carried out to make out any prostatic hypertrophy.
Malignancies of rectum could also be made out. Rectal examination
is as important for detection of cancer Prostate as PAP test
for cancer cervix.
The above examination, supplemented by simple
urinary examination should lead to one of these three possibilities.
1. Obstructive urinary pathology
2. Inflammatory process
3. Basic renal failure.
The urine is examined for albumin-albuminuria
indicating infections most commonly and sugar indicating glycosuria-commonly
due to diabetes mellitus.
Deposits reveal casts in chronic renal failure
and crystals in renal calculus.
Patient with retention, irrespective of the
cause of obstructive pathology can be managed by catheterisation
with a sterile rubber catheter, or if possible a metal catheter.
If catheterisation is not possible, a lumbar puncture needle
may be passed in the supra pubic area into the bladder and
the contents may be aspirated. The patient can then be transported
comfortably to the referral hospital for active management.
Infection of Urinary Tract
The infections are either non-specific or
tuberculosis of the urinary tract. The patient presents with
fever with rigors, dysuria, increased frequency and supra-pubic
Treat with antibiotics or sulpha group of
drugs for 2 weeks. Further, continue for two weeks to avoid
recurrence. During treatment patient is advised to take plenty
of oral fluids-3 litres in summer and 2½ litres in
winter. A recurrent infection or non-responsive one is referred
to the referral centre for further management.
Commonest causes in the elderly are diabetes,
hypertension, and abuse of drugs. There is either polyuria
or anuria. The specific gravity in early cases is very low
10.02. The patient is asked to void 24 hours urine in a container
to ascertain quantity.
Refer these patients to the hospital. In
female patients, owing to fibrosis, urethral caruncles, there
may be difficulty in passing urine. An urethral dilatation
Malignancy in urinary
AIl cases of suspected malignancy should be
referred. Haematuria, unless otherwise proved is thought
to indicate malignancy. A renal mass, bladder tumor, nodule
of the prostate may also be present. The absence of these
does not exclude malignancy.
Tuberculosis of the urinary
This occurs secondary to bone and joint tuberculosis
and involves the epididymis and testis. Sterile acid pyuria
is pathognomonic of the disease. In cases of haematuria, other
causes must be excluded. The common presenting clinical patterns
are those of hydronephrosis and epididymoorchitis. The infection
is always chronic. Tuberculosis of the urinary tract is diagnosed
by investigations only.
450 mgms/day of Rifampicin, 300 mgms/day
of INH and 1000 mgms of Ethambutol are administered for the
first four months and the therapy is continued for the