Introduction To Urology

Genitourinary System
The term "genitourinary" actually refers to two different systems . Urinary refers to the system responsible for removal of nitrogenous waste products of metabolism from the bloodstream, disposal of concentrated wastes (urine), and also water conservation. Genito refers to the genital organs and the reproductive system

Urinary System
The urinary system's primary function is to help keep the body in homeostasis by controlling the composition and volume of blood. The urinary system is made up of two kidneys, two ureters, one urinary bladder, and one urethra.

Urinary System
The kidneys are essentially regulatory organs which maintain the volume and composition of body fluid by filtration of the blood and selective reabsorption or secretion of filtered solutes. The two kidneys are reddish, bean-shaped organs. They are located on the posterior wall of the abdominal cavity between the level of the twelfth thoracic vertebra(T-12) and the third lumbar vertebra (L3

Urinary System
The kidneys take their blood supply directly from the aorta via the renal arteries; blood is returned to the inferior vena cava via the renal veins.

Urine (the filtered product containing waste materials and water) excreted from the kidneys passes down the fibromuscular ureters and collects in the bladder.

Urinary System
The urinary bladder is a musculomembranous sac located in the lower portion of the abdominal cavity behind the symphysis pubis. The organ is highly specialized to store urine until the urine is eliminated from the body.

Urinary System
The bladder muscle (the detrusor muscle) is capable of distending to accept urine without increasing the pressure inside; this means that large volumes can be collected (700-1000ml) without high-pressure damage to the renal system occurring. When urine is passed, the urethral sphincter at the base of the bladder relaxes, the detrusor contracts, and urine is voided via the urethra

Male Reproductive System

External Genitalia: The penis and the scrotum are the external parts of the male genital system. Internal Genitalia. includes the testes, epididymis, vas deferens/ductus deferens, seminal vesicles, ejaculatory duct, prostrate gland, bulbourethral (Cowper's) gland, and the urethra.

Male Reproductive System

FUNCTIONS: To produce sperm Reproduce Production of sex hormones STRUCTURES Testes: male gonads; produce sperm Scrotum: pouch of skin that surrounds the scrotum Sperm: male sex cell

Male Reproductive System

Seminiferous Tubulescolloid duct within the testes that make and transport sperm Epididymis-colloid tube near the testes where sperm matures Vas Deferens-tube that connects epididymis to the urethra

Male Reproductive System

Seminal Vesicle- sac like structure at the base of the vas deferens that adds to the seminal fluid Prostate Gland-gland at the base of the bladder that adds to seminal fluid Ejaculatory Duct-opens within the urethra within the prostate gland. Carries both sperm and seminal vesicle fluid.

Male Reproductive System

STRUCTURES: Urethra: tube that carries both urine and semen Cowpers gland: is a small organ near the prostate that adds to seminal fluid Penis: male excretory and copulatory organ

Male Genital System

THE PENIS: Made up of three cylindrical masses of tissue bound together by fibrous tissue. The two back and side tissue masses are called the corpora cavernosa penis. The smaller third tissue mass is the corpus spongiosum penis located toward the middle of the shaft and containing spongy urethra.

Male Genital System

These three tissue masses are erectile (capable of erection) and contain blood sinuses (channels).
Erection = PNS Ejaculation = SNS

When sexually stimulated, the arteries of the penis dilate. Large quantities of blood enter the blood sinuses. Expansion of these spaces compresses the veins draining the penis, causing most entering blood to be retained.

Male Genital System

An erection is caused by these vascular changes, the erection being a parasympathetic reflex. When the arteries constrict and the pressure on the veins is relieved, the penis returns to its flaccid (soft, limp) state. The terminal enlarged end of the penis is called the glans.

Female Genital System

External Genitalia. The vulva and its parts make up the external genitalia. The word vulva is a term that has been designated to stand for the external genitalia of the female Mons pubis Labia majora Labia minora Clitoris Urinary meatus Vaginal orifice Bartholins glands Perineum: anus/vaginal opening; episiotimy

Female Genital System

Internal Genitalia: Uterus Fallopian/Uterine tubes Ovaries Vagina

Basics: Urology
Urological imaging has benefit from the advancement of technology today. Now have the ability to diagnose and evaluate genitourinary disorders without surgical exploration. Use of contrast media has significantly contributed to the advancement. Smokers get bladder CA = painless hematuria; picked up on urinalysis

Basic Imaging in Urology

Kidney-ureter-bladder (KUB) is often the first imaging performed after urinalysis to visualize the abdomen and urinary tract Film is taken with patient supine and should include the entire abdomen from the base of the sternum to pubic bone

KUB
Can show bony abnormalities, calcifications, and large soft tissue masses Kidneys can be visualized because of the perirenal fatty tissue within Gerotas fascia Provides info regarding the number of kidneys and their position relative to the bony structures and the shadows of the psoas muscle Radiodense renal, ureteral, and bladder calculi can be seen

KUB

Urography
Urography involves injection or instillation of contrast material to better visualize the collecting or lumenal structures of the kidneys, ureters, bladder, and urethra. Can be performed IV or by direct instillation into the urinary tract. The intravenous urogram (IVU) is also called the intravenous pyelogram (IVP)

Urography
Classical modality for imaging Use has become antiquated secondary to use of newer advanced imaging in its place

Cystography
A diagnostic procedure that uses x-ray to evaluate the urinary bladder Permits imaging of a opacified urinary bladder after retrograde instillation of contrast media through a urethral or suprapubic catheter Usually performed with fluoroscopy to allow realtime imaging Most often used to demonstrate a suspected urinary leak Also used to identify bladder fistulas and diverticuli

Cystography (bladder fistula)

-Crohns pts prone to multiple fistulas

Voiding Cystourethrography
Used to evaluate abnormal function of the lower urinary tract Similar to a cystogram, but after full distention of the bladder, the pt is instructed to void Abnormal findings include vesicoureteral reflux (VUR), ureterocele, posterior urethral valve, strictures, bladder diverticula, and hypermobility in females

Retrograde Urethrography
Complete evaluation of the urethra includes both antegrade and retrograde urethrography The antegrade is part of the VCUG The retrograde allows visualization of the anterior male urethra Used for suspected traumatic urethral injury or urethral stricture Used for diagnosis of urethral diverticulum in females

Ultrasonography
Sonography uses ultrasound frequencies to image organs of the kidneys, bladder, ureter, prostate, testis and scrotum Note: normal, nondilated ureter cannot be adequately evaluated by sonography Calculi and ureteroceles, when present can be seen

Computer Tomography
Computerized axial tomography (CT Scan) creates a three-dimensional image of the body from xrays that have been taken from several different angles Scan can be with or without PO or IV contrast or both
PO/IV = GI ex. Crohns

Used to detect and diagnose: recurrent urinary tract infections, sources of blood in the urine (hematuria), kidney stones, renal cysts and masses. Moreover, it can help to rule out prostate, bladder, and renal cancers.

Magnetic Resonance Imaging

Magnetic resonance imaging (MRI scan) is a diagnostic test that uses electromagnetic radio waves (i.e., electrical current and magnetism) to produce two- or three-dimensional (2-D or 3-D) computer images of internal body structures such as organs, muscles, bones, and nerves. Less invasive; no radiation! Gives more clear and detailed images of the soft-tissue structures Magnetic resonance imaging can be performed on any part of the body and, unlike other imaging procedures (e.g., CT scan, x-ray), does not involve radiation MRI contrast (gadolinium) is safer than the CT contrast; easily absorbed, less toxic to kidneys

Urodynamics
Urodynamics is the investigation of the function of the lower urinary tract the bladder and urethra using physical measurements, such as urine pressure and flow rate as well as clinical assessment Any procedure designed to provide information about a bladder problem can be called a urodynamic test. The type of test you take depends on your problem USED TO EVALUATE: incontinence frequent urination sudden, strong urges to urinate problems starting a urine stream painful urination problems emptying your bladder completely recurrent urinary tract infections

Urodynamics
Cystometrogram (CMG) measures how much your bladder can hold, how much pressure builds up inside your bladder as it stores urine, and how full it is when you feel the urge to urinate Uroflowmeter automatically measures the amount of urine and the flow rate Electromyography measures the destrusor muscle activity in and around the urethral sphincter by using special sensors

Urodynamics
Tests may be performed with or without equipment to take pictures of the bladder during filling and emptying Video Urodynamics uses x rays or sound waves.

Endoscopy: used to visualize

Cystoscopes Types rigid and flexible
Flexible easily maneuverable Rigid commonly used on women only Dorsal lithotomy position

Sounds, Bougies, And Dilators

Used for urethral dilation (urethral strictures) and circumventing an old or newly created urethral false passage Available 8F TO 30F

Filiform and Follower

Urologists are often called to the operating room or bedside to assist with the placement of urethral catheters when the primary team is unsuccessful Before the advent of flexible cystoscopy, urologists used instruments called filiforms and followers to help negotiate the true path of the urethral lumen and access the bladder Filiform are smaller than urethral catheters

Urinary Catheters: scenarios

A latex or silicone tube that is inserted into bladder Common in several designs and sizes Foley (2 ports), Hematuria (3 ports) Types of Indwelling Catheters: Foley (balloon inflations) Robinsons (straight) Coude (curved tip) Hematuria (multiple lumens)
Flushing

Texas (external)-looks like condom, used in males

Coude

Urology H&P And Urinalysis

H&P most important clinical tool Must include a separate statement of the chief complaint and an extended history of the present illness Accurate H&P with U/A can speed clinical diagnosis without use of unnecessary/costly testing All patients should receive urinalysis! INCLUDE: Description of body location Quality and quantity Chronology Aggravating and alleviating factors Associated manifestations

Voiding Symptoms
Frequency-voiding at 2hr interval or less
Diabetics (polyuria) Ask pt how much/ when their drinking water?

Nocturia-voiding 2 or more times a night Urgency-sudden strong feeling of need to void

UTI

Dysuria- pain on urination Hesitancy-difficulty in starting the flow of urine Pyuria-pus in the urine Pneumaturia-passage of air or gas in urine; bubble appearance, sounds like their farting
Fistulas

Urinary Terminology
Polyuria > 2.5L/day Oliguria <300/5OOml/day Anuria <50ml/day Hematuria Microscopic Hematuria Urinary Incontinenceinvoluntary loss of urine Irritable bladderinvoluntary contractions of the muscles in the bladder