Welcome to week 3!! Urology

1. Welcome to week 3!!Urology

2. Lets review week 2 errors

3. What is Urology? • Urology: study of the urinary system and male reproductive organs • Urologist: has specialized skill with both the urinary and male genital organs

4. Anatomy of the Genitourinary System • Kidneys • Nephrology is the branch of medicine concerned with the kidneys • The term renal is an adjective referring to the kidneys, from ren, Latin word for “kidney” • Purpose of the kidneys: • To filter the blood to remove waste products • To help regulate the body’s blood pressure • Secrete hormones that assist in body function

5. Kidneys-two bean shaped organs

6. Components of the kidney: • Renal capsule: protective membrane • Renal fascia: attaches kidney to abdominal wall • Adrenal gland: one on top of each kidney • Renal sinus: hollow chamber in kidney • Renal hilus: entrance to renal sinus

7. Three regions of the kidney: • Renal cortex: Contains blood-filtering mechanisms • Renal medulla: Collecting chamber, which contains renal pyramids. The tip of each pyramid is called the papilla, and the tissue forms structures called renal columns. • Renal pelvis: Collects urine as it is produced

8. Nephrons: • Located in the cortex and medulla • Number over a million • Two components: Renal corpuscle and renal tubule • Renal corpuscle contains the glomerulus which trap proteins and red and white blood cells • Renal tubule receives fluid filtered by the glomerulus during the process of making urine

9. Renal arteries: Major source of blood to the kidneys and branch off from the abdominal aorta • Inferior vena cava: The major vein that returns blood from the kidneys back to the heart • Urine: A waste product composed of water, certain electrolytes, and various soluble waste manufactured by the kidneys during the process of cleaning and filtering the blood

10. Ureters: Carry urine from kidneys to bladder • One begins in the renal pelvis of each kidney • Contain smooth muscle that forces urine downward from the kidneys to the bladder • Ureteral orifice: The opening from the ureter to the bladder • Ureteral sphincter: The fold that covers the opening and acts like a valve to allow urine into the bladder but prevents it from backing up into the ureter.

11. Urinary bladder: A hollow sac in the pelvic cavity that serves to store urine until it is eliminated from the body • Detrusor muscle/muscularis propria: The layer of muscle that surrounds the bladder • Trigone: Base of the bladder formed by the two ureteral openings and the bladder neck, which opens into the urethra • Urethra: The tube that conveys urine from the bladder to the outside of the body

12. A pictorial to remember

13. Male Genital Organs • Penis • Contains the urethra • Opening at tip: meatus • Testicles: Contained in the scrotum and produce sperm and male sex hormones • Epididymis • Seminal vesicles • Prostate gland • Bulbourethral (Cowper) glands

14. The Process of Urination Blood enters glomerulus of kidneys Fluid (filtrate) → glomerulus → tubule → selective reabsorption → into collecting ducts → calyces → renal pelvis → ureter → into bladder → urethra → out of the body

15. Common Genitourinary Diseases and Treatments • Urinary tract infection (UTI): An infection in the urinary tract caused by the invasion of disease-causing microorganisms • Cystitis: infection of the bladder • Urethritis: infection of the urethra Diagnosed by clean-catch urinary specimen

16. Antibiotic Treatments for UTI: • Fluoroquinolones: Cipro, Levaquin, Tequin • Cephalosporins: Ceftin, Ceclor • Tetracyclines: Doxycin • Other types of antibiotics: Amoxicillin (Amoxil), Augmentin, Macrodantin, or trimethoprim-sulfamethoxazole (combination of Bactrim, Cotrim, and Septra)

17. Kidney Disorders • Kidney failure: The loss of the kidneys’ ability to filter waste • Acute renal failure: sudden loss of filtering ability • Chronic renal failure: filtering ability lost over time Treatment: dialysis • Hemodialysis: through machine outside the body • Access by AV fistula or AV graft • Peritoneal dialysis: abdominal cavity used as filtering membrane

18. Kidney Transplantation: The process of placing a healthy kidney from one person (donor) into the body of another person (recipient) • Living-related transplant: Donor is a living relative of the recipient • Cadaveric transplant: Donated kidney comes from a dead person. • The ultimate goal: To match a donor kidney with a person whose body will tolerate the transplanted kidney

19. Nephritis: A broad term for any inflammation of one or both kidneys • Glomerulonephritis: Inflammation of the glomeruli, causing hematuria (blood in the urine) • Focal segmental glomerulosclerosis (FSGS): Scar tissue that forms on glomeruli in the kidney • Interstitial nephritis: Inflammation of the spaces between the renal tubules • Pyelonephritis: Inflammation of the renal pelvis from bacteria, treated with antibiotics

20. Polycystic Kidney Disease (PKD): A genetic disorder characterized by the grown of fluid-filled sacs in the kidneys that grow out of the nephrons, leading to kidney dysfunction • Autosomal dominant polycystic kidney disease (ADPKD) : Most common inherited form of the disease Treatments: • Pain medication • Control of blood pressure • Dialysis or transplantation

21. Kidney stones (renal calculi): Hard pieces of material that form in the kidneys from crystals that separate form the urine and build up in inner surfaces of kidneys • Types of stones: • Calcium: most common • Struvite stones: result of UTIs, stag-horn shape • Uric acid stones: byproduct of metabolism • Cystine stones: very small percentage of stones

22. Treatment for Kidney Stones • Most pass through urinary system unobstructed • Surgical interventions: • Extracorporeal shock wave lithotripsy (ESWL): A method of breaking kidney stones using high-energy shock waves • Percutaneous nephrolithotomy (PCN): Surgical removal of the stone through small abdominal incision with a nephroscope

23. Bladder Disorders • Interstitial cystitis (painful bladder syndrome) causing hematuria, difficult/painful urination (dysuria) and pelvic pain • Chronic inflammation of bladder wall • Treatments: • Medications: Elmiron, antidepressants (Elavil), pain medication • Surgical treatments: • Bladder distention • Bladder instillation

24. Cystocele: bladder sags into vagina • Treatments: • Kegel exercises • Pessary • Surgery to relocate bladder • Neurogenic bladder: results from damage to nerves controlling urinary tract • Treatments: Medications, surgery, or catheterization if necessary

25. Bladder Cancer • Superficial (does not spread) • Invasive (spreads to surrounding organs and tissue) Treatments: Radiation, chemotherapy, or a combination of these

26. Surgical options for bladder cancer: • Transurethral resection of bladder tumor (TURB): Removal of the tumor • Resection means the surgical removal of tissue or part or all of an organ • A cystoscope is inserted through the urethra to the tumor to remove the tumor • Remaining cells are burned away with laser or high-energy electricity, called fulguration • Radical cystectomy: Entire removal of bladder and nearby structures that may be cancerous • Segmental cystectomy: Only part of bladder is removed

27. Bladder reconstruction: Used when bladder is removed to collect urine • Section of bowel is used to recreate bladder • Urostomy or urinary diversion: Section of intestine is used to drain urine outside the body through new connection called ileal conduit to outside pouch • Koch pouch: Pouch is located inside the abdomen

28. Male Genitourinary Disorders • Hypospadias: Abnormal location of urethra • Treatment: Surgery to correct • Testicular torsion: Testicles twist around spermatic cord • Treatment: Immediate surgical intervention is required

29. Prostate Disorders • Prostatitis: inflammation of prostate gland. • Benign prostatic hyperplasia (BPH): enlargement of the prostate Treatments: • Drug therapy • Transurethral resection of prostate (TURP): Removal of excess tissue from the prostate

30. The Prostate gland

31. Prostate cancer: Growth of malignant cells in the prostate gland Treatments: • Brachytherapy: Implantation of radioactive seeds • Cryosurgery: Use of extreme cold to destroy cancerous tissue • Photoselective vaporization prostatectomy (PVP): laser therapy to destroy cancerous tissue • Radical prostatectomy: Complete surgical removal of prostate

32. Sexually Transmitted Diseases (STDs) • Caused by a pathogen (virus, bacterium, parasite, or fungus) • Spread by sexual contact

33. Genital Herpes • Caused by herpes simplex virus (HSV) • Two types: HSV-1 (mouth sores) and HSV-2 (genital herpes) • Drug treatments: acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex)

34. Gonorrhea (GC) • Bacterial infection caused by Neisseria gonorrhoeae • Transmitted by sexual contact • Treatments: ciprofloxacin (Cipro), ofloxacin (Floxin), or levofloxacin (Levaquin) • Chlamydia • Most common STD • Caused by bacterium Chlamydia trachomatis, sexual contact • Treatment: azithromycin (Zithromax) or doxycycline

35. Diagnostic Studies and Procedures • Laboratory Tests • Blood studies: • Glomerular filtration rate (GFR) • BUN, creatinine, electrolytes, CBC, PSA • Urine Studies: • Urinalysis and culture • Creatinine clearance • STD cultures

36. Radiologic Studies • Kidney, ureter, and bladder x-ray (KUB): Supine x-ray of the abdomen showing kidneys (K), ureters (U) and bladder (B) • Intravenous pyelogram: Series of x-rays taken with contrast dye to show narrowing or blockages • Voiding cystourethrogram: Contrast dye inserted with catheter and x-rays taken during urination to show blockages of urethra or backflow of urine into ureters • Ultrasound Studies: Uses high-frequency sound waves to get images of the kidneys

37. Endoscopic Studies • Cystoscopy: Uses a lighted scope (cystoscope) to view urethra and bladder • Ureteroscopy: Uses ureteroscope to examine ureters for presence of stones • Urodynamic Studies • Uroflowmetry: Analyzes urine speed and volume • Postvoid residual: Amount of remaining urine after urination • Cystometrogram (CMG) or cystometry: Analyzes function and stability of bladder

38. Insight Complications of Circumcision