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Semen discharged with the urine The presence of spermatozoa in the urine. Abnormal ejaculation into the bladder on orgasm (retrograde ejaculation) may occur after prostatectomy or other surgical procedures or in certain neurological conditions.


Inflammation of the bladder and urethra. These medical condition or symptom of Cystourethritis:

Inflammation Bladder Bladder symptoms Bladder disease Bladder disorder Bladder pain Urethra Urethra symptoms Urethra disorder


Chyluria is a morbid condition in which the urine contains chyle or fatty matter, giving it a milky appearance.

Chyluria, also called chylous urine, Chyluria appearance is irregular and intermitten. It may last several days, weeks or even months. There are several factors that trigger Chyluria recurrence.

Chyluria is often caused by filariasis due to the parasite Wuchereria bancrofti, a thready nematode which lodges the lymph channels. Another cause is pregnancy or childbirth. Patients claimed that Chyluria occurred after overwork. Mental tension, sadness, annoyance, anger etc could also produce attack of Chyluria.

Non-parasitical causes of chyluria: Tumors, abscesses, trauma, tuberculosis, congenital, etc.

In the United States, one of the most common causes is partial nephrectomy or thermal ablation of a kidney lesion.

Difference between normal urine and urine containing chyle:

Normal Urine



Milky appearance of the urine is the striking sign of Chyluria. Prolonged chyluria results in loss of weight and subcutaneous fat, hypoprotenemia, lymphopenia
and anaemia.

Once the lymph channels are blocked, one may open into the kidney hilum or ureter or sometimes into the bladder and chyle can leak into the urinary tract resulting in milky white urine. Blood sometimes mixes with the urine resulting in haematochyluria. Usually the condition is self limiting and can sometimes lead to complications. If left untreated, chronic chyluria can lead to malnutrition and vitamin deficiency.


Lymphography (imaging procedure) demonstrates the site, the calibre and the number of the fistulous communications.


Oliguria is decreased production of urine. It can be defined as a urine output that is less than 500 mL/day in adults. It is important and requires investigation because it can be one of the earliest signs of renal failure however in most cases it can be reversed. in infants is not considered to be a reliable sign of renal failure.
The decreased output of urine may be a sign of

Dehydration, Renal Failure, Hypovolemic Shock, Hhns Hyperosmolar Hyperglycemic Nonketotic Syndrome, Multiple Organ Dysfunction Syndrome, Or Urinary Obstruction/Urinary Retention.

Perform ultrasound examination of the kidney to rule out obstructive processes.

The pathophysiologic mechanisms causing oliguria can be categorized globally in three different categories

Prerenal: in response to hypoperfusion of the kidney (e.g. as a result of dehydration by poor oral intake, cardiogenic shock, diarrhea, massive bleeding or sepsis)


due to kidney damage (severe hypoperfusion, rhabdomyolysis, medication)

Postrenal: as a consequence of obstruction of the urine flow (e.g. enlarged prostate, tumour compression urinary outflow, expanding hematoma or fluid collection)

Postoperative oliguria
Patients usually have decrease in urine output after a major operation that may be a normal physiological response to:

fluid/ blood loss decreased glomerular filtration rate secondary to hypovolemia and/or hypotension response of adrenal cortex to stress -increase in aldosterone (Na and water retention) and antidiuretic hormone (ADH) release

Oliguria is significantly reduced URINE production that occurs as a consequence of RENAL FAILURE, DEHYDRATION, hemorrhage (massive BLOOD loss), or SHOCK. Normal adult urinary output is 1500 milliliters to 3000 milliliters per day. In oliguria urinary output is 500 ml per day or less. Oliguria indicates that the KIDNEYS are not receiving enough blood or are not functioning to filter the blood. Unless urine output increases, toxins will accumulate in the blood and the circumstance may become lifethreatening. VATA KUNADALIKA SPASMODIC PAINFUL DYSURIA

Dysuria refers to painful urination. Difficult urination is also sometimes described as dysuria. It is one of a constellation of irritative bladder symptoms, which includes urinary frequency and haematuria.

Differential diagnosis
This is typically described to be a burning or stinging sensation. It is most often a result of a urinary tract infection. It may also be due to an STD, bladder stones, bladder tumours, and virtually any condition of the prostate.

It can also occur as a side effect of anticholinergic medication used for Parkinson's disease.

Dysuria causes can be split into four categories. These include a large number of conditions which may or may not be included in this list. 1. Urinary Tract

Kidney stones Urethral stricture Cystitis Prostatic enlargement i.e prostatic cancer and Benign prostatic hyperplasia(male) Prostatitis (male) Urinary tract infection (UTI) caused by bacterial infection Sexually transmitted disease Chlamydia Urethritis Urinary schistosomiasis Malignancy i.e bladder cancer, prostatic cancer or urethral cancer Pyelonephritis Hemorrhagic cystitis

2. Genital

Endometriosis (female) Vaginitis (female) Prostatic cancer (male) Benign prostatic hyperplasia(male) Prostatitis (male)

3. Drugs and Irritants

Chemical Irritants e.g Soaps, Tampons, Toilet paper Drugs e.g NSAIDS, anticholinergics, 6

4. Other

Reactive arthritis Diverticulitis Hypotension Mass in the abdomen

Benign prostatic hyperplasia is nonmalignant (noncancerous) enlargement of the prostate gland, a common occurrence in older men. It is also known as benign prostatic hyperplasia and abbreviated as BPH.
BPH generally begins in a man's 30s, evolves slowly, and most commonly only causes symptoms after 50.
BPH is completely benign. It is not a precursor (a forerunner) to prostate cancer.

symptoms of BPH
In BPH, the prostate gland grows in size. It may compress the urethra which courses through the center of the prostate. This can impede the flow of urine from the bladder through the urethra to the outside. It can cause urine to back up in the bladder (retention) leading to the need to urinate frequently during the day and night. Other common symptoms include aslow flow of urine, the need to urinate urgently and difficulty starting the urinary stream.

More serious problems include urinary tract infections and

complete blockage of the urethra, which may be a medical emergency and can lead injury to the kidneys.
Early Symptoms of BPH: Occasional Urinary retention, reduced urinary stream caliber and force, Difficulty when starting to urinate

Advanced Symptoms of BPH consist of ;

Incontinence, Excessive Urinating at Night, Blood in Urine, frequent urination

Causes of Prostatic Hypertrophy are the following :


Metabolic disturbances, Hormonal imbalance, Abnormal growth of tissue (tumor may be benign or malignant)


A bladder neck obstruction is a condition in which the narrow area of the membrane that holds waste urine becomes more narrow and restricts urine flow because the neck of the bladder doesn't fully open during urination. A bladder neck obstruction may also be called a bladder neck contracture. Bladder neck obstruction can occur in both men and women. Bladder neck obstruction causes slow release of urine, and may also cause incontinence and eventual damage to the kidneys. Bladder neck obstruction may occur following radiation for prostate cancer, or following prostatectomy surgery for prostate cancer. Bladder neck obstruction may be treated with a small cut in the bladder or widening the bladder neck.


A large, dilated, and nonemptying urinary bladder; usually attributable to disturbance of innervation or to chronic obstruction.

Atonic bladder, meaning a bladder that doesnt squeeze, and therefore doesnt empty; Also known as detrusor atony or flaccid

The bladder enters a state of permanent fullness at which point urine may passively leak, or overflow, through the urinary sphincter which cannot withstand the constant pressure. Atonic bladder and the resulting incontinence is caused by atrophy, or some form of damage, to the detrusor muscle (which causes the bladder to contract and expel urine) . This muscle weakness results in an inability to proerly empty the bladder. If a weak detrusor muscle is indeed the problem detrusan electrical stimulation therapy can exercise the detrusor muscle to restore the strength it needs to fully void the bladder.


Bladder outlet obstruction (BOO) is a blockage at the base of the bladder that reduces or prevents the flow of urine into the urethra, the tube that carries urine out of the body.

Bladder outlet obstruction (BOO) can have many different causes, including:

Benign prostatic hyperplasia (BPH), or enlarged prostate Bladder stones Bladder tumors (cancer) Pelvic tumors (cervix, prostate, uterus, rectum) Urethral stricture (scar tissue)

Less common causes include:

Cystocele Foreign objects Posterior urethral valves (congenital birth defect) Urethral spasms

Urethral diverticula This condition is most common in aging men. It is often caused by BPH. Bladder stones and bladder cancer are also more commonly seen in men than women. As a man ages, the chance of developing these diseases increases dramatically.

Symptoms The symptoms of bladder outlet obstruction may vary, but can include:

Abdominal pain Continuous feeling of a full bladder Delayed onset of urination (urinary hesitancy) Frequent urination Inability to urinate (acute urinary retention) Pain on urination (dysuria) Slow urine flow Urinary tract infection Urine stream starts and stops (urinary intermittency) Waking up at night to urinate (nocturia)

Exams and Tests If bladder outlet obstruction is suspected, your health care provider will take a thorough history of your problems. During a physical exam, your provider may find one or more of the following possible causes:

Abdominal mass Cystocele (women) Distended bladder Enlarged prostate (men)


Tests may include:

Blood chemistries to look for signs of kidney damage Cystoscopy and retrograde urethrogram (x-ray) to look for narrowing of the urethra Ultrasound to locate the blockage of urineand find out how well the bladder empties Urinalysis to look for blood or signs of infection in the urine Urine culture to check for an infection Uroflowmetry to determine how fast urine flows out of the body Urodynamic testing to see how much the urine flow is blocked and how well the bladder contracts


A urethral stricture is a narrowing of the urethra caused by injury or disease such as urinary tract infections or other forms of urethritis. A urethral stricture is an abnormal narrowing of the urethra that slows or blocks the stream of urine exiting the body. The urethra is part of your urinary system, which is also known as the urinary tract


A history of sexually transmitted disease (STD) Any instrument inserted into the urethra (such as a catheter or cystoscope) Benign prostatic hyperplasia (BPH) Injury or trauma to the pelvic area Repeated episodes of urethritis Short strictures in the bulbar urethra, particularly between the proximal 1/3 and distal 2/3 of the bulb, may be congenital. kidney stones In infants and toddlers, can be as a result of inflammation following a circumcision and not noticeable until toilet training when a deflected

stream is observed or when the child must strain to produce a urinary stream.

During the early stages of the condition, The Patient may experience pain during urination and the inability to fully empty the bladder. It is not uncommon for the bladder's capacity to significantly increase due to this inability to completely void. Urethral strictures may cause problems with urination, including in certain cases the complete inability to urinate, which is a medical emergency. Additionally, a urinary tract infection is often present at, or prior to initial diagnosis


Blood in the semen Bloody or dark urine Decreased urine output Difficulty urinating Discharge from the urethra Frequent or urgent urination Inability to urinate (urinary retention) Incontinence Painful urination (dysuria) Pain in the lower abdomen Pelvic pain Slow urine stream (may develop suddenly or gradually) Spraying of urine stream Swelling of the penis


Urinary retention Urethral diverticulum


Periurethral abscess Urethral fistula Bilateral hydronephrosis Urinary infections Urinary calculus Hernia, haemorrhoids or Rectal prolapse from straining


Cystoscopy Urethrography

Exams and Tests

A physical examination may show the following:

Decreased urinary stream Discharge from the urethra Enlarged (distended) bladder Enlarged or tender lymph nodes in the groin (inguinal) area Enlarged or tender prostate Hardness (induration) on the under surface of the penis Redness or swelling of the penis

Sometimes the exam reveals no abnormalities. Tests include the following:

Cystoscopy Post-void residual (PVR) volume Retrograde urethrogram Tests for chlamydia and gonorrhea Urinalysis Urinary flow rate Urine culture 14


Vesicoureteral reflux (VUR) is an abnormal movement of urine from the bladder into ureters or kidneys. Urine normally travels from the kidneys via the ureters to the bladder.
In vesicoureteral reflux the direction of urine flow is reversed (retrograde).