Urination diary
The urination diary is a simple table that the patient fills out independently, which takes into account: the amount of liquid consumed, the frequency and volume of urination, the presence of imperative urges and episodes of urinary incontinence. At the same time, as a rule, patients additionally take into account the volume of liquid consumed during the day. The urination diary allows you to give an objective assessment of the patient's symptoms. Its completion is necessary for a specialist to make a decision on conducting invasive urodynamic studies and prescribing treatment, including conservative therapy.
In most cases, the interpretation of the urination diary is not difficult for a specialist, but the assessment of all parameters should take place with the participation of the patient himself. Thus, after filling out the diary for 2-3 days, the patient returns to talk to the doctor, who evaluates the frequency of urination, their volume and a description of the act of urination by the patient himself.
Urinalysis
Clinical analysis and bacteriological examination (microscopy) of urine are mandatory for patients suffering from urinary disorders. If a urinary tract infection is suspected, a bacteriological urine test (culture) is performed, which allows you to confidently identify the pathogen and determine its sensitivity to antimicrobials.
Cystoscopy
Cystoscopy is a method of examining the bladder using a special optical instrument, a cystoscope, which is inserted through the urethra. Cystoscopy is usually combined with urethroscopy, an examination of the urethra. These instrumental studies are very important and serve to diagnose diseases of the urethra, bladder and kidneys. Cystoscopy allows you to determine the condition of the mucous membrane of the bladder, the mouths of the ureters, the presence of foreign bodies, concretions (stones), the nature of urine released from the mouths of the ureters. Cystoscopy remains the leading method in the diagnosis of bladder tumors.
Comprehensive urodynamic examination
In the course of a comprehensive urodynamic examination, the function of the bladder and urethra is diagnosed during the filling of the bladder and its emptying. There are two types of urodynamic studies: noninvasive and invasive.
Noninvasive urodynamic examinations begin with filling out a urination diary for 1-3 days. After that, the rate of urination is measured using a special device – a uroflowmeter, as well as the volume of residual urine using ultrasound.
A comprehensive urodynamic examination may include uroflowmetry with the determination of residual urine, cystometry, registration of the intraurethral pressure profile, electromyography of the pelvic floor muscles, as well as a pressure–flow study, which allows to find out the causes of various urination disorders. During this process, the pressure in the bladder and in the abdominal cavity is measured when filling the bladder, as well as when urinating.
Outpatient urodynamic studies make it possible to study the function of the lower urinary tract as the bladder fills naturally outside the clinic, for example, at home.
This approach to the patient helps the specialist to establish the true causes of the disease and prescribe the correct treatment for patients suffering from frequent urination, urgent urge (sudden urge to urinate), urinary incontinence, as well as difficulty urinating.
Ultrasound examination (ultrasound)
Ultrasound examination is performed to exclude concomitant diseases of the pelvic organs and to identify structural changes in the bladder, as well as to determine residual urine.
Determination of residual urine is a common test for all patients with functional urinary disorders. An ultrasound examination of the abdominal cavity and retroperitoneal space, where the urinary organs are located, is informative and most comfortable for the patient.
The presence of residual urine in the bladder is of clinical importance only if it causes a deterioration in the function of the upper urinary tract or causes symptoms of impaired bladder emptying. The most common such symptoms are frequent urge to urinate, weak urine stream, interruption of urine stream, urinary retention, urinary incontinence and recurrent urinary tract infection.
Gynecological examination of urological patients (examination in a chair)
During a vaginal examination, the following is determined: the presence of cicatricial deformities of the vagina and urethra (due to surgery or radiation therapy); the size of the anterior vaginal arch; the position of the urethra and neck of the bladder; the position of the vaginal walls; the position of the cervix and body of the uterus.
When assessing the mucous membrane of the vulva and vagina, the specialist will pay attention to the presence of atrophic changes that may indicate a lack of estrogen, leading to a decrease in the tone of the urethra and a violation of its closing function.
The determination of involuntary urine discharge during coughing or straining (cough test) is perhaps the most important test performed during a gynecological examination. In the case of involuntary urine discharge when coughing, urinary incontinence during exertion may be a preliminary diagnosis.
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