA

Red or Brown Urine

1. Red supernatant myoglobulinuria, hemoglobinuria

2. Red sediment hematuria

II. MICROSCOPIC HEMATURIA

Clear Urine

More than 2 RBC per high power field in a spun urine sediment
THREE TUBE TEST
Three different urine specimens of roughly equal volume :

I. The first few milliliter

Urethral lesion
Equivalent degrees of
hematuria :
II. Mid-stream sample
Renal, Ureteric,
Diffuse bladder lesion.

III. The last few milliliter

Lesion near the bladder trigone
RED CELL CAST
DYSMORPHIC RED CELLS
DYSMORPHIC RED CELLS
 Distinguishing Extraglom. from Glomerular Hematuria

URINE EXTRA GLOMERULAR

GLOMERULAR
Color Red or Pink Red, Coca-Cola
Clots May be present Absent
Proteinuria < 500 mg/day > 500 mg/day
RBC Normal Dysmorphic
Morphology
RBC Casts Absent May be present
CHYLURIA
Lymphatic fluid in the urine.

Rupture of the renal lymphatics.

Filariasis: Obstruction of the retroperitoneal lymphatics

leads to the increased of renal lymphatic
pressure.
Pyuria.
The presence of at least eight thousand leukocytes per mL of
uncentrifuged urine, which corresponds to two to five leukocytes
per high-power field in a centrifuged sediment.
UTI : A significant number of leukocytes (>10/L or
10,000/mL) should be presented in truly infected patients.
Determination of leukocyte counts per high- power field is
not sufficiently accurate and that the use of white cell counting is
preferred in the diagnosis of UTI. The presence of bacteria in
the absence of pyuria, especially when various strains are
found, is usually due to contamination during sampling.