Urinary

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urologist
physician certified by american board of urology ABU
male and female urinary tract male reproductive organs 8 subspecialty areas

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pediatric urology***
urological problem in children hypospadias undescended testicles circumsisions kidney cancer

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urologic oncology****
treatment of cancers of male and female urinary tract male reproductive organs prostate bladder penile testicular cancer men kidney bladder cancer women

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renal transplantation****
kidney transplants

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Male Infertility***
problems fathering children

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Urinary Tract Stones****
kidney stones formed when urine too concentrated and chemicals usually dissolve crystallize pain

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Female Urology*****
treatment of ruinary ioncontinence pelvic outlet relaxation disorders genitourinary trauma injury

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Neurourology*****
treatment voiding disorders caused by neurological trauma neruological diseases MS musc dystrophy Parkinson's disease spinal bifida urodynamic evaluation patients

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Erectile dysfunction**** or impotence

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treatment of difficulties men have in achieving erection

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urinary system consists of kidneys ureters bladder urethra****

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kidneys purplish-brown organs below ribs remove liquid waste from blood in form of urine*****

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kidneys
keep stable balance salts other subs in blood produce hormone aids formation of RBCs

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ureters
narrow tubes carry urine from kidneys*** to bladder triangle-shpaed chamber in lower abdomen

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Urine
stored in bladder and emptied through urethra***

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average adult passes quart 1/2**** urine eday amount varies fluids and foods consumed
volume at night 1/2 that formed in daytime

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wastes
sweat*** carbon dioxide gas feces urine

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sweat released pores skin
water vapor carbon dioxide exhaled by lungs
undigested food materials feces intestines**** solid waste
kidneys and urinary system in charge of filtering wastes from blood eliminating liquid*** urine

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kidneys regulate acid-base balance pH of blood and body fluids***

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renin
enzyme regulates salts*** and others kidneys regulate blood pressure

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erythropoietin
hormone from kidneys stimulates controls RBC production

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kidneys release 3 hormones

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erythropoietin
EPO stimulates bones make rbc

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Renin
regulates blood pressure

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active form Vit D
maintains calcium bones for normal chemical balance in body

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kidneys work in tandem
can live with one*** if one removed the other enlarges in few months takes ober increased role of filtering blood

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kidneys under rib*** cage in back right kid below liver little lower each kidney about 5long***x3"widex1"thick

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cortex ***outer layer filtering units
medulla middle 10-15 fan shaped structures pyramids
pyramids drain urine to cup-shaped tubes CALYXES
FAT*** surrounds kidneys cushion hold in place

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bean shape dented facing toward center of body HILUS large blood vessels enter and leave kidney

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renal artery
sends fresh blood into kidney to be filtered

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filtered blood leaves through RENAL VEIN*** flows to heart continuous blood supply give kidneys dark red color

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1 million filtering units NEPHRONS*** perform blood-filtering process produce urine waste product

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each NEPHRON contain filter GLOMERULUS network of blood vessels capillaries***

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fluid from blood by glomerulus travels to tube TUBULE adjusts level of salts water wastes excreted urine

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renal pelvis
near hilus**** collects urine in chamber from pelvis urine goes to ureter tube carries urine to urinary bladder*** muscular collection sac in lower abdomen

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bladder holds 1/2 liter*** 2cups
at any time
urine expelled from bladder out of body through urethra tube-like structure
fe/male urinary tracts same except length urethra****

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renal arteies
bring blood to kidneys
nephrons**** small branches at ends of arteries remove harmful substances from blood

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kidneys filter and clean**** blood urine carrying liquid waste is produced

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every minute more than 1 quart blood passes through kidneys 425 gallons of blood each day

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1/4 uman blood in kidneys at any time
kidneys cleanse blood in body every 50 minutes

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while blood in kidneys wat3r and some blood components acids glucose other nutrients reabsorbed**** back to bloodstream
urine is left

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urine
concentrated solution waste material
water UREA waste product forms when proteins broken down salts glucose amino acids by-products bile from liver ammonia others

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urine contains UROCHROME*** pigmented blood product yellow color to urine

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urine transported from kidneys through URETERS
pass urine to urinary bladder for storage expands to fill 1/2liter 2 cups

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average adult 11/2liters 6 cups of urine per day need to excrete 1/3 of that amount to clear waste products from body

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excessive or inadequate**** urine production may indicate illness

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when bladder full nerve endings in wall send impulses to brain

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when ready to urinate full feeling triggers bladder walls to contract

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SPHINCTER*** ring-like muscle guards entrance from bladder to urethra relaxes

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urination through urethra bladder empties
male tip of penis
female urethra ends above vaginal opening

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ability to hold and maintain continence dependent on lower urinary tract and nervous system

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person must possess physical and psychological ability recognize appropriately respond to urge

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process of urination 2 phases
filling and storage phase
emptying phase***

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filling and storage phase
bladder fills stretches to accommodate sensation of urge when 200 ml urine stored

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nervous system reponds to stretching gives urge allows bladder to fill

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average person holds 350-550*** ml ability to fill and store requires functional sphincter*** circular muscles around opening of bladder
and stable bladder wall muscle DETRUSOR

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emptying phase ability of detrusosr muscle appropriately contract force urine out of bladder simultaneously relax sphincter

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urinalysis
exam of urine physical or chemical means
chemical and microscopic tests

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urinalysis
screens for renal disease and diseases of other organs result in abnormal metabolites break-down products

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clean-catch midstream urine sample need to clean
let small amount fall into toilet bowl clears urethra contaminants clean container catch 1-2 ounces urine

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screening urinalysis tests measured by reagent dipstick contains little pads of chemicals change color contact with substances of interest

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several types of reagent strips checks for early signs of disease monitor diabetes or kidney disease

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normal urine
almost colorless to dark yellow beets and blackberries red

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specific gravity*****
1.006 and 1.030 higher numbers = higher concentration
varies time of day amount of food and liquids and exercise

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pH balance****
4.e6-8.0 average of 6.0

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RBCs*** hemoglobin bilirubin nitrites wbcs leukocytes no urine glucose urine ketones or urine protein either
usually none

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urine unusual color not by food intake or meds urinalysis + consult

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urine specific gravity
higher or lower normal range may indicate kidney prob

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ureine pH
alkaline urine is good not too much kidney stones less to form antibiotics more effective prevent bacteria

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urine sugar
blood levels glucose very high or ketones may be present in uncontrolled diabetes

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urine protein
finding protein screening for kidney disease

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blood in urine
urinary tract disease or bleeding kidneys or vigorous physical exercise

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bilirubin
liver or bile duct disease
urobilinogen small traces

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Nitrites wbc's
urinary tracct infection

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vit C
normal
measurable amounts may interfere other urine tests false negs or pos

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home test
if color blind need someone else to read
choroquine iron supps levodopa nitrofuantoin phenazopyridine phenothiazine phenytoin rirboflavin and triamterene CHANGE COLOR URINE

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cancer****
cells reproducing divide toomuch too fast tumor if does not invade surrounding tissues benign
if tumor spreads to tissues or other part METASTASIS

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adrenal cancer
medulla and cortex malignancies in cortex majority functional or nonfuctional produce steroids or don't rare 2per 1million

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bladder cancer
cancer grows in inner lining specialized expanding and deflating cell transitional cells invades reproductive abdominal pelvis lymph nodes

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kidney cancer
most common renal cell carcinoma RCC 85% all kidney cancers usually single

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urethral cancer
women unusual older inflammation factor males transurethral biopsy diagnosis

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penile cancer 2% urogenital cancers america 10% where don't do circumcision incisional or excisional biopsy squamous cells most

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prostate cancer***
after lung cancer prostate second most common cancer deaths US called ADENOCARCINOMA OF PROSTATE for tumor outside prostate gland if spread through bloodstream deadly

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diabetic nephropathy****
damage to nephrons from unused sugar in blood
nephropathy

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high blood pressure***
hypertension damage small blood vessels in kidneys can't filter poisonsfrom blood need ACE inhibitors protection to kidneys

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interstitial cystitis IC****
painful bladder syndrome frequency-urgency-dysuria syndrome chronic inflamed irritated bladder wall scarring glomerulations pinpoint bleeding ulcers

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nonulcerative IC****
most common young to middle-age normal near normal increased bladder cap. glomerulations in bladder wall

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ulcerative IC****
midd to older women bladder cap low less than 1/2 c fibrosis cracks scars Hunner's ulcers star shaped sores

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incontinence****
inability to control urination acute infections or persistent stress, urge, overflow, functional incontinences

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congenital problems****
fetal development urinary tract grow abnormally size shape position
DUPLICATION OF URETERS 2 ureters per kidney
horseshoe kidney fused prone cancer 1 per 500 7% girls with Turner Syndrome

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urinary tract infection****
UTIs bacterial E coli
pyelonephritis systitis urethritis

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vesicoureteral reflux VUR****
urine flows backward from bladder into ureters diagnosed injecting dye in bladder

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renal failure
acute sudden bacterial injury shock heart failure toxic
chronic over time progressive deterioration of kidney function

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end-stage renal disease
total nearly total kidney failure called end-stage renal disease ESRD dialysis or transplantation

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kidney stones
buildup of crystallized salts and minerals calcium in urinary tract calculi after infection nephrolitiasis renal stone disease

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bladder stones ****
large pieces minerals in urinary bladder

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bladder stone locations
pelvis uterus urinary bladder bladder stone

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benign prostatic hyperplasia BPH*****
prostate enlarlged aging surrounding tissue prevents from expanding squeeze gland pinch urethra restrict flow of urine bigger creates need to urinate small amount urine

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nephrotic syndrome\
group of symptoms protein water salt fats in blood disease or drugs hereditary

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nephritis
inflammation of kidney infection autoimmune disease lupus protein blood in urine glomerulonephritis inflammation of glomeruli

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hypertension ***
kidneys control blood pressure regulating salt in body enzyme renin controls constricion of muscle cells in walls of blood vessels

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Wilm's tumor ****
most common kidney cancer children birth defects of genitourinary tract remove kidney

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cystocele*** fallen bladder
wall between womans bladder and vagina weakens bladder droops in vagina

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erectile dysfunction***
ED inability achieve erection

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hematuria****
rbc's in urine microscopic and gross seen with naked eye color of cola

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interstitial cystitis***
IC chronic pelvic pain disorders

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kidney failure ***
complete irreversible kidney failure end-stage- disease ESRD ruemia seizures coma death

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renal cell carcinoma***
cancerous changes in cells of renal tubule most common adults

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Goodpasture Syndrome ****
rare affects lungs and kidneys auto immune disease cough blood burn urine immunosuppressive drugs by mouth few weeks 2yrs.

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diabetes insipidus***
DI excretion large amounts of dilute urine disrupt's water regulation

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glomerular diseases ***
tiny units where blood is cleaned many conditions
2 categories

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glomerulonephritis
inflammation of membrane tissue in kidney serves as filter wastes extra fluid

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glomerulosclerosis
scarring hardening of tiny blood vessels in kidney

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pyelonephritis****
infection of kidey ducts carry urine away

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acute bilateral obstructive uropathy****
blockage of flow of urine from both kidneys backup of urine injury

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renal artery stenosis****
narrowing or blockage of artery supplies kidey atherosclerosis fibromuscular dysplasia of renal artery wall or scar

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urethral syndrome**** females
under evaluation no specific findings to account for symptoms

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male infertility
sterility
doesn't produce sperm enough or at all

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varicocele****
male infertilityi varicose vein develops in testicles poor circ decreased sperm

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oliguria****
decreased urine output <500ml 24 hours

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priapism****
penis stays erect erectile bodies damage discomfor pain up to 6 hours

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Peyronie's disease***
curved penis scar tissue pull one side causing curve when erect

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testitis***
orchitis inflammation of testis

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prostatitis***
family of diseases inflammation/pain region of prostate 4 forms

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acute bacterial prostatitis ABP
rapid fever pain lower back genital burning urinary frequency urgency

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chronic bacterial prostatitis CBP
similar to ABP but high incidence of bladder infections

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prostadynia PD
prostatitis

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not true form

pain in pelvis or perineum area between scrotum anus

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urinary catheterization
hollow tube inflatable balloon tip8*** inserted in urinary bladder when bladder needs to be empty decompressed urinary flow assured

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digital rectal exam****
DRE
physician inserts lubed gloved finger to feel prostate gland should be soft malignant hard stony

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prostate specific antigen PSA test****
if tumor on prostate blood screening test how much cancer present spread? PSA produced by cells of prostate capsule membrane periuretharal glands >10ng/ml cancer 4-10 ng/ml inconclusive

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prostatic acid phosphatase PAP ***
enzyme produced tissues production increases as prostate disease progresses detects and monitors advanced prostate cancer

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radical prostatectomy ****
most common treatment localized cancer under ages 70 surgically removing cancerous gland seminal vesicles

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cryosurgery TRUS-guided probe**** delivers freezing to cancerous tumor

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brachytherapy*(***
therapy implantation of tinpy radioactive implants into cancerous prostate gland small cancers stage 1-2

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dialysis
hemodialysis blood sent through machine filters waste
peritoneal dialysis
fluid put into abdomen dalysate captures waste products from blood then fresh bag dripped
continuous ambulatory peritoneal dialysis CAPD home use 4xa day

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CT scan computed tomographic CAT scan ****
cros sectional X-ray produces 3 dimentsional images of internal organs andfd glands tumors

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MRI magnetic resonance imaging***
similar to CAT large magnets projects magnetic waves through body

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ultrasound***
sound waves into body produce viewable image of internal organs

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intravenous pyelogram IVP***
injecting dye oidine through vein in arm collects in urinary system contrast for X-ray film tumor

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arteriogram or venacavagram****
X-rays of blood vessels supply kidneys check for tumors

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chest x-ray****
metastasized cancer check in lungs

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Bone scan****
nuclear imaging procedure spread of cancer to bones for aggressive tumors and metastasis low level radioactive material injected in body

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cystoscopy
lenses like telescope or microscope ureteroscope for ureters thin optical scope finc bleeding

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intravenous pyelogram
contrast material injecting vein x-rays timed intervals

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kidney biopsy
renal biopsy kidney tissue removed with needle blood or protein in urine

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Kegel exercises ****
strengthen pelvic floor muscles improve bladder control stress ur incontin

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penile tumescence self test***
night time erections determine cause of dysfunction one cent stamps wrapped aropund penis if strip of stamps broken

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penile implant ***
device in penis

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intravenous urogram IVU injecting liquid visible on X-rays into forearm exact location of stone obstructions visualized

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ultrasound
ultrasonic sound waves kidney liver gallbladder stones visualized

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vasectomy****
male contraception 1/2 mill men undergo

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CT scan body scanning cut into small slices contrast-medium

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renography slightly radioactive substance injected into vein like IVU excreted by kidneys special camera detects image of radioactivity

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retrograde urogram
small tube inserted in ureter using cystoscope with contrast medium in ureter

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renoscopy
ureter viewed through small tube even renal pelvis seen
when no other exasm give good view tissue samples can be taken

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renal biopsy
needle trough skin into back of kidney to retreive 1/2-3/4 inch

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uroflow
how quickly and completly you empty bladder reduced indicates BPH

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pressure flow study
pressure in bladder as urinate determine how much urine blocked

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post-void residual PVR
how much urine left in bladder after urination how BPH affected bladder

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AUA american urological asociation Score or Symptom Index

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self-administered questionnaire how severe BPH smptoms may be 7 questions rates degree frequency or severity scale 1-5 7mild 8-9moderate 20-35severe

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Blood tests show if kidneys failing to remove wastes***** Urine tests how quickly body wastes being removed leaking protein

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urinalysis
blood in urine=hematuria microscopic procedure =urine cytology****** disclose cancer cells in urine
urine creatinine levels used as screening test evaluates kidney function or creatinine clearance test

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creaTININE=waste roduct inHEALTHY KIDNEYS TAKE OUT PUT IN URINE **** blood breakdown of muscle during activity creatinine build up not working creatinine values variable affected by diet 2.0mg/dl-50% normal 4.0mg/dl-25%

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creatinine clearance
how fast kidneys remove creatinine from blood ml/min men normal is 97-137 women 88-128ml/min <not working well

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blood urea nitrogen BUN
blood carries protein for cells after cells use becomes waste returned to blood as UREA contains nitrogen if kidneys not working urea stays in blood 7-20 mg/dL normal >20not working

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urine tests
few ounces to 24 hour urine test how much urine per day measures protein

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proteinuria PROTEIN IN URINE*****
healthy kidneys take out wastes leave protein bad kidneys leave protein in waste

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If foams in toilet may contain high levels protein doctor tests using dipstick maybe a 24 hour urine test needed