CHAPTER 1  Evaluation of the Urologic Patient 15

Bacteria. A fresh uncontaminated urine specimen should not con- tain bacteria. Presence of bacteria is indicative of a UTI.

Yeast. Funguria is more commonly seen in patients with diabetes mellitus or vaginal candidiasis and typically Candida albicans. Protein. Proteinuria increases suspicion for underlying medical renal disease or overflow of abnormal proteins in the urine (multiple my- eloma). If proteinuria is present, consider nephrology consultation. Glucose and Ketones. Often used for screening patients for diabetes mellitus. The renal threshold for glucose detection in urine is serum glucose .180 mg/dL. Ketones are found in urine when carbohydrate sources in the body are depleted and body fat utilization occurs. Bilirubin and Urobilinogen. Normal urine contains no bilirubin and only small amounts of urobilinogen.

Urine Cytology

Ordered when urologic malignancy is suspected. Do not order as a screening tool or during initial workup for gross/microscopic hematuria. This test is highly specific for high-grade urothelial cell carcinoma (UCC).

SERUM STUDIES

Creatinine and Glomerular Filtration Rate (GFR)

Obtained to evaluate baseline or current renal function and can aid in investigating renal compromise in the context of urinary tract obstruction.

Prostate-Specific Antigen (PSA)

Tumor marker for diagnostic evaluation of prostate pathology in- cluding cancer, benign prostatic hyperplasia (BPH), and inflam- matory conditions of the prostate.

Alpha-Fetoprotein (AFP), Human Chorionic Gonadotropin (HCG), and Lactate Dehydrogenase (LDH)

Serum tumor markers for workup of testicular mass/cancer.

Endocrinologic Studies

Total testosterone, free testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL), and thyroxine T4 may be ordered in the workup of the male patient with suspected hypogonadism.