Chapter 9 The Urinary System

Related Combining Forms Structure Related Combining Forms Kidneys nephr/o, ren/o Renal pelvis pyel/o Urine ur/o, urin/o Ureters ureter/o Urinary bladder cyst/o Urethra urethr/o Prostate prostat/o

Functions of the Urinary System Maintaining homeostasis by: Proper balance of water, salts, and acids by filtering of blood flowing through the kidneys Filtering blood to remove urea, creatinine, uric acid, and other waste products Converting waste products and excess fluids into urine in the kidneys, and excreting them from the body

Structures of the Urinary System Two kidneys Two ureters One bladder One urethra

Structures of the Urinary System

The Kidneys Located in retroperitoneal space Filter blood to remove waste products and excess water Assist with maintenance of fluid level, production of hormones controlling blood pressure, erythrocyte production, and activation of Vitamin D

The Kidneys Renal cortex Renal medulla Outer region Contains nephrons Inner region Contains urine-collecting tubules

Nephrons Microscopic functional units Site of urine production using filtration, reabsorption, and secretion Contains glomeruli (clusters of capillaries) Renal artery supplies blood from kidney to nephrons Renal vein carries filtered blood from kidney to bloodstream

Nephrons Urine is transported to renal pelvis and collected in preparation for entry into ureters

The Renal Pelvis Funnel-shaped area surrounded by renal cortex and renal medulla Site of urine collection before it flows into the ureters

The Ureters Two narrow tubes transporting urine from kidneys to bladder, through process of peristalsis Ureteral orifices allow draining of urine from ureters into the bladder

The Urinary Bladder Located in anterior portion of pelvic cavity behind pubic symphysis Muscular reservoir for urine Lined with rugae allowing for expansion when full, and contraction when empty

The Urethra Tube extending from bladder to exterior of the body Urinary sphincters located at either end of urethra controll flow of urine from bladder to urethra, and from urethra to urethral meatus (external opening of the urethra)

The Urethra Female urethra Approximately 1.5 inches long Meatus located between clitoris and vaginal opening Transports only urine

The Urethra Male urethra Approximately 8 inches long Meatus located at tip of penis Transports urine and semen Surrounded by prostate gland

The Excretion of Urine Known as: Urination Voiding Micturition Requires coordinated contraction of bladder muscles and relaxation of sphincters

Medical Specialties Related to the Urinary System Nephrologist Specializes in diagnosing/treating diseases/disorders of kidneys (nephr: kidney; -ologist: specialist) Urologist Specializes in diagnosing/treating diseases/disorders of urinary system of females and genitourinary system of males (ur: urine; -ologist: specialist)

Pathology of the Urinary System Nephropathy Any disease of the kidney (nephr/o: kidney; -pathy: disease) Renal failure Improper function of one or both kidney(s) Destruction of nephrons

Renal Failure Azotemia Uremia Elevated BUN due to lack of blood flow to kidneys Uremia Toxic condition resulting from renal failure Urea and other waste products are retained in the blood (ur: urine; -emia: blood condition)

Chronic kidney disease Renal Failure Acute renal failure Sudden onset of uremia Fatal if not reversed promptly Chronic kidney disease Progressive loss of renal function Can be life-threatening

End-stage renal disease Renal Failure End-stage renal disease Final stage of chronic kidney disease Fatal unless kidney function replaced by dialysis or kidney transplant

Nephrotic (nephr/o: kidney; -tic: pertaining to) Nephrotic Syndrome Nephrotic (nephr/o: kidney; -tic: pertaining to) Group of conditions when excessive amounts of protein are lost through urine Edema Excessive fluid accumulation in body tissues as symptom of nephrotic syndrome or other kidney diseases

Nephrotic Syndrome Hyperproteinuria Abnormally high concentrations of protein in urine (hyper-: excessive; protein: protein; -uria: urine)

Nephrotic Syndrome Hypoproteinemia Abnormally low concentration of protein in the blood May be associated with hyperproteinuria (hypo-: deficient or decreased; protein; protein; -emia: blood condition

Additional Kidney Conditions Hydronephrosis Dilation of one or both kidney(s) due to obstruction resulting in reflux of urine (hydr/o: water; nephr: kidney; -osis: abnormal condition or disease) Nephritis Inflammation of kidney(s) (nephr: kidney; -itis: inflammation)

Additional Kidney Conditions Glomerulonephritis Inflammation of glomeruli causing erythrocytes and proteins to leak into urine (glomerul/o: glomeruli; nephr: kidney; -itis: inflammation)

Additional Kidney Conditions Nephroptosis Prolapse of kidney into pelvic area when a person stands (nephr/o: kidney; -ptosis: droop or sag) Nephropyosis Suppuration of kidney (nephr/o: kidney; py: pus; -osis: abnormal condition or disease)

Additional Kidney Conditions Polycystic kidney disease Genetic disorder Growth of numerous fluid-filled cysts in kidney which replace much of the mass of the kidney Leads to reduced kidney function and kidney failure (poly-: many; cyst: cyst; -ic: pertaining to)

Additional Kidney Conditions Renal colic Acute pain in kidney area caused by blockage during passage of kidney stone Wilms tumor Malignant tumor of kidney Occurs in young children

A stone also known as calculus Stones A stone also known as calculus Abnormal mineral deposit formed within the body Nephrolithiasis The presence of stones in the kidney (nephr/o: kidney; -lithiasis: the presence of stones)

Nephrolith: located in kidney Ureterolith: located in ureter Stones Nephrolith: located in kidney (nephr/o: kidney; -lith: stone) Ureterolith: located in ureter (ureter/o: ureter; -lith: stone) Cystolith: located in urinary bladder (cyst/o: bladder; -lith: stone)

Stones

The Ureters Hydroureter Ureterectasis Distention of ureter with urine due to blockage (hydr/o: water; -ureter: ureter) Ureterectasis Distention of ureter due to hydroureter or congenital abnormalities (ureter: ureter; -ectasis: enlargement)

The Ureters Ureterorrhagia Discharge of blood from the ureter (ureter/o: ureter; -rrhagia: bleeding)

Cystalgia (cystodynia) The Urinary Bladder Cystalgia (cystodynia) Pain in the bladder (cyst: bladder; -algia: pain) Cystocele Hernia of bladder through vaginal wall (cyst/o: bladder; cele: hernia) Interstitial cystitis Chronic inflammation within bladder walls

Vesicoureteral reflux The Urinary Bladder Vesicoureteral reflux Backward flow of urine into ureters from the bladder (vesic/o: bladder; ureter: ureter; -al: pertaining to) Vesicovaginal fistula Abnormal opening from bladder to vagina allowing constant involuntary flow of urine from bladder to vagina (vesic/o: bladder; vagin: vagina; -al: pertaining to)

The Urinary Bladder Neurogenic bladder Caused by interference of normal nerve pathways associated with urination (neur/o: nerve; -genic: created by) May cause urinary incontinence May cause inability to empty bladder

Benign prostatic hyperplasia The Prostate Gland Benign prostatic hyperplasia Enlargement of prostate gland May cause difficulty in urination Prostatism Results from compression of urethra due to benign prostatic hyperplasia (prostat: prostate gland; -ism: condition of)

The Prostate Gland Prostate cancer Prostatitis One of the most common cancers in men May be asymptomatic or aggressive Prostatitis Group of disorders characterized by inflammation of prostate gland

The Urethra Urethrorrhagia Urethrorrhea Bleeding from the urethra (urethr/o: urethra; -rrhagia: bleeding) Urethrorrhea Abnormal discharge from urethra (urethr/o: urethra; -rrhea: flow or discharge)

The Urethra Urethrostenosis Narrowing of urethra (urethr/o: urethra; -stenosis: tightening or narrowing)

Abnormal Urethral Openings Epispadias Congenital abnormality Male: urethral opening located on upper surface of penis Female: urethral opening located in region of clitoris

Abnormal Urethral Openings Hypospadias Congenital abnormality Male: urethral opening is on ventral surface of penis Female: urethra opens into the vagina

Urinary Tract Infections Cystitis Inflammation of bladder (cyst: bladder; -itis: inflammation) Polynephritis Inflammation of renal pelvis and kidney (pyel/o: renal pelvis; nephr: kidney) Urethritis Inflammation of urethra (urethr: urethra)

Urination Anuria Diuresis Absence of urine formation (an-: without; -uria: urine) Diuresis Increased output of urine (di-: through; -uresis: urination)

Urination Dysuria Enuresis Difficult, painful urination (dys-: painful; -uria: urination) Enuresis Involuntary discharge of urine (en-: into; -uresis: urination)

Urination Nocturnal enuresis Nocturia Oliguria Urinary incontinence during sleep Nocturia Frequent, excessive urination during the night (noct: night: -uria: urination) Oliguria Scant urination (olig: scanty; -uria: urination)

Urination Polyuria Urinary hesitancy Urinary retention Excessive urination (poly-: many; -uria: urination) Urinary hesitancy Difficulty in starting urinary stream Urinary retention Inability to completely empty the bladder

Inability to control excretion of urine, feces, or both Incontinence Inability to control excretion of urine, feces, or both Urinary incontinence Inability to control voiding Overflow incontinence Continuous leaking from bladder

Incontinence Stress incontinence Overactive bladder Inability to control voiding under physical stress (running, sneezing, laughing, etc.) More common in women Overactive bladder Bladder muscles contract involuntarily when bladder is not full enough to indicate need to urinate

Diagnostic Procedures of the Urinary System Urinalysis Determines presence of abnormal elements (urin: urine; -alysis: a study of the parts) Bladder ultrasound Assists with visualization of stones, elevation of bladder by enlarged prostate, or measuring of residual urine

Diagnostic Procedures of the Urinary System Urinary catheterization Insertion of a tube into bladder to procure a sterile specimen for diagnostic purposes Procedure must be performed under sterile conditions Obtaining sterile specimen, draining urine from bladder, placement of medication into bladder Cystoscopy Use of endoscope for visual examination of urinary bladder (cyst/o: bladder; -scopy: visual examination)

Diagnostic Procedures of the Urinary System Voiding cystourethrography Use of fluoroscope to determine flow of urine from bladder and through the urethra Computed tomography For evaluation of urinary system Glomerular filtration rate Blood test for determination of filtering of blood by the kidneys

Radiographic Examinations of the Urinary System Cystography X-ray examination of bladder Requires contrast medium (cyst/o: bladder; -graphy: the process of creating a picture or record) Intravenous pyelography Provides image of kidneys and ureters (pyel/o: renal pelvis)

Radiographic Examination of the Urinary System KUB (kidneys, ureters, bladder) Assists with detection of bowel obstructions and nephroliths Does not require contrast medium Retrograde urography Observes upward flow of urine Requires contrast medium (ur/o: urine: -graphy: the process of creating a picture or record)

Diagnostic Procedures of the Prostate Gland Digital rectal examination Lubricated, gloved finger placed in rectum to palpate prostate gland Prostate-specific antigen blood test Screens for prostate cancer

Treatment Procedures of the Urinary System Medications Diuretics Increase urine secretion, primarily to rid body of excess water and salt Antibiotics Treatment of urinary tract infections Antispasmodics Block signals that cause urinary incontinence

Treatment Procedures of the Urinary System Nutritional Interventions Monitoring of sodium, potassium, protein, and phosphorus in diet

Treatment Procedures of the Urinary System Dialysis (dia-: complete or through; -lysis: separation) Removes waste products, and excess water from blood when kidneys do not function properly Hemodialysis (waste products filtered directly from patient's blood; cleansed blood returned to body through a vein) Peritoneal dialysis (lining of peritoneal cavity acts as filter to remove waste from the blood)

The Kidneys Nephrolysis Nephropexy Surgical freeing of a kidney from adhesions (nephr/o: kidney; -lysis: setting free) Nephropexy Surgical fixation of floating kidney (nephr/o: kidney; -pexy: surgical fixation)

The Kidneys Nephrostomy Placement of catheter to maintain opening from pelvis of one or both kidneys to exterior of the body (nephr: kidney; -ostomy (creating an opening)

Renal transplantation The Kidneys Pyelotomy Surgical incision into renal pelvis (pyel: renal pelvis; -otomy: surgical incision) Renal transplantation Grafting of donor kidney to replace recipient's failed kidney

Treatment of Nephroliths Extracorporeal shockwave lithotripsy Breaking of stones into fragments, which are then excreted in urine (lith/o: stone; -tripsy: to crush) Percutaneous nephrolithotomy Surgical removal of nephrolith through small opening in the back (nephr/o: kidney; lith: stone; -otomy: surgical incision)

The Ureters Ureterectomy Ureterorrhaphy Ureteroscopy Surgical removal of a ureter Ureterorrhaphy Surgical suturing of a ureter Ureteroscopy Treatment for nephrolith lodged in the ureter

The Urinary Bladder Cystectomy Ileal conduit Cystopexy Surgical removal of all or part of the urinary bladder Ileal conduit Use of small piece of intestine to convey urine to ureters and then to abdominal stoma Cystopexy Surgical fixation of bladder to abdominal wall

The Urinary Bladder Cystorrhaphy Lithotomy Surgical suturing of wound/defect in bladder Lithotomy Surgical incision for removal of nephrolith from bladder Surgical procedure is rarely performed; term now refers to physical examination position for procedures involving pelvis and lower abdomen

Urinary Catheterization Sterile Procedure Indwelling catheter Catheter remains inside body for prolonged time Most common type is Foley catheter Urethral catheterization Insertion of catheter through urethra and into the bladder

Urinary Catheterization Suprapubic catheterization Placement of catheter into bladder through small incision in abdominal wall just above the pubic bone Intermittent catheter Inserted as needed several times per day to drain urine from bladder

The Urethra Meatotomy Urethroplasty Surgical incision in urethral meatus to enlarge opening (meat: meatus; -otomy: surgical incision) Urethroplasty Surgical repair of damage/defect in walls of urethra (urethr/o: urethra; -plasty: surgical repair)

The Urethra Urethrotomy Surgical incision into urethra to relieve stricture (urethr: urethra; -otomy: surgical incision)

Prostate Treatment Ablation Prostatectomy Removal of a body part, or destruction of its function Prostatectomy Surgical removal of part or all of the prostate gland (prostat: prostate; -ectomy: surgical removal)

Transurethral prostatectomy Prostate Treatment Transurethral prostatectomy Use of resectoscope to remove excess tissue from enlarged prostate gland Radiation therapy and hormone therapy Additional treatment for prostate cancer Watchful waiting May be prescribed approach due to slow progression of prostate cancer

Urinary Incontinence Training Kegel exercises Exercises to strengthen muscles of pelvic floor Bladder retraining Behavioral therapy Teaches the patient to urinate at a scheduled time and at longer intervals as bladder capacity increases Assists with reestablishing voluntary bladder control