Urology deals with the treatment of diseases of the genitourinary system in men, women and children. The first stage of diagnosis. It is laboratory and instrumentalnoy. Consider the main laboratory diagnostic methods in urology.
- CLINICAL (COMMON) URINALYSIS
- SOME OF THE MOST IMPORTANT INDICATORS OF THE GENERAL ANALYSIS OF URINE
- EXAMINATION OF THE URINE SEDIMENT
- BACTERIOLOGICAL ANALYSIS
- CLINICAL (GENERAL) BLOOD TEST
- BIOCHEMICAL ANALYSIS OF BLOOD, BLOOD SUGAR, HORMONES, ETC.
- Rheumatology test
- FUNCTIONAL KIDNEY TESTS
Urolithiasis, pyelonephritis, cystitis, renal colic, and dozens of other diseases, the competence of urology. Indications for referral to a specialist-a urologist varied: urinary incontinence, pain when urinating, problems in sexual relationships and reduced libido in men, lower back pain, swelling.
And since the spectrum of urological problems broad enough, the first thing that begins the conversation of the urologist with the patient, it is the purpose of the respective analyses. Their results give the user a General understanding of the problem and are the main reference for the appointment of proper treatment. What laboratory tests appoints the urologist in the first place?
Clinical (common) urinalysis
The normal daily intake of urine person – 1-1,5 liters. For problems of the genitourinary system indicates a greater or smaller quantity of urine. In the analysis pay attention to its color, acidity, determine the content of substances. Thus, increase in white blood cells tells about chronic or acute inflammation, increase of white blood cells can be due to the admixture of secretions from the vulva, when they are inflammation.
Method of sampling: collect a morning urine sample because it is considered the most informative (the kidneys are working in a quiet mode without excessive water load). In the morning portion more likely to see the presence of bacteria, salts, etc.
Some of the most important indicators of the General analysis of urine
When conducting urinalysis pay attention to the following indicators:
- The color and transparency. The normal color of the urine from pale yellow to dark yellow depending on the concentration of salts. It is noteworthy that to change the color of urine can some drugs. For example, in the orange color stains the urine phenazopyridine. Receiving nitrofurantoin may color the urine brown, and metronidazole red-brown. Red urine may indicate impurities in her blood (hematuria). It is a pathological condition which requires a diagnosis. It should be noted that to be painted in red color urine can and after eating beets. It is believed that normal urine should be transparent. If urine is cloudy, most often this is due to the impurities of phosphates and urates. In some cases, cloudy urine indicates leukocyturia.
- the pH of urine. Hydrogen indicator (pH) of urine varies with a number of diseases. For example, in the presence of urate stones pH rarely exceeds 6.5, but with calcium stones, the pH is always greater than 6. It is noteworthy that urinary tract infections caused by bacteria, the pH often increases because of bacterial infection degradable lactic acid.
- Smell. In fact, the smell of urine is of less diagnostic value, because many different foods contain certain essential oils and other components that can give the urine a particular odor. At the same time, in cystitis the urine has an ammonia smell; when infected with E. coli putrid; when ketonuria smell of acetone; if trimethylaminuria smell of rotting fish.
- Protein. The normal concentration of the protein should not be more than 0,033 g/l. If the level of protein in the urine exceeds this level, then I suspect a variety of inflammatory pathology of the kidneys and urinary tract. However, it should be noted that increased protein in the urine is marked by elevated physical exercise, heavy sweating and even when you walk long.
- Sugar. Normal level of sugar in the urine should not exceed 0.8 mmol/L. If the concentration of glucose exceeds this figure, then, as a rule, this occurs in diabetes. In addition, elevated sugar in the urine detected with excessive consumption of sweets, disorders of the kidneys, in acute pancreatitis, with elevated adrenaline levels, Cushing’s syndrome, and during pregnancy.
- Bilirubin. This is a bile pigment which in norm should not be in the urine. Bilirubin is excreted in the feces through the intestine, and if the level of bilirubin in the blood exceeds the norm, the kidneys take on the burden of excretion of this metabolite from the body. Generally, the high content of this pigment in the urine indicates liver disease, hepatitis, cirrhosis, hepatic failure, cholelithiasis and other diseases. The reason for high bilirubin levels can become a massive destruction of red blood cells hemolytic disease, malaria, sickle cell anemia, hemolysis and other pathologies.
- Ketone bodies. Normal ketone bodies (acetone) must not be in the urine. If they are present in the urine, it usually indicates violations of metabolic processes in the body and pathologies such as diabetes mellitus, acute pancreatitis, thyrotoxicosis, and others. Ketone bodies in the urine are formed and in the process of starvation, alcohol intoxication, excessive consumption of protein and fatty foods, as well as in pregnant women during toxicosis.
Examination of the urine sediment
Urine sediment is divided into organized (it includes elements of organic origin erythrocytes, leukocytes, epithelial cells, cylinders and other) and disorganized crystals, amorphous salts and other.
- The red blood cells. The normal number of red blood cells in the urine is 0-3 to 0-1 women and men in the field of view during microscopic examination. As a rule, such indicators have been found in excretion of up to 2 million RBCs per day. If the number of red blood cells exceeds a specified number, it is called hematuria. If this changes the color of the urine (it turns red), it is called gross hematuria. If color change does not occur, but the number of red blood cells exceeds 2 million a day, it is microhematuria. The urine sediment red blood cells can be unmodified (those that contain hemoglobin) and changed (without hemoglobin, which is leached). Unmodified erythrocytes, as a rule, is characteristic of lesions of the urinary tract (cystitis, urethritis, passing the stone). The appearance in the urine leached erythrocytes is of great diagnostic value, since they are most often renal in origin and occur in glomerulonephritis, tuberculosis and other diseases of the kidneys. To determine the source of hematuria use the so-called trehstakannoy trial. When bleeding from the urethra hematuria is highest in the first portions (unchanged red cells) of the urinary bladder in the last portion (unmodified erythrocytes). Other sources of bleeding red blood cells are distributed evenly in all three portions (it is leached erythrocytes).
- The white blood cells. In the urine of healthy person contains small amounts of leukocytes. For men the norm is 0-3, and for women 0-6 leukocytes in the field of view during microscopic examination. In the case of increasing the number of leukocytes in the urine is a suspected inflammatory process, especially when it is also noted bacteriuria and clinical symptoms of the inflammatory process in the urinary tract.
- Epithelial cells. Cells of epithelial tissues in the urine almost always. In the field of view microscopic study notes, usually up to 10 epithelial cells. If their number is significantly more, it may indicate the presence of a lesion in a particular division of the urinary system where urine and enter these cells. The epithelium is of different types and the cells are of different origin. So, the squamous cells get into the urine from the urethra, vagina, and the presence of these cells in urine is of particular value in the diagnosis of diseases. As for cells of transitional epithelium, then they vysilani the mucous membranes of the bladder, pelvis, ureter, pelvis, large ducts of the prostate, and if these cells in the urine is noticeably more than normal, this indicates the presence of kidney stones, tumors, inflammatory processes and other pathologies. When lesions of the renal parenchyma, fever, infectious diseases, and blood circulation in the urine detected cells of renal epithelium.
- Cylinders. The cylinder is a protein coagulated in the lumen of the renal tubules and that includes your matrix any content of the lumen of the tubules. The cylinders take the form of the tubules themselves. Normal in the urine sample taken for General analysis, cylinders are missing. The appearance of the cylinders is a symptom of kidney damage, and this condition is called cylindruria.
- Bacteria. Normal urine from a healthy person is sterile. However, the lower portion of the urethra during urination in urine get germs. If in urine there are bacteria in the background of clinical symptoms, this usually indicates the presence of infections of the genitourinary system. While bacteriuria can be asymptomatic.
- Yeast fungi. As a rule, we are talking about the yeast of the genus Candida, which often grow in irrational antibiotic therapy.
- Parasites. In the urine can be detected in some parasitic organisms, for example, Schistosoma, hydatid bladder, intestinal price, eggs, pinworms and others.
As a rule, identify bacteria using bacteriological tests. However, recent years increasingly for the detection of bacteria, viruses and yeasts using the technique of polymerase chain reaction. This is a unique tool in molecular biology that allows you to identify areas of DNA or RNA that are characteristic only for a certain type of microorganisms. If such microorganism in the urine not, the test shows a negative result. This is a sensitive method for the determination of specific DNA or RNA, which can detect them even with tiny concentrations of just a few molecules!
Clinical (General) blood test
Urological diseases a blood test is needed to identify the content of leukocytes and leukocyte formula, number of erythrocytes, hemoglobin, platelets, prothrombin, increased erythrocyte sedimentation rate (ESR). Any deviation from the norm of each component of blood is estimated from the position of age norms and gender, which is especially important when testing children.
Method of sampling: blood sampling is performed from the ring finger. To avoid the possibility of falsely high numbers of white blood cells before blood delivery it is impossible to eat.
Biochemical analysis of blood, blood sugar, hormones etc.
Necessary for the determination of neonatal bilirubin, total protein and its fractions, cholesterol, glucose. Deviation from normal values in either direction indicates the presence of diseases of the genitourinary system. Aimed at identifying the content of urea and creatinine in the serum of the result obtained gives an indication of the total renal function.
In various laboratories, there are differences in units of measurement, so the figures obtained need to be the correct interpretation of a professional doctor. It needs to focus not only on research data, but also on complaints of the patient and these symptoms.
Method of sampling: blood sampling is performed in the morning from Vienna and only on an empty stomach. After-meal blood sugar always goes up in addition can occur in hemolysis of the blood in vitro due to the presence of a dispersion of fat after a meal. Blood some types hormones pass at 7-8 am, when reaching the peak of its physiological concentration.
This set of analyses aimed at identifying systemic disease of an autoimmune nature, among which and rheumatic pathology. Also rheumatology test detect cancer at initial stages and inflammatory processes in the body. The complex includes the following parameters: total protein and albumin, C-reactive protein (CRP), circulating immune complexes (CIC), rheumafaktor (RF), antistreptolysin-O (ASL-O), and uric acid. A deviation from the norm of any of the indicators may indicate progressive disease, and not only from the sphere of urology.
For example, elevated blood levels of C-reactive protein can cause a number of inflammatory processes: all inflammatory processes, including fungal and bacterial; rheumatism, rheumatoid arthritis, cancer of the prostate, acute myocardial infarction.
Method of sampling: blood samples for analysis in rheumatology test is carried out on an empty stomach between the last meal and taking blood must pass 8-12 hours. You can drink the water. Tea, juice, and coffee is not acceptable.
Functional kidney tests
The purpose of the analysis to determine the functional state of the kidneys, which are the main body displays the body of creatinine, urea, uric acid, indican, purine bases. These substances together constitute the residual (labelcopy) nitrogen. The norm of its content in the serum of 20-40 mg% and with severe renal failure its concentration can reach 200-300 mg%.
Also about the condition of the kidneys, says the creatinine level: in a healthy person, its content is in the range of 1-2 mg%, in renal failure can reach 8-10 mg% or more.
Method of sampling: Urine was collected over a period of time (1 or 2 hours) separately for each kidney by catheterization of the ureters.
In the case when these tests do not provide a complete picture of the patient’s condition, the specialist may prescribe additional study. It can be these tests: the prostate specific antigen, semen, scrapings from the urethra for STIs by PCR in men, and several others.
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General analysis of blood
Bacteriological blood cultures