1. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Language, Second Edition Susan Turley CHAPTER Medical Language Second Edition Urology 11

2. Figure 11-1 Urinary system

3. Anatomy and Physiology The urinary system is a body system that begins with the kidneys. The kidneys are located in the retroperitoneal space, a small area behind the peritoneum of the abdominal cavity. Other structures of the urinary system are located within the abdominopelvic cavity.

4. Anatomy and Physiology (cont’d) The male urethra is located in the penis. The purpose of the urinary system is to produce, transport, store, and excrete urine.

5. Anatomy of the Urinary System Kidneys – Reddish-brown in color – Shaped like kidney beans – Measure 4 inches long and 2 inches wide, and weighs less than 1/2 pound

6. Anatomy of the Urinary System (cont’d) Kidneys (cont’d) – The upper end of each kidney is under the lower edge of the rib cage in the flank area of the back. – The hilum is an area of indentation on the medial surface of the kidney where the renal artery enters and the renal vein and ureter exit. – A capsule of fibrous connective tissue surrounds the kidney.

7. Anatomy of the Urinary System (cont’d) Kidneys (cont’d) – Just beneath the capsule is the renal cortex layer of tissue. – Beneath that is the renal medulla that contains the triangular-shaped renal pyramids. – The tip of each renal pyramid connects to a minor calix, a duct that drains urine.

8. Anatomy of the Urinary System (cont’d) Kidneys (cont’d) – Several minor calices drain into a common duct, the major calix. – The major calices drain into the renal pelvis, a large, funnel-shaped cavity that then narrows to become the ureter. – Urine flows continuously through the minor calices, into the major calices, into the renal pelvis, and into the ureter.

9. Figure 11-2 Right kidney

10. Figure 11-3 Cut section of a kidney Reprinted from McMinn’s Color Atlas of Human Anatomy, 2/E. McMinn, Hutchings, Human Anatomy, 19,46,66,71.78,127,137,237,238. Copyright 2002, with permission from Elsevier.

11. Anatomy of the Urinary System (cont’d) Ureters – Each ureter is a 12-inch tube that connects the renal pelvis of the kidney to the bladder. – The ureteral orifices are the openings into the bladder. – The walls of the ureters are composed of smooth muscle that contracts periodically to propel urine into the bladder, a process known as peristalsis.

12. Anatomy of the Urinary System (cont’d) Bladder – Located in the pelvic cavity and held in place by ligaments – Rounded top of bladder is the dome or fundus – Inside of bladder is lined with mucosa, a mucous membrane

13. Anatomy of the Urinary System (cont’d) Bladder (cont’d) – When bladder is empty, the mucosa collapses into folds, or rugae. – When bladder is full, smooth muscle in the bladder wall contracts to expel urine.

14. Figure 11-4 Bladder

15. Anatomy of the Urinary System (cont’d) Urethra – A tube that carries urine from the bladder to the outside of the body. – External urethral sphincter is a muscular ring that can be consciously controlled to release or hold back urine. – Urethral meatus is where the urethra opens to the outside of the body.

16. Anatomy of the Urinary System (cont’d) Urethra (cont’d) – In men, the urethra is 7 to 8 inches long. – As the urethra leaves the bladder, it travels through the center of the prostate gland, a spherical gland at the base of the bladder. – Enlargement of the prostate gland can affect the urinary system by pressing on and narrowing the urethra.

17. Anatomy of the Urinary System (cont’d) Urethra (cont’d) – The urethra is part of both the urinary and the male reproductive system, because it transports both urine and semen. In women, the urethra is much shorter, traveling only 1 to 2 inches from the bladder to the external surface of the body.

18. Figure 11-5 Male urinary system

19. Figure 11-6 Female urinary system

20. Physiology of the Formation of Urine The parenchyma is the functional or working area of any organ. The nephron, a microscopic structure, is the functional unit of the kidney and the site of urine production. The first part of the nephron is the glomerular capsule.

21. Physiology of the Formation of Urine (cont’d) Within this ball-shaped structure, the arteriole divides and forms the glomerulus, a network of intertwining capillaries. Waste products in the blood include: – Urea – Creatinine – Uric acid – Drugs and products of drug metabolism

22. The blood that enters the nephron also contains the following nutritional substances: – Electrolytes – Glucose – Amino acids – Vitamins Physiology of the Formation of Urine (cont’d)

23. The job of the nephron is to remove the waste products from the blood but keep the nutritional substances. The pressure of the blood pushes the waste products as well as water and nutritional substances through the capillary pores and out into the ball-shaped collecting area of glomerular capsule. This process is known as filtration. Physiology of the Formation of Urine (cont’d)

24. Figure 11-7 Nephron

25. The filtrate (waste products, water, and nutritional substances) in the glomerular capsule then flows into the proximal convoluted tubule of the nephron. Most of the water and nutritional substances move out of the tubule and return to the blood. This process is known as reabsorption. Physiology of the Formation of Urine (cont’d)

26. The proximal convoluted tubule becomes a U- shaped tubule known as the nephron loop. In the nephron loop, more water and electrolytes are reabsorbed. Physiology of the Formation of Urine (cont’d)

27. The nephron loop widens to become the distal convoluted tubule where more water and electrolytes, as well as amino acids and other nutritional substances, are reabsorbed. Urine is produced continuously by the nephrons in the kidneys.

28. Figure 11-8 Pathway of urine production and elimination Richard Hutchings/PhotoEdit Inc.

29. The process of eliminating urine from the body is described in several ways: – Urination – Micturition – Voiding – Passing water Physiology of the Formation of Urine (cont’d)

30. Physiology of Other Functions of the Kidneys Besides producing and excreting urine, the kidneys also help the body to maintain a normal and constant internal environment. The kidneys respond if blood pressure decreases, if the pH of the blood decreases, or if the number of red blood cells decreases.

31. Diseases and Conditions Kidneys and Ureters – Glomerulonephritis – Hydronephrosis – Nephrolithiasis

32. Figure 11-9 Kidney stone Custom Medical Stock Photo, Inc.

33. Figure 11-10 Nephrolithiasis Dr. E. Walker/Science Photo Library/Photo Researchers, Inc.

34. Diseases and Conditions (cont’d) Kidneys and Ureters (cont’d) – Nephropathy – Nephroptosis – Nephrotic syndrome – Polycystic kidney disease

35. Figure 11-11 Polycystic kidney disease Custom Medical Stock Photo, Inc.

36. Diseases and Conditions (cont’d) Kidneys and Ureters (cont’d) – Pyelonephritis – Renal cell cancer – Renal failure – Uremia

37. Figure 11-12 CT scan of the kidneys Simon Fraser/Freeman Hospital/Photo Researchers, Inc.

38. Diseases and Conditions (cont’d) Bladder – Bladder cancer – Cystitis

39. Figure 11-13 Acute cystitis Courtesy Chiang Mai University, The Faculty of Medicine, www.med.cmu.ac.th

40. Diseases and Conditions (cont’d) Bladder (cont’d) – Cystocele – Neurogenic bladder – Overactive bladder

41. Diseases and Conditions (cont’d) Bladder (cont’d) – Urinary retention – Vesicovaginal fistula

42. Diseases and Conditions (cont’d) Urethra – Epispadias – Urethritis

43. Diseases and Conditions (cont’d) Urine and Urination – Albuminuria – Anuria – Bacteriuria – Dysuria – Enuresis – Frequency

44. Diseases and Conditions (cont’d) Urine and Urination (cont’d) – Glycosuria – Hematuria – Hesitancy – Hypokalemia – Incontinence

45. Diseases and Conditions (cont’d) Urine and Urination (cont’d) – Ketonuria – Nocturia – Oliguria

46. Diseases and Conditions (cont’d) Urine and Urination (cont’d) – Polyuria – Pyuria – Urgency – Urinary tract infection (UTI)

47. Figure 11-14 Cranberry juice.

48. Laboratory and Diagnostic Procedures Blood Tests – Blood urea nitrogen (BUN) – Creatinine

49. Laboratory and Diagnostic Procedures (cont’d) Urine Tests – Culture and sensitivity (C&S) – Drug screening – Leukocyte esterase – 24-hour creatinine clearance

50. Figure 11-15 Culture and sensitivity testing

51. Laboratory and Diagnostic Procedures (cont’d) Urine Tests (cont’d) – Urinalysis (UA) Color―Normal urine is light yellow to amber in color, depending on its concentration Odor―Urine has a faint odor due to the waste products in it pH―A test of how acidic or alkaline the urine is Protein―Protein is not normally found in the urine; its presence indicates damage to the glomerulus

52. Laboratory and Diagnostic Procedures (cont’d) Urine Tests (cont’d) – Urinalysis (UA) (cont’d) Glucose―Glucose is not normally found in the urine; its presence indicates uncontrolled diabetes mellitus

53. Figure 11-16 Urine dipstick Faye Norman/Photo Researchers, Inc.

54. Laboratory and Diagnostic Procedures (cont’d) Urine Tests (cont’d) – Urinalysis (UA) (cont’d) Red blood cells (RBCs) White blood cells (WBCs) Ketones―not normally found in the urine; produced when the body cannot use or does not have enough glucose and instead metabolizes fat

55. Laboratory and Diagnostic Procedures (cont’d) Urine Tests (cont’d) – Urinalysis (UA) (cont’d) Specific gravity (SG) Sediment Other substances

56. Figure 11-17 Urinometer

57. Laboratory and Diagnostic Procedures (cont’d) Radiology and Nuclear Medicine Procedures – Intravenous pyelography (IVP) – Kidneys, ureters, bladder (KUB) x-ray – Nephrotomography

58. Figure 11-18 Intravenous pyelogram CNRI/Photo Researchers, Inc.

59. Laboratory and Diagnostic Procedures (cont’d) Radiology and Nuclear Medicine Procedures (cont’d) – Renal angiography – Renal scan – Ultrasonography

60. Figure 11-19 Sonogram Custom Medical Stock Photo, Inc.

61. Laboratory and Diagnostic Procedures (cont’d) Other Laboratory Tests – Cystometry – Voiding cystourethrography (VCUG)

62. Medical and Surgical Procedures Medical Procedures – Catheterization – Dialysis

63. Figure 11-20 Foley catheter

64. Figure 11-21 Hemodialysis

65. Medical and Surgical Procedures (cont’d) Medical Procedures (cont’d) – Intake and output (I&O) – Urine specimen

66. Figure 11-22 Urine output Michal Heron/Pearson Education/PH College

67. Medical and Surgical Procedures (cont’d) Surgical Procedures – Bladder neck suspension – Cystectomy – Cystoscopy

68. Figure 11-23 Cystoscopy

69. Medical and Surgical Procedures (cont’d) Surgical Procedures (cont’d) – Kidney transplantation – Lithotripsy

70. Figure 11-24 Kidney transplantation Custom Medical Stock Photo, Inc.

71. Figure 11-28 Lithotripsy Visuals Unlimited

72. Medical and Surgical Procedures (cont’d) Surgical Procedures (cont’d) – Nephrectomy – Nephrolithotomy – Nephropexy – Renal biopsy

73. Medical and Surgical Procedures (cont’d) Surgical Procedures (cont’d) – Stone basketing – Transurethral resection of a bladder tumor (TURBT) – Urethroplasty

74. Drug Categories These categories of drugs are used to treat urinary Diseases and Conditions: – Antibiotic drugs – Antispasmodic drugs – Diuretic drugs – Drugs for overactive bladder – Potassium supplements – Urinary analgesic drugs

75. Abbreviations