1. THE URINARY SYSTEM Chapter 9 Page 274-294

2. Answer the questions as we go…

3. The Urinary System Homeostasis is the process through which the body maintains a constant internal environment. The urinary system maintains the proper balance of water, salts and acids in the body by filtering the blood thru the kidneys…thereby maintaining homeostasis Filters waste from protein metabolism (urea) and muscle metabolism (creatinine) Converts waste products and excess water into urine

4. Kidneys (renal = pertaining to kidneys) Filter 200 quarts of blood every day to remove waste products and excess water. This is urine (95% water, 5% waste) Kidneys also produce hormones that have an effect on B/P, RBC production and Vitamin D

5. Kidneys Bean-shaped and located in the retroperitoneal space Renal cortex is the outer region of the kidney Has > 1,000,000 nephrons Medulla is the inner region of the kidney Contains urine-collecting tubules

6. Nephrons Microscopic functional units of the kidney. - They produce the urine Each nephron has a Glomerulus: cluster of capillaries

7. Production of urine Blood enters the kidney thru the renal artery and goes to the nephrons It is then filtered by the glomerulus The now-filtered blood (blood cells and proteins remain… too big to be filtered) returns to the blood stream through the renal vein. What was filtered out goes to the renal tubules where a lot of the water, sugar, salts are returned to the bloodstream The remaining waste products are turned into urine and transported to the renal pelvis and eventually to the ureters.

8. Urinary Anatomy Ureters: 12” long tubes that transport urine from kidney to bladder Uses peristalsis Urinary Bladder: oval hollow organ; reservoir for urine Urethra: Transports urine from bladder to outside of the body. Urethral meatus is the external opening of the urethra Urination is AKA voiding or micturition (mik-chuh-rish-uhn)

9. For 2015: add ureteral orifices!!!

10. Nephropathology (disease of the kidney) Renal failure Inability of kidney(s) to perform their functions. Nephrons cannot be replaced! Uremia: AKA uremic poisoning – kidney function compromised and waste products are retained in the blood Acute renal failure: Sudden onset of uremia. Can be fatal. Cause is kidneys not receiving enough blood to filter from dehydration, ↓ B/P or ↓ blood volume from injury, burns or severe infection

11. More Renal Failure Chronic renal failure: progressive loss of renal function over months or years. Diabetes, ↑ B/P, family hx, of renal disease Build up of waste products can lead to heart attacks or strokes. End-stage renal disease: final stage of chronic kidney disease. Fatal without dialysis or a kidney transplant.

12. Nephrotic Syndrome AKA Nephrosis: condition in which excessive amounts of protein are lost thru the urine. Usually d/t damaged glomeruli Sx: Edema: excessive fluid accumulation Hyperproteinuria: ↑ protein in the urine Hypoproteinemia: ↓ protein in the blood Pitting edema

13. Kidney conditions Hydronephrosis: dilation(swelling) of kidney(s) d/t backup of urine from a blockage (kidney stone or stricture of ureter) Glomerulonephritis: inflammation of the glomeruli that causes RBCs and protein to leak into the urine. Nephroptosis: AKA floating kidney – prolapse (dropping down) of a kidney into the pelvic area when the patient stands Kidney position while laying down (a) and standing up (b)

14. More Kidney conditions Nephropyosis: suppuration (pus formation) of the kidney Polycystic Kidney Disease (PKD): Genetic, growth of numerous fluid-filled cysts in the kidneys. These cysts slowly replace much of the mass of the kidney leading to kidney failure Wilms tumor: rare malignant kidney tumor, found in young children, high cure rate if treated early.

15. Stones (AKA calculus or calculi) Abnormal mineral deposit Vary in size from too small to notice (sand or smaller) to marble like and very painful Nephrolithiasis: presence of kidney stones. They are named based on where they lodge Nephrolith – in kidney Ureterolith (you-REE-ter-oh-lith) – ureter Cystolith - bladder Renal colic: acute pain in kidneys d/t passage of a nephrolith

16. Treatment of nephroliths Most small stones pass out of the urinary tract on their own within a few weeks…Painful! Extracorporeal shockwave lithotripsy (ESWL): Most common treatment, high- energy ultrasonic waves traveling thru water or gel break up the stone which is then excreted

17. More nephrolith treatments Percutaneous nephrolithotomy: Surgical removal of a stone through a small incision in the back. Used if ESWL is unsuccessful, there is an infection, or if the stone if really big. Ureteroscopy: (you-reet-eh-ROS-koh-pee) Treatment of a stone lodged near the ureter. Ureteroscope is inserted through the urethra, thru the bladder and into the ureter. Can remove the stone whole, but if too big, can be cut with a laser.

18. Ureters Hydroureter: Blocked ureter causes distention (swelling) with urine Always accompanies hydronephrosis Ureterectasis: distention of a ureter Ureterorrhagia: discharge of blood from the ureter Hydroureter with end-stage kidney disease

19. Urinary Bladder Cystocele: AKA prolapsed bladder – hernia of the bladder through the vaginal wall. Cause: pregnancy/childbirth Interstitial cystitis: chronic inflammation within the walls of the bladder. Vesicovaginal fistula: Abnormal opening between bladder and vagina. Cause: prolonged labor/childbirth Fistula – abnormal opening between two internal organs

20. Neurogenic bladder Urinary problem caused by interference with the normal nerves associated with urination. Bladder may empty spontaneously (incontinence) Or, the bladder may not empty at all or may empty incompletely resulting in retention or overflow leakage Causes: nervous system tumor, trauma, neuropathy, or an inflammatory condition

21. Prostate Gland Benign prostatic hyperplasia (BPH) AKA benign prostatic hypertrophy or enlarged prostate Usually in men >50 Makes urination difficult Prostatism: disorder from the compression or obstruction of the urethra d/t BPH

22. Enlarged prostates and urination Overflow incontinence: continuous leaking from the bladder d/t being too full or not emptying completely. Prevalent in older men with enlarged prostates. Urinary hesitancy: difficulty in starting a urinary stream Common in older men with prostate problems In younger people, hesitancy may be caused by Bashful bladder syndrome – inability to urinate near another person Urinary retention: Aka ischuria (is-kūr´e-ah) – inability to completely empty the bladder when urinating. Also associated with enlarged prostates

23. Urethra Urethrorrhagia: bleeding from the urethra Urethrostenosis: narrowing of the urethra Almost exclusive to men – scar tissue from infection or injury

24. Abnormal urethral openings Congenital abnormalities: Epispadias: Male: urethral opening on the upper surface of the penis Female: urethral opening near the clitoris Hypospadias: Male: Urethral opening on ventral (undersurface) of the penis Female: Urethral opening in the vagina

25. Urinary tract infections (UTI) Usually begins in the bladder, but can affect all parts of the urinary system Usually bacterial (E. coli) More common in women b/c their urethra is shorter and closer to the rectum Cystitis: inflammation of the bladder Pyelonephritis: inflammation of the renal pelvis and kidney – cause: infection that has spread upward Urethritis- inflammation of the urethra

26. Urination Anuria: Absence of urine Kidney failure or obstruction Oliguria: scanty urination Dehydration, renal failure or obstruction Polyuria: excessive urination Common symptom of diabetes

27. More on urination… Diuresis: Increased output of urine Dysuria: difficult or painful urination (UTI) Enuresis: Involuntary discharge of urine Nocturnal enuresis: urinary incontinence during sleep. AKA bedwetting Nocturia: Frequent/excessive urination at night

28. Incontinence Inability to control the excretion of urine, feces or both (urinary incontinence, fecal incontinence) Stress incontinence: incontinence d/t physical stress such as running, lifting, sneezing, laughing or coughing. More common in women than men Overactive bladder: Aka urge incontinence Muscles of bladder contract involuntarily resulting in urinary frequency or accidental urination. Related to excessive caffeine or alcohol consumption, UTIs neurological disease, bladder/prostate problems.

29. Diagnostic Procedures Urinalysis: Examination of urine to determine the presence of abnormal elements Cystoscopy: Visual exam of the bladder with and endoscope Cystoscopes are specialized endoscopes that can remove tumors or reduce an enlarged prostate.

30. Catheterization Urinary Catheterization: Insertion of a tube into the bladder Can be used to get a sterile urine specimen Or to drain urine from the bladder when the patient is unable to urinate normally (indwelling) Or it can be used to place fluids into the bladder (like chemotherapy medications or contrast mediums) Suprapubic catheterization: catheter placed into bladder thru a small incision in the abdominal wall just above the pubic bone Foley catheter: most common type of indwelling catheter Made of a flexible tube with a balloon filled with sterile water on the end to hold it in place in the bladder.

31. Radiographic Exams Cystography: X-ray exam of the bladder after a contrast medium is instilled via a urethral catheter. Voiding cystourethrography: dx procedure using a fluoroscope is used to examine the flow of urine from the bladder thru the urethra. Abnormal! The dye should not flow up toward the kidneys

32. More Radiographic exams Intravenous pyelogram (IVP) – Radiographic study of kidneys and ureters Contrast medium put in an IV Can see stones, infections, enlarged prostate, tumors, injuries KUB (kidney, ureters, bladder) AKA flat-plate of the abdomen. No contrast medium used Shows bowel obstructions, stones Does not show ureters.

33. Dialysis Is a procedure to remove waste products and excess water from the blood of a patient whose kidneys lo longer function Hemodialysis: Waste products are filtered directly from the patient’s blood using an external hemodialysis unit (artificial kidney) Peritoneal dialysis: The lining of the peritoneal cavity acts as a filter to remove waste from the blood. Fluid is placed in the peritoneal cavity thru a catheter placed in the abdominal wall. It is left there for a period of time to absorb the waste products and then drained out This is repeated several times each day

34. Kidney procedures Nephrolysis: Surgical freeing of a kidney from an adhesion (band of fibers that holds structures together abnormally) Nephropexy: AKA nephrorrhaphy – surgical fixation of nephroptosis (floating kidney) Nephrostomy: Placement of a catheter (tube) to maintain an opening from the pelvis of the kidney to the exterior of the body Used for draining urine from kidneys with hydronephrosis. Or for gaining access to kidneys for diagnostic procedures

35. More kidney procedures Pyeloplasty – Surgical repair of the ureter and renal pelvis (sometimes from hydronephrosis) Pyelotomy: surgical incision into the renal pelvis To correct obstructions such as a stone lodged between the renal pelvis and the ureter.

36. Urinary Bladder Neobladder: Replacement of a missing bladder created by using about 20 inches of the small intestines Ileal conduit: AKA a type of ileostomy – use of a small piece of intestine (ileum) to convey urine from the ureters to a stoma in the abdomen Cystopexy: Surgical fixation of the bladder to the abdominal wall.

37. Urethral procedures Meatotamy: Surgical incision made in the urethral meatus to enlarge the opening Urethropexy: surgical fixation of the urethra to nearby tissue. Often performed to correct urinary stress incontinence. Urethrotomy: surgical incision into the urethra for relief of a stricture

38. Prostate Treatments Ablation: Removal of a body part or the destruction of its function thru surgery, hormones, drugs, heat, chemicals, electrocautery, etc. Prostatectomy: surgical removal of part or all of the prostate gland. Radical prostatectomy: removal of the entire prostate Transurethral Prostatectomy (TURP): Removal of excess tissue from and enlarged prostate using a resectoscope.

39. Urinary Incontinence Treatment Kegel exercises: pelvic muscle exercises used to strengthen the muscles of the pelvic floor Bladder retraining: Behavior therapy in which the patient learn to urinate on a schedule. Useful for patients suffering from urge incontinence.