Abnormalities in micturition: Difference between revisions
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=== Differentiating the diseases that can cause abnormality in micturition: === | === Differentiating the diseases that can cause abnormality in micturition: === | ||
<span style="font-size:85%">'''Abbreviations:''' N= Normal, UTI= [[Urinary tract infection]], CBC= [[Complete blood count]], CT= [[Computed tomography]], IBS= [[Irritable bowel syndrome]], DRE= Digital rectal examination, HSV= [[Herpes simplex virus]], | <span style="font-size:85%">'''Abbreviations:''' N= Normal, UTI= [[Urinary tract infection]], CBC= [[Complete blood count]], CT= [[Computed tomography]], IBS= [[Irritable bowel syndrome]], DRE= Digital rectal examination, HSV= [[Herpes simplex virus]], RBCs= [[red blood cells]], STI= Sexually transmitted infection, PCR=[[Polymerase chain reaction]] | ||
</span> | |||
<small> | |||
{| | {| | ||
|- style="background: #4479BA; color: #FFFFFF; text-align: center;" | |- style="background: #4479BA; color: #FFFFFF; text-align: center;" | ||
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* [[Papules]] | * [[Papules]] | ||
* [[Vesicles]] | * [[Vesicles]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Aphthous | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Aphthous ulcer]] in mouth | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
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| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | | style="padding: 5px 5px; background: #F5F5F5;" align="left" | | ||
* [[Neurogenic bladder]] | * [[Neurogenic bladder]] | ||
* Genital [[Aphthous ulcer| | * Genital [[Aphthous ulcer|Aphthous ulcers]] | ||
* Recurrent [[cystitis]] | * Recurrent [[cystitis]] | ||
* [[Epididymitis]] | * [[Epididymitis]] | ||
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |– | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Leukopenia]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Leukopenia]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | | style="padding: 5px 5px; background: #F5F5F5;" align="left" | | ||
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* Bladder wall thickening | * Bladder wall thickening | ||
* Intraluminal gas in emphysematous cystitis | * Intraluminal gas in emphysematous cystitis | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="left" | | ||
* [[ | * [[Hydronephrosis]] | ||
* beaded necklace like in emphysematous cystitis | * beaded necklace like in emphysematous cystitis | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Urine culture to sensitivity | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Urine culture to sensitivity | ||
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* Hypoechoic when there is edema(swollen kidney) | * Hypoechoic when there is edema(swollen kidney) | ||
* Gas buubles in emphysematous pyelonephritis | * Gas buubles in emphysematous pyelonephritis | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="left" | | ||
* Round swollen [[Kidney|kidneys]] | * Round swollen [[Kidney|kidneys]] | ||
* Hypodense appearance | * Hypodense appearance | ||
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |– | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |– | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | | style="padding: 5px 5px; background: #F5F5F5;" align="left" | | ||
* Cremasteric | * [[Cremasteric reflex]]es present | ||
* [[Prehn's sign]] | * [[Prehn's sign]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Leukocytosis]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Leukocytosis]] | ||
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |– | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |– | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |± | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |– | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |– | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |– | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |– | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |– | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |– | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |– | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |– | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |– | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Post void residual; volume is high | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Post void residual; volume is high | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |– | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |– | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Retrograde urethrogram]]+[[cystoscopy]](urodynamic studies) | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | | style="padding: 5px 5px; background: #F5F5F5;" align="left" | | ||
|- | |- | ||
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |– | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |– | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |– | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Enlarged and smooth prostate on DRE | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Enlarged and smooth prostate on DRE | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Thinning of endometrium | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Thinning of endometrium | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Clinical | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Clinical examination | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | | style="padding: 5px 5px; background: #F5F5F5;" align="left" | | ||
|- | |- | ||
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |– | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |– | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |– | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |– | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |– | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | | ||
* [[Dyspareunia]] | * [[Dyspareunia]] | ||
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |– | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |– | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |– | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |– | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |– | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hematuria]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hematuria]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Anemia]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Anemia]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hematuria]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hematuria]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="left" |Nodal involvement in the pelvis or retroperitoneum, visceral, pulmonary, or osseous metastasis | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Cystoscopy]] and biopsy | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Cystoscopy]] and biopsy | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | | style="padding: 5px 5px; background: #F5F5F5;" align="left" | | ||
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |– | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |– | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="left" |When infected, | ||
* [[WBC]] | * [[WBC]] | ||
* [[Leukocyte esterase]] | * [[Leukocyte esterase]] | ||
* [[Nitrite|Ntrite]] | * [[Nitrite|Ntrite]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Contrast enhancement (vascularity) showing the extent of the disease | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Contrast enhancement(vascularity) showing the extent of the disease | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Biopsy | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Biopsy | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | | style="padding: 5px 5px; background: #F5F5F5;" align="left" | | ||
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |± | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |± | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |± | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |± | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Erythema | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |– | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |– | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Maybe[[Leukocytosis]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Maybe[[Leukocytosis]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="left" |When infected, | ||
* [[WBC]] | * [[WBC]] | ||
* [[Leukocyte esterase]] | * [[Leukocyte esterase]] | ||
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |– | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |– | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |± | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |± | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Laceration/bruise | | style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Laceration]]/[[bruise]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hematuria]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hematuria]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align=" | | style="padding: 5px 5px; background: #F5F5F5;" align="left" | | ||
* [[ | * [[Anemia]] | ||
* [[ | * [[Leukocytosis]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hematuria]] | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hematuria]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Blood in pelvic cavity | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Blood in pelvic cavity | ||
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| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | | style="padding: 5px 5px; background: #F5F5F5;" align="left" | | ||
|} | |} | ||
</small> | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} |
Revision as of 23:44, 25 July 2018
Micturation Abnormalities Microchapters |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
Overview
Classification
- There is no established system for the classification of abnormalities in micturition.
Causes
- The causes of abnormalities in micturition includes causes of dysuria and incontinence:
Abnormalities of Micturition Differential Diagnosis
Differentiating the diseases that can cause abnormality in micturition:
Abbreviations: N= Normal, UTI= Urinary tract infection, CBC= Complete blood count, CT= Computed tomography, IBS= Irritable bowel syndrome, DRE= Digital rectal examination, HSV= Herpes simplex virus, RBCs= red blood cells, STI= Sexually transmitted infection, PCR=Polymerase chain reaction
Diseases | Clinical manifestations | Para-clinical findings | Gold standard | Additional findings | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Symptoms | Physical examination | ||||||||||||||||
Lab Findings | Imaging | ||||||||||||||||
Fever | Urinary symptoms | Supra-pubic tenderness | Skin lesions | Other | CBC | Urinalysis | Ultrasonography | CT scan | |||||||||
Dysuria | Frequency | Dribbling | Hesitancy | Nocturia | |||||||||||||
Inflammatory | Dermatological disorders | Lichen sclerosus[1] | – | + | – | – | + | – | – | Lichenified plaques | – | N | often shows UTI in women | N | N | Biopsy | |
Behcet's syndrome[2][3][4] | – | + | + | – | + | + | – | Aphthous ulcer in mouth | N | N | N | N | None |
| |||
Infectious diseases | Cystitis[5][6] | + | + | + | + | + | + | + | N | – | Leukopenia |
|
|
Urine culture to sensitivity | N | ||
Urethritis[7][8][9] | + | + | + | – | + | – | + |
|
– | Leukocytosis | N | N | N | Urethral swab for culture, NAAT | N | ||
Pyelonephritis[10][11] | + | + | + | – | – | + | ± | N | Urgency | Leukocytosis |
|
Urinalysis and Urine culture | |||||
Diseases | Fever | Dysuria | Frequency | Dribbling | Hesitancy | Nocturia | Suprapubic tenderness | Skin lesions | Other | CBC | Urinalysis | Ultrasonography | CT scan | Gold standard | Additional findings | ||
Vulvovaginitis[12] | ± | + | + | + | + | – | – |
|
Thick white discharge | N | N | N | N | Microbiological diagnosis
|
|||
Cervicitis | + | ± | + | ± | – | – | + |
|
Thick yellow green pus | Leukocytosis | WBC | N or show PID like feature | N or show PID like feature | Culture of vaginal discharge | NAAT for gonocooccal cervicitis | ||
Prostatitis | + | + | + | + | + | + | ± | – | Tender prostate | Leukocytosis | N | N | Urine culture | Prostate massage for chronic prostatits leads to raised leukocytes in urine | |||
Epididymoorchitis[13] | ± | + | + | + | – | – | – | – |
|
Leukocytosis | WBC | N | N | Urine culture |
| ||
Non-inflammatory | Anatomic | Urethral stricture | – | + | ± | + | – | – | – | – | – | N | RBCs | Post void residual; volume is high | – | Retrograde urethrogram+cystoscopy(urodynamic studies) | |
Benign prostatic hyperplasia (BPH)[14] | – | + | + | + | + | + | – | – | Enlarged and smooth prostate on DRE | N | May have UTI like picture on some occassion | Enlarged prostate | – | TURP is gold standard treatment | |||
Diseases | Fever | Dysuria | Frequency | Dribbling | Hesitancy | Nocturia | Suprapubic tenderness | Skin lesions | Other | CBC | Urinalysis | Ultrasonography | CT scan | Gold standard | Additional findings | ||
Gynecological | Atrophic vaginitis[15] | – | + | + | ± | ± | + | – |
|
Vaginal discharge | N | N | Thinning of endometrium | N | Clinical examination | ||
Endometriosis | – | + | – | – | – | – | – | – | N | N | Cystic masses attached to adnexa | Cysts | Laparoscopy | ||||
Malignancy | Bladder cancer | – | + | + | – | – | – | – | – | Hematuria | Anemia | Hematuria | N | Nodal involvement in the pelvis or retroperitoneum, visceral, pulmonary, or osseous metastasis | Cystoscopy and biopsy | ||
Vulvovaginal cancer[16] | – | ± | ± | ± | – | – | – |
|
– | N | When infected, | N | Contrast enhancement(vascularity) showing the extent of the disease | Biopsy | |||
Iatrogenic | Genitourinary instrumentation/ pelvic irradiation | – | + | ± | – | ± | ± | ± | Erythema | – | MaybeLeukocytosis | When infected, | N | N | Culture | ||
Trauma | ± | ± | – | – | – | – | ± | Laceration/bruise | Hematuria | Hematuria | Blood in pelvic cavity | Blood in pelvic cavity | Laparotomy |
References
- ↑ Ventolini G, Patel R, Vasquez R (2015). "Lichen sclerosus: a potpourri of misdiagnosed cases based on atypical clinical presentations". Int J Womens Health. 7: 511–5. doi:10.2147/IJWH.S82879. PMC 4431497. PMID 26056492.
- ↑ Theodorou C, Floratos D, Hatzinicolaou P, Vaiopoulos G (August 1999). "Neurogenic bladder dysfunction due to Behçet's disease". Int. J. Urol. 6 (8): 423–5. PMID 10466456.
- ↑ Porru D, Pau AC, Scarpa RM, Zanolla L, Cao A, Usai E (May 1996). "Behçet's disease and the neuropathic bladder: urodynamic features: case report and a literature review". Spinal Cord. 34 (5): 305–7. PMID 8963981.
- ↑ Cetinel B, Akpinar H, Tüfek I, Uygun N, Solok V, Yazici H (January 1999). "Bladder involvement in Behçet's syndrome". J. Urol. 161 (1): 52–6. PMID 10037367.
- ↑ Grover S, Srivastava A, Lee R, Tewari AK, Te AE (February 2011). "Role of inflammation in bladder function and interstitial cystitis". Ther Adv Urol. 3 (1): 19–33. doi:10.1177/1756287211398255. PMC 3126088. PMID 21789096.
- ↑ Eken A, Alma E (2013). "Emphysematous cystitis: The role of CT imaging and appropriate treatment". Can Urol Assoc J. 7 (11–12): E754–6. doi:10.5489/cuaj.472. PMC 3840514. PMID 24282470.
- ↑ Glicksman, Joseph M. (1967). "Gonococcal Skin Lesions". Archives of Dermatology. 96 (1): 74. doi:10.1001/archderm.1967.01610010080015. ISSN 0003-987X.
- ↑ Siboulet, A. (1955). "Inclusion Bodies in Non-Gonococcal Urethritis, also Skin Lesions with Inclusions". Sexually Transmitted Infections. 31 (4): 235–237. doi:10.1136/sti.31.4.235. ISSN 1368-4973.
- ↑ Tsai, Chia-Chun; Li, Ching-Chia (2013). "Nonchlamydial nongonococcal urethritis in men". Urological Science. 24 (3): 73–77. doi:10.1016/j.urols.2013.06.001. ISSN 1879-5226.
- ↑ Gil-Ruiz MA, Alcaraz AJ, Marañón RJ, Navarro N, Huidobro B, Luque A (March 2012). "Electrolyte disturbances in acute pyelonephritis". Pediatr. Nephrol. 27 (3): 429–33. doi:10.1007/s00467-011-2020-9. PMID 21983846.
- ↑ Edell SL, Bonavita JA (September 1979). "The sonographic appearance of acute pyelonephritis". Radiology. 132 (3): 683–5. doi:10.1148/132.3.683. PMID 472247.
- ↑ Esim Buyukbayrak E, Kars B, Karsidag AY, Karadeniz BI, Kaymaz O, Gencer S, Pirimoglu ZM, Unal O, Turan MC (November 2010). "Diagnosis of vulvovaginitis: comparison of clinical and microbiological diagnosis". Arch. Gynecol. Obstet. 282 (5): 515–9. doi:10.1007/s00404-010-1498-x. PMID 20461391.
- ↑ Trojian TH, Lishnak TS, Heiman D (April 2009). "Epididymitis and orchitis: an overview". Am Fam Physician. 79 (7): 583–7. PMID 19378875.
- ↑ Foo KT (August 2015). "Diagnosis and treatment of benign prostate hyperplasia in Asia". Transl Androl Urol. 4 (4): 478–83. doi:10.3978/j.issn.2223-4683.2015.08.07. PMC 4708589. PMID 26816845.
- ↑ Gandhi J, Chen A, Dagur G, Suh Y, Smith N, Cali B; et al. (2016). "Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, etiology, evaluation, and management". Am J Obstet Gynecol. 215 (6): 704–711. doi:10.1016/j.ajog.2016.07.045. PMID 27472999.
- ↑ Kim, Kyung Won; Shinagare, Atul B.; Krajewski, Katherine M.; Howard, Stephanie A.; Jagannathan, Jyothi P.; Zukotynski, Katherine; Ramaiya, Nikhil H. (2013). "Update on Imaging of Vulvar Squamous Cell Carcinoma". American Journal of Roentgenology. 201 (1): W147–W157. doi:10.2214/AJR.12.9594. ISSN 0361-803X.