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Urinary 2


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physician certified by american board of urology ABU
male and female urinary tract male reproductive organs 8 subspecialty areas
pediatric urology***
urological problem in children hypospadias undescended testicles circumsisions kidney cancer
urologic oncology****
treatment of cancers of male and female urinary tract male reproductive organs prostate bladder penile testicular cancer men kidney bladder cancer women
renal transplantation****
kidney transplants
Male Infertility***
problems fathering children
Urinary Tract Stones****
kidney stones formed when urine too concentrated and chemicals usually dissolve crystallize pain
Female Urology*****
treatment of ruinary ioncontinence pelvic outlet relaxation disorders genitourinary trauma injury
treatment voiding disorders caused by neurological trauma neruological diseases MS musc dystrophy Parkinson's disease spinal bifida urodynamic evaluation patients
Erectile dysfunction**** or impotence
treatment of difficulties men have in achieving erection
urinary system consists of kidneys ureters bladder urethra****
kidneys purplish-brown organs below ribs remove liquid waste from blood in form of urine*****
keep stable balance salts other subs in blood produce hormone aids formation of RBCs
narrow tubes carry urine from kidneys*** to bladder triangle-shpaed chamber in lower abdomen
stored in bladder and emptied through urethra***
average adult passes quart 1/2**** urine eday amount varies fluids and foods consumed
volume at night 1/2 that formed in daytime
sweat*** carbon dioxide gas feces urine
sweat released pores skin
water vapor carbon dioxide exhaled by lungs
undigested food materials feces intestines**** solid waste
kidneys and urinary system in charge of filtering wastes from blood eliminating liquid*** urine
kidneys regulate acid-base balance pH of blood and body fluids***
enzyme regulates salts*** and others kidneys regulate blood pressure
hormone from kidneys stimulates controls RBC production
kidneys release 3 hormones
EPO stimulates bones make rbc
regulates blood pressure
active form Vit D
maintains calcium bones for normal chemical balance in body
kidneys work in tandem
can live with one*** if one removed the other enlarges in few months takes ober increased role of filtering blood
kidneys under rib*** cage in back right kid below liver little lower each kidney about 5long***x3"widex1"thick
cortex ***outer layer filtering units
medulla middle 10-15 fan shaped structures pyramids
pyramids drain urine to cup-shaped tubes CALYXES
FAT*** surrounds kidneys cushion hold in place
bean shape dented facing toward center of body HILUS large blood vessels enter and leave kidney
renal artery
sends fresh blood into kidney to be filtered
filtered blood leaves through RENAL VEIN*** flows to heart continuous blood supply give kidneys dark red color
1 million filtering units NEPHRONS*** perform blood-filtering process produce urine waste product
each NEPHRON contain filter GLOMERULUS network of blood vessels capillaries***
fluid from blood by glomerulus travels to tube TUBULE adjusts level of salts water wastes excreted urine
renal pelvis
near hilus**** collects urine in chamber from pelvis urine goes to ureter tube carries urine to urinary bladder*** muscular collection sac in lower abdomen
bladder holds 1/2 liter*** 2cups
at any time
urine expelled from bladder out of body through urethra tube-like structure
fe/male urinary tracts same except length urethra****
renal arteies
bring blood to kidneys
nephrons**** small branches at ends of arteries remove harmful substances from blood
kidneys filter and clean**** blood urine carrying liquid waste is produced
every minute more than 1 quart blood passes through kidneys 425 gallons of blood each day
1/4 uman blood in kidneys at any time
kidneys cleanse blood in body every 50 minutes
while blood in kidneys wat3r and some blood components acids glucose other nutrients reabsorbed**** back to bloodstream
urine is left
concentrated solution waste material
water UREA waste product forms when proteins broken down salts glucose amino acids by-products bile from liver ammonia others
urine contains UROCHROME*** pigmented blood product yellow color to urine
urine transported from kidneys through URETERS
pass urine to urinary bladder for storage expands to fill 1/2liter 2 cups
average adult 11/2liters 6 cups of urine per day need to excrete 1/3 of that amount to clear waste products from body
excessive or inadequate**** urine production may indicate illness
when bladder full nerve endings in wall send impulses to brain
when ready to urinate full feeling triggers bladder walls to contract
SPHINCTER*** ring-like muscle guards entrance from bladder to urethra relaxes
urination through urethra bladder empties
male tip of penis
female urethra ends above vaginal opening
ability to hold and maintain continence dependent on lower urinary tract and nervous system
person must possess physical and psychological ability recognize appropriately respond to urge
process of urination 2 phases
filling and storage phase
emptying phase***
filling and storage phase
bladder fills stretches to accommodate sensation of urge when 200 ml urine stored
nervous system reponds to stretching gives urge allows bladder to fill
average person holds 350-550*** ml ability to fill and store requires functional sphincter*** circular muscles around opening of bladder
and stable bladder wall muscle DETRUSOR
emptying phase ability of detrusosr muscle appropriately contract force urine out of bladder simultaneously relax sphincter
exam of urine physical or chemical means
chemical and microscopic tests
screens for renal disease and diseases of other organs result in abnormal metabolites break-down products
clean-catch midstream urine sample need to clean
let small amount fall into toilet bowl clears urethra contaminants clean container catch 1-2 ounces urine
screening urinalysis tests measured by reagent dipstick contains little pads of chemicals change color contact with substances of interest
several types of reagent strips checks for early signs of disease monitor diabetes or kidney disease
normal urine
almost colorless to dark yellow beets and blackberries red
specific gravity*****
1.006 and 1.030 higher numbers = higher concentration
varies time of day amount of food and liquids and exercise
pH balance****
4.e6-8.0 average of 6.0
RBCs*** hemoglobin bilirubin nitrites wbcs leukocytes no urine glucose urine ketones or urine protein either
usually none
urine unusual color not by food intake or meds urinalysis + consult
urine specific gravity
higher or lower normal range may indicate kidney prob
ureine pH
alkaline urine is good not too much kidney stones less to form antibiotics more effective prevent bacteria
urine sugar
blood levels glucose very high or ketones may be present in uncontrolled diabetes
urine protein
finding protein screening for kidney disease
blood in urine
urinary tract disease or bleeding kidneys or vigorous physical exercise
liver or bile duct disease
urobilinogen small traces
Nitrites wbc's
urinary tracct infection
vit C
measurable amounts may interfere other urine tests false negs or pos
home test
if color blind need someone else to read
choroquine iron supps levodopa nitrofuantoin phenazopyridine phenothiazine phenytoin rirboflavin and triamterene CHANGE COLOR URINE
cells reproducing divide toomuch too fast tumor if does not invade surrounding tissues benign
if tumor spreads to tissues or other part METASTASIS
adrenal cancer
medulla and cortex malignancies in cortex majority functional or nonfuctional produce steroids or don't rare 2per 1million
bladder cancer
cancer grows in inner lining specialized expanding and deflating cell transitional cells invades reproductive abdominal pelvis lymph nodes
kidney cancer
most common renal cell carcinoma RCC 85% all kidney cancers usually single
urethral cancer
women unusual older inflammation factor males transurethral biopsy diagnosis
penile cancer 2% urogenital cancers america 10% where don't do circumcision incisional or excisional biopsy squamous cells most
prostate cancer***
after lung cancer prostate second most common cancer deaths US called ADENOCARCINOMA OF PROSTATE for tumor outside prostate gland if spread through bloodstream deadly
diabetic nephropathy****
damage to nephrons from unused sugar in blood
high blood pressure***
hypertension damage small blood vessels in kidneys can't filter poisonsfrom blood need ACE inhibitors protection to kidneys
interstitial cystitis IC****
painful bladder syndrome frequency-urgency-dysuria syndrome chronic inflamed irritated bladder wall scarring glomerulations pinpoint bleeding ulcers
nonulcerative IC****
most common young to middle-age normal near normal increased bladder cap. glomerulations in bladder wall
ulcerative IC****
midd to older women bladder cap low less than 1/2 c fibrosis cracks scars Hunner's ulcers star shaped sores
inability to control urination acute infections or persistent stress, urge, overflow, functional incontinences
congenital problems****
fetal development urinary tract grow abnormally size shape position
DUPLICATION OF URETERS 2 ureters per kidney
horseshoe kidney fused prone cancer 1 per 500 7% girls with Turner Syndrome
urinary tract infection****
UTIs bacterial E coli
pyelonephritis systitis urethritis
vesicoureteral reflux VUR****
urine flows backward from bladder into ureters diagnosed injecting dye in bladder
renal failure
acute sudden bacterial injury shock heart failure toxic
chronic over time progressive deterioration of kidney function
end-stage renal disease
total nearly total kidney failure called end-stage renal disease ESRD dialysis or transplantation
kidney stones
buildup of crystallized salts and minerals calcium in urinary tract calculi after infection nephrolitiasis renal stone disease
bladder stones ****
large pieces minerals in urinary bladder
bladder stone locations
pelvis uterus urinary bladder bladder stone
benign prostatic hyperplasia BPH*****
prostate enlarlged aging surrounding tissue prevents from expanding squeeze gland pinch urethra restrict flow of urine bigger creates need to urinate small amount urine
nephrotic syndrome\
group of symptoms protein water salt fats in blood disease or drugs hereditary
inflammation of kidney infection autoimmune disease lupus protein blood in urine glomerulonephritis inflammation of glomeruli
hypertension ***
kidneys control blood pressure regulating salt in body enzyme renin controls constricion of muscle cells in walls of blood vessels
Wilm's tumor ****
most common kidney cancer children birth defects of genitourinary tract remove kidney
cystocele*** fallen bladder
wall between womans bladder and vagina weakens bladder droops in vagina
erectile dysfunction***
ED inability achieve erection
rbc's in urine microscopic and gross seen with naked eye color of cola
interstitial cystitis***
IC chronic pelvic pain disorders
kidney failure ***
complete irreversible kidney failure end-stage- disease ESRD ruemia seizures coma death
renal cell carcinoma***
cancerous changes in cells of renal tubule most common adults
Goodpasture Syndrome ****
rare affects lungs and kidneys auto immune disease cough blood burn urine immunosuppressive drugs by mouth few weeks 2yrs.
diabetes insipidus***
DI excretion large amounts of dilute urine disrupt's water regulation
glomerular diseases ***
tiny units where blood is cleaned many conditions
2 categories
inflammation of membrane tissue in kidney serves as filter wastes extra fluid
scarring hardening of tiny blood vessels in kidney
infection of kidey ducts carry urine away
acute bilateral obstructive uropathy****
blockage of flow of urine from both kidneys backup of urine injury
renal artery stenosis****
narrowing or blockage of artery supplies kidey atherosclerosis fibromuscular dysplasia of renal artery wall or scar
urethral syndrome**** females
under evaluation no specific findings to account for symptoms
male infertility
doesn't produce sperm enough or at all
male infertilityi varicose vein develops in testicles poor circ decreased sperm
decreased urine output <500ml 24 hours
penis stays erect erectile bodies damage discomfor pain up to 6 hours
Peyronie's disease***
curved penis scar tissue pull one side causing curve when erect
orchitis inflammation of testis
family of diseases inflammation/pain region of prostate 4 forms
acute bacterial prostatitis ABP
rapid fever pain lower back genital burning urinary frequency urgency
chronic bacterial prostatitis CBP
similar to ABP but high incidence of bladder infections
prostadynia PD
not true form

pain in pelvis or perineum area between scrotum anus
urinary catheterization
hollow tube inflatable balloon tip8*** inserted in urinary bladder when bladder needs to be empty decompressed urinary flow assured
digital rectal exam****
physician inserts lubed gloved finger to feel prostate gland should be soft malignant hard stony
prostate specific antigen PSA test****
if tumor on prostate blood screening test how much cancer present spread? PSA produced by cells of prostate capsule membrane periuretharal glands >10ng/ml cancer 4-10 ng/ml inconclusive
prostatic acid phosphatase PAP ***
enzyme produced tissues production increases as prostate disease progresses detects and monitors advanced prostate cancer
radical prostatectomy ****
most common treatment localized cancer under ages 70 surgically removing cancerous gland seminal vesicles
cryosurgery TRUS-guided probe**** delivers freezing to cancerous tumor
therapy implantation of tinpy radioactive implants into cancerous prostate gland small cancers stage 1-2
hemodialysis blood sent through machine filters waste
peritoneal dialysis
fluid put into abdomen dalysate captures waste products from blood then fresh bag dripped
continuous ambulatory peritoneal dialysis CAPD home use 4xa day
CT scan computed tomographic CAT scan ****
cros sectional X-ray produces 3 dimentsional images of internal organs andfd glands tumors
MRI magnetic resonance imaging***
similar to CAT large magnets projects magnetic waves through body
sound waves into body produce viewable image of internal organs
intravenous pyelogram IVP***
injecting dye oidine through vein in arm collects in urinary system contrast for X-ray film tumor
arteriogram or venacavagram****
X-rays of blood vessels supply kidneys check for tumors
chest x-ray****
metastasized cancer check in lungs
Bone scan****
nuclear imaging procedure spread of cancer to bones for aggressive tumors and metastasis low level radioactive material injected in body
lenses like telescope or microscope ureteroscope for ureters thin optical scope finc bleeding
intravenous pyelogram
contrast material injecting vein x-rays timed intervals
kidney biopsy
renal biopsy kidney tissue removed with needle blood or protein in urine
Kegel exercises ****
strengthen pelvic floor muscles improve bladder control stress ur incontin
penile tumescence self test***
night time erections determine cause of dysfunction one cent stamps wrapped aropund penis if strip of stamps broken
penile implant ***
device in penis
intravenous urogram IVU injecting liquid visible on X-rays into forearm exact location of stone obstructions visualized
ultrasonic sound waves kidney liver gallbladder stones visualized
male contraception 1/2 mill men undergo
CT scan body scanning cut into small slices contrast-medium
renography slightly radioactive substance injected into vein like IVU excreted by kidneys special camera detects image of radioactivity
retrograde urogram
small tube inserted in ureter using cystoscope with contrast medium in ureter
ureter viewed through small tube even renal pelvis seen
when no other exasm give good view tissue samples can be taken
renal biopsy
needle trough skin into back of kidney to retreive 1/2-3/4 inch
how quickly and completly you empty bladder reduced indicates BPH
pressure flow study
pressure in bladder as urinate determine how much urine blocked
post-void residual PVR
how much urine left in bladder after urination how BPH affected bladder
AUA american urological asociation Score or Symptom Index
self-administered questionnaire how severe BPH smptoms may be 7 questions rates degree frequency or severity scale 1-5 7mild 8-9moderate 20-35severe
Blood tests show if kidneys failing to remove wastes***** Urine tests how quickly body wastes being removed leaking protein
blood in urine=hematuria microscopic procedure =urine cytology****** disclose cancer cells in urine
urine creatinine levels used as screening test evaluates kidney function or creatinine clearance test
creaTININE=waste roduct inHEALTHY KIDNEYS TAKE OUT PUT IN URINE **** blood breakdown of muscle during activity creatinine build up not working creatinine values variable affected by diet 2.0mg/dl-50% normal 4.0mg/dl-25%
creatinine clearance
how fast kidneys remove creatinine from blood ml/min men normal is 97-137 women 88-128ml/min <not working well
blood urea nitrogen BUN
blood carries protein for cells after cells use becomes waste returned to blood as UREA contains nitrogen if kidneys not working urea stays in blood 7-20 mg/dL normal >20not working
urine tests
few ounces to 24 hour urine test how much urine per day measures protein
proteinuria PROTEIN IN URINE*****
healthy kidneys take out wastes leave protein bad kidneys leave protein in waste
If foams in toilet may contain high levels protein doctor tests using dipstick maybe a 24 hour urine test needed

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