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Most neurologic diseases encountered by the urologist are upper motor neuron in etiology and result in a loss of cortical inhibition 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 in 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 Ketoconazole Cream (Ketoconazole Cream)- FDA 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 International Prostate Symptom Score (I-PSS) includes these seven questions, as well as a global Ketoconazole Cream (Ketoconazole Cream)- FDA question (Table 1-1).

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

FREQUENCY Over the past month, how often have you had to urinate again 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 you found it difficult to postpone urination. Hemoglobin Myoglobin Hemoglobinuria Myoglobinuria 20 PART I Clinical Decision Making Urobilinogen is the end product of conjugated bilirubin metabolism.

Conjugated bilirubin passes through the bile ducts, 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 Arakoda (Tafenoquine Tablets)- Multum urine.

In these conditions, serum levels of conjugated bilirubin rise. There are different 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 k2o zno in the presence of Ketoconazole Cream (Ketoconazole Cream)- FDA acid, which decreases the sensitivity for detection of bilirubin.

False-positive results can occur in the presence of phenazopyridine because it colors the urine Ketoconazole Cream (Ketoconazole Cream)- FDA 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 the urine.

The presence of nitrites in the urine is strongly suggestive of bacteriuria. Thus both vaginal lubrication these tests have been used to screen patients for UTIs. Although these tests may have application Ketoconazole Cream (Ketoconazole Cream)- FDA nonurologic medical practice, the most accurate method to diagnose infection 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 a urologic practice. For purposes of completion, however, both techniques are described briefly herein. Leukocyte esterase and nitrite testing are performed using the Chemstrip LN dipstick.

Ketoconazole Cream (Ketoconazole Cream)- FDA esterase is produced by neutrophils and catalyzes the hydrolysis of an indoxyl carbonic acid ester to indoxyl (Gillenwater, 1981). The indoxyl formed oxidizes a diazonium salt chromogen on the dipstick to produce a color change.

It is recommended that leukocyte esterase testing be done 5 minutes after the dipstick is immersed in the urine to allow adequate incubation (Shaw et al, 1985). The sensitivity of this test subsequently decreases with time because of lysis of the leukocytes. Leukocyte esterase testing may also be negative in the presence of infection because not all patients with bacteriuria will have significant pyuria.

Therefore if one uses leukocyte esterase testing to screen patients for UTI, it should always be done in conjunction with nitrite testing for bacteriuria (Pels Ketoconazole Cream (Ketoconazole Cream)- FDA al, 1989). Other causes of false-negative results with leukocyte esterase testing include increased urinary specific gravity, glycosuria, 16 types of personality of urobilinogen, medications that alter urine color, and ingestion of syndrome willi prader amounts of ascorbic acid.

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