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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 pain.

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.

Renal failure

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 can help.

Malignancy in urinary tract

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 tract

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

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