Diagnostic Tests for Bladder Cancer
Bladder Cancer: Diagnostic Tests
The list of diagnostic tests
mentioned in various sources as
used in the diagnosis of Bladder Cancer
includes:
Bladder Cancer Tests: Book Excerpts
Home Diagnostic Testing
These home medical tests may be relevant to Bladder Cancer:
- Colon & Rectal Cancer: Home Testing
- Bladder & Urinary Health: Home Testing:
- Prostate Health: Home Testing:
- Kidney Health: Home Testing:
- Cancer-Related Home Testing:
Bladder Cancer Diagnosis: Book Excerpts
Tests and diagnosis discussion for Bladder Cancer:
If a patient has symptoms that suggest bladder cancer, the
doctor may check general signs of health and may order lab
tests. The person may have one or more of the following
procedures:
-
Physical exam -- The doctor feels the abdomen and
pelvis
for tumors. The physical exam may include a rectal
or vaginal
exam.
-
Urine tests -- The laboratory checks the urine for
blood, cancer cells, and other signs of disease.
-
Intravenous
pyelogram -- The doctor injects dye into a blood
vessel. The dye collects in the urine, making the bladder
show up on x-rays .
-
Cystoscopy
-- The doctor uses a thin, lighted tube (cystoscope )
to look directly into the bladder. The doctor inserts the
cystoscope into the bladder through the urethra to examine
the lining of the bladder. The patient may need anesthesia
for this procedure.
The doctor can remove samples of tissue with the
cystoscope. A pathologist
then examines the tissue under a microscope. The removal of
tissue to look for cancer cells is called a biopsy .
In many cases, a biopsy is the only sure way to tell whether
cancer is present. For a small number of patients, the doctor
removes the entire cancerous area during the biopsy. For these
patients, bladder cancer is diagnosed and treated in a single
procedure.
|
A patient who needs a biopsy may want to ask the
doctor some of the following questions:
-
Why do I need to have a biopsy?
-
How long will it take? Will I be awake? Will it
hurt?
-
How soon will I know the results?
-
Are there any risks? What are the chances of
infection or bleeding after the biopsy?
-
If I do have cancer, who will talk with me about
treatment? When? |
(Source: excerpt from
What You Need To Know About Bladder Cancer: NCI)
Diagnostic Tests for Bladder Cancer: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the diagnostic tests for Bladder Cancer.
DYSURIA:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
Obviously, a urinalysis and Gram stain of the unspun urine should be done in all cases. If this is positive, treatment can be initiated. Urine cultures are only necessary for resistant or repeated episodes. I also recommend a urethral smear and a vaginal smear and culture if sufficient material can be obtained. This may mean massaging the prostate for an adequate specimen. Even four white cells per high-powered field on a urethral smear probably indicates urethritis. Cultures for both gonorrhea and chlamydia should be done. In persistent cases of dysuria, an intravenous pyelogram and a cystoscopy must be done. A urologist needs to be consulted before ordering these tests. Blood cultures should be done in cases of acute pyelonephritis. Cultures for anaerobic bacilli and tuberculosis may be necessary in persistent pyuria. It should go without saying that a rectal and vaginal examination should be done in all cases. However, this is frequently neglected.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Bladder distention:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If distention isn't severe, begin by reviewing the patient's voiding patterns. Find out the time and amount of the patient's last voiding and the amount of fluid consumed since then. Ask if he has difficulty urinating. Does he use Valsalva's or Credé's maneuver to initiate urination? Does he urinate with urgency or without warning? Is urination painful or irritating? Ask about the force and continuity of his urine stream and whether he feels that his bladder is empty after voiding.
Explore the patient's history of urinary tract obstruction or infections; venereal disease; neurologic, intestinal, or pelvic surgery; lower abdominal or urinary tract trauma; and systemic or neurologic disorders. Note his drug history, including his use of over-the-counter drugs.
Take the patient's vital signs, and percuss and palpate the bladder. (Remember that if the bladder is empty, it can't be palpated through the abdominal wall.) Inspect the urethral meatus, and measure its diameter. Describe the appearance and amount of any discharge. Finally, test for perineal sensation and anal sphincter tone; in male patients, digitally examine the prostate gland.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Urethral discharge:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Ask the patient when he first noticed the discharge, and have him describe its color, consistency, and quantity. Does he experience pain or burning on urination? Does he have difficulty initiating a urine stream? Does he experience urinary frequency? Ask the patient about other associated signs and symptoms, such as fever, chills, and perineal fullness. Explore his history for prostate problems, sexually transmitted disease, or urinary tract infection. Ask the patient if he has had recent sexual contacts or a new sexual partner.
Inspect the patient’s urethral meatus for inflammation and swelling. Using proper technique, obtain a culture specimen. (See Collecting a urethral discharge specimen.) Then obtain a urine sample for urinalysis, culture, and possibly a three-glass urine sample. (See Performing the three-glass urine test, page 608.) In the male patient, the prostate gland may have to be palpated.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Urinary hesitancy:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Ask the patient when he first noticed hesitancy and if he’s ever had the problem before. Ask about other urinary problems, especially reduced force or interruption of the urine stream. Ask if he’s ever been treated for a prostate problem or urinary tract infection or obstruction. Obtain a drug history.
Inspect the patient’s urethral meatus for inflammation, discharge, and other abnormalities. Examine the anal sphincter and test sensation in the perineum. Obtain a clean-catch sample for urinalysis and culture. In a male patient, the prostate gland requires palpation. A female patient requires a gynecologic examination.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Urinary urgency:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Ask the patient about the onset of urinary urgency and whether he’s ever experienced it before. Ask about other urologic symptoms, such as dysuria and cloudy urine. Also ask about neurologic symptoms, such as paresthesia. Examine his medical history for recurrent or chronic UTIs or for surgery or procedures involving the urinary tract.
Obtain a clean-catch sample for urinalysis and culture. Note urine character, color, and odor, and use a reagent strip to test for pH, glucose, and blood. Then palpate the suprapubic area and both flanks for distention and tenderness. If the patient’s history or symptoms suggest neurologic dysfunction, perform a neurologic examination.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Bladder distention:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If distention isn’t severe, begin by reviewing the patient’s voiding patterns. Find out the time and amount of the patient’s last voiding and the amount of fluid consumed since then. Ask if he has difficulty urinating. Does he use Valsalva’s or Credé’s maneuver to initiate urination? Does he urinate with urgency or without warning? Is urination painful or irritating? Ask about the force and continuity of his urine stream and whether he feels that his bladder is empty after voiding.
Explore the patient’s history of urinary tract obstruction or infections; venereal disease; neurologic, intestinal, or pelvic surgery; lower abdominal or urinary tract trauma; and systemic or neurologic disorders. Ask about his drug history, including his use of over-the-counter drugs.
Take the patient’s vital signs, and percuss and palpate the bladder. (Remember that if the bladder is empty, it can’t be palpated through the abdominal wall.) Inspect the urethral meatus, and measure its diameter. Describe the appearance and amount of any discharge. Finally, test for perineal sensation and anal sphincter tone; in male patients, digitally examine the prostate gland.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Dysuria:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient complains of dysuria, have him describe its severity and location. When did he first notice it? Did anything precipitate it? Does anything aggravate or alleviate it?
Next, ask about previous urinary or genital tract infections. Has the patient recently undergone an invasive procedure, such as cystoscopy or urethral dilatation, or had a urinary catheter inserted? Also, ask if he has a history of intestinal disease. Ask the female patient about menstrual disorders and use of products that irritate the urinary tract, such as bubble bath salts, feminine deodorants, contraceptive gels, or perineal lotions. Also ask her about vaginal discharge or pruritus.
During the physical examination, inspect the urethral meatus for discharge, irritation, or other abnormalities. A pelvic or rectal examination may be necessary.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Urethral discharge:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Ask the patient when he first noticed the discharge, and have him describe its color, consistency, and quantity. Does he experience pain or burning on urination? Does he have difficulty initiating a urine stream? Does he experience urinary frequency? Ask the patient about other associated signs and symptoms, such as fever, chills, and perineal fullness. Explore his history for prostate problems, sexually transmitted disease, or urinary tract infection. Ask the patient if he has had recent sexual contacts or a new sexual partner.
Inspect the patient’s urethral meatus for inflammation and swelling. Using proper technique, obtain a culture specimen. (See Collecting a urethral discharge specimen, page 778.) Then obtain a urine specimen for urinalysis, culture and, possibly,, a three-glass urine test. (See How to perform the three-glass urine test.) Palpation of the male patient’s prostate gland may be necessary.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Urinary hesitancy:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Ask the patient when he first noticed hesitancy and if he has ever had the problem before. Ask about other urinary problems, especially reduced force or interruption of the urine stream. Ask if he has ever been treated for a prostate problem, a UTI, or a urinary tract obstruction. Obtain a drug history.
Inspect the patient’s urethral meatus for inflammation, discharge, and other abnormalities. Examine the anal sphincter and test sensation in the perineum. Obtain a clean-catch urine specimen for urinalysis and culture and sensitivity tests. A male patient requires prostate gland palpation. A female patient requires a gynecologic examination.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Urinary urgency:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Ask the patient about the onset of urinary urgency and whether he’s ever experienced it before. Ask about other urologic symptoms, such as dysuria and cloudy urine. Also ask about neurologic symptoms such as paresthesia. Explore his medical history for recurrent or chronic UTIs and for surgery or procedures involving the urinary tract.
Obtain a clean-catch urine specimen for urinalysis and culture and sensitivity tests. Note urine character, color, and odor, and use a reagent strip to test for pH, glucose, and blood. Then palpate the suprapubic area and both flanks for distention and tenderness. If the patient’s history or symptoms suggest neurologic dysfunction, perform a neurologic examination.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Dysuria:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
The physical examination is essential in narrowing the diagnosis. It helps to rule out pyelonephritis and other systemic infections in patients with dysuria, allowing the physician to search for the less severe causes. Fever, flank tenderness, and suprapubic tenderness are useful findings. A careful genital examination (speculum in women, foreskin retraction and prostate examination in uncircumcised men) can point to specific localized causes. The genital examination also allows collection of samples for testing. Attention to localized lesions (e.g., HSV lesions), discharge (yeast, bacterial vaginosis, gonorrhea, and trichomoniasis) and trauma also help make the diagnosis.
Testing
The history and physical examination usually suggests which tests are most appropriate. A urinalysis is the most common study performed. It is important also to gather samples for gonorrhea, chlamydia, and HSV, using wet preparations and potassium hydroxide testing when appropriate. Rapid tests on urine samples for the detection of bacteria and leukocytes can be done while patients wait. Direct microscopic examination of the urine can isolate bacteria and leukocytes. Rapid dipstick biochemical tests can isolate leukoesterase and nitrate, which are consistent with leukocytes and urea-fixing bacteria. Urine cultures require overnight to 48 hours of incubation to detect specific bacterial pathogens. Pyuria (defined as white blood cell count >10/mm3 of urine) is seen in more than 95% of patients with acute UTI but is uncommon in the absence of infection. Pyuria without bacteriuria suggests a chlamydia infection. Urine dipstick testing is generally less sensitive for pyuria than microscopic examination, but it is more convenient (5).
Diagnostic assessment
Given the many causes of dysuria, an accurate diagnosis can be difficult without a thorough approach to each patient. Because most causes have other associated symptoms and findings, a diagnosis can usually be made with a carefully taken history, a focused physical examination, and appropriate laboratory tests. Separating an uncomplicated UTI or STD from the more serious pyelonephritis and other possible diagnoses is the challenge in these patients.
References
1. Carlson KJ, Mulley AG. Management of acute dysuria. Ann Intern Med 1985;102:
244–249.
2. Johnson JR, Stamm WE. Diagnosis and treatment of acute urinary tract infections. Infect Dis Clin North Am 1987;4(1):773–791.
3. Ainsworth JG, Weaver T, Murphy S, Renton A. General practitioners’ immediate management of men presenting with urethral symptoms. Genitourin Med 1996;72(6):427–430.
4. Roberts RO, Lieber MM, Rhodes R, Girman CJ, Bostwick DG, Jacobsen SJ. Prevalence of a physician-assigned diagnosis of prostatitis: the Olmsted County Study of Urinary Symptoms and Health Status Among Men. Urology 1998;51(4):578–584.
5. Kurowiski K. The woman with dysuria. Am Fam Physician 1998;57(9):2155–2164, 2169–2170.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Urethral Discharge:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A. Focused physical examination (PE) should include vital signs, and urologic and rectal examination. In men, this should include examination of the penis, perimeatal region (for evidence of erythema), urethral meatus, scrotum, testicles, epididymis, prostate, and perianal and inguinal region. Stains present on the patient’s underwear may indicate the characteristics of the discharge, which is particularly useful in a patient who has urinated shortly before examination. Recent micturition can eliminate much inflammatory discharge. Sometimes it is necessary to examine the patient in the morning before voiding to enhance the diagnosis. Perform a complete gynecologic and urologic examination in women.
B. Abdomen. Completely examine the abdomen to rule out intraabdominal pathology, including masses and inflammation, obstruction, or distention of organs.
C. Additional physical examination should include the skin and other systems, as needed. If a patient is suspected of gonococcal infection, it may be essential to check the patient’s joints, skin, throat, eye and other organs.
Testing
A. UD sample collection. Proper collection and handling of UD sample is essential for the diagnosis. When the discharge is not spontaneous, the urethra should be gently stripped. This is best accomplished by grasping the penis firmly between the thumb and forefinger with the thumb pressing on the ventral surface. Then move the hand distally, compressing the urethra. This maneuver may express a small amount of discharge. The urethral meatus can be gently spread and if no urethral discharge is expressed, a calcium-alginate urethral (or nasopharyngeal) swab should be inserted at least 2 cm into the urethra and the discharge collected. The use of cotton-tipped swabs is contraindicated because their large size makes the insertion extremely uncomfortable and the cotton fibers can inhibit the growth of certain fastidious organisms (4).
B. Clinical laboratory investigations
1. UD Gram’s stain. The test involves staining the UD with Gram’s stain and examining it under a microscope. The presence of polymorphs with intracellular diplococci is diagnostic of GC. Polymorphs without the intracellular diplococci are suggestive of NGC disease. Few or no polymorphs are suggestive of other causes. The Gram’s stain is quite accurate for men but it is not very sensitive for women (50%).
2. UD culture is essential to identify specific organisms. Other useful tests are:
a. Detection of bacterial DNA by polymerase chain reaction (PCR)
b. DNA probes
c. Direct monoclonal testing and enzyme-linked assays. These tests have a high sensitivity and specificity. Cultures of throat, rectum, and sometimes conjunctivae may be required to establish the diagnosis.
3. UD wet preparation is done to establish the diagnosis of trichomoniasis, candidiasis, and some viral and bacterial infections.
4. Urine analysis and urine cultures are essential for the diagnosis of urinary infections. Collect the urine specimen [as described by Stamey (5)] with four sterile containers (before and after prostatic massage), which is useful to identify the site of infection in men.
5. Urinary leukocyte esterase is a useful screening test for chlamydial and GC infections in asymptomatic men. The usefulness of other neutrophil enzyme (elastace, myeloperoxidase) studies of urine have been reported.
6. Blood studies, including a complete blood count, serum chemistry profile, serologic test for syphilis, blood test for human immunodeficiency virus infection, and immunologic studies, may be required in an appropriate clinical setting.
C. Diagnostic imaging. Urethrogram, urologic diagnostic studies, and pelvic, vaginal, and rectal ultrasound studies are indicated in some clinical conditions.
D. Diagnostic procedures. Children and elderly patients may need to be examined under anesthesia to evaluate UD. Anoscopy is done for patients who have had anal intercourse or for those with anal and rectal symptoms. Cystourethroscopy and laparoscopy are also useful in certain conditions.
Diagnostic assessment
A. Special concerns. Neisseria gonorrhoeae and C. trachomatis infections are reportable to State Health Departments and a specific diagnosis is essential. UD secondary to STD involves many psychosocial and medicolegal implications to the patient, his or her partner, their families, and society. Sexual partners can be traced, tested, and treated. In children with UD, sexual abuse may be suspected. Pregnant women with gonococcal infection or chlamydia can infect the infant at birth (ophthalmia neonatorum).
B. Complications following UD and urethritis. Some of the complications following UD are postgonococcal urethritis, pelvic inflammatory disease (in women) and infertility, perihepatitis, chronic pelvic pain (Chapter 11.3), adhesions of the intraabdominal organs, obstructions in the gastrointestinal and genitourinary tracts, chronic urethritis, periurethral abscess, fistula, prostatitis, epididymitis, orchitis, urethral syndrome, psychosexual problems, and Reiter’s syndrome.
References
1. Centers for Disease Control and Prevention. National Center for HIV, STD, and TB Prevention. Sexually Transmitted Disease Surveillance. Atlanta: CDC, 1997.
2. American Social Health Association. Sexually transmitted diseases in America: how many cases and at what cost? Menlo Park, CA: Kaiser Family Foundation, 1998.
3. Institute of Medicine. Committee on Prevention and Control of STD. Eng TR, Butler WT, eds. The hidden epidemic: confronting STD. Washington, DC: National Academy Press, 1997.
4. Williams R, Kreder KJ Jr. Examination of UD and vaginal exudates. In: Tanagho EA, McAninch JW, eds. Smith’s general urology, 14th ed. Norwalk, CT: Appleton & Lange, 1995.
5. Stamey TA. Diagnosis, localization, and classification of urinary infections. In: Stamey TA, ed. Pathogenesis and treatment of urinary tract infections. Baltimore: Williams & Wilkins, 1980:262.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Dysuria:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
In women, ask whether burning is internal (urinary tract infection) or external (vaginitis). Women who have had a prior urinary tract infection are more than 90% accurate in identifying recurrences.
The urine dipstick is a useful diagnostic adjunct for determining the presence of pyuria. Leukocyte esterase and nitrate tests are complementary, increasing the overall sensitivity.
Always consider a sexually transmitted infection, especially with minimal pyuria and/or a new sexual partner.
The combination of symptoms of dysuria and frequency without vaginal discharge or irritation has an overall likelihood ratio of 24.6 in predicting acute urinary tract infection.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Bladder distention:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Take the patient’s vital signs, and percuss and palpate the bladder. (Remember that if the bladder is empty, it can’t be palpated through the abdominal wall.) Inspect the urethral meatus, and measure its diameter. Describe the appearance and amount of any discharge. Finally, test for perineal sensation and anal sphincter tone; in male patients, digitally examine the prostate gland.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Dysuria:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Ask the patient to void before beginning your examination. Inspect the urethral meatus for discharge, irritation, and other abnormalities. Then percuss over the kidneys. Costovertebral angle tenderness indicates kidney inflammation. Percuss the bladder. Start at the symphysis pubis and percuss upward. You should hear tympany; a dull sound signals retained urine. Then palpate the kidneys. Normally, they aren’t palpable unless they’re enlarged. If the kidneys feel enlarged, the patient may have hydronephrosis, cysts, or tumors. You won’t be able to palpate the bladder unless it’s distended. (See Palpating the kidneys.) A pelvic or rectal examination may be necessary.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Urethral discharge:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Inspect the patient’s urethral meatus for inflammation and swelling. Using proper technique, obtain a culture specimen. (See Collecting a urethral discharge specimen, page 664.) Then obtain a urine specimen for urinalysis, culture, and possibly a three-glass urine test. (See How to perform the three-glass urine test, page 665.) In the male patient, the prostate gland may have to be palpated.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Urinary hesitancy:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Inspect the patient’s urethral meatus for inflammation, discharge, and other abnormalities. Examine the anal sphincter and test sensation in the perineum. Obtain a clean-catch specimen for urinalysis and culture. In a male patient, the prostate gland requires palpation. A female patient requires a gynecologic examination.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Urinary urgency:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Obtain a clean-catch specimen for urinalysis and culture. Note urine character, color, and odor, and use a reagent strip to test for pH, glucose, and blood. Then palpate the suprapubic area and both flanks for distention and tenderness. If the patient’s history or symptoms suggest neurologic dysfunction, perform a neurologic assessment.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Dysuria:
Diagnostic Approach
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
History and physical exam are usually diagnosticof trauma, vulvovaginitis, labial adhesions, chemical irritation,and diaper dermatitis. Otherwise, suspect UTI and perform UA andurine culture.
Urinalysis
Presenceof WBCs (>10/high-power field) in sediment ofcentrifuged specimen of urine suggests but is not diagnostic ofUTI. Neither is positive leukocyte esterase test (urine dipstick), whichindicates presence of WBCs in urine.Positive nitrite test using nitritestrip (Griess test) on urine dipstick is highly sensitive and specificfor detection of gram-negative bacteria (e.g., E. coli, Klebsiella,and Proteus species). Positive reaction usually indicates 105 CFUs/mL.False-positive reactions are uncommon if urine is fresh; however,if urine is not examined immediately, test result may be positivebecause of bacteria growing at room temperature. False-negativereactions may occur when there has been inadequate time for bacterialproliferation (random collection rather than first morning specimen)or when infection is due to Enterococcal species and some Staphylococcaland Pseudomonas species that do not convert nitrate to nitrite.Presence of ≥1 bacteria/oilimmersion field of unspun urine (unstained or Gram stain) from clean-catchmidstream specimen correlates with urine colony count of >105 CFUs/mL80–95% of the time. Urine Culture
Quantitative culture of properly collectedurine specimen establishes diagnosis of UTI, and susceptibilitytesting can be performed. Table15.1, based on data from many studies, is useful guidefor diagnosis of UTI.
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Bladder distention:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If distention isn't severe, begin by reviewing the patient's voiding patterns. Find out the time and amount of the patient's last voiding and the amount of fluid consumed since then. Ask if he has difficulty urinating. Does he use Valsalva's maneuver or Credé's method to initiate urination? Does he urinate with urgency or without warning? Is urination painful or irritating? Ask about the force and continuity of his urine stream and whether he feels that his bladder is empty after voiding.
Explore the patient's history of urinary tract obstruction or infections; venereal disease; neurologic, intestinal, or pelvic surgery; lower abdominal or urinary tract trauma; and systemic or neurologic disorders. Note his drug history, including his use of over-the-counter drugs and herbal medicines.
Take the patient's vital signs, and percuss and palpate the bladder. (Remember that if the bladder is empty, it can't be palpated through the abdominal wall.) Inspect the urethral meatus, and measure its diameter. Describe the appearance and amount of any discharge. Finally, test for perineal sensation and anal sphincter tone; in male patients, digitally examine the prostate gland.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Dysuria:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If the patient complains of dysuria, have him describe its severity and location. When did he first notice it? Did anything precipitate it? Does anything aggravate or alleviate it?
Next, ask about previous urinary or genital tract infections. Has the patient recently undergone an invasive procedure, such as cystoscopy or urethral dilatation, or had a urinary catheter placed? Also ask if he has a history of intestinal disease. Ask the female patient about menstrual disorders and the use of products that irritate the urinary tract, such as bubble bath salts, feminine deodorants, contraceptive gels, or perineal lotions. Also ask her about vaginal discharge or pruritus.
During the physical examination, inspect the urethral meatus for discharge, irritation, or other abnormalities. A pelvic or rectal examination may be necessary.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Urethral discharge:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Ask the patient when he first noticed the discharge, and have him describe its color, consistency, and quantity. Does he experience pain or burning on urination? Does he have difficulty initiating a urine stream? Does he experience urinary frequency? Ask the patient about other associated signs and symptoms, such as fever, chills, and perineal fullness. Explore his history for prostate problems, sexually transmitted disease, or urinary tract infection. Ask the patient if he has had recent sexual contacts or a new sexual partner. Obtain a complete drug history.
Inspect the patient's urethral meatus for inflammation and swelling. Using proper technique, obtain a culture specimen. (See Collecting a urethral discharge specimen.) Then obtain a urine specimen for urinalysis, culture, and possibly a three-glass urine specimen. (See Performing the three-glass urine test, page 613.) In the male patient, the prostate gland may have to be palpated.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Urinary hesitancy:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Ask the patient when he first noticed hesitancy and if he has ever had the problem before. Ask about other urinary problems, especially reduced force or interruption of the urine stream. Ask if he has ever been treated for a prostate problem or UTI or obstruction. Obtain a drug history.
Inspect the patient's urethral meatus for inflammation, discharge, and other abnormalities. Examine the anal sphincter and test sensation in the perineum. Obtain a clean-catch specimen for urinalysis and culture. In a male patient, the prostate gland requires palpation. A female patient requires a gynecologic examination.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Urinary urgency:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Ask the patient about the onset of urinary urgency and whether he has ever experienced it before. Ask about other urologic symptoms, such as dysuria and cloudy urine. Also ask about neurologic symptoms, such as paresthesia. Examine his medical history for recurrent or chronic UTIs or for surgery or procedures involving the urinary tract. Obtain a complete drug history.
Obtain a clean-catch specimen for urinalysis and culture. Note urine character, color, and odor, and use a reagent strip to test for pH, glucose, and blood. Then palpate the suprapubic area and both flanks for distention and tenderness. If the patient's history or symptoms suggest neurologic dysfunction, perform a neurologic examination.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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