1. Chapter 9
The Urinary System

2. 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

3. 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

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

5. Structures of the Urinary System

6. 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

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

8. 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

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

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

11. 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

12. 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

13. 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)

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

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

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

17. 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)

18. 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

19. 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)

20. 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

21. 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

22. 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

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

24. 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

25. 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)

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

27. 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)

28. 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)

29. 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

30. 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)

31. 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)

32. Stones

33. 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)

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

35. 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

36. 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)

37. 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

38. 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)

39. 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

40. 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)

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

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

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

44. 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)

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

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

47. 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)

48. 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

49. 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

50. 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

51. 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

52. 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)

53. 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

54. 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)

55. 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)

56. 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

57. 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

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

59. 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)

60. 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)

61. 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)

62. 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

63. 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)

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

65. 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

66. 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

67. 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

68. 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

69. 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)

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

71. 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)

72. 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

73. 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