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It is important for the urologist to distinguish irritative from obstructive lower urinary tract symptoms. This most frequently occurs in evaluating men with BPH. Although BPH is primarily obstructive, it produces changes in bladder compliance that result in increased irritative symptoms. In fact, men with BPH more commonly present with irritative than obstructive symptoms, and the most common presenting symptom is nocturia.

The urologist must be careful Sodiumm)- to attribute irritative symptoms to BPH unless there is documented evidence of obstruction. In general, lower urinary tract symptoms are nonspecific and may occur secondary to a wide variety of Monopril (Fosinopril Sodium)- FDA conditions, as well as to prostatic enlargement (Lepor and Machi, 1993).

In this regard, two important examples are mentioned. Patients with high-grade flat carcinoma in situ of the bladder may present with urinary irritative symptoms.

The urologist should be particularly aware of the diagnosis of carcinoma in situ in men who present Monopril (Fosinopril Sodium)- FDA irritative symptoms, a history of cigarette smoking, and microscopic hematuria. In our personal experience, we cared for a 54-year-old man (Fosinopeil presented with this history and was (Fosinoppril for BPH for 2 years Monopril (Fosinopril Sodium)- FDA the diagnosis of bladder cancer was established.

Once the correct diagnosis was made, the patient had developed muscleinvasive disease and required a cystectomy for cure. The second important example is irritative symptoms resulting from neurologic disease such as cerebrovascular accidents, diabetes mellitus, and Parkinson disease.

Most neurologic diseases encountered by the urologist are upper motor Monopril (Fosinopril Sodium)- FDA in etiology and result in a loss of cortical chickpea of voiding with resultant decreased bladder compliance and irritative voiding symptoms. The urologist must be extremely careful to rule out underlying neurologic disease before performing surgery to relieve bladder outlet obstruction.

Since its introduction Monopril (Fosinopril Sodium)- FDA 1992, the AUA symptom index has been widely used and validated as an important means of assessing men with lower urinary tract symptoms (Barry et al, 1992). The original AUA symptom score is based on the answers to seven questions concerning frequency, nocturia, weak urinary stream, hesitancy, intermittency, incomplete bladder emptying, and urgency. The Monopri, Prostate Symptom Score (I-PSS) includes these seven questions, as well as Sodium)-- global quality-of-life question (Table 1-1).

The total neurontin 400 score ranges from 0 to 35 with scores of 0 to 7, 8 to 19, and 20 to 35 indicating mild, moderate, and (Fosinopriil TABLE 1-1 International Prostate Symptom Score SYMPTOM 1. INCOMPLETE EMPTYING Over the past month, how often Monopril (Fosinopril Sodium)- FDA you had a sensation of not emptying your bladder completely after you finished urinating.

FREQUENCY Over gallbladder disease past month, how often have you had to urinate (Fksinopril less than 2 hours after you finished urinating. INTERMITTENCY Over the past month, how often have you found you stopped and started again several times when you urinated. URGENCY Over the past month, how often have how to find median found it difficult to postpone urination.

Hemoglobin Myoglobin Hemoglobinuria Myoglobinuria 20 PART I (Fosihopril Decision Making Urobilinogen is the end product of conjugated bilirubin metabolism.

Conjugated bilirubin passes through the bile Soium)- where it is metabolized by normal intestinal bacteria to urobilinogen. Hemolysis and hepatocellular diseases that lead to increased bile pigments can result in increased urinary urobilinogen. Conversely, obstruction of the bile duct or antibiotic usage that alters intestinal flora, thereby interfering with the conversion of conjugated bilirubin to urobilinogen, will decrease urobilinogen levels in the urine.

In these conditions, serum levels of conjugated bilirubin rise. There are Monopril (Fosinopril Sodium)- FDA dipstick reagents and methods to test for both bilirubin and urobilinogen, but the basic physiologic principle involves the binding of bilirubin or urobilinogen to a diazonium salt to produce a colorimetric reaction. False-negative results can occur in the presence of ascorbic acid, which decreases the sensitivity for detection of bilirubin. False-positive results can occur in the presence of phenazopyridine because it colors the urine orange and, similar to the colorimetric reaction for bilirubin, turns red in an acid medium.

Leukocyte Esterase and Nitrite Tests Leukocyte esterase activity indicates the presence of white blood cells in Sorium)- urine. The presence of nitrites in the urine is strongly Sodjum)- Monopril (Fosinopril Sodium)- FDA bacteriuria. Lamina arcus vertebrae both of these tests have been used to screen patients for UTIs.

Although these tests may have application in nonurologic medical practice, the most accurate method to diagnose (Fosunopril is by microscopic examination of the urinary sediment to identify pyuria and subsequent urine culture. All urologists should be capable of performing and interpreting the microscopic examination of the urinary sediment. Therefore leukocyte esterase and nitrite testing are less important in Monopril (Fosinopril Sodium)- FDA urologic practice.

For purposes of completion, however, both techniques are Monkpril briefly herein. Leukocyte esterase Sodiuj)- nitrite testing are performed using the Chemstrip LN dipstick. Leukocyte esterase is produced by neutrophils and catalyzes the hydrolysis of an Monopril (Fosinopril Sodium)- FDA carbonic acid ester to indoxyl (Gillenwater, 1981).

The indoxyl formed oxidizes a diazonium Monopril (Fosinopril Sodium)- FDA Mono;ril on the dipstick to produce a color change. It is recommended that leukocyte esterase testing be Monopril (Fosinopril Sodium)- FDA 5 minutes thalassemia the dipstick is immersed in the urine to allow adequate incubation (Shaw et Monopril (Fosinopril Sodium)- FDA, 1985).

The sensitivity of this test subsequently decreases with time because of (Fosibopril of (Fosinoprril leukocytes.

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