Download The Urinary System

Assisting in Urology and
Male Reproduction
Chapter 39
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
The Urinary System
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 2
Urinary System
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Urinary system—two kidneys located bilaterally
in the retroperitoneum, two ureters, urinary
bladder, and urethra.
Functions include:
– Maintain water-electrolyte balance
– Activate vitamin D
– Secrete erythropoietin for RBC production
– Regulate blood pressure through renin
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Primary function is to remove waste products
from blood and form urine for secretion.
– Byproducts of metabolic processes
– Salts and nitrogenous wastes
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Slide 3
Kidney Anatomy and Physiology
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Cortex—outer layer of kidney contains the nephron
unit.
Urine passes from the cortex to the calyxes, which are
the distal collection areas of the renal pelvis.
Emptied through bilateral ureters to urinary bladder.
When the bladder is full, sphincters open, and urine
flows into the urethra.
Urethra 20 cm long in males and 3 to 4 cm in female;
urine passes through the urinary meatus.
Micturition.
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Slide 4
Urine Production
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Three processes are involved in urine formation:
filtration, reabsorption, and excretion.
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Filtration and reabsorption occur in the nephron
unit
– Glomerulus
– Partially surrounded by Bowman’s capsule
– Fluid and dissolved substances pass into Bowman’s capsule
– Continues into convoluted tubules where reabsorption occurs
– Then on to the collecting tubules in the medulla
– Urine excreted starting from the calyx outward
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Slide 5
The Kidney
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Slide 6
Disorders of the Urinary System
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The urinary tract has a continuous mucosal lining,
which gives organisms that enter the urethra a direct
pathway through the system.
Most common symptoms of renal system disorders:
– Changes in the frequency of urination
– Dysuria
– Urgency
– Retention
– Incontinence
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Slide 7
Diagnosis of Urinary System Disorders
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Urinalysis, blood urea nitrogen (BUN) levels, and
analysis of creatinine clearance
Kidney-ureter-bladder radiograph (KUB)—flat plate of
abdomen; shows size, shape, location, and
malformations of kidneys and bladder
Renal scanning—nuclear scans to determine size,
shape, and function of kidney; used to diagnose renal
obstruction or hypertension
Cystography—radiograph with contrast dye to study the
bladder
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Slide 8
Diagnostic Procedures
• Intravenous pyelogram (IVP)—x-ray taken at intervals after dye
is injected intravenously to visualize the urinary system; used to
diagnose tumors, calculi, or obstructions
• Renal arteriogram—dye injected into renal artery to show
kidney blood flow
• Renal computed tomography—provides transverse views of the
kidneys to detect tumors, abscesses, or hydronephrosis
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Slide 9
Diagnostic Procedures (cont’d)
• Renal ultrasound—high frequency sound waves used to detect
functional defects in the kidneys or polycystic disease.
• Cystoscopy—endoscopic view of the urethra and bladder for
biopsy, to find or remove calculi, or to place renal stents.
• Retrograde pyelogram—visualizes renal system after injection
of dye into bladder, ureters, or kidneys.
• The Medical Assistant needs to understand the patient
preparation for each diagnostic procedure.
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Slide 10
Urinary Incontinence
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A temporary or chronic loss of urinary control
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Causes vary
– Infections, brain disorders, tissue damage
– Stress incontinence
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Treatment methods for incontinence depend on the
causative factor
– Kegel exercises, antispasmodic medications, catheters
– Surgical intervention
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Slide 11
Urinary Infections and Inflammation
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Most urinary tract infections (UTIs) are ascending; start
with pathogens in perineal area infecting the
continuous mucosa up through urethra, bladder,
ureters, to kidneys.
Infection and inflammation of urethra is urethritis;
that of bladder is cystitis; resident bacteria of the
colon, Escherichia coli, is the usual causative agent.
Women anatomically at greater risk because of close
relation of anus and urethra.
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Slide 12
General UTI Signs and Symptoms
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An overwhelming urge to urinate
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Burning on urination
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Urgency with frequent, small amounts of urine
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Blood in the urine (hematuria) or cloudy, dark, foulsmelling urine
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Slide 13
UTIs Continued
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Pyelonephritis—inflammation of renal pelvis and
kidney; caused by ascending bacterial infection
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Conditions such as urinary retention or obstruction
promote urinary stasis and growth of bacteria
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UTI treatment:
– Antibiotics—Keflex, Bactrim
– Force fluids
– Proper hygiene
– Empty bladder completely
– Cranberry juice
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Slide 14
Glomerulonephritis
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Acute—degenerative inflammation of glomeruli;
develops in children and adolescents about 2
weeks after strep infection
– Low-grade fever, anorexia, flank pain, hypertension, edema
– Hematuria and proteinuria
– Treatment: diuretics
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Chronic—causes progressive, irreversible renal
damage; may result in renal failure; caused by
antigen-antibody reaction that destroys the
nephron unit
– Hypertension, hematuria, proteinuria, oliguria, edema
– Only cure is kidney transplant
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Slide 15
Renal Calculi
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Renal calculi—created when salts in urine collect in the
kidney or when fluid intake is low, creating a highly
concentrated filtrate; are common and tend to recur if
the cause of formation is not treated
Small stones usually do not cause any difficulty until
they grow large enough to lodge in the ureters or renal
pelvis. Very painful if passed. Blockage can result in:
– Hydronephrosis
– Dilation of calyxes and increased pressure on nephron units
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Treatment: cystoscopy, extracorporeal shockwave
lithotripsy (ESWL)
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Slide 16
Shock-wave Lithotripsy
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Slide 17
Hydronephrosis
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The swelling of the kidney caused by the inability of
urine to drain out of the renal pelvis; is usually caused
by blockage from renal calculi but may also result from
an enlarged prostate or a tumor
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Slide 18
Hydronephrosis (cont’d)
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Slide 19
Polycystic Disease
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Autosomal dominant genetic disorder.
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Slowly progressive and irreversible.
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Causes formation of multiple grapelike cysts in the
kidneys.
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Slide 20
Polycystic Disease (cont’d)
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Slide 21
Polycystic Disease
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As cysts enlarge, they compress surrounding tissue,
causing necrosis, uremia, and renal failure.
Patients have family history of disease.
Symptoms develop as patient ages—adolescence or
early adulthood.
Will eventually require renal dialysis or transplant.
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Slide 22
Bladder Cancer
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Most common cancer of urinary tract.
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Two to three times more common in men.
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Risk increases with smoking, recurrent UTIs, exposure
to carcinogens, large amounts of analgesics.
Characterized by one or more tumors that can recur.
Tumors are invasive and can metastasize through the
blood or surrounding pelvic lymph nodes.
NMP22 urine test diagnostic for recurrence.
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Slide 23
Neoplasms of the Urinary Tract
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Slide 24
Renal Carcinoma
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Adenocarcinoma of the kidney
– Primary tumor initially asymptomatic
– Frequently has metastasized before being diagnosed
– Typically seen in men over 50 and smokers
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Wilms’ tumor
– Cancer of kidney in children
– Results from an inherited genetic defect
– Occurs unilaterally at about 2 to 5 years of age
– 90% survival rate
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Slide 25
Renal Failure
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Acute—sudden, severe onset; caused by exposure to
toxic chemicals, severe or prolonged circulatory or
cardiogenic shock from serious burns or heart disease,
or from an acute bilateral kidney infection or
inflammation. Primary problem must be resolved as
quickly as possible to prevent permanent renal failure.
Chronic—slowly progressive process; caused by the
gradual destruction of nephron unit. Three stages
ending in end-stage renal failure requiring dialysis or
transplant.
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Slide 26
Dialysis
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Dialysis, or cleansing of the blood, is used to treat
acute renal failure until the problem is reversed or, for
those patients in end-stage renal disease, until a
transplant can be done.
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Hemodialysis.
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Peritoneal dialysis.
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Slide 27
Dialysis (cont’d)
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Slide 28
Pediatric Urologic Disorders
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Enuresis—inability to control urination or bedwetting;
may be caused by physical or psychologic disorders
Cryptorchidism—failure of one or both testes to
descend into the scrotum; can result in male infertility;
may be corrected with an orchiopexy
Urine reflux disorder—backward flow of urine into the
ureters when voiding; usually caused by an infection.
Treatment includes:
– Prophylactic antibiotics
– Surgical repair of ureters
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Slide 29
Anatomy and Physiology of the Male
Reproductive System
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Made up of a pair of testes located in the scrotum.
Testes contain seminiferous tubules, where
spermatozoa are produced.
Sperm cells are tadpole-like structures, less than 0.1
mm long, that are carried to the epididymis for
maturation.
Epididymis, a long coiled tube, rests on the top and
lateral side of each testis. Peristaltic waves in the
epididymis help the sperm move into the vas deferens,
where the sperm is stored until ejaculation.
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Slide 30
Anatomy and Physiology Continued
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Prostate gland surrounds the urethra at the base
of the bladder. It secretes a thin fluid with an alkaline
pH that neutralizes the acidic sperm-containing fluid
and vaginal secretions to provide an optimal pH for
fertilization.
Organ of male copulation is the penis, which has a
slightly enlarged end, called the glans penis.
Male sex hormones are called androgens. Testosterone
stimulates the testes to enlarge, increases body hair
growth, thickens skin and bone, increases muscle
growth, and matures sperm cells.
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Slide 31
Male Reproductive Anatomy
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Slide 32
Disorders of the Male Reproductive Tract:
Prostatic Diseases
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Prostatitis—inflammation of prostate usually caused by
bacterial infection. Symptoms are dysuria, tenderness
of prostate region, secretion of pus. Treatment:
antibiotic.
Benign prostatic hypertrophy—swelling of prostate
gland; partially blocks flow of urine, creating medium
for bacterial infection.
– Diagnosis: patient complaints and digital rectal examination
– Treatment: αlpha-adrenergic blockers to relax smooth muscles;
surgical removal of the prostrate gland through a transurethral
resection
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Slide 33
Prostate Cancer
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Common over age 50; second highest cause of cancer
deaths in males.
Symptoms—urinary obstruction, increased bouts of urinary
infection, and frequent nocturia.
Digital rectal examination identifies a firm or irregular area.
Prostate specific antigen levels increase with presence of
cancer.
PSA blood test most reliable mass screening test for disease;
recommended by age 50 or younger if family history.
Treatment: hormone therapy with estrogen; surgical removal
of prostate; radioactive seed implantation.
Surgical treatment may result in impotence.
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Slide 34
Benign Prostatic Hypertrophy and
Carcinoma of the Prostate
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Slide 35
Pathologic Conditions
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Epididymitis—caused by UTI, prostatitis, or an STD.
Patients complain of severe low abdominal and
testicular pain; swelling and scrotal tenderness. Treat
with antibiotics.
Balanitis—inflammation of glans penis; occurs most
often in uncircumcised patients with narrow foreskins
that do not retract easily and in patients with diabetes.
– Treatment: antibiotics and cleansing for buildup of smegma
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Hydrocele—buildup of fluid in the scrotum; may be
congenital, acquired because of injury, or age-related.
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Slide 36
Tumors of Testes
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Testicular tumors usually occur in young men and are
generally malignant. The patient complains of a hard,
painless, mass affecting one testicle.
Treatment of the tumors is usually a combination of
orchiectomy, radiation therapy, and sometimes
chemotherapy.
Male patients should be taught testicular selfexamination by the age of 15. See Procedure 39-1.
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Slide 37
Impotence and Infertility
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Impotence is the inability to achieve and maintain an
erection sufficient for intercourse. It has many causes,
both psychologic and physiologic. This condition can be
treated medically with Viagra.
Male infertility may be caused by cryptorchidism;
varicoceles; low sperm count and motility; obstruction
of vas deferens; and hormonal imbalances.
– Diagnosis: Examination of semen specimen; sperm count and
motility
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Slide 38
Sexually Transmitted Diseases (STDs)
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There is no cure for viral STDs such as HIV or herpes.
STDs are frequently asymptomatic and can cause
serious health problems, even death.
Genital herpes simplex (HSV-2)—Painful vesicles and
ulcers with erythema and pruritus; pain before
outbreak; lesions heal in 3 to 4 weeks; may have viral
shedding when asymptomatic; dangerous to newborn.
Treatment: Zovirax, Valtrex.
Genital warts (HPV)—Cause lesions but not always
present in infected males; warts tend to recur; may
cause cancer of the cervix. Treatment: cryosurgery,
creams.
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Slide 39
Bacterial STDs
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Bacterial STDs are increasingly resistant to antibiotics.
Gonorrhea and chlamydia—tend to coexist; symptoms
similar to acute urethritis and epididymitis.
Chlamydia resistant to penicillin, so antibiotics other
than penicillin should be used.
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Slide 40
Bacterial STDs
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Syphilis begins with a chancre on the male genitalia
within a few days to a few weeks after exposure.
Diagnosis: VDRL or RPR blood tests. Goes through six
stages if not treated early; can cause death, severe
debilitation. Treatment: penicillin G, doxycycline.
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Slide 41
HIV and AIDS
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HIV transmitted by sexual exposure, IV drug use, blood
and blood products, infected mother to fetus.
Virus invades T lymphocytes, affecting cellular
immunity.
Initial symptoms flulike—fever, arthralgia, myalgia,
lymphadenopathy, rash, night sweats, malaise.
Could be at least 10 years before clinical symptoms of
AIDS.
Greatest increase in incidence—young sexually active
women.
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Slide 42
AIDS
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Marked by wide range of opportunistic infections.
develop because of low T cell counts. Patient diagnosed
with AIDS when T cell count below 200 and/or
opportunistic infections diagnosed.
– Pneumocystis carinii pneumonia
– Candidiasis
– Kaposi’s sarcoma
– Dementia
– Wasting syndrome
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Treatment: combination of antiviral drugs; cost more
than $1000/month; medications must be taken two to
three times per day. Current treatment involves
postponing development of AIDS.
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Slide 43
The Medical Assistant’s Role in Urologic and
Male Reproductive Examinations
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Assisting with a urologic examination
– Drape, gown, and position patient
– Assist male physicians with female patient examination
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Assisting with a male reproductive examination
– Drape, gown, and position patient
– Watch for signs of discomfort and anxiety
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Slide 44
Vasectomy
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A vasectomy is a surgical procedure for sterilizing a
male patient.
May be done in the doctor’s office.
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Slide 45
Vasectomy (cont’d)
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Slide 46
Patient Education
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Male Preventative Medicine
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By age 50
– Annual physical exam
– PSA level and prostate exam
– Fecal occult test
– Sigmoidoscopy or colonoscopy
– Screening for heart disease and diabetes
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Slide 47