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Chapter 13
Urology
Week three already!
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Review etc…….
• Week 2-The GI system review of common errors.
• MT client understanding and use
• Transition week
• Lets start now-looking up meds
• Looking up terms
• Listening for what the doctor is acutally saying
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What is Urology?
• Urology: study of
the urinary system
and male
reproductive
organs
• Urologist: has
specialized skill
with both the
urinary and male
genital organs
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Anatomy of the Genitourinary System
• Kidneys
– Nephrology is the branch of medicine concerned
with the kidneys
– The term renal is an adjective referring to the
kidneys, from ren, Latin word for “kidney”
– Purpose of the kidneys:
– To filter the blood to remove waste products
– To help regulate the body’s blood pressure
– Secrete hormones that assist in body function
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– Components of the kidney:
– Renal capsule: protective membrane
– Renal fascia: attaches kidney to abdominal wall
– Adrenal gland: one on top of each kidney
– Renal sinus: hollow chamber in kidney
– Renal hilus: entrance to renal sinus
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• Three regions of the kidney:
– Renal cortex: Contains blood-filtering mechanisms
– Renal medulla: Collecting chamber, which contains
renal pyramids. The tip of each pyramid is called the
papilla, and the tissue forms structures called renal
columns.
– Renal pelvis: Collects urine as it is produced
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– Nephrons:
• Located in the cortex and medulla
• Number over a million
• Two components: Renal corpuscle and renal tubule
• Renal corpuscle contains the glomerulus which
trap proteins and red and white blood cells
• Renal tubule receives fluid filtered by the
glomerulus during the process of making urine
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• Renal arteries: Major source of blood to the kidneys and
branch off from the abdominal aorta
• Inferior vena cava: The major vein that returns blood
from the kidneys back to the heart
• Urine: A waste product composed of water, certain
electrolytes, and various soluble waste manufactured by
the kidneys during the process of cleaning and filtering
the blood-Urine is sterile when it leaves the body
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• Ureters: Carry urine from kidneys to bladder
– One begins in the renal pelvis of each kidney
– Contain smooth muscle that forces urine downward
from the kidneys to the bladder
– Ureteral orifice: The opening from the ureter to
the bladder
– Ureteral sphincter: The fold that covers the
opening and acts like a valve to allow urine into the
bladder but prevents it from backing up into the
ureter.
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• Urinary bladder : A hollow sac in the pelvic cavity that
serves to store urine until it is eliminated from the body
– Detrusor muscle/muscularis propria: The layer of
muscle that surrounds the bladder
– Trigone: Base of the bladder formed by the two
ureteral openings and the bladder neck, which opens
into the urethra
• Urethra: The tube that conveys urine from the bladder
to the outside of the body We only have 1!!
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Male Genital Organs
• Penis
– Contains the urethra
– Opening at tip: meatus
– Testicles: Contained in the scrotum and produce
sperm and male sex hormones
– Epididymis
– Seminal vesicles
– Prostate gland
– Bulbourethral (Cowper) glands
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The Process of Urination
Blood enters glomerulus of kidneys
Fluid (filtrate) → glomerulus → tubule
→ selective reabsorption → into collecting ducts
→ calyces → renal pelvis → ureter (we have 2 of these!!)
→ into bladder → urethra → out of the body
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Common Genitourinary Diseases and
Treatments
• Urinary tract infection (UTI): An infection in the urinary
tract caused by the invasion of disease-causing
microorganisms
– Cystitis: infection of the bladder
– Urethritis: infection of the urethra
Diagnosed by clean-catch urinary specimen or by a cathed
specimen (catheterize)
More than 100,000 baceria for a a CCMS and 10,000 for a
cathed spec
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• Antibiotic Treatments for UTI:
– Fluoroquinolones: Cipro, Levaquin, Tequin
– Cephalosporins: Ceftin, Ceclor
– Tetracyclines: Doxycin
– Other types of antibiotics: Amoxicillin (Amoxil),
Augmentin, Macrodantin, or trimethoprimsulfamethoxazole (combination of Bactrim, Cotrim,
and Septra)
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• Kidney Disorders
• Kidney failure: The loss of the kidneys’ ability to filter waste
– Acute renal failure: sudden loss of filtering ability
– Chronic renal failure: filtering ability lost over time
Treatment: dialysis
– Hemodialysis: through machine outside the body
• Access by AV fistula or AV graft
– Peritoneal dialysis: abdominal cavity used as filtering
membrane
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• Kidney Transplantation: The process of placing a healthy
kidney from one person (donor) into the body of another
person (recipient)
– Living-related transplant: Donor is a living relative
of the recipient
– Cadaveric transplant: Donated kidney comes from a
dead person.
– The ultimate goal: To match a donor kidney with a
person whose body will tolerate the transplanted
kidney
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• Nephritis: A broad term for any inflammation of one or
both kidneys
– Glomerulonephritis: Inflammation of the glomeruli,
causing hematuria (blood in the urine)
– Focal segmental glomerulosclerosis (FSGS): Scar
tissue that forms on glomeruli in the kidney
– Interstitial nephritis: Inflammation of the spaces
between the renal tubules
– Pyelonephritis: Inflammation of the renal pelvis from
bacteria, treated with antibiotics
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• Polycystic Kidney Disease (PKD): A genetic disorder
characterized by the grown of fluid-filled sacs in the
kidneys that grow out of the nephrons, leading to kidney
dysfunction
– Autosomal dominant polycystic kidney disease
(ADPKD) : Most common inherited form of the
disease
Treatments:
– Pain medication
– Control of blood pressure
– Dialysis or transplantation
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• Kidney stones (renal calculi): Lithiasis means stoneHard pieces of material that form in the kidneys from
crystals that separate form the urine and build up in
inner surfaces of kidneys
– Types of stones:
• Calcium: most common
• Struvite stones: result of UTIs, stag-horn shape
• Uric acid stones: byproduct of metabolism
• Cystine stones: very small percentage of stones
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• Treatment for Kidney Stones
– Most pass through urinary system unobstructed
– Surgical interventions:
• Extracorporeal shock wave lithotripsy (ESWL): A
method of breaking kidney stones using highenergy shock waves
• Percutaneous nephrolithotomy (PCN): Surgical
removal of the stone through small abdominal
incision with a nephroscope
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• Bladder Disorders
•
–
Interstitial cystitis (painful bladder syndrome)
causing hematuria, difficult/painful urination
(dysuria) and pelvic pain
–
Chronic inflammation of bladder wall
Treatments:
–
Medications: Elmiron, antidepressants (Elavil), pain
medication
–
Surgical treatments:
•
Bladder distention
•
Bladder instillation
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• Cystocele: bladder sags into vagina
• Treatments:
• Kegel exercises
• Pessary
• Surgery to relocate bladder
• Neurogenic bladder: results from damage to nerves
controlling urinary tract
• Treatments: Medications, surgery, or catheterization if
necessary
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• Bladder Cancer
– Superficial (does not spread)
– Invasive (spreads to surrounding organs and tissue)
Treatments: Radiation, chemotherapy, or a combination
of these
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Surgical options for bladder cancer:
– Transurethral resection of bladder tumor (TURB):
Removal of the tumor
• Resection means the surgical removal of tissue or
part or all of an organ
• A cystoscope is inserted through the urethra to the
tumor to remove the tumor
• Remaining cells are burned away with laser or
high-energy electricity, called fulguration
– Radical cystectomy: Entire removal of bladder and
nearby structures that may be cancerous
• Segmental cystectomy: Only part of bladder is
removed
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• Bladder reconstruction: Used when bladder is removed
to collect urine
– Section of bowel is used to recreate bladder
– Urostomy or urinary diversion: Section of intestine is
used to drain urine outside the body through new
connection called ileal conduit to outside pouch
– Koch pouch: Pouch is located inside the abdomen
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Male Genitourinary Disorders
• Hypospadias: Abnormal location of urethra
– Treatment: Surgery to correct
• Testicular torsion: Testicles twist around
spermatic cord
– Treatment: Immediate surgical intervention is
required
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• Prostate Disorders
– Prostatitis: inflammation of prostate gland.
– Benign prostatic hyperplasia (BPH): enlargement of
the prostate
Treatments:
– Drug therapy
– Transurethral resection of prostate (TURP): Removal
of excess tissue from the prostate
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• Prostate cancer: Growth of malignant cells in the
prostate gland
Treatments:
– Brachytherapy: Implantation of radioactive seeds
– Cryosurgery: Use of extreme cold to destroy
cancerous tissue
– Photoselective vaporization prostatectomy (PVP):
laser therapy to destroy cancerous tissue
– Radical prostatectomy: Complete surgical removal of
prostate
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Sexually Transmitted Diseases (STDs)
– Caused by a pathogen (virus, bacterium, parasite, or
fungus)
– Spread by sexual contact
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• Genital Herpes
– Caused by herpes simplex virus (HSV)
– Two types: HSV-1 (mouth sores) and HSV-2 (genital
herpes)
– Drug treatments: acyclovir (Zovirax), famciclovir
(Famvir), and valacyclovir (Valtrex)
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• Gonorrhea (GC)
– Bacterial infection caused by Neisseria gonorrhoeae
– Transmitted by sexual contact
– Treatments: ciprofloxacin (Cipro), ofloxacin (Floxin),
or levofloxacin (Levaquin)
• Chlamydia
– Most common STD
– Caused by bacterium Chlamydia trachomatis, sexual
contact
– Treatment: azithromycin (Zithromax) or doxycycline
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Diagnostic Studies and Procedures
• Laboratory Tests
• Blood studies:
• Glomerular filtration rate (GFR)
• BUN, creatinine, electrolytes, CBC, PSA
• Urine Studies:
• Urinalysis and culture
• Creatinine clearance
• STD cultures
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• Radiologic Studies
– Kidney, ureter, and bladder x-ray (KUB): Supine xray of the abdomen showing kidneys (K), ureters (U)
and bladder (B)
– Intravenous pyelogram: Series of x-rays taken with
contrast dye to show narrowing or blockages
– Voiding cystourethrogram: Contrast dye inserted
with catheter and x-rays taken during urination to
show blockages of urethra or backflow of urine into
ureters
•
Ultrasound Studies: Uses high-frequency sound waves
to get images of the kidneys
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• Endoscopic Studies
– Cystoscopy: Uses a lighted scope (cystoscope) to
view urethra and bladder
– Ureteroscopy: Uses ureteroscope to examine ureters
for presence of stones
• Urodynamic Studies
– Uroflowmetry: Analyzes urine speed and volume
– Postvoid residual: Amount of remaining urine after
urination
– Cystometrogram (CMG) or cystometry: Analyzes
function and stability of bladder
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Catheterization
• Why
• Different types of
• Orders related to
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Urinary sugrgical procedures
• Cystosocopy
• Urethrotomy
• Instruments used
• TURB
• TURP
• Kidney surgeries
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Physical examination: General: The patient is seen today. She is in her room. She is alert, oriented and able to answer questions appropriately. S
Assessment and plan:
•Left occipital pain around the cochlear implant. She states the pain is relieved when she plugs her ear. She has a CT scheduled. Will continue with
LADawn Logic, N.P.
DD: 11-18-2011
DT: 11-21-2011
P. Sarvepalli, M.D./dlg:dz
The end
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