Urine contains pus and mucus, is alkaline in reaction, and there is marked frequency. The patient complains of pain above the pubes and deep in the permeum. A cystoscopic examination should not be made in this condition, but the urine should be examined bacteriologically to determine the cause. Chronic cystitis is characterized by moderate frequency, an alkaline urine with some pus and mucus; it usually occurs as a sequel to calculus, stricture, catheterism, growths in the bladder, or enlarged prostate. Vesical calculus is suspected if pain above the pubes or referred to the end of the penis is reported, along with frequency during the day and occasional slight hematuria. Diagnosis can be confirmed by a skiagram, sound use, or cystoscope. Tumors of the bladder first show their presence through hematuria; diagnosis is confirmed by finding portions of the growth in the urine and by cystoscopic examination. Malignant tumors cause more constant but less profuse hematuria with pain exaggerated by micturition. Fissures of the bladder result from ulceration due to tumours, typhoid ulcers, or local peritonitis, shown by passage of faecal matter and flatus per urethra. Examination of kidneys includes palpation, percussion, urine examination, X-rays for calculi, cystoscopy for ureteric orifices, and pyelography for mapping the pelvis and calyces. Hydronephrosis results from partial obstruction to urine passage; diagnosis confirmed by variable size of tumour and pyelography showing distension of renal pelvis with greater absorption of distended calyces into a common cavity. Pyonephrosis occurs when urine is primarily infected with organisms and there is partial obstruction, confirmed by withdrawal or passage of purulent urine from the affected side.
Key Takeaways
- Cystitis is characterized by alkaline urine with pus and mucus, often following bladder issues.
- Vesical calculus diagnosis involves pain above the pubes or referred to the penis end, frequency during day, and occasional slight hematuria.
- Tumors of the bladder are diagnosed through hematuria and cystoscopic examination.
Practical Tips
- Use urine analysis to determine the presence of pus and mucus for diagnosing cystitis.
- Confirm vesical calculus with a skiagram or cystoscopy if symptoms suggest it.
- Cystoscopic examination is crucial in identifying tumors, their size, and extent within the bladder.
Warnings & Risks
- Avoid performing cystoscopic examinations when urine contains shreds of bladder mucous membrane in quantities of pus.
- Be cautious not to mistake resistance from a tumor or pelvic bones for the audible 'click' of a sound against a stone during kidney examination.
Modern Application
While many diagnostic methods have advanced, understanding historical techniques like those described here remains valuable. They provide foundational knowledge on recognizing symptoms and conditions that are still relevant today. Modern imaging and lab tests refine these diagnoses but the principles remain crucial for initial assessment.
Frequently Asked Questions
Q: What is a key symptom of vesical calculus?
A key symptom of vesical calculus includes pain felt above the pubes or referred to the end of the penis, with frequency most marked during the day and occasional slight hematuria.
Q: How can hydronephrosis be diagnosed?
Hydronephrosis is diagnosed by recognizing a fluid renal tumour in one or both loins. The cause may be clear from the case history, or complete examination of the urinary tract may reveal causative affections.
Q: What distinguishes pyonephrosis from hydronephrosis?
Pyonephrosis is distinguished by the presence of pus in the distended kidney and signs of chronic septic absorption such as rigors, fever, local pain and tenderness, anemia, wasting, and leucocytosis.