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Chapter 13
Urology
Instructor: Kathleen A. Bishop, MS, PHD
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
What you will need for this class
– Medical Transcription Fundamentals,
Gilmore
– AAMT Book of Style for Medical
Transcription
– Any other resource books you may have
available such as medical dictionary, PDR,
Merck Manual, etc.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
How this class will work
• This is an open book Seminar.
• Be prepared to respond to the questions on each slide.
• Be prepared to share your thoughts with the other class
participants.
• After the questions slide you will see an answer slide so
you can check to see how you did.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
SEMINAR
Traditional Work Environment
• The traditional work environment is one where you travel
to an office and work. This environment includes medical
offices, transcriptions services, hospitals, etc.
• Pros
– Can you name a few?
• Cons
– Can you name a few?
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Home Work Environment
• In the home work environment , you should have a
designated area that is dedicated for your work. This
environment should be distraction-free.
• Pros
– Can you name a few?
• Cons
– Can you name a few?
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
AHDI Tips for Becoming a Self-Employed MT
If you are planning to become a self-employed medical transcriptionist,
AHDI recommends that you…
• Have at least basic knowledge, through education or experience, in:
– English grammar and punctuation
– Medical language
– Disease processes
– Anatomy and physiology
– Pharmacology
– Laboratory medicine
– Radiology and imaging
– Medical transcription technology
– Healthcare documentation
– Medicolegal issues
– Ethics
– Medical transcription practices
– Business practices
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Tips (cont.)
• Have work experience or have completed at least a 240hour externship in a hospital or clinic setting under the
supervision and direction of a certified or experienced
medical transcriptionist.
• Attend seminars on small business and marketing,
review available business publications and references,
and determine the transcription needs of the medical
community you seek to serve.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Tips (cont.)
• Consult an attorney to create and review contracts and
to determine what regulations and laws apply to
businesses in your area. Remember, you will be
operating under the laws and regulations of your city,
county, and state, and you may also be subject to the
rules and regulations of a multitude of federal agencies.
• Complete a business plan, perhaps with assistance from
the Small Business Administration (SBA).
• Consult a tax advisor who is familiar with the regulations
and laws covering such issues as:
– Independent contracting
– Tax audits
– Tax schedules and requirements
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Tips (cont.)
• Consult an insurance broker regarding necessary
coverage for such things as:
– Business liability (also known as errors and
omissions)
– Disability/life/retirement
– Property/equipment
– Unemployment
– Workers compensation
• Research current publications to determine what
equipment and materials will best suit your needs and
your clients' needs. Be sure to investigate warranties and
maintenance agreements.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Tips (cont.)
• Research current publications to determine what
equipment and materials will best suit your needs and
your clients' needs. Be sure to investigate warranties and
maintenance agreements.
• Begin to assemble a medical and business library,
including a style manual such as The AHDI Book of Style
for Medical Transcription, a standard medical dictionary,
and pharmaceutical, laboratory, surgery, and various
specialty references.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Tips (cont.)
• Identify one or more experienced medical
transcriptionists in your community who are willing to
serve as mentors and be available to assist you with
questions regarding medical terminology and
transcription practices.
• Along with planning and preparation, perform a reality
check. Remind yourself: If I become self-employed, I will
be responsible for paying self-employment tax and
providing my own
– Medical and retirement benefits
– Sick leave and vacation
– Time with family and friends
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Tips (cont.)
• Make a commitment to yourself and your business
to seek continuing medical education and
professional development through membership and
participation in the professional association for
medical transcriptionists-AHDI-and make a plan for
achieving the professional credential of CMT
(Certified Medical Transcriptionist) in order to
demonstrate to your clients a commitment to
excellence.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Critical Thinking Skills
 Learning to be a critical thinker is imperative in our
business.
 Developing critical thinking techniques ensures the
accuracy and validity of your documents.
 Using critical thinking techniques will help you find the
answers to all the questions that will come up as you are
transcribing.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Characteristics of a Critical Thinker
• Raymond S. Nickerson (1987), an authority on
critical thinking, characterizes a good critical thinker
in terms of knowledge, abilities, attitudes, and
habitual ways of behaving. Here are some of the
characteristics of such a thinker.
http://www.freeinquiry.com/critical-thinking.html
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nickerson’s Partial List…
– Uses evidence skillfully and impartially.
– Distinguishes between logically valid and
invalid inferences [conclusions].
– Can learn independently and has an
abiding interest in doing so.
– Is aware of the fact that one's
understanding is always limited, often
much more so than would be apparent to
one with a non-inquiring attitude [mind].
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nickerson’s Partial List…
– Uses evidence skillfully and impartially.
– Distinguishes between logically valid and
invalid inferences [conclusions].
– Can learn independently and has an
abiding interest in doing so.
– Is aware of the fact that one's
understanding is always limited, often
much more so than would be apparent to
one with a non-inquiring attitude [mind].
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Four Steps to Critical Thinking
1. Identify the elements of your document
a. Body system and/or specialty
b. type of document
c. report headings, paragraph content, and the other
sentences in the paragraph that you have already
transcribed
d. Find the diagnosis or procedure.
e. Use any other information you may have on hand,
such as the medical record or previous reports.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Four Steps to Critical Thinking (cont.)
2. Evaluate your assumptions about those
elements
a. Does this word, test, etc. belong in or with this
body system, procedure, operation, diagnosis?
3. Judge your choices probability or
acceptability of being right.
4. Evaluate your choices by asking: “With
what I already know, which is the most
probable or likely to be correct, and why?”
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Best Practices for Success
• Each week we will cover a variety of topics that will help
you be successful in your career.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Transcription Tip
• Do not mistranscribe the term double-J ureteral stent as
J and J ureteral stent. The ends of the double-J stent
actually look like the letter J, hence the name double-J
stent. Therefore, J and J, J&J, and JJ are all incorrect and
can mean other things. For example, J&J has a product
line for knee and hip prostheses as well as surgical
dressing supplies (Gilmore, 2009).
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Soundalike Words
Which is the correct word in the following sentences.
• 1. We recommended Kegel exercises to help with her
(cystocele/cystogram).
• 2. Enlargement of the prostate or (TURP/BPH) is a
common disorder of aging.
• 3. The tube that carries urine from the kidney to the
bladder is the (urethra/ureter).
• 4. The patient is scheduled to have her
(cystectomy/cystocele) procedure next week.
• 5. PKD can cause cysts to interfere with
(necrotic/nephron) function.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Soundalike Words Answers
• 1. We recommended Kegel exercises to help with her
(cystocele/cystogram).
• 2. Enlargement of the prostate or (TURP/BPH) is a
common disorder of aging.
• 3. The tube that carries urine from the kidney to the
bladder is the (urethra/ureter).
• 4. The patient is scheduled to have her
(cystectomy/cystocele) procedure next week.
• 5. PKD can cause cysts to interfere with
(necrotic/nephron) function.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Transcription Tip
• Sometimes physicians will shorten the names of
vancomycin, ampicillin, and gentamicin in dictation,
respectively, as vanc, amp, and gent. As with other
shortened forms of words, spell out these terms when
transcribing the names of these medications (Gilmore,
2009).
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Soundalike Words
• 6. A kidney stone is also called a renal
(calcium/calculus).
• 7. (BUN/BUS) is produced from the breakdown of food
protein.
• 8. The lab work showed his (PSA/PKD) level had risen to
4.5 in the last month.
• 9. Physicians use (urodynamic/urethroscopic) studies to
evaluate how the body stores and releases urine.
• 10. As kidney disease progresses, the level of
(creatine/creatinine) in the blood increases.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Soundalike Words Answers
• 6. A kidney stone is also called a renal
(calcium/calculus).
• 7. (BUN/BUS) is produced from the breakdown of food
protein.
• 8. The lab work showed his (PSA/PKD) level had risen to
4.5 in the last month.
• 9. Physicians use (urodynamic/urethroscopic) studies to
evaluate how the body stores and releases urine.
• 10. As kidney disease progresses, the level of
(creatine/creatinine) in the blood increases.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Are the statements True or False
• 1. A Koch pouch is a pouch placed outside the
abdomen.
• 2. The glomerular capsule is also called the Bowman
capsule.
• 3. Urodynamics is the study of the function or
dysfunction of the bladder and urethra.
• 4. A cystocele is an inflammation of the bladder.
• 5. The middle part of the kidney is called the renal
medulla.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
True/False (cont.)
• 6. A patient's cross-matching antigen test is the most
important matching factor to a donated kidney and its
recipient.
• 7. ADH is a hormone that aids in the formation of red
blood cells.
• 8. Urea is the most abundant of the waste products
excreted by the kidneys.
• 9. The enlargement of the prostate is called PSA.
• 10. A cystocope is used to break up stones located in the
lower portion of the ureter.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
True/False Answers
1.
2.
3.
4.
False. A Koch pouch is a pouch placed inside the abdomen.
True.
True.
False. A cystocele is a condition that occurs when the bladder
drops or sags into the vagina.
5. True.
6. False. The patient’s blood group and typing are the most
important matching factors to a donated kidney and its
recipient.
7. False. ADH is a hormone that is released when the amount of
water in the body decreases.
8. True.
9. False. The enlargement of the prostate is called benign
prostatic hypertrophy (BPH).
10. False. A ureteroscope is used to break up stones located in the
lower portion of the ureter.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Matching
Match following terms to the organ in which they belong. Some
organs may be used more than once.
A. Kidneys
B. Ureters
C. Bladder
D. Urethra
E. Prostate
F. Penis
G. Testicles
1. Cystocele
2. Brachytherapy
3. ADPKD
4. Hypospadias
5. Pessary
6. Torsion
7. Pyelonephritis
8. BPH
9. Trigone
10. Meatus
11. Renin
12. Nephron
13.Detrusor
14. Ureteroscope
15. transplant
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Matching Answers
1. C
2. E
3. A
4. F
5. C
6. G
8. E
9. C
10. F
11. A
12. A
13. C
14. B
15. A
7. A
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Review Questions
1. What are the three distinct regions of the kidney?
2. What openings form the bladder trigone?
3. Describe the difference between glomerulonephritis and
focal segmental glomerulosclerosis.
4. Name the four types of kidney stones that form as a
result of electrolyte imbalances.
5. What is PSA?
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Review Question Answers
1. The three regions of the kidney include the renal cortex, the
renal medulla, and the renal pelvis.
2. Three openings form the bladder trigone: Two are from the
ureters, which form the base of the trigone, and the third
opening is the bladder neck, which leads to the urethra.
3. Glomerulonephritis is an inflammation of the glomeruli, where
as focal segmental glomerulosclerosis is a condition in which
some of the glomeruli become scarred as a result of
progressive damage to the kidneys.
4. The four types of stones are calcium stones, struvite stones,
uric acid stones, and cystine stones.
5. PSA stands for prostate-specific antigen, a protein secreted
by the cells lining the prostate gland.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Review Questions
• 6. What do Cowper glands do?
• 7. What does GFR stand for and what does it measure?
• 8. Name three different functions of the kidneys.
• 9. What is the treatment for hypospadias?
• 10. How does BPH affect the urethra?
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Review Question Answers
6. Cowper glands produce a clear, slippery fluid that helps
lubricate the urethra and neutralize any acidity that may be
present due to residual urine left in the urethra.
7. GFR stands for glomerular filtration rate and is a test that
measures how well the kidneys are removing excess fluid and
waste from the blood.
8. The kidneys: (1) filter the blood, remove excess wastes, and
excrete the wastes through other structures from the body;
(2) they produce renin, an enzyme that helps raise blood
pressure levels when needed; and (3) they secrete hormones
that are vital to body function, including erythropoietin and
calcitriol.
9. Surgery to correct the deformity is the only treatment for
hypospadias.
10. BPH causes enlargement of the prostate, which puts pressure
on the urethra, causing urinary difficulties such as incomplete
emptying of the bladder and urinary frequency.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Define the following:
1. glomerulus (plural, glomeruli)
2. hypospadias
3. negative crossmatch
4. positive crossmatch
5. nephritis
6. uric acid
7. urea
8. squamous cell carcinoma
9. transitional cell carcinoma
10.invasive cancer
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Define the following Answers
1. A ball-shaped cluster of tiny capillaries on a renal
corpuscle, which is the area of blood filtering in the
kidney.
2. A birth defect found in boys in which the opening to the
urethra develops at a point under the penis instead of
at the tip of the penis.
3. A blood test result indicating that an organ
transplantation should proceed.
4. A blood test result indicating that an organ
transplantation should not proceed.
5. A broad term for any inflammation of one or both
kidneys.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Define the following Answers
6. A byproduct of metabolism that can cause crystals to
develop in the kidneys.
7. A byproduct of the metabolic process in the liver.
8. A cancer that begins in the squamous cells of the
bladder.
9. A cancer that originates in the transitional cells of the
bladder.
10.A cancer that spreads beyond its site of origin to involve
other tissues and organs.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Define the following:
1. carcinoma in situ
2. struvite
3. luteinizing hormone releasing hormone (LHRH) agonists
4. antiandrogens
5. epididymis
6. vesicoureteral reflux
7. cystocele
8. focal segmental glomerulosclerosis
9. sexually transmitted disease (STD)
10.neurogenic bladder
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Define the following Answers
1. A cancer that usually does not spread to other areas of
the body or nearby organs.
2. A chemical compound that can form crystals in the
kidney and bladder.
3. A class of drugs that block the message from the
pituitary gland for the testes to produce testosterone
that enables a tumor to grow.
4. A class of hormonal drugs used to stop testosterone
from the testicles from getting to cancer cells and
encouraging them to grow.
5. A coiled tube in each testis that stores sperm until
ejaculation.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Define the following Answers
6. A condition of urine backing up from the bladder into
the ureters.
7. A condition that occurs when the wall between the
bladder and the vagina weakens, causing the bladder to
drop or sag into the vagina.
8. A condition that results from scar tissue that forms
some segments of the glomeruli in the kidney.
9. A disease caused by a pathogen that is spread from
person to person, primarily through sexual contact.
10.A disorder resulting from damage to nerves that govern
the urinary tract.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Define the following:
1. chordee
2. polycystic kidney disease (PKD)
3. prostate
4. kidney stone
5. renal calculus (plural, calculi)
6. urinary bladder
7. erythropoietin
8. antidiuretic hormone (ADH)
9. renal fascia
10.chronic kidney failure
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Define the following Answers
1. A downward curve of the shaft of the penis.
2. A genetic disorder characterized by the growth of
numerous fluid-filled cysts in the kidneys.
3. A gland in the male reproductive system just below the
bladder that secretes PSA, which helps form part of
semen.
4. A hard, solid piece of material that forms in the kidney
from crystals that sep5. A hard, solid piece of material that forms in the kidney
from crystals that separate from the urine and build up
on the inner surface of the kidney.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Define the following Answers
6. A hollow, muscular sac that stores urine before it is
eliminated from the body.
7. A hormone that aids in the formation of red blood cells.
8. A hormone that is released when the amount of water
in the body decreases.
9. A layer of connective tissue that attaches the kidney to
the abdominal wall.
10.A long-term condition in which the kidneys gradually
and progressively lose their ability to function.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Define the following:
1. dialysis machine
2. dihydroxy testosterone (DHT)
3. culture
4. lithotripsy
5. ureteral sphincter
6. end-stage renal disease (ESRD)
7. urologist
8. pessary
9. photoselective vaporization prostatectomy
10.cryosurgery Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Define the following Answers
1. A machine that artificially filters blood similar to the way the
kidneys filter blood in the renal glomeruli and tubules.
2. A male hormone that is known to have a key role in prostate
growth.
3. A material or specimen obtained from the body and incubated
with a nutrient medium to isolate organisms and determine
the cause of an illness or infection.
4. A method of breaking up urinary stones with a specialized
tool and shock waves.
5. A muscular flap that covers the opening where the urine
enters and acts like a valve which allows urine to enter the
bladder but prevents it from backing up from the bladder into
the ureter.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Define the following Answers
6. A name given to kidney failure that is so advanced that
it cannot be reversed.
7. A physician who has specialized knowledge and skill
regarding problems with both the male and female
urinary tracts and the male genital organs.
8. A plastic or rubber ring placed in the vagina to push the
bladder back into place.
9. A procedure in which a high-power laser is used to
vaporize prostatic adenomas.
10.A procedure in which extreme cold is used to destroy
cancerous tissue.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Define the following:
1. segmental cystectomy
2. radical cystectomy
3. cystoscopy
4. percutaneous nephrolithotomy (PCN)
5. extracorporeal shock wave lithotripsy (ESWL)
6. ureteroscopy
7. digital rectal examination (DRE)
8. bladder distention
9. bladder instillation
10.hemodialysis
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Define the following Answers
1. A procedure in which part of the bladder is removed.
2. A procedure in which the entire bladder is removed,
along with part of the urethra and nearby organs and
structures that may contain cancer cells.
3. A procedure that examines structures of the urinary
system.
4. A procedure that uses a scope placed through an
incision in the side of the abdomen to remove a kidney
stone that is too big to pass.
5. A procedure that uses highly focused impulses projected
from outside the body to pulverize kidney stones.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Define the following Answers
6. A procedure used to remove or break up stones located
in the lower portion of the ureter.
7. A procedure whereby a gloved finger is inserted into the
rectum and pressed on the prostate to check for
enlargement.
8. A procedure whereby the bladder is inflated with gas or
liquid.
9. A procedure whereby the bladder is inflated with the
chemical compound DMSO, to reduce inflammation and
pain.
10.A process of dialysis involving filtering blood through
special filters in a machine located outside the body.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
The End
• Well that’s all for tonight!
• Thanks for joining us. I hope you learned something to
help you in your transcription career.
• See you next week! Same time—same place!
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
References
• Administrative Medical Assisting, Molle & Durham, 2004
• Medical Transcription Fundamentals, Gilmore
• www.ahdi.org
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins