Patient Presentations Related to the Genitourinary/Renal System and Breasts

The guide to clinical presentations in this category may include, but is not limited to, the following ways in which patients present for osteopathic medical care:

bleeding, abnormal genital (vaginal or uterine), such as menorrhagia, menometrorrhagia, non-gynecologic causes (e.g., in pregnant or anovulatory women) • breast conditions – masses, benign or malignant, including fibrocystic disease; nipple discharge, including galactorrhea; gynecomastia and mastitis; mastalgia • breast procedures – mastectomy (modified, radical), lumpectomy; augmentation or reduction; stereotactic biopsy • estrogen deficiency • genital lesions, inflammatory or neoplastic causes, local or systemic, male or female – excoriations and infestations; ulcers and erosions (painful or painless); vesicles, plaques and papules; vulvovaginitis • gynecologic and pelvic masses and lesions – cyst or tumor of uterus, ovaries, or fallopian tube – benign, malignant, or metastatic; pelvic adhesions • kidney disease, acute or chronic including nephrolithiasis or calculus disease (kidney stones); diabetic nephropathy; end-stage renal disease; hemolytic uremic syndrome; nephrotic syndrome; renal masses, solid or cystic • kidney injury, acute • menopause • menstrual abnormalities, including dysmenorrhea, ovulation pain (mittelschmerz); ovarian torsion; premenstrual syndrome; primary and secondary amenorrhea; toxic shock syndrome • pelvic infection and inflammation, female (e.g., endometriosis, pelvic inflammatory disease) • pelvic pain, acute or chronic • pelvic relaxation and pelvic organ prolapse – uterus, vagina, bladder (cystocele), bowel/rectum (enterocele, rectocele) • prostate conditions, including prostatitis; benign prostatic hyperplasia; masses, benign, malignant, or metastatic • sexually transmitted diseases and infections, male and female • testicular and scrotal conditions, including orchitis, epididymitis; testicular torsion; scrotal masses, painful or painless, benign or malignant (e.g., hydrocele, varicocele, tumor) • tubular necrosis, acute • urinary tract infections and conditions – upper vs lower, cystitis, urethritis, pyelonephritis, glomerulonephritis; obstruction; painful bladder syndrome/interstitial cystitis; dysuria, pyuria, hematuria (glomerular, extraglomerular, nephritic/nephrotic), bacteriuria (symptomatic or asymptomatic) • urination dysfunctions – altered frequency, incontinence (stress, urge, overflow, neurogenic), retention, enuresis (nocturnal or diurnal), hesitancy, congenital outflow tract abnormalitiesasymptomatic) • urination dysfunctions – frequency, altered frequency, incontinence (stress, urge, overflow, neurogenic), retention, enuresis (nocturnal or diurnal), hesitancy, congenital outflow tract abnormalities

CONSTITUTIONAL SIGNS AND SYMPTOMS
fatigue • fever • generalized weakness • involuntary weight loss • malaise • night sweats • pallor

PHYSICAL EXAM FINDINGS
cervical motion tenderness • costovertebral angle tenderness • pelvic organ prolapse and pelvic relaxation

LABORATORY TEST FINDINGS AND DIAGNOSTIC IMAGING
acid-base disorders (e.g., metabolic acidosis with elevated or normal anion gap, metabolic alkalosis) • blood urea nitrogen levels • CA-125 • calcium levels • CT scanning • cystoscopy • dipstick urinalysis and sediment microscopy • FSH levels • LH levels • magnetic resonance imaging • mammography • microscopy • nuclear medicine imaging • oxalate levels • prolactin levels • prostate-specific antigen levels • radiography • serum β-HCG levels • serum creatinine levels • serum estrogen levels • serum testosterone levels • struviteuria • ultrasonography • uric acid levels • urinary citrate levels • urinary protein levels • urine culture and sensitivity • vaginal wet mount, KOH prep