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Pain in the genitourinary tract

It is usually associated with distention of hollow viscus or the capsule of an organ. Pain may be local or referred.
A. Renal
Pain of Renal origin is usually located in the ipsilateral costovertebral angel. It may radiate to the umbilicus and may be referred to the ipsilateral testicle in men or the labium in women. In infection, the pain is typically constant. Nausea and vomiting may result from reflex stimulation of the celiac ganglion.
B. Ureteral
It is usually acute and a result of obstruction. Distention may cause a constant dull ache, while the spasms result in colic. Upper: result in pain referred to the scrotum or to the labium. Mid: pain in the lower quadrant (may be confused with apendicitis). Lower: associated with symptoms of vesical irritability.
C. vesical
Urinary retention results in severe suprapubic discomfort. Cystitis pain is usually referred to the distal urethra and is associated with micturition.
D. Prostatic
pain is located in perineum. Pain radiates to the lumbosacral spine, inguinal canal, or lower extremities. Inflammatory result in irritative voiding complaints.
E. Penile
Pain in the flaccid penis is secondary to inflammatory caused by STD. Pain in the erect penis may be due to peyronie's disease(fibrous plaque of the tunica albuginea) or to priapism(prolonged painful erection).
F. Testicular
Acute pain within the scrotum with radiation to the ipsilateral groin. Varicocele or hydrocele results in heaviness without radiation.

Hematologic evaluation

Several Hematologic disorders may have an impact on the outcomes of surgery. Two of the more common clinical situations faced by the medical consultant are the patient with preexisting anemia and the assessment of bleeding risk. Most data suggest that morbidity and mortality increase as the preoperative hemoglobin level decreases. Hemoglobin levels below 7 or 8 g/dl appear to be associated with significantly more preoperative complications than higher levels. When the directed bleeding history is unreliable or incomplete or when abnormal bleeding is suggested, a formal evluation of hemostasis should be done prior to surgery and should include measurement of prothrombine time, the activated partial thromboplastin time, the platelet count, and the bleeding time.