Genitourinary Diseases and Conditions

Urinary System

https://commons.wikimedia.org/wiki/File:Illu_urinary_system.jpg

Anatomy

https://upload.wikimedia.org/wikipedia/commons/thumb/8/87/2610_The_Kidney.jpg/320px-2610_The_Kidney.jpg

Primary components

Kidneys
Ureter
Bladder
Urethra

Secondary Components

Prostate
Pelvic Floor Muscles
Genitals

Physiology

Fluids are filtered through the kidneys and the filtrate is converted to urine. Urine is mostly water and urea, which is a metabolic by-product of protein metabolism, and electrolytes

Urination is mediated by voluntary and involuntary nervous system actions:

L1-L3 forms the sympathetic branch
S2-S4 forms the parasympathetic branch - visceral and afferent pathways

Selected GU Medical Terminology

Dysuria = abnormal urine/urination. Incontinence is a form of dysuria
Incontinence = involuntary loss of urine. Incontinence can be

urge - sensation of needing to urinate - overactive
stress - muscular insufficiency
overflow - insufficient bladder emptying or urethra blockage
functional - unable to find/get to the toilet in time

Enuresis= involuntary voiding during sleep

Voiding =emptying urine from bladder

Micturition = urination: good interactive activity with graded quiz found here Link to animation of the micturition reflex

Hematuria = blood in urine

Pyuria = presence of pus/bacterial infection in urine

Urgency = sensation of need to urinate, may be neurological or due to a spasm of smooth muscle in the bladder

Value: 1

Pathology Overview

Urinary Tract Infection UTI = bacterial infection
Uretritis=inflammation of the urethra
Cystitis= inflammation of the bladder
Pyelonephritis = bacterial infection of the kidneys
Nephrolithiasis= kidney stones composed of minerals and salts
Cystocele= fallen bladder
Neurogenic bladder = dysfunctional autonomic control of the micturition
Benign prostate hypertrophy or dysplasia BPH= enlargement of the prostate gland (American Urology Assn, 2019)

Urinary Tract Infection (UTI)

Overview

Increased risk with catheterization
Increased risk with hospitalization
Higher risk if a medical history of UTI's is present
Higher incidence with individuals with diabetes and women.

women have a shorter urinary tract which increases the risk (NYT, 2013)

Most common cause is E Coli bacterial infection
If untreated can lead to kidney infection and sepsis/septic shock

Signs and Symptoms

Frequency of urination/urinary urgency
Painful urination

More common in men with UTI's than women with UTI's which is one of the reasons why UTI's are under diagnosed in women

Burning feeling in the bladder
Confusion
Milky or cloudy urine
Blood in urine
Fever
LBP

Value: 1

Uretritis and Cystitis

Associated with sexually transmitted disease (STD)
Signs and symptoms include increased frequency and urinary urgency
Supra pubic pain, foul smelling urine, pyuria
Asymptomatic bacteriuria, fatigue, anorexia, cognitive changes
Results in pain, swelling of involved structure
Treated with antibiotics and education/nursing care

Pyelonephritis

image from Kidneys: Structure, function, and diseases

Medical News Today|1100 × 734 jpeg

Acute or chronic inflammation of renal pelvis, or parenchyma of kidney
Infection ascends from lower urinary tract.
Often pre-existing factor = hx of UTI's and or Diabetes Mellitus (DM)
Signs and symptoms: mild sluggishness, s/sx cystitis, fever, chills, vomiting, malaise, severe flank pain, costovertebral tenderness on affected side
Bacteriemia, septic shock
Chronic pyelonephritis starts in medulla of kidney spreads to cortex.

Nephrolithiasis

Problem primarily associated with the kidneys
Kidney stones: crystallization of calcium, uric acid, magnesium-ammonium acetate
Stones may form anywhere along the urinary tract
Stone formation is associated with decreased fluid intake, low urine volume, genetic factors, bed rest and sedentary lifestyle
Higher risk in areas of hot temperatures and high humidity
S/sx similar to pyelonephritis marked increase in flank pain and urination pain

https://commons.wikimedia.org/wiki/File:Blausen_0595_KidneyStones.png

Value: 1

Renal Trauma

Bike Crash.jpg

Blunt trauma to the kidneys can occur in a bike accident

Blunt trauma: car, bicycle accidents, sports injuries, falls with injury to flank, abdomen or back
Penetrating gun shot and/or stab wounds
Renal trauma is diagnosed using ultrasound, CT scan, MRI, recent history, hematuria, intravenous pyelogram/IVP.