Investigation of Urinary Tract Disease : A Short Review

Urology is one of the most competitive and highly sought surgical specialties for surgeons. There are many urological conditions like BPH, Carcinoma prostate, Bladder tumour, Urinary incontinence, Urinary tract infection, Urolithiasis etc. An actual diagnosis is very important issue to treat these conditions. In modern era investigations are essential part to make a diagnosis. Without investigations diagnosis is uncertain. In urology there are many investigations like Urine, KFT, Intravenous pylography, retrograde urethrogram, Angiography, Ultrasonography etc. In this article a short essential view of some urological investigations are given.


INTRODUCTION
Urology is rapidly becoming superspeciality branch present scenario . In present population urological condition such as prostate cancer, urinary incontinence, and lower urinary tract conditions like stricture are becoming more prevalent .
Prevalence of urinary tract disease is more in children and female. In old age males usually after 40 are more prone to urinary tract disease like Prostatomegaly Prostate cancer, urine incontinence etc. In modern era with increasing incidence of disease like Diabetes Mellitus , hypertension , sexually transmitted disease , improper use of medicine like antibiotics , analgesics etc , injustified use of pesticides , insectides have raised the incidence of urinary tract disease . @ IJTSRD | Available Online @ www.ijtsrd.com | Volume -2 | Issue -3 | Mar-Apr 2018 Congenital malformation of urinary tract are not very less common .Sooner or later the symptoms present in the patient either immediately after birth ,in infancy , childhood or at late age. Congenital malformation / abnormality of urinary tract are readily being detected by pediatricians or pediatric with the recent advances of investigations With the daily advancement in research in investigation it has become easier and helps in maki correct diagnosis. The investigations specific gravity, pH ,urine protein etc whereas when complicated special investigations like urogram cystography or radioactive isotopes like DTPA ,TcDM etc .
They are classified as following URINE EXAMINATION 1 :

Physical
Colour: normal colour of urine is amber colour and clear .It may vary from light amber to yellow colour depending on the concentration of urine . Pathological changes occur due to the presence of bile pigments ,urobilinogen ,pus, blood ,crystals. Several drugs also may change the colour of urine Volume: the total amount of urine excreted in 24 hrs .The time of collection along with volume collected should be charted. Usually col 8 AM to next 24 hrsin a bottle containing a preservative usually 10 ml of glacial acetic acid. Normal value is 700 to 2500 ml.

Apr 2018
Page: 2397 International Open Access Journal

Investigation of Urinary Tract Disease : A Short Review vigyan Evam
Congenital malformation of urinary tract are not very less common .Sooner or later the symptoms present in the patient either immediately after birth ,in infancy od or at late age. Congenital malformation / abnormality of urinary tract are readily being detected pediatric urologist or urologist cent advances of investigations.
With the daily advancement in research in on it has become easier and helps in making investigations can be basic like specific gravity, pH ,urine protein etc whereas when ial investigations like urogram, cystography or radioactive isotopes like DTPA hey are classified as following: normal colour of urine is amber colour and clear .It may vary from light amber to yellow colour depending on the concentration of urine . Pathological the presence of bile pigments ,urobilinogen ,pus, blood ,crystals. Several drugs also may change the colour of urine.
: the total amount of urine excreted in 24 hrs .The time of collection along with volume collected should be charted. Usually collection time starts from 8 AM to next 24 hrsin a bottle containing a preservative usually 10 ml of glacial acetic acid. Normal value is 700 to 2500 ml. its collected for Specific gravity: This is measured using a urinometer. The specific gravity depends upon the concentration of solutes present in urine. Crystalloids like salts sugar and urea raise specific gravity .it varies from 1.005 to 1.040 .
Osmolality: its more accurate parameter to express the concentration of solutes in urine .it can be measured using an osmometer. Osmolality of urine varies from 50 to 1200 mOsm/kg water. Osmolality and specific gravity indicates the concentrating ability of the kidney. Serum uric acid: Uric acid is the end product of purine metabolism and is excreated by kidney.
Normal level: In males-2.5 to 8 mg/dl In females-1.5 to 6mg/dl Serum electrolyte : Serum electrolyte chiefly sodium ,potassium and bicarbonates is severly affected by deranged kidney function hence they have to be closely watched during renal failure .Calcium phosphorus are also deranged in chronic renal failure.
Prostate surface antigen (PSA) 5 :This is the most important tumour marker now available .It is a glycoprotein elevated in prostatic diseases . Its estimation is used for screening of carcinoma prostate but it is not specific for this condition . Normal level is 0-4 ng /ml. If PSA is more than 4ng/ml carcinoma is suspected . shadow .The patient should not take oral fluid 6 hours prior to procedure. The dye used is 45% sodium diatrizoate . 20-40 ml of this dye is injected to median cubital vein .Now the films are taken at a interval of 1) Early radiograph after 2to5 minutes-Nephrogrm

2) After 5 minutes -Pyelogram
3) After 15 to 20 minutes -Ureter and bladder is visualized 4) Once the bladder is visualized post voiding picture is taken to show any residual contrast in urinary bladder.
Retrograde pyelogram :The urinary passage is visualized by introducing contrast dye into the ureter by retrograde catheterization through a cystoscope. Uretheric catheter are introduced and 4to 6 ml of iodinated dye is injected into the ureter or renal pelvis and pictures are taken .This brings out pelvicalyceal system and ureter clearly .
Antegrade pyelogram : The radio contrast dye is injected directly into the renal pelvis through percutaneous puncture or nephrostomy tube. Micturating cystourography is taken.
This help to identify : 1) Reflux of urine from the bladder to one or both ureter . 2) To detect posterior urethral wall .

Angiography Flush abdominal aortogram
: This study is necessary to visualized the vascular pattern of the kidney of donor for transplantation .
Selective renal arteriogram : A special arteriography catheter is positioned in renal artery and pictures are taken after dye injection .This help to study arterial pattern of kidney in detail in addition dilation of narrow segments using balloon ,occlusion of vessels of tumors of vascular malformation .
Digital substraction angiogram : This gives an angiographic picture without interference from other structures like bones ,gas and soft tissue hence its clarity is very good .

USG-(Ultrasonography)
It is a non-invasive investigation modality in the diagnosis of anatomical abnormalities of urinary system .It can be used through different approaches transabdominal , transrectal , transvaginal .It helps to visualise kidney , adrenals ,ureter ,urinary bladder and prostate ,their size ,morphological abnormalities like enlargement , contraction ,distortion ,tumour ,cyst , abscess , stones etc.USG should be performed before undertaking any invasive procedure like IVU.

Computed Tomography Scan
It reveals the size ,morphology,vasculature normalities and abnormalities .It is helpful in detection and staging of malignancies of urinary tract.
CT urogram , MR angio ,spiral CT and MRI scan are other recent diagnostic investigation.

ENDOSCOPY :
Cystoscopy-Bladder can be visualized .It helps in therapeutics procedure such as removal of stone and biopsy.

HISTOPATHOLOGICAL STUDY
Percutaneous renal biopsy -It is an invasive procedure. It is the most specific diagnostic method in renal disease .It is of great value in estabilising the pathology . It is done with automatic spring loaded biopsy gun under USG guidance .
Isotopic studies : DTPA (Diethylene triamine penta-acetic acid)-It is employed to study renal blood flow ,Obstructed uropathy ,bladder empting and glomerular filtration rate .It is also known as Dynamic Renal Scintigraphy .
DMSA (Dimercapto succinic acid )-It is most commonly used for cortical imaging . It shows detail of renal parenchyma .It is particularly useful when looking for segmental abnormalities of kidney like renal scarring .
MR (Magnetic resonance ) Urography : MRI of genito urinary system in many situation like 1) For accurate evaluation of IVC thrombus in renal cell carcinoma .
2) It is also useful for delination of uretheral injuries.
In this article its here by updated all latest investigations like MRI ,scintigraphy histopathology International Journal of Trend in Scientific Research and Development (IJTSRD) ISSN: 2456-6470 @ IJTSRD | Available Online @ www.ijtsrd.com | Volume -2 | Issue -3 | Mar-Apr 2018 Page: 2400 etc along with the old and basic investigation .urinary tract has same clinical presentation but the pathology is different .the advancement of the investigations has helped all clinicians along especially urologist to make proper diagnosis and treat the patient .