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The Urinary System

Functions of the Urinary System

Urinary system

Performs many functions that are important in maintaining homeostasis

Homeostasis

Process for maintaining a constant internal environment

Maintaining proper balance of water, electrolytes, and acids in the body

Constantly filtering the blood to remove urea, creatinine, uric acid, and other waste

Converting waste products and excess fluids into urine in the kidneys

Schroeder/Ehrlich/Schroeder Smith/Ehrlich, Medical Terminology for Health Professions, 9th Edition. © 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Learning Objective 9.01: Identify and describe the major functions and structures of the urinary system.

Structures of the Urinary System (1 of 7)

Urinary system (urinary tract)

Consists of two kidneys, two ureters, one bladder, and one urethra

Adrenal glands

Part of the endocrine system

Located on the top of the kidneys

Genitourinary tract

Reference to two body systems: urinary tract and reproductive organs

Located in close proximity

Learning Objective 9.01: Identify and describe the major functions and structures of the urinary system.

Structures of the Urinary System (2 of 7)

The primary structures of the urinary system, as shown here in a male, are the kidneys, ureters, urinary bladder, and urethra. The adrenal gland, positioned on top of each kidney, is a structure of the endocrine system. The prostate gland, which is part of the male reproductive system, surrounds the urethra.

Learning Objective 9.01: Identify and describe the major functions and structures of the urinary system.

Structures of the Urinary System (3 of 7)

The Kidneys

Constantly filter blood to remove waste products and excess water

Excreted as urine: 95% water and 5% urea and other body wastes

Roughly 150–200 quarts of blood processed daily; produces 1–2 quarts of urine

Bean-shaped; located in the retroperitoneal space

Renal cortex

Outer region of the kidney; contains nephrons

Medulla

Inner region of the kidney; contains most urine-collecting tubules

Nephrons

Microscopic functional units of kidneys

Produce urine

Learning Objective 9.01: Identify and describe the major functions and structures of the urinary system.

Structures of the Urinary System (4 of 7)

A kidney, with a nephron in close-up, showing the nephron’s associated structures.

Learning Objective 9.01: Identify and describe the major functions and structures of the urinary system.

Structures of the Urinary System (5 of 7)

The Renal Pelvis

Funnel-shaped area inside each kidney

Surrounded by the renal cortex and medulla

The Ureters

Two narrow tubes

Transport urine from the kidney to the bladder

Urine drains from the ureters into the bladder through ureteral orifices

Learning Objective 9.01: Identify and describe the major functions and structures of the urinary system.

Structures of the Urinary System (6 of 7)

The Urinary Bladder

Oval, hollow, muscular organ

Reservoir for urine before it is excreted

Located in the anterior portion of the pelvic cavity behind the pubic symphysis

Lined with rugae (folds that allow the bladder to expand when full and contract when empty)

The structures of the male urinary bladder.

Learning Objective 9.01: Identify and describe the major functions and structures of the urinary system.

Structures of the Urinary System (7 of 7)

The Urethra

Tube from bladder to exterior of body

Has two urinary sphincters

Urethral meatus (urinary meatus)

External opening of the urethra

Female urethra

Approximately 1.5 inches long

Male urethra

Approximately 8 inches long

Prostate gland

Part of male reproductive system

Surrounds the urethra

Cross-sections of the male and female urinary systems.

Learning Objective 9.01: Identify and describe the major functions and structures of the urinary system.

The Excretion of Urine

Urination

Also known as voiding or micturition

Normal process of excreting urine

Requires coordinated contraction of bladder muscles and relaxation of sphincters

Forces the urine through the urethra and out through the urethral meatus

Learning Objective 9.01: Identify and describe the major functions and structures of the urinary system.

Medical Specialties Related to the Urinary System

Nephrologist

Physician (specialist)

Diagnoses and treats diseases and disorders of the kidneys

Urologist

Physician (specialist)

Diagnoses and treats diseases and disorders of the urinary system of females and the genitourinary system of males

Learning Objective 9.02: Identify the medical specialists who treat disorders of the urinary system.

Pathology of the Urinary System (1 of 15)

Nephropathy

Any disease of the kidney

Includes both degenerative and inflammatory conditions

Diabetic nephropathy

Kidney disease resulting from poorly controlled diabetes mellitus

Renal Failure

Inability of one or both of the kidneys to perform their functions

The body cannot replace damaged nephrons

When too many nephrons have been destroyed, the result is kidney failure

Azotemia

Elevation of the blood urea nitrogen (BUN)

Uremia can occur when this excess becomes toxic

Learning Objective 9.03: Recognize, define, spell, and pronounce the primary terms related to the pathology and the diagnostic and treatment procedures of the urinary system.

Pathology of the Urinary System (2 of 15)

Uremia (uremic poisoning)

Results from renal failure; kidney function is compromised

Urea and waste products normally secreted in the urine are retained in the blood

Acute renal failure (ARF)

Sudden onset and is characterized by uremia

Chronic kidney disease (CKD)

Progressive loss of renal function over months or years

Buildup of waste in the blood can be a contributing factor in heart attacks and stroke

End-stage renal disease (ESRD)

Also known as kidney failure

Final stage of chronic kidney disease

Fatal without dialysis or a successful kidney transplant

Learning Objective 9.03: Recognize, define, spell, and pronounce the primary terms related to the pathology and the diagnostic and treatment procedures of the urinary system.

Pathology of the Urinary System (3 of 15)

Nephrotic Syndrome (Nephrosis)

Group of conditions

Excessive amounts of protein are lost through the urine

Usually caused by damage to the glomeruli

Edema: excessive fluid accumulation in body tissues

Hyperproteinuria: abnormally high concentrations of protein in urine

Hypoproteinemia: abnormally low concentrations of protein in the blood

Causes of nephrotic syndrome

Diabetes mellitus

Infection

Kidney disorders

Learning Objective 9.03: Recognize, define, spell, and pronounce the primary terms related to the pathology and the diagnostic and treatment procedures of the urinary system.

Pathology of the Urinary System (4 of 15)

Additional Kidney Conditions

Ectopic kidney

Congenital condition

One kidney is located in an abnormal position or has fused with the other kidney

Hydronephrosis

Dilation (swelling) of one or both kidneys

Nephritis

Inflammation of the kidney or kidneys

Glomerulonephritis

Inflammation of the glomeruli

Red blood cells and proteins leak into urine

A stricture of the ureter can cause both hydronephrosis and hydroureter.

Learning Objective 9.03: Recognize, define, spell, and pronounce the primary terms related to the pathology and the diagnostic and treatment procedures of the urinary system.

Pathology of the Urinary System (5 of 15)

Pyonephrosis (nephropyosis)

Suppuration of the kidney

Polycystic kidney disease (PKD)

Genetic disorder

Numerous fluid-filled cysts in the kidneys

Renal colic

Acute pain caused by a blockage during passage of a nephrolith (kidney stone)

Renal cell carcinoma

Most common kidney cancer in adults

Wilms tumor (nephroblastoma)

Rare malignant tumor in young children

Polycystic kidney disease: On the left is the exterior of a kidney with polycystic disease. On the right is a cross-section view of a kidney with polycystic disease.

Learning Objective 9.03: Recognize, define, spell, and pronounce the primary terms related to the pathology and the diagnostic and treatment procedures of the urinary system.

Pathology of the Urinary System (6 of 15)

Stones (Calculi)

Abnormal mineral deposit formed within the body

Named for the organ or tissue where it is located

Form when waste products in urine separate and crystallize

Nephrolithiasis

Presence of stones in the kidney

Travel with the flow of urine

Named for the location where they become lodged

Potential locations of renal stones (calculi) as they move through the urinary system.

Learning Objective 9.03: Recognize, define, spell, and pronounce the primary terms related to the pathology and the diagnostic and treatment procedures of the urinary system.

Pathology of the Urinary System (7 of 15)

Urinary tract obstruction

Blockage that prevents the flow of urine

Named for its location

Commonly caused by stones, congenital abnormalities, or an enlarged prostate

Nephrolith

Kidney stone or renal calculus found in the kidney

Ureterolith

Stone located anywhere along the ureter

Cystolith

Stone located within the urinary bladder

Learning Objective 9.03: Recognize, define, spell, and pronounce the primary terms related to the pathology and the diagnostic and treatment procedures of the urinary system.

Pathology of the Urinary System (8 of 15)

The Ureters

Hydroureter

Distention (swelling) of the ureter with urine that cannot flow because of a ureteral obstruction

Ureteral obstruction

Blockage of one or both ureters

Due to congenital abnormality, ureterolith, or other disorders

Ureterorrhagia

Discharge of blood from the ureter

Learning Objective 9.03: Recognize, define, spell, and pronounce the primary terms related to the pathology and the diagnostic and treatment procedures of the urinary system.

Pathology of the Urinary System (9 of 15)

The Urinary Bladder

Cystalgia and cystodynia

Pain in the bladder

Cystocele (prolapsed bladder)

Hernia of the bladder through the vaginal wall

Interstitial cystitis

Chronic inflammation within the walls of the bladder

Vesicoureteral reflux (VUR)

Backward flow of urine into the ureters from the bladder

Vesicovaginal fistula

Abnormal opening between the bladder and vagina

Allows constant involuntary flow of urine from the bladder into the vagina

A vesicovaginal fistula allows urine to flow into the vagina.

Learning Objective 9.03: Recognize, define, spell, and pronounce the primary terms related to the pathology and the diagnostic and treatment procedures of the urinary system.

Pathology of the Urinary System (10 of 15)

Neurogenic Bladder

Interference with the normal nerve pathways associated with urination

The bladder may empty spontaneously, resulting in incontinence

Can also prevent the bladder from emptying at all or from emptying completely

Some of the causes of this condition:

Tumor of the nervous system

Trauma

Neuropathy

Inflammatory condition such as multiple sclerosis

Learning Objective 9.03: Recognize, define, spell, and pronounce the primary terms related to the pathology and the diagnostic and treatment procedures of the urinary system.

Pathology of the Urinary System (11 of 15)

The Prostate Gland

Benign prostatic hyperplasia (BPH)

Benign prostatic hypertrophy or an enlarged prostate

Enlargement of the prostate gland

Prostatism

Compression/obstruction of the urethra

Prostate cancer

Common cancer among men

Prostatitis

Inflammation of the prostate gland

Bacterial prostatitis

Usually results from bacteria transported in the urine

In benign prostatic hyperplasia, the enlarged prostate presses against the bladder and slows the flow of urine through the urethra.

Learning Objective 9.03: Recognize, define, spell, and pronounce the primary terms related to the pathology and the diagnostic and treatment procedures of the urinary system.

Pathology of the Urinary System (12 of 15)

The Urethra

Urethrorrhagia: bleeding from the urethra

Urethrorrhea: abnormal discharge from the urethra

Urethrostenosis (urethral stricture): narrowing of the urethra

Abnormal Urethral Openings

Epispadias: congenital abnormality

Male: opening is located on the upper surface of the penis

Female: opening is in the region of the clitoris

Hypospadias: congenital abnormality

Male: opening is on the ventral surface (underside) of the penis

Female: opens into the vagina

Learning Objective 9.03: Recognize, define, spell, and pronounce the primary terms related to the pathology and the diagnostic and treatment procedures of the urinary system.

Pathology of the Urinary System (13 of 15)

Urinary Tract Infections

Commonly caused by bacteria

Occur more frequently in women

Can affect all parts of the urinary system

Urosepsis

Systemic bacterial infection

Cystitis

Inflammation of the bladder

Pyelonephritis

Inflammation of the renal pelvis and kidney

Urethritis

Inflammation of the urethra

Infections of the urinary tract, indicated in green: (A) cystitis and (B) pyelonephritis.

Learning Objective 9.03: Recognize, define, spell, and pronounce the primary terms related to the pathology and the diagnostic and treatment procedures of the urinary system.

Pathology of the Urinary System (14 of 15)

Urination

Anuria: absence of urine formation by the kidneys

Diuresis: increased output of urine

Dysuria: difficult or painful urination

Enuresis: involuntary discharge of urine

Nocturnal enuresis: urinary incontinence during sleep

Nocturia: frequent and excessive urination during the night

Learning Objective 9.03: Recognize, define, spell, and pronounce the primary terms related to the pathology and the diagnostic and treatment procedures of the urinary system.

Pathology of the Urinary System (15 of 15)

Urination

Oliguria: scanty urination

Polyuria: excessive urination

Urinary hesitancy: difficulty in starting a urinary stream

Urinary retention: inability to completely empty the bladder

Incontinence: inability to control the excretion of urine, feces, or both

Urinary incontinence: inability to control the voiding of urine

Overflow incontinence: continuous leaking from the bladder

Stress incontinence: voiding of urine when running, sneezing, laughing, or coughing

Overactive bladder (OAB): also known as urge incontinence; bladder muscles contract involuntarily

Learning Objective 9.03: Recognize, define, spell, and pronounce the primary terms related to the pathology and the diagnostic and treatment procedures of the urinary system.

Diagnostic Procedures of the Urinary System (1 of 4)

Urinalysis (UA)

Examination of urine for the presence of abnormal elements

Glomerular filtration rate (GFR)

Blood test; checks kidney function

Bladder ultrasound

Handheld ultrasound transducer

Urinary catheterization

Insertion of a tube into the bladder

Cystoscopy

Examination of the urinary bladder using a specialized type of endoscope

Use of a cystoscope to examine the interior of the bladder in a male.

Learning Objective 9.03: Recognize, define, spell, and pronounce the primary terms related to the pathology and the diagnostic and treatment procedures of the urinary system.

Diagnostic Procedures of the Urinary System (2 of 4)

Radiographic Examinations of the Urinary System

Computed tomography (CT scan)

Radiographic imaging of the abdomen

Cystography

X-ray or fluoroscopy examination of the bladder

A contrast medium is instilled via a urethral catheter

Intravenous pyelogram (IVP)

X-ray images of the kidneys, ureters, and bladder using an intravenous contrast medium to clearly visualize the structures

This normal intravenous pyelogram shows the urinary tract, including the ureters, a kidney, and the bladder.

Learning Objective 9.03: Recognize, define, spell, and pronounce the primary terms related to the pathology and the diagnostic and treatment procedures of the urinary system.

Diagnostic Procedures of the Urinary System (3 of 4)

KUB (kidneys, ureters, bladder)

X-ray study without the use of a contrast medium

Also referred to as a flat-plate of the abdomen

Retrograde pyelogram

A contrast medium is instilled and caused to flow upward through the urinary tract

Usually as part of cystoscopy

Voiding cystourethrography

Fluoroscopy used to examine the flow of urine from the bladder through the urethra

Learning Objective 9.03: Recognize, define, spell, and pronounce the primary terms related to the pathology and the diagnostic and treatment procedures of the urinary system.

Diagnostic Procedures of the Urinary System (4 of 4)

Diagnostic Procedures of the Prostate Gland

Digital rectal examination (DRE)

Palpation of the prostate gland

In this context, the term digital means using a finger

Prostate-specific antigen (PSA) blood test

Used to screen for prostate cancer

Measures the amount of prostate-specific antigen present in a blood specimen

The higher a man’s PSA level, the more likely cancer is present

Learning Objective 9.03: Recognize, define, spell, and pronounce the primary terms related to the pathology and the diagnostic and treatment procedures of the urinary system.

Treatment Procedures of the Urinary System (1 of 9)

Medications

Diuretics

Medications administered to increase urine secretion

Primarily to rid the body of excess water and salt

Some foods and drinks (such as coffee, tea, and alcoholic beverages) have a diuretic effect

Other drugs used to treat urinary tract problems

Antibiotics for urinary tract infections

Antispasmodics to block the signals that cause urinary incontinence

Learning Objective 9.03: Recognize, define, spell, and pronounce the primary terms related to the pathology and the diagnostic and treatment procedures of the urinary system.

Treatment Procedures of the Urinary System (2 of 9)

Dialysis

Procedure to remove waste products

Used when kidneys no longer function

Hemodialysis

Waste products are filtered directly from the patient’s blood

Performed on an external hemodialysis machine, sometimes referred to as an artificial kidney

Most common type of dialysis

In a hemodialysis unit, waste is filtered from the patient’s blood. The filtered blood is then returned to the patient’s body.

Learning Objective 9.03: Recognize, define, spell, and pronounce the primary terms related to the pathology and the diagnostic and treatment procedures of the urinary system.

Treatment Procedures of the Urinary System (3 of 9)

Peritoneal dialysis

The lining of the peritoneal cavity acts as a filter to remove waste from blood

Repeated several times during the day; can be done using an automated system

Continuous ambulatory peritoneal dialysis (CAPD)

Provides dialysis as the patient goes about daily activities

Continuous cycling peritoneal dialysis (CCPD) or automated peritoneal dialysis (APD)

Provides dialysis during the night while the patient sleeps

Peritoneal dialysis removes waste through a fluid exchange in the peritoneal cavity.

Learning Objective 9.03: Recognize, define, spell, and pronounce the primary terms related to the pathology and the diagnostic and treatment procedures of the urinary system.

Treatment Procedures of the Urinary System (4 of 9)

The Kidneys

Nephrolysis

Surgical freeing of a kidney from adhesions

Nephrostomy

Catheter used to maintain an opening from one or both kidneys to the exterior of the body

Tubes are also used to gain access to the kidneys for diagnostic procedures

Pyelotomy

Surgical incision into the renal pelvis

Removes obstructions, such as a stone

Learning Objective 9.03: Recognize, define, spell, and pronounce the primary terms related to the pathology and the diagnostic and treatment procedures of the urinary system.

Treatment Procedures of the Urinary System (5 of 9)

Renal transplantation (kidney transplant)

Grafting of a donor kidney

Tissue match increases success rate

Extracorporeal shockwave lithotripsy (ESWL)

Most common kidney stone treatment

Uses high-energy ultrasonic waves

Percutaneous nephrolithotomy (PCNL)

Surgical removal of a nephrolith

Performed through a small incision in the back

In a kidney transplant, the nonfunctioning kidney is usually not removed. Instead, the donor kidney and its associated structures are sutured into place at a lower point in the abdomen.

Learning Objective 9.03: Recognize, define, spell, and pronounce the primary terms related to the pathology and the diagnostic and treatment procedures of the urinary system.

Treatment Procedures of the Urinary System (6 of 9)

The Ureters

Ureterectomy: surgical removal of a ureter

Ureteroscopy: treatment for a nephrolith lodged in the ureter

Ureteroscope: specialized instrument to remove nephrolith

The Urinary Bladder

Cystectomy: surgical removal of all or part of the urinary bladder

Cystorrhaphy: surgical suturing of a wound or defect in the bladder

Lithotomy: surgical incision for removal of a nephrolith in the bladder

Learning Objective 9.03: Recognize, define, spell, and pronounce the primary terms related to the pathology and the diagnostic and treatment procedures of the urinary system.

Treatment Procedures of the Urinary System (7 of 9)

The Urinary Bladder

Urinary catheterization (cathing)

Indwelling catheter

Remains for a prolonged time

Foley: most common catheter type

Urethral catheterization

Inserting a catheter through the urethra

Suprapubic catheterization

Inserting a catheter through an incision

Intermittent catheter (short-term)

Inserted as needed several times a day to drain urine from the bladder

Types of urinary catheterization.

Learning Objective 9.03: Recognize, define, spell, and pronounce the primary terms related to the pathology and the diagnostic and treatment procedures of the urinary system.

Treatment Procedures of the Urinary System (8 of 9)

The Urethra

Meatotomy

Surgical incision made in the urethral meatus to enlarge the opening

Urethroplasty

Surgical repair of damage or a defect in the walls of the urethra

Urethrotomy

Surgical incision into the urethra for relief of a stricture

Prostate Treatment

Ablation

Removal of a body part or the destruction of its function

Uses surgery, hormones, drugs, heat, chemicals, electrocautery, or other methods

Learning Objective 9.03: Recognize, define, spell, and pronounce the primary terms related to the pathology and the diagnostic and treatment procedures of the urinary system.

Treatment Procedures of the Urinary System (9 of 9)

Prostatectomy

Removal of part or all of the prostate gland

Transurethral prostatectomy (TURP)

Removal of excess tissue from an enlarged prostate

Radiation therapy; hormone therapy

Additional treatments to control prostate cancer

Urinary incontinence treatment

Kegel exercises: pelvic muscle exercises

Bladder retraining: increases bladder capacity

A transurethral prostatectomy (TURP) being performed with the use of a resectoscope.

Learning Objective 9.03: Recognize, define, spell, and pronounce the primary terms related to the pathology and the diagnostic and treatment procedures of the urinary system.

Abbreviations Related to the Digestive System

Reference Table 9.1 in the text for an overview of the abbreviations related to the terms introduced in this chapter

Examples:

Acute renal failure = ARF

Benign prostatic hyperplasia = BPH

Chronic kidney disease = CKD

End-stage renal disease = ESRD

Polycystic kidney disease = PKD

Urinary tract infection = UTI

Learning Objective 9.03: Recognize, define, spell, and pronounce the primary terms related to the pathology and the diagnostic and treatment procedures of the urinary system

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