Urology and Nephrology Study Guide

Urology and Nephrology

Introduction to Urology and Nephrology

  • Urology:
    • Study of urinary structures carrying urine from the kidney to the bladder and out.
    • Concerned with conditions of the male reproductive system.
    • Urologists treat:
      • Urinary tract infections (UTIs) in males and females.
      • Reproductive conditions of males.
  • Nephrology:
    • Study of the kidney and how it makes urine.
    • Nephrologists treat:
      • Renal failure.
      • Kidney and electrolyte imbalances.
      • Kidney disease in dialysis patients.
      • Provide care for kidney transplant patients.

Functions of the Urinary System

  • Involves three homeostatic processes:
    • Removing waste products.
    • Adjusting water and electrolyte levels.
    • Maintaining normal pH.
  • Kidneys remove unnecessary substances and water in the form of urine.
  • Urine flows through ureters to the bladder.
  • Urethra carries urine out from the bladder.

Functions of the Male Reproductive System

  • Produces sperm and secretes testosterone via the testes.
  • Other organs handle sperm storage, transport, and fluid secretion:
    • Epididymis
    • Vas deferens
    • Seminal vesicles
    • Prostate gland
    • Bulbourethral glands
    • Urethra
    • Penis

Urology and Nephrology Combining Forms

  • balan/o: Glans penis
  • cyst/o: Urinary bladder, sac
  • epididym/o: Epididymis
  • glomerul/o: Glomerulus
  • lith/o: Stone
  • nephr/o: Kidney
  • orch/o, orchi/o, orchid/o: Testis
  • prostat/o: Prostate gland
  • pyel/o: Renal pelvis
  • ren/o: Kidney
  • semin/i: Semen
  • sperm/o, spermat/o: Sperm
  • testicul/o: Testis
  • ur/o, urin/o: Urine
  • ureter/o: Ureter
  • urethr/o: Urethra
  • vas/o: Vas deferens
  • vesicul/o: Seminal vesicle

Other Combining Forms

  • albumin/o: Albumin
  • azot/o: Nitrogen waste
  • bacteri/o: Bacteria
  • bi/o: Life
  • corpor/o: Body
  • crypt/o: Hidden
  • genit/o: Genitals
  • glycos/o: Sugar, glucose
  • hem/o, hemat/o: Blood
  • hydr/o: Water
  • noct/i: Night
  • olig/o: Scanty
  • py/o: Pus
  • rect/o: Rectum
  • varic/o: Dilated vein
  • ven/o: Vein

Suffix Review

  • -al, -ar, -ary, -eal, -ic, -ous, -tic: pertaining to
  • -algia: Pain
  • -cele: Protrusion
  • -cyte: Cell
  • -ectomy: Surgical removal
  • -emia: Blood condition
  • -genesis: Produces
  • -gram: A record
  • -graphy: Process of recording
  • -ia: Condition
  • -iasis: Abnormal condition
  • -ism: State of
  • -itis: Inflammation
  • -lith: Stone
  • -logist: One who studies
  • -logy: Study of
  • -lysis: To destroy
  • -megaly: Enlarged
  • -meter: Instrument for measuring
  • -oma: Tumor, mass
  • -osis: Abnormal condition
  • -ostomy: Surgically create an opening
  • -otomy: Cutting into
  • -pathy: Disease
  • -pexy: Surgical fixation
  • -plasia: Formation of cells
  • -plasty: Surgical repair
  • -ptosis: Drooping
  • -rrhaphy: To suture
  • -rrhea: Discharge
  • -sclerosis: Hardening
  • -scope: Instrument for viewing
  • -scopy: Process of visually examining
  • -stenosis: Narrowing
  • -tripsy: Surgical crushing
  • -uria: Urine condition

Prefix Review

  • a-, an-: Without
  • anti-: Against
  • dys-: Abnormal, difficult, painful
  • epi-: Above
  • extra-: Outside of
  • hyper-: Excessive
  • hypo-: Below
  • intra-: Within
  • poly-: Many
  • trans-: Across

Organs Treated in Urology and Nephrology

  • Kidneys:
    • Located on either side of the spine at the lower ribs, outside of the peritoneal membrane.
    • Made up of thousands of nephrons.
    • Glomerulus of the nephron filters waste and excess fluid out of the blood to make urine.
    • Urine collects in the renal pelvis.
    • Drains into the ureters.
  • Ureters:
    • Carry urine away from the kidneys to the urinary bladder.
  • Urinary Bladder:
    • Muscular, elastic organ that stores urine until released.
  • Urethra:
    • Carries urine from the bladder and exits the body at the meatus.
  • Testes:
    • Male reproductive organs that produce sperm and testosterone.
    • Sperm contains one-half of the normal chromosomes.
    • Suspended outside of the body in the scrotum.
    • Scrotum maintains ideal testicular temperature and pulls the testes into or lowers them away from the body.
  • Epididymis:
    • Sperm are stored and matured here.
  • Vas Deferens:
    • Upon ejaculation, sperm enter the vas deferens and travel toward the urethra.
  • Reproductive Glands:
    • Add fluid to the sperm as it travels through the vas deferens.
    • Seminal vesicles and bulbourethral glands (paired).
    • Prostate (single gland).
  • Prostate Gland:
    • Sperm enter the urethra at the prostate gland.
    • Releases a milky fluid that nourishes sperm and makes up the majority of semen.
  • Penis:
    • The urethra carries semen through the penis.
    • Semen exits the body at the glans penis.

Building Urology and Nephrology Terms

  • balan/o (glans penis):
    • balanorrhea: discharge from the glans penis
  • cyst/o (urinary bladder):
    • cystalgia: bladder pain
    • cystocele: protrusion of the bladder
    • cystolith: stone in the bladder
  • epididym/o (epididymis):
    • epididymal: pertaining to the epididymis
  • lith/o (stone):
    • lithotripsy: surgical crushing of a stone
    • cystolithiasis: abnormal condition of stone in bladder
  • nephr/o (kidney):
    • nephromegaly: enlarged kidney
    • nephroptosis: drooping kidney
  • orch/o (testis):
    • anorchism: state of being without testes
  • orchi/o (testis):
    • orchiopexy: surgical fixation of a testis
    • orchialgia: testis pain
  • orchid/o (testis):
    • orchidectomy: surgical removal of a testis
    • cryptorchidism: state of hidden testis
  • -ostomy (surgically create an opening):
    • ureterostomy: surgically create an opening in the ureter
    • pyelostomy: surgically create an opening in the renal pelvis
  • prostat/o (prostate gland):
    • prostatectomy: surgical removal of the prostate gland
  • pyel/o (renal pelvis):
    • pyelonephritis: renal pelvis and kidney inflammation
  • ren/o (kidney):
    • renogram: record of the kidney
  • semin/i (semen):
    • seminuria: condition of semen
  • sperm/o (sperm):
    • aspermia: condition of being without sperm
    • oligospermia: condition of having scanty sperm
  • spermat/o (sperm):
    • spermatogenesis: produces sperm
    • spermatolysis: to destroy sperm
  • testicul/o (testis):
    • testicular: pertaining to a testis
  • ur/o (urine):
    • urology: study of urine
  • ureter/o (ureter):
    • ureteritis: ureter inflammation
    • ureterostenosis: narrowing of the ureter
  • urethr/o (urethra):
    • urethroplasty: surgical repair of the urethra
    • urethralgia: urethra pain
  • -uria (urine condition):
    • glycosuria: sugar urine condition
    • nocturia: night urine condition
  • urin/o (urine):
    • urinometer: instrument for measuring urine
  • vas/o (vas deferens):
    • vasectomy: surgical removal of the vas deferens
  • vesicul/o (seminal vesicle):
    • vesiculectomy: surgical removal of the seminal vesicle

Symptoms and Signs

  • Diuresis: Increased formation and secretion of urine.
  • Frequency: Urinating more often than normal (without increased volume), indicates bladder/urethra inflammation or benign prostatic hyperplasia.
  • Hesitancy: Difficulty initiating urine flow, often due to blockage along the urethra.
  • Urgency: Feeling the need to urinate immediately
  • Nocturia: Night time urination
  • Oliguria: Few or scanty urine
  • Anuria: Condition of kidneys not producing urine
  • Dysuria: Painful urination
  • Enuresis: Involuntary discharge of urine after age 5 (when bladder control should be established).
    • Nocturnal enuresis: bed-wetting at night

Urinary Incontinence

  • Involuntary urination; also called enuresis.
    • Stress incontinence: Urine loss when pressure is exerted on the bladder (coughing, laughing, etc.).
    • Urge incontinence: Sudden, intense urge to urinate followed by involuntary urine loss.
    • Overflow incontinence: Frequent or constant dribbling of urine, can occur with a damaged bladder, blocked urethra, nerve damage, or prostate issues in men.

Diseases

  • Calculus: Term for a “stone formed within an organ”.
    • Most are formed from mineral salts.
    • Commonly found in the kidney, renal pelvis, ureters, bladder, or urethra
    • Plural is calculi.
  • Polycystic kidney disease (PKD): Inherited kidney disease with multiple cysts throughout the kidney tissue, eventually leads to kidney failure.
  • Pyelonephritis: Inflammation of the renal parenchyma, calyces, and pelvis; commonly caused by bacterial infection (often E. coli) that has spread up the urinary tract, often associated with structural abnormalities , kidney stones, prostate disease, or vesicourethral reflex.
  • Cystitis: Inflammation of the urinary bladder
  • Chlamydia: Bacterial STD: causes inflammation of the urethra of males or cervix of females with purulent discharge
  • Genital herpes: Viral STD: causes blister like lesions on the penis of males or the cervix and vagina of females
  • Gonorrhea: Bacterial STD: Infects the mucous membranes and can spread throughout the entire genitourinary system, often doesn't cause many symptoms until it is widespread.
  • Syphilis: Bacterial, chronic STD: begins as localized ulcer at point of infection; easily treated early with antibiotics; if left untreated, infection eventually spreads through lymph nodes to nervous system, causing death many years later
  • Trichomoniasis: Protozoan STD: causes inflammation of the genitourinary tract in both men and women
  • Urinary tract infection (UTI): Infection of any region of the urinary tract; characterized by fever, low back or abdominal pain, and burning pain during urination
  • Chancroid: Bacterial STD: highly infectious non-syphilitic venereal ulcer that resembles a syphillic
  • Glomerulonephritis: Inflammation of the glomeruli within the kidney
  • Nephrotic syndrome: Abnormal condition of the kidney characterized by marked proteinuria and edema; can occur as a complication of DM
  • Renal failure: Inability of the kidneys to filter wastes from blood and/or produce urine; treatment of severe renal failure is dialysis or renal transplant
  • Azotemia: Accumulation of nitrogenous waste in the bloodstream; occurs when either or both kidneys fail to filter these wastes from blood
  • Obstructive nephropathies: Conditions that block or interfere with the flow of urine.
  • Hydronephrosis: Distension of the renal pelvis and kidney by urine that cannot flow past an obstruction in a ureter.
  • Bladder cancer: More common in men than women.
  • Wilms tumor: Malignant kidney tumor found most often in children; also called nephroblastoma
  • Erectile dysfunction (ED): Inability to achieve erection of the penis for coitus; also called impotence
  • Hydrocele: Accumulation of fluid within the scrotum
  • Hypospadias: Congenital malformation of penis with the urethra opening on underside of penis
  • Epispadias: Congenital malformation of penis with the urethra opening located above the usual opening
  • Phimosis: Narrowing of the prepuce over the glans penis; may cause difficulty with urination and infection; treatment is circumcision
  • Priapism: Persistent and painful erection due to pathological causes, not sexual arousal.
  • Sterility: Inability to produce children; in males, it is usually due to a problem with sperm production, such as aspermia or oligospermia; also called infertility
  • Testicular cancer: Cancer of one or both testicles; more commonly seen in young men or boys
  • Undescended testicle: Congenital anomaly involving failure of one or both of testes to descend into scrotal sac before birth; a surgical procedure called orchiopexy may be required to bring testes down into the scrotum permanently; also called cryptorchidism
  • Testicular torsion: Twisting of the spermatic cord
  • Varicocele: Development of varicose veins in the scrotal veins
  • Benign prostatic hyperplasia (BPH): Nonmalignant, non inflammatory enlargement of the prostate; condition places pressure on the urethra and narrows it, resulting in frequency, urgency, and nocturia; commonly seen in males over age 50
  • Prostate cancer: Common and slow-growing cancer of the prostate gland occurring in males over age 50; prostate-specific antigen (PSA) test is used to assist in early detection of this disease
  • Anorchism: Absence of testes; may be congenital or as a result of accident or surgery

Diagnosis

  • Urinalysis (U/A, UA): Physical, chemical, and microscopic examination of the urine
    • pH
    • Specific gravity
    • Proteins: proteinuria indicates glomerulonephritis or preeclampsia in pregnant women
    • Glucose: glucosuria indicates uncontrollable diabetes
    • Ketones: ketonuria indicates diabetic ketoacidosis, dehydration, starvation
    • WBC: indicates UTI
    • Blood: hematuria indicates glomerulonephritis, cancer of the urinary tract, trauma
    • Urinary Casts: Gelatinous structures that take the shape of the renal tubules. Presence of many casts can be due to renal diseases or stones
  • Clean catch specimen: Obtaining a urine sample in midstream after cleaning the urethral meatus to minimize contamination
  • Urine culture & sensitivity (C&S): Identifies bacterial infection of the urinary system and determines the best antibiotic to treat it
  • Blood urea nitrogen (BUN): Blood test to determine kidney function by measuring the level of nitrogenous waste, or urea, in the blood
  • Creatinine clearance: Evaluates kidney function; urine is collected for 24 hours, and the amount of creatinine in urine compared to creatinine remains in the blood
  • Intravenous pyelogram (IVP): X-ray of the kidney following injection of dye into a vein to visualize renal pelvis as the kidney filters dye out of the bloodstream and puts it into the urine.
  • Intravenous urography: X-ray images of the entire urinary system or part of it after the urine has been rendered opaque by an IV injected contrast medium. Both structural and functional abnormalities can be detected
  • Retrograde pyelogram (RP): X-ray of the urinary bladder, ureters, and renal pelvis following insertion of dye through the urethra
  • KUB: Xray o kidney, ureters and bladder
  • Urinary catheterization (cath): Insertion of a flexible tube, or catheter, into the urinary bladder through the urethra; used to withdraw urine or insert dye
  • Voiding cystourethography (VCUG): X-rays made while the patient voids dye that has been placed in the urinary bladder through the urethra
  • Prostate specific antigen (PSA): Blood test to screen for prostate cancer. Elevated PSA indicates prostate cancer
  • Semen analysis: Evaluation of the semen for fertility; sperm in the semen are analyzed for number, swimming strength, and shape; procedure is also used to determine if a vasectomy has been successful
  • Digital rectal examination: Manual examination for enlarged prostate gland performed by palpating (feeling) the prostate gland though the wall of the rectum.
  • Intake and output (I & O): 24 hour test to check the oral/IV/tube feeding and the urine out put.
  • Pyuria: Pus cells (necrotic WBCs) are in the urine
  • Creatinine clearance test: Diagnostic test that measures the rate at which creatinine is cleared from the blood by the kidney
  • Cystometrography: Provides information about the amount of pressure exerted on bladder wall
  • Cytometer: Measures bladder capacity in relation to changing urine pressure
  • Cystography: Radiography of the bladder using radiopaque contrast medium
  • Cystourethrography: Radiography of the bladder and urethra after using a urinary catheter to instill the contrast medium
  • Voiding cystourethrograms (VCUG): Radiograph made before, during, and after voiding . This procedure checks for reflux (abnormal backflow) of urine
  • Cystoscopy: a pencil thin flexible tube-like optical instrument is inserted through the urethra into the bladder to examine the bladder’s lining and to take a biopsy if needed.

Treatment – Medical

  • Antibiotic: Medication used to treat bacterial infections
  • Antispasmodic: Prevents or reduces bladder muscle spasms
  • Diuretics: increases the volume of urine produced by the kidneys; useful in treatment of edema, kidney failure, heart failure and hypertension

Treatment

  • Extracorporeal shockwave lithoscope (ESWL): Uses ultrasound waves to break up stones; noninvasive.
  • Foley catheter: Indwelling catheter designed to left in place for a prolong period
  • Ureteral catheter: Insertion of the catheter into the distal part of the ureter through the urethra, bladder and into the ureter with cystoscopy guidance or inserted through the abdominal wall.
  • Suprapubic catherization: Surgical insertion of a catheter through the skin above the pubic bone into the bladder
  • Peritoneal dialysis: Artificial means to remove wastes by placing a warm, chemically balanced solution into the peritoneal cavity; treatment for renal failure
  • Hemodialysis (HD): Treatment for renal failure using an artificial kidney machine to filter waste from the blood
  • Androgen deprivation therapy (ADT): using medicine to reduce the amount of testosterone produced by the testes; treatment for prostate cnacer.
  • HPV vaccine: Human papillomavirus vaccine: protect against HPV infection
  • Castration: surgically remove the testes
  • Orchidectomy: surgical removal of on or both testes
  • Prostatectomy: surgical removal of the prostate
  • Nephrotomy: Surgical insertion of a catheter via a new opening into the renal pelvis through the overlying skin
  • Renal transplant: Replacement of diseased kidney by a donor kidney
  • Transurethral resection of the prostate (TURP): Surgical removal of prostate tissue by inserting a device called a resectoscope through the urethra and removing prostate tissue; may also be referred to as transurethral resection (TUR)
  • Circumcision: Surgical removal of the prepuce, or foreskin, from glans penis; commonly performed on newborn males at the request of parents; primary reason is for ease of hygiene; also a ritual practiced in some religions

Urology and Nephrology Abbreviations

  • ARF: Acute renal failure
  • BPH: Benign prostatic hyperplasia
  • BUN: Blood urea nitrogen
  • C&S: Culture and sensitivity
  • cath: Catheterization
  • CRF: Chronic renal failure
  • cysto: Cystoscopy
  • DRE: Digital rectal exam
  • ED: Erectile disfunction
  • ESRD: End-stage renal disease
  • ESWL: Extracorporeal shockwave lithotripsy
  • GU: Genitourinary
  • HD: Hemodialysis
  • HPV: Human papillomavirus
  • I&O: intake and output
  • IVP: intravenous pyelogram
  • KUB: kidneys, ureters, bladder
  • PKD: polycystic kidney disease
  • PSA: prostate-specific antigen
  • RP: retrograde pyelogram
  • STD: Sexually transmitted disease
  • STI: Sexually transmitted infection
  • TUR: transurethral resection
  • TURP: transurethral resection of the prostate
  • U/A, UA: urinalysis
  • UC: urine culture
  • UTI: urinary tract infection
  • VCUG: voiding cystourethrography
  • VD: venereal disease