Symptoms
The symptoms arising from the urinary system fall into three main headings (Table 71). Pain arises from any segment from the kidney to the urethra (Fig. 90). The passage of small stones in the renal pelvis or ureter cause spasm giving rise to acute, colicky loin pain radiating down to the groin. The renal parenchyma itself is free from pain, but the renal capsule is not and when stretched (from hydronephrosis, an impacted staghorn stone in the pelvis or a tumour) usually causes a dull ache in the renal angle. Acute pyelonephritis and pyonephrosis cause severe pain in the renal angle associated with rigors and pyuria. Spontaneous haemorrhage into a cyst in polycystic disease can cause severe pain which may be associated with haematuria.
Table 71. Symptoms relevant to the urological system
1. Pain - site, character, organ involved
2. Symptoms associated with micturition
3. Urine
(a) Output
(b) Appearance
Stones, tumour or infection in the urinary bladder cause a pain in the suprapubic region which is often associated with dysuria. Prostatic pain may be felt in the perineum, groin or the scrotum of a patient who will also have the symptoms of bladder neck obstruction (hesitancy, urgency, dribbling, etc.).
The problems of flow and pain associated with micturition may be caused by a pathology either in the
bladder (cystitis, stones, tumour) or in the urethra (prostatic compression, stone, urethritis). A poor urinary stream, hesitancy, frequency and dribbling are common in elderly men with prostatic enlargement. (Table 72)
Table 72. Disorders of micturition
1. Flow - hesitancy, urgency, straining, poor stream, dribbling, frequency, feeling of incomplete emptying, intermittent stream
2. Associated pain (dysuria) - scalding, irritation, strangury