Chapter 10 Urology

Urinary (Genitourinary) System

The urinary system consists of a

pathway that begins with the

kidneys and ends with the

urethra.

• The functions of the urinary

system are to remove some of

the waste products of cellular

metabolism from the blood by

producing, transporting, storing,

and excreting urine

Gross Anatomy of the Urinary System

The ureter is a 12-inch tube that

connects the kidney to the urinary

bladder.

• Smooth muscle in the walls of the

ureters moves urine toward the

bladder via peristalsis.

• Valves prevent urine from reentering

the ureters.

• The urethra drains the bladder

Nephropathy

General term for any disease of the kidney.

Nephroptosis

Abnormally low position of a kidney.

• nephr/o- = kidney

• -ptosis = state of drooping

Renal failure

Disease in which urine production decreases and

may even stop; can occur due to acute or chronic

disease processes.

• Acute kidney injury (AKI) occurs suddenly,

usually due to trauma, blood loss, or

overwhelming infection.

• Chronic kidney disease (CKD) occurs

gradually, with renal insufficiency progressing to

renal failure

Polycystic

kidney disease

Hereditary disease characterized by cysts in the

kidney; growth of these cysts eventually destroys

the nephrons and causes kidney failure

Pyelonephritis

Infection and inflammation of the renal

pelvis of the kidney; caused by bacteria

that travel upward from the bladder.

• pyel/o- = renal pelvis

• nephr/o- = kidney

• -itis = infection or inflammation of

Renal cell cancer

A cancerous tumor (carcinoma) that

begins in the epithelial cells in the tubules

of the nephron

Hydronephrosis

Condition in which urine distends the renal

pelvis and calices or ureter; occurs when a

blood clot, infection, or kidney stone blocks

the flow of urine

Glomerulonephritis

Infection and inflammation of the

glomeruli of the kidney; occurs as a

complication of acute viral or

streptococcal infection, when antigen–

antibody complexes clog the pores of

capillaries in the glomeruli.

• glomerul/o- = glomerulus

• nephr/o- = nephron

• -itis = infection or inflammation of

Uremia

Condition in which there is excessive

buildup of urea in the blood due to renal

failure.

Urinary tract infection

(UTI)

Bacterial infection somewhere in the

urinary tract; usually involves E. coli that

have traveled from the rectum into the

urethra

Nephrolithiasis

Formation of a kidney stone (calculus) in the

urinary system; scraping of the stone against

the mucosa of the ureter and bladder causes

muscle spasm (renal colic), severe pain,

nausea, vomiting, and/or hematuria.

• nephr/o- = kidney

• lith/o- = stone

• -iasis = process or state

The many sharp, jagged

edges of a kidney stone

cause hematuria, vomiting,

renal colic (= pain), and

severe pain

Nephrolithiasis

This x-ray shows multiple kidney

stones in the right kidney that

have become so large that they

cannot pass spontaneously

Bladder

There are two combining forms that mean “bladder”:

cyst/o- and vesic/o-.

• Cyst/o- is commonly used when talking about

diseases of the bladder.

• The adjective form of “bladder” is vesical.

• Don’t confuse vesical with the noun vesicle, which is a

small, fluid-filled blister on the skin

Bladder cancer

Presence of a cancerous tumor

(carcinoma) in the epithelial cells of the

bladder

Cystitis

Infection or inflammation of the bladder,

often due to bacterial infection.

• cyst/o- = bladder

Cystocele

Hernia in which the bladder bulges through a

weakness in the muscular wall of the vagina or

rectum, causing retention of urine inside the hernia.

• cyst/o- = bladder

• -cele = hernia

Neurogenic

bladder

Condition in which nerves

to the bladder are not

working properly; this

causes urinary retention

because the bladder does

not contract.

• neur/o- = nerve

• gen/o= arising from

Overactive bladder

Condition in which the bladder has too

many involuntary contractions, resulting in

urgency and frequency; also known as

urge incontinence.

Urinary retention

Inability to empty the bladder.

• May occur due to obstruction, nerve

damage, or side effects of certain

drugs.

• Even when the bladder does contract,

a large amount of urine (called the

postvoid residual) still remains

Vesicovaginal

fistula

Abnormal passageway connecting the bladder to

the vagina; urine flows through this passageway

and continually leaks out of the body through the

vagina.

This occurs commonly when a young woman’s

body is too immature (small) to have a birth

• vesici/o- = bladder

• vagin/o- = vagina

The internal urethral sphincter

is under involuntary control

The external urethral sphincter

is under voluntary control

(is involved with the ability to “hold it” until voiding is more

convenient)

Incontinence

Inability to voluntarily keep urine in the bladder.

• May be caused by injury, surgery,

unconsciousness, dementia, etc.

• Incontinence is normal in young children because

nerve connections to the external urethral sphincter

have not yet developed.

• Stress urinary incontinence (SUI) is caused by

weak pelvic floor muscles.

• in- = not

• contin/o = hold together

• -ence = state

Urethritis

Infection or inflammation of the urethra

Anuria

Complete absence of urine production by the

kidneys.

• an- = not, without

• ur/o- = urinary system, urine

• -ia = condition

Oliguria

Decreased or scanty production of urine due to

kidney failure or dehydration.

• olig/o- = few or scanty

• ur/o- = urinary system, urine

• -ia = condition

Dysuria

Difficult or painful urination

Polyuria

Excessive urine production; common symptom of

diabetes mellitus and diabetes insipidus

Frequency

Urinating often, usually in small amounts

Urgency

Strong urge to urinate with a sense of pressure in the

bladder; caused by obstruction or inflammation

Hesitancy

Inability to initiate a normal stream of urine, with

dribbling and a decrease in the width of the urinary

stream

Nocturia

Increased frequency and urgency of urination at night.

• noct/o- = night

Bacteriuria

Presence of bacteria in the urine; indicative of

infection somewhere in the urinary tract

Pyuria

Presence of white blood cells (WBCs) or pus in the

urine; indicative of urinary tract infection.

• py/o- = pus

Albuminuria

Presence of albumin in the urine; also called

proteinuria.

• Arises from damage to pores in the capillaries of

the glomerulus.

• Is an early sign of kidney disease or preeclampsia

Glycosuria

Presence of glucose in the urine; associated with

uncontrolled diabetes mellitus.

• glyc/o- = glucose

Ketonuria

Presence of ketones in the urine; occurs when the

body metabolizes fat rather than glucose. Common

with uncontrolled diabetes mellitus

Hematuria

Blood in the urine; may be gross/frank or microscopic

Urinalysis (UA)

Urine test that describes the general

characteristics of a patient’s urine and

detects substances in it (see next slides)

Drug screening

Urine test performed to evaluate whether

an individual is using illegal, addictive, or

performance-enhancing drugs

Albumin

Albumin in the urine is an abnormal finding that

indicates damage to the glomerulus

Color

Normal urine is light yellow to amber in color.

• Pink or reddish urine indicates bleeding in the urinary

tract.

• Turbid urine indicates presence of a UTI

Glucose

Glucose in the urine is an abnormal finding that

indicates uncontrolled diabetes mellitus

Ketones

Ketones in the urine are an abnormal finding that

suggests uncontrolled diabetes mellitus or malnutrition

Odor

Normal urine has a faint odor; fruity-smelling urine

suggests diabetes mellitus

pH

Normal urine is slightly alkaline, with a pH just over 7

Red blood cells

(RBCs)

Presence of RBCs indicates bleeding in the urinary

tract

Sediment

Several types of sediment may be present in urine:

• Crystals (calcium oxalate, uric acid, etc.) can

form kidney stones.

• Epithelial cells are a normal finding because

they are continually shed in the urinary tract

Specific gravity

(SG, sp gr)

Measurement of the concentration of urine as

compared to that of water

White blood cells

(WBCs)

Presence of WBCs indicates a urinary tract

infection; if the specimen is milky or cloudy, the

result is reported as too numerous to count

(TNTC)

Blood urea nitrogen

(BUN)

Blood test that measures the amount of

urea in the blood; elevated levels mean

the kidneys aren’t working properly.

• Liver produces ammonia (has

nitrogen)

• Nitrogen combines with other

elements to form urea

Creatinine

Blood test that measures the amount of

creatinine in the blood; elevated levels

mean the kidneys aren’t working

properly.

• Creatinine is a waste product from

muscle metabolization

Leukocyte esterase

Quick urine dipstick test that detects the

enzyme esterase, which is associated with

the white blood cells that are present with a

urinary tract infection

Culture and

sensitivity (C&S)

Test in which a urine sample is swabbed

onto a culture medium so that any bacteria

present in the sample can be identified; the

bacteria are then tested to determine their

sensitivity to various antibiotics

Intake and output

(I&O)

Procedure that documents a patient’s total

amount of fluid intake (oral, nasogastric tube,

intravenous line, etc.) and total amount of fluid

output (urine, wound drainage, etc.) over the

course of a day

Catheterization

(short form:

cath)

Gk.= “to send

or let down“

Insertion of a flexible tube called a catheter

through the urethra and into the bladder to

drain urine.

• A Foley catheter is an indwelling tube held

in place by a balloon in the bladder.

• A condom catheter fits over the penis and

collects urine as it leaves the urinary meatus

Dialysis

Procedure to remove waste products from the blood

of a patient who is in renal failure (see next slide).

• In hemodialysis, a fistula is surgically created to

accommodate two needles; one needle removes

the blood and sends it to the dialysis machine for

purification, and the other needle returns the

blood to the body.

• In peritoneal dialysis, a permanent catheter is

inserted through the abdominal wall; dialysate

fluid is put into the abdominal cavity via the

catheter and left for several hours, then removed

along with waste products from the blood.

• dia = complete

• -lysis = breakdown

Hemodialysis

Needles inserted into the fistula in the

patient’s arm take blood from the patient to

the dialysis machine. In the machine, waste

products move from an area of higher

concentration (in the blood) to an area of

lower concentration (in the dialysate fluid).

The cleansed blood is pumped back through

the fistula to the patient.

Antibiotics

Treat urinary tract infections caused by bacteria

Antispasmodics

Relax smooth muscle in the walls of the urinary

tract; used to treat cystitis or overactive bladder

Diuretics

Block sodium reabsorption in the kidney, which

decreases blood volume and increases urine

volume. (dia= complete, ur/o- = urine)

Overactive

bladder drugs

Decrease contractions of smooth muscle in the

bladder

Potassium

supplements

Replace potassium that is lost when taking

diuretic drugs

Urinary

analgesics

Relieve pain in the mucosa of the urinary tract

Intravenous

pyelography (IVP)

Radiologic procedure that uses x-rays and

contrast dye to visualize the urinary system.

• Dye is injected intravenously, then flows

through the blood into the kidneys.

• From the kidneys, the dye outlines the

structures of the renal pelvis, ureters,

bladder, and urethra.

Kidneys, ureters,

bladder (KUB) x-ray

X-ray of the kidneys, ureters, and bladder

that shows only those structures and does

not use contrast dye

Renal angiography

Procedure that uses x-rays and

radiopaque contrast dye to produce

images of the renal artery

Ultrasonography

Use of high-frequency sound waves to

produce an image of the urinary system

Voiding

cystourethrography

(VCUG)

Procedure in which contrast dye is

inserted into the bladder through a

catheter; the dye outlines the bladder and

urethra, and an x-ray image is taken while

the patient is urinating

Lithotripsy

Procedure that uses a laser or sound waves to

break up a kidney stone.

• Cystoscopic laser lithotripsy

• Extracorporeal shock wave lithotripsy (ESWL)

• Percutaneous ultrasonic lithotripsy

• lith/o- = stone

• -tripsy = process of crushing

Nephrolithotomy

Procedure in which an endoscope is

inserted into the kidney through a slit in the

skin, then used to remove a stone

embedded in the renal pelvis or calices

Stone basketing

Procedure in which a cystoscope is

inserted into the bladder, then a small

wire basket is passed through the

scope to grab and remove kidney

stones from the bladder or ureter

Cystectomy

Surgical removal of the bladder; used in the

treatment of bladder cancer

Cystoscopy

Use of an instrument called a cystoscope to

examine the inside of the bladder (see next slide)

• The cystoscope is inserted through the urethra.

• A wide-angle lens and light allow a full view of

the bladder

Bladder neck

suspension

Procedure to correct stress urinary incontinence;

involves insertion of a supportive sling of muscle

tissue or synthetic mesh around the bladder neck

and urethra

Renal biopsy

Procedure in which a small piece of kidney

is removed for microscopic analysis

Nephrectomy

Surgical removal of a diseased or

cancerous kidney; also the procedure used

to remove a healthy kidney from a living

donor

Nephropexy

Surgical correction of an abnormally low kidney

by suturing it into the correct position.

• -pexy = fixing in place

Kidney

transplantation

Procedure to treat a patient in end-stage renal

failure by transplanting a new kidney from a

donor.

• Recipients and donors are matched by

blood and tissue type.

• Donors may be living or deceased.

• Recipients must take immunosuppressant

drugs for the rest of their lives to prevent

kidney rejection

Urethroplasty

Plastic surgery procedure to reposition the

urethral meatus in male patients who have

hypospadias or epispadias.

• urethr/o- = urethra

• -plasty = process of reshaping by surgery

• epi- = above

• spad/o- = opening

AKI

acute kidney injury

ARF

acute renal failure

BUN

blood urea nitrogen

C&S

culture and sensitivity

CAPD

continuous ambulatory peritoneal dialysis

cath

catheterize or catheterization (short form)

CCPD

continuous cycling peritoneal dialysis

Cl-

Chloride

CMG

cystometrogram

CKD

chronic kidney disease

CRF

chronic renal failure

cysto

cystoscopy (short form)

epi’s

epithelial cells (in urine specimen; short

form)

ESRD

end-stage renal disease

ESWL

extracorporeal shock wave lithotripsy

GU

genitourinary gonococcal urethritis

HCO3

bicarbonate

hpf

high-power field