Mohammad Hammad Ather

By M. Hammad Ather, Ammara Mushtaq and M. Nasir Sulaiman

Part of the book: Clinical Use of Local Anesthetics

By Raheela M. Rizvi and Mohammad Hammad Ather

The diagnosis and assessment of urinary incontinence (UI) are variable. In general, diagnosis is made in primary care using clinical evaluation (a good history and physical examination), bladder diary and validated symptom scales. Condition-specific diagnosis is made in secondary care, and it often involves interventional tools such as urodynamic studies. The evidence available on the accuracy and acceptability of the assessment of UI is inconsistent and variable. A structured data collection tool was used for initial assessment of UI. Some key questions are required for initial assessment of UI in order to diagnose the type of UI. This chapter includes a gender-specific evaluation based on history and clinical examination. Pelvic organ prolapse (POP) in female patients is associated with UI and POP diagnosis, and staging is made by clinical examination only, while male patients are examined for prostate obstructive urinary symptoms. Basic evaluation includes bladder diary in cases of overactive bladder and stress test, for stress urinary incontinence. Other diagnostic tests include urine analysis, uroflowmetry and measurement of post-void residual volume in cases of neurogenic bladder and benign prostate hypertrophy. Patients referred to specialist require further assessment of UI using urodynamic testing, electrophysiological test and imaging.

Part of the book: Synopsis in the Management of Urinary Incontinence

By Mohammad Hammad Ather, Wasim Memon, Wajahat Aziz and Mohammad Nasir Sulaiman

Non-contrast computed tomography (CT) abdomen has emerged as a first line investigation in suspected upper urinary tract obstruction. Underlying causes can usually be ascertained on computed tomography of kidneys, ureters and bladder (CT KUB). However, further investigations may be required to delineate/confirm underlying pathology like ureteropelvic junction obstruction (UPJ), differentiation between obstruction and residual dilatation. Actual protocol of CT KUB for evaluation of stone disease and haematuria vary on institutional guidelines. CT KUB is not only extremely sensitive and specific in the diagnosis of stone; it is now used in the pre-operative nomograms in predicting success of various endourological interventions like percutaneous nephrolithotomy (PCNL) and shock wave lithotripsy (SWL). Determination of stone density, stone volume, stone composition, skin to stone distance, presence of ureteral wall oedema, perinephric oedema are highly predictive of stone free rate. CT recognition of various anomalies, presence of retro-renal colon, horse-shoe kidney, malrotation, etc. can help in better planning to avoid complications. One of the major limitations of CT is the radiation dose, besides cost and availability. Modification in technique and technological innovation has resulted in significant dose reduction from 4.5 to about 1 mSv.

Part of the book: Computed Tomography