| What family history increases the risk of genitourinary malignancy? | Family History of Genitourinary malignancy | SYMPTOMS • Blood in urine - red coloured or dark coloured • May be associated with pain: • Pain during voiding (urethra) • Pain in suprapubic region (bladder) • Pain in flank (kidney) • Acute retention of urine due to clots RISK FACTORS • Age > 40 years and male gender • Smoking • Occupational exposure (Textile, Chemicals, Rubber, Dye, Printing) • Family History of Genitourinary malignancy • Personal history of contact with tuberculosis • History of stone disease • Recurrent UTI EXAMINATION • Pulse, blood pressure • Check for pallor • Check for anasarca • Per abdomen examination: Palpable bladder, flank mass • Digital rectal examination: Enlarged prostate, hard nodular/ smooth surfaced prostate • Rule out vaginal causes of bleeding | 350 | relationship | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1768800256_grosshaematuria-2.pdf | SYMPTOMS • Blood in urine - red coloured or dark coloured • May be associated with pain: • Pain during voiding (urethra) • Pain in suprapubic region (bladder) • Pain in flank (kidney) • Acute retention of urine due to clots RISK FACTORS • Age > 40 years and male gender • Smoking • Occupational exposure (Textile, Chemicals, Rubber, Dye, Printing) • Family History of Genitourinary malignancy • Personal history of contact with tuberculosis • History of stone disease • Recurrent UTI EXAMINATION • Pulse, blood pressure • Check for pallor • Check for anasarca • Per abdomen examination: Palpable | 1 | page=1,block=5 | 0.700 | valid |
| What are the essential tests for evaluating genitourinary conditions? | Urine examination - routine, microscopy • Complete Hemogram • Kidney function tests (KFT) • Ultrasonography of kidney urinary bladder and prostate region | • Deranged kidney functions • Suspecting malignancy • Haematuria with hypertension / albuminuria • Persistent severe haematuria WHEN TO REFER (WARNING SIGNS) ESSENTIAL • Urine examination - routine, microscopy • Complete Hemogram • Kidney function tests (KFT) • Ultrasonography of kidney urinary bladder and prostate region DESIRABLE • Contrast enhanced computed tomography of kidney urinary bladder region/ intravenous pyelography (if KFT normal) • Magnetic resonance imaging of Kidney urinary bladder region (if KFT deranged) • Urine cytology if > 40yrs or smoker • Cystoscopy if > 40 years or smoker OPTIONAL • Urine culture • Urine for active sediments(if nephrotic/ nephritic syndrome suspected) • PT/INR (if bleeding disorder suspected) • Serum prostate specific antigen (if required) • Urine for acid fast bacilli - 3 samples (if tuberculosis suspected) INITIAL • Urethra: stone, urethritis, stricture • Prostate: inflammation, benign hyperplasia, malignancy TOTAL • Kidney: stone, malignancy (renal parenchyma, pelvis/ureter, genito-urinary tuberculosis • Ureter: stone, malignancy, genito- urinary tuberculosis • Bladder: infection, genitourinary tuberculosis, stone, malignancy) TERMINAL • Bladder: stone, tumor at bladder neck • Prostate: inflammation, benign hyperplasia, malignancy |
| What are the symptoms of a suspected urinary tract infection? | dysuria, increased frequency of voiding and other irritative lower urinary tract symptoms with/ without fever | • Start intravenous fluids if required • If Anaemia - may transfuse blood as required • Manage clot colic /flank pain with analgesics • If Acute urinary retention - catheterise with 20/22Fr 3 way Foley and may start continuous irrigation with normal saline SPECIFIC • Suspect urinary tract infection : presents with dysuria, increased frequency of voiding and other irritative lower urinary tract symptoms with/ without fever- treat with broad spectrum oral antibiotics • Cystoscopic clot evacuation may be performed if feasible • If basic evaluation and management facilities are unavailable SPECIFIC • Haematuria should be considered as a symptom of genitourinary malignancy in patients >40years old until proven otherwise • Suspected nephrotic/nephritic syndrome: cola coloured urine, proteinuria, anasarca, hypertension - Refer to nephrologist PHC/DH (GENERAL) | 316 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1768800256_grosshaematuria-2.pdf | • Start intravenous fluids if required • If Anaemia - may transfuse blood as required • Manage clot colic /flank pain with analgesics • If Acute urinary retention - catheterise with 20/22Fr 3 way Foley and may start continuous irrigation with normal saline SPECIFIC • Suspect urinary tract infection : presents with dysuria, increased frequency of voiding and other irritative lower urinary tract symptoms with/ without fever- treat with broad spectrum oral antibiotics • Cystoscopic clot evacuation may be performed if feasible • If basic evaluation and management facilities are unavailable |
| What are the warning signs that indicate the need for referral in genitourinary conditions? | Deranged kidney functions • Suspecting malignancy • Haematuria with hypertension / albuminuria • Persistent severe haematuria | • Deranged kidney functions • Suspecting malignancy • Haematuria with hypertension / albuminuria • Persistent severe haematuria WHEN TO REFER (WARNING SIGNS) ESSENTIAL • Urine examination - routine, microscopy • Complete Hemogram • Kidney function tests (KFT) • Ultrasonography of kidney urinary bladder and prostate region DESIRABLE • Contrast enhanced computed tomography of kidney urinary bladder region/ intravenous pyelography (if KFT normal) • Magnetic resonance imaging of Kidney urinary bladder region (if KFT deranged) • Urine cytology if > 40yrs or smoker • Cystoscopy if > 40 years or smoker OPTIONAL • Urine culture • Urine for active sediments(if nephrotic/ nephritic syndrome suspected) • PT/INR (if bleeding disorder suspected) • Serum prostate specific antigen (if required) • Urine for acid fast bacilli - 3 samples (if tuberculosis suspected) INITIAL • Urethra: stone, urethritis, stricture • Prostate: inflammation, benign hyperplasia, malignancy TOTAL • Kidney: stone, malignancy (renal parenchyma, pelvis/ureter, genito-urinary tuberculosis • Ureter: stone, malignancy, genito- urinary tuberculosis • Bladder: infection, genitourinary tuberculosis, stone, malignancy) TERMINAL • Bladder: stone, tumor at bladder neck • Prostate: inflammation, benign hyperplasia, malignancy |
| What imaging methods are desirable for patients with normal kidney function tests? | Contrast enhanced computed tomography of kidney urinary bladder region/ intravenous pyelography | • Deranged kidney functions • Suspecting malignancy • Haematuria with hypertension / albuminuria • Persistent severe haematuria WHEN TO REFER (WARNING SIGNS) ESSENTIAL • Urine examination - routine, microscopy • Complete Hemogram • Kidney function tests (KFT) • Ultrasonography of kidney urinary bladder and prostate region DESIRABLE • Contrast enhanced computed tomography of kidney urinary bladder region/ intravenous pyelography (if KFT normal) • Magnetic resonance imaging of Kidney urinary bladder region (if KFT deranged) • Urine cytology if > 40yrs or smoker • Cystoscopy if > 40 years or smoker OPTIONAL • Urine culture • Urine for active sediments(if nephrotic/ nephritic syndrome suspected) • PT/INR (if bleeding disorder suspected) • Serum prostate specific antigen (if required) • Urine for acid fast bacilli - 3 samples (if tuberculosis suspected) INITIAL • Urethra: stone, urethritis, stricture • Prostate: inflammation, benign hyperplasia, malignancy TOTAL • Kidney: stone, malignancy (renal parenchyma, pelvis/ureter, genito-urinary tuberculosis • Ureter: stone, malignancy, genito- urinary tuberculosis • Bladder: infection, genitourinary tuberculosis, stone, malignancy) TERMINAL • Bladder: stone, tumor at bladder neck • Prostate: inflammation, benign hyperplasia, malignancy |
| What occupational exposures are listed as risk factors for genitourinary conditions? | Textile, Chemicals, Rubber, Dye, Printing | SYMPTOMS • Blood in urine - red coloured or dark coloured • May be associated with pain: • Pain during voiding (urethra) • Pain in suprapubic region (bladder) • Pain in flank (kidney) • Acute retention of urine due to clots RISK FACTORS • Age > 40 years and male gender • Smoking • Occupational exposure (Textile, Chemicals, Rubber, Dye, Printing) • Family History of Genitourinary malignancy • Personal history of contact with tuberculosis • History of stone disease • Recurrent UTI EXAMINATION • Pulse, blood pressure • Check for pallor • Check for anasarca • Per abdomen examination: Palpable bladder, flank mass • Digital rectal examination: Enlarged prostate, hard nodular/ smooth surfaced prostate • Rule out vaginal causes of bleeding | 305 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1768800256_grosshaematuria-2.pdf | SYMPTOMS • Blood in urine - red coloured or dark coloured • May be associated with pain: • Pain during voiding (urethra) • Pain in suprapubic region (bladder) • Pain in flank (kidney) • Acute retention of urine due to clots RISK FACTORS • Age > 40 years and male gender • Smoking • Occupational exposure (Textile, Chemicals, Rubber, Dye, Printing) • Family History of Genitourinary malignancy • Personal history of contact with tuberculosis • History of stone disease • Recurrent UTI EXAMINATION • Pulse, blood pressure • Check for pallor • Check for anasarca • Per abdomen examination: Palpable |
| What imaging methods are used to investigate flank pain and haematuria caused by renal cell cancer? | Ultrasonography Computed tomography/MRI | Stones Renal cell cancer Bladder tumor Genito-urinary tuberculosis Symptoms Investiga- tions Treatment Flank pain Ureteric colic Recurrent urinary tract infection Haemturia Ultrasonography Xray KUB Intravenous pyelography or Computed tomography >5mm or symptomatic - refer to urologist Flank mass Flank pain Haematuria Ultrasonography Computed tomography/MRI Mostly surgical treatment - refer to urologist Haematuria Urinary retention Ultrasonography Computed tomography/MRI Urine cytology Mostly surgical treatment - refer to urologist Dysuria Frequency Nocturia Haematuria Urine analysis Urine acid fast bacilli Urine tuberculosis culture CBNAAT (optional) Intravenous pyelography or Computed tomography Oral Antitubercular treat- ment - 6months, refer to a urologist, close follow up | 319 | list | 0.740 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1768800256_grosshaematuria-2.pdf | Stones Renal cell cancer Bladder tumor Genito-urinary tuberculosis Symptoms Investiga- tions Treatment Flank pain Ureteric colic Recurrent urinary tract infection Haemturia Ultrasonography Xray KUB Intravenous pyelography or Computed tomography >5mm or symptomatic - refer to urologist Flank mass Flank pain Haematuria Ultrasonography Computed tomography/MRI Mostly surgical treatment - refer to urologist Haematuria Urinary retention Ultrasonography Computed tomography/MRI Urine cytology Mostly surgical treatment - refer to urologist Dysuria Frequency Nocturia Haematuria Urine analysis Urine |