Chapter 6: Urinary Sytem

oliguria (ol-i-GŪ-rē-a)

scanty urine (amount)

olig/o

scanty, few

nephrolysis (ne-FROL-i-sis)

separating the kidney (from other body structures)

-lysis

separation; destruction; loosening

visual examination of the ureter DIAGNOSTIC IMAGING KUB (kidney, ureter, and bladder) (K-Ū-B)

simple radiographic image of the abdomen. It is often used to view the kidneys, ureters, and bladder to determine size, shape, and location. Also used to identify radiopaque calculi in the kidney, ureters, or bladder, or to diagnose intestinal obstruction; (also called flat plate of the abdomen) (Fig. 6.18

;cystolith (SIS-tō-lith)

stone in the bladder (usually comes from kidneys)

renal calculus (pl. calculi) (RĒ-nal) (KAL-kū-lus), (KAL-kū-lī

stone in the kidney

lith/o

stone, calculus

distended (dis-TEN-ded)

stretched out (a bladder is distended when filled with urine)

nephrology (ne-FROL-o-jē)

study of the kidney (a branch of medicine dealing with diseases of the kidney)

urology (ū-ROL-o-jē)

study of the urinary tract (a branch of medicine dealing with diseases of the male and female urinary systems and the male reproductive system)

urinary suppression (Ū-rin-ār-ē) (sū-PRESH-un

sudden stoppage of urine formation

glyc/o, glycos/o

sugar

glycosuria (glī-kō-SŪ-rē-a)

sugar (glucose) in the urine

-tripsy

surgical crushing

lithotripsy (LITH-ō-trip-sē)

surgical crushing of stone(s) (using shock waves) (Exercise Figure C)

nephrolithotripsy (nef-rō-LITH-o-trip-sē)

surgical crushing of stone(s) in the kidney (using shock waves) (Fig. 6.9)

nephropexy (NEF-rō-peks-ē)

surgical fixation of the kidney

renal transplant (RĒ-nal) (TRANS-plant

surgical implantation of a donor kidney into a patient with inadequate renal function (Fig. 6.11)

pyeloplasty (PĪ-el-ō-plas-tē)

surgical repair of the renal pelvis

urethroplasty (ū-RĒ-thrō-plas-tē)

surgical repair of the urethra

vesicourethral suspension (ves-i-kō-ū-RĒ-thral) (sus-PEN-shun

suspension pertaining to the bladder and urethra

cystorrhaphy (sist-OR-a-fē)

suturing the bladder

-rrhaphy

suturing, repairing

specific gravity (SG) (spe-SIF-ik) (GRAV-i-tē)

test performed on a urine specimen to measure the concentrating or diluting ability of the kidneys

void (voyd)

to empty or evacuate waste material, especially urine

micturate (MIK-tū-rāt)

to pass urine (also called urinate)

nephroma (nef-RŌ-ma)

tumor of the kidney

Organs and Anatomic Structures of the Urinary System kidneys (KID-nēz)

two bean-shaped organs located on each side of the vertebral column on the posterior wall of the abdominal cavity covered anteriorly by the parietal peritoneum. Their function is to remove waste products from the blood and to aid in maintaining water and electrolyte balances.

ureters (Ū-re-ters)

two slender tubes, approximately 10 to 13 inches (26 to 33 cm) long, that receive the urine from the kidneys and carry it to the posterior portion of the bladder

Chronic kidney disease (CKD),

unlike ARF, is a progressive, irreversible, loss of renal function, and the onset of uremia. Hypertension, diabetes mellitus, and glomerulonephritis may cause CKD. Dialysis and kidney transplant are used in treating this disease, which was formerly referred to as chronic renal failure (CRF).

Disease and Disorder Terms Built From Word Parts azotemia (az-ō-TĒ-mē-a)

urea in the blood (a toxic condition resulting from disease of the kidney in which waste products are in the blood that are normally excreted by the kidney); (also called uremia)

azot/o

urea, nitrogen

ureter/o

ureter

urethr/o

urethra

-uria

urination, urine

urin/o, ur/o

urine, urinary tract

nephron (NEF-ron)

urine-producing microscopic structure. Approximately 1 million nephrons are located in each kidney.

FIG. 6.9 Percutaneous nephrolithotomy or percutaneous lithotripsy

uses a small incision in the back to remove medium or larger-size kidney stones. A nephroscope is passed into the kidney through the incision. In a nephrolithotomy, the surgeon removes the stone through the nephroscope. In a nephrolithotripsy, the stone is broken into fragments by a lithotripter and then removed through the nephroscope.

cystoscopy (sis-TOS-ko-pē)

visual examination of the bladder (Fig. 6.16)

nephroscopy (ne-FROS-ko-pē)

visual examination of the kidney (Fig. 6.17)

ureteroscopy (ū-rē-ter-OS-ko-pē)

visual examination of the ureter

hydr/o

water

Female urethra 1.5 inches long lies anterior to vagina, male urethra 8 inches, extends downward through prostate

women get more UTI's because of structural differences

urinary system function

The urinary system removes waste material from the body, regulates fluid volume, maintains electrolyte concentration in the body fluid, and assists in blood pressure regulation. The kidneys secrete urine formed from water and waste materials such as urea, potassium chloride, sodium chloride, phosphates, and other elements. Urine is collected in the renal pelvis of the kidney and is transported through the ureters into the bladder, where it is stored until it can be eliminated. Urine passes from the bladder through the urethra and urinary meatus to the outside of the body (Fig. 6.4).

urinary retention (Ū-rin-ār-ē) (rē-TEN-shun)

abnormal accumulation of urine in the bladder because of an inability to urinate

hydronephrosis (hī-drō-ne-FRŌ-sis)

abnormal condition of water in the kidney (obstruction of urine drainage causes urine to collect in the renal pelvis and the pressure transmitted throughout the kidney, if not relieved, can result in kidney damage)

stricture (STRIK-chūr)

abnormal narrowing, such as a urethral stricture

anuria (an-Ū-rē-a)

absence of urine (failure of the kidney to produce urine)

Combining Forms Commonly Used With Urinary System Terms albumin/o

albumin

Complementary Terms Built From Word Parts albuminuria (al-bū-min-Ū-rē-a)

albumin in the urine (albumin is an important protein in the blood, but when found in the urine, may indicate kidney disease; small amounts may be present in the absence of kidney disease)

Uremia

also called azotemia, translated literally is urine in the blood; however, the term refers to urea and other waste products in the blood. The term uremia was first used by Pierre Piorry, a French physician (1794-1879). He also created the medical terms toxin, toxemia, and septicemia.

Wilms Tumor

also called nephroblastoma, is a rare malignancy of the kidney that primarily affects children. Named for German surgeon Dr. Max Wilms who described the disease in 1899, Wilms tumors are generally unilateral and can be successfully managed with appropriate surgical and oncology treatment.

Diuretics

are medications that stimulate diuresis and are commonly called "water pills." Diuretics cause a marked increase in the excretion of urine and are used in the management of high blood pressure, heart failure, and edema.

Combining Forms of the Urinary System cyst/o, vesic/o

bladder, sac (Note: cyst/o and vesic/o refer to the urinary bladder unless otherwise identified.)

hematuria (hēm-a-TŪ-rē-a

blood in the urine

creatinine (crē-AT-i-nin)

blood test that measures the amount of creatinine in the blood. An elevated amount may indicate impaired kidney function

LABORATORY blood urea nitrogen (BUN) (blud) (ū-RĒ-a) (NĪ-trō-jen)

blood test that measures the amount of urea in the blood. An increased BUN detects an abnormality in renal function

glomerulus (pl. glomeruli) (glō-MER-ū-lus) (glō-MER-ū-lī)

cluster of capillaries at the entrance of the nephron. The process of filtering the blood, thereby forming urine, begins here.

Suffixes -iasis, -esis

condition

polycystic kidney disease (pol-ē-SIS-tik) (KID-nē) (di-ZĒZ)

condition in which the kidney contains many cysts causing progressive interference with the ability to form urine (Fig. 6.8)

nephrolithiasis (nef-rō-lith-Ī-a-sis)

condition of stone(s) in the kidney

ureterolithiasis (ū-rē-ter-ō-lith-Ī-a-sis)

condition of stone(s) in the ureter

diuresis (dī-ū-RĒ-sis)

condition of urine passing through (increased excretion of urine) (Note: The a is dropped from dia- because uresis begins with a vowel.)

hypospadias (hī-pō-SPĀ-dē-as)

congenital defect in which the urinary meatus is located on the underside of the penis. Females may also have a form of hypospadias where the urinary meatus is unusually located. (Fig. 6.7

Disease and Disorder Terms Not Built From Word Parts epispadias (ep-i-SPĀ-dē-as)

congenital defect in which the urinary meatus is located on the upper surface of the penis

cystostomy (sis-TOS-to-mē)

creation of an artificial opening into the bladder (for urinary drainage) (Exercise Figure B)

nephrostomy (nef-ROS-to-mē)

creation of an artificial opening into the kidney (Exercise Figure D)

ureterostomy (ū-rē-ter-OS-to-mē)

creation of an artificial opening into the ureter (for drainage of urine)

fulguration (ful-gū-RĀ-shun)

destruction of living tissue with an electric spark (a method commonly used to destroy bladder growths) (Fig. 6.10)

blast/o

developing cell, germ cell

dysuria (dis-Ū-rē-a

difficult or painful urination

nephroptosis (nef-rop-TŌ-sis

drooping kidney (also called floating kidney and occurs when the kidney is no longer held in place and drops out of its normal position. The kidney is normally held in position by connective and adipose tissue, so it is prone to injury, which may also cause the ureter to twist. Truck drivers and horseback riders are prone to this condition.)

-ptosis

drooping, sagging, prolapse

renal hypertension (RĒ-nal) (hī-per-TEN-shun)

elevated blood pressure resulting from kidney disease

nephromegaly (nef-rō-MEG-a-lē)

enlargement of a kidney

Surgical Terms Built From Word Parts cystectomy (sis-TEK-to-mē)

excision of the bladder

nephrectomy (ne-FREK-to-mē)

excision of the kidney

ureterectomy (ū-rē-ter-EK-to-mē)

excision of the ureter

Complementary Terms Not Built From Word Parts catheter (cath) (KATH-e-ter)

flexible, tubelike device, such as a urinary catheter, for withdrawing or instilling fluids

renal pelvis (RĒ-nal) (PEL-vis)

funnel-shaped reservoir in the kidney that collects the urine and passes it to the ureter

glomerul/o

glomerulus

incontinence (in-KON-ti-nens)

inability to control the bladder and/or bowels

cystotomy, vesicotomy (sis-TOT-o-mē) (ves-i-KOT-o-mē)

incision into the bladder

cystolithotomy (sis-tō-li-THOT-o-mē)

incision into the bladder to remove stone(s)

nephrolithotomy (nef-rō-li-THOT-o-mē)

incision into the kidney to remove stone(s) (Fig. 6.9)

meatotomy (mē-a-TOT-o-mē)

incision into the meatus (to enlarge it)

pyelolithotomy (pī-el-ō-lith-OT-o-mē)

incision into the renal pelvis to remove stone(s) (Exercise Figure E)

hilum (HĪ-lum)

indentation on the medial side of the kidney where the renal artery, vein, and pelvis are located and the ureter leaves the kidney

urinary tract infection (UTI) (Ū-rin-ār-ē) (trakt) (in-FEK-shun)

infection of one or more organs of the urinary tract (Fig. 6.5)

nephritis (ne-FRĪ-tis)

inflammation of a kidney

ureteritis (ū-rē-ter-Ī-tis)

inflammation of a ureter

cystitis (sis-TĪ-tis)

inflammation of bladder

nephr/o, ren/o

kidney

nephroblastoma (nef-rō-blas-TŌ-ma)

kidney tumor containing developing (germ) cells (malignant tumor) (also called Wilms tumor)

renal failure (RĒ-nal) (FĀL-ūr)

loss of kidney function resulting in its inability to remove waste products from the body and maintain electrolyte balance (Table 6.1)

urethra (ū-RĒ-thra

lowest part of the urinary tract, through which the urine passes from the urinary bladder to the outside of the body. This narrow tube varies in length by sex. It is approximately 1.5 inches (3.8 cm) long in the female and approximately 8 inches (20 cm) in the male, in whom it is also part of the reproductive system. It carries seminal fluid (semen) at the time of ejaculation.

Extracorporeal

means occurring outside the body.

meat/o

meatus (opening)

electrolytes (ē-LEK-trō-lītz)

minerals in the body, such as sodium and potassium, that carry an electrolyte charge. Electrolyte balance is necessary for the body to function normally and is maintained by the kidneys.

polyuria (pol-ē-Ū-rē-a

much (excessive) urine

urinalysis (UA) (ū-rin-AL-is-is)

multiple routine tests performed on a urine specimen. Visual examination and chemical analysis of a urine specimen provides screening for blood, glucose, protein, and other substances in the urine and offers a picture of overall health.

urinary bladder (Ū-ri-nar-ē) (BLAD-er)

muscular, hollow organ that temporarily holds the urine. As it fills, the thick, muscular wall becomes thinner, and the organ increases in size.

ureterostenosis (ū-rē-ter-ō-sten-Ō-sis

narrowing of the ureter

noct/i

night

nocturia (nok-TŪ-rē-a)

night urination

Surgical Terms Not Built From Word Parts extracorporeal shock wave lithotripsy (ESWL) (eks-tra-kor-POR-ē-al) (LITH-ō-trip-sē)

noninvasive surgical procedure to crush stone(s) in the kidney or ureter by administration of repeated shockwaves. Stone fragments are eliminated from the body in urine. (also called shock wave lithotripsy [SWL]) (see Exercise Figure C).

pyel/o

renal pelvis

urinary meatus (Ū-ri-nar-ē) (mē-Ā-tus)

opening through which the urine passes to the outside

urinary catheterization (Ū-rin-ār-ē) (kath-e-ter-i-ZĀ-shun)

passage of a catheter into the urinary bladder to withdraw urine (Exercise Figure G

urodynamics (ū-rō-dī-NAM-iks)

pertaining to the force and flow of urine within the urinary tract. Urodynamic studies examine the process of voiding and test bladder tone, capacity, and pressure along with urine flow and perineal muscle function. An enlarged prostate and urethral stricture will diminish urine flow rate

meatal (mē-Ā-tal)

pertaining to the meatus

urinary (Ū-rin-ār-ē)

pertaining to urine

nephrologist (ne-FROL-o-jist

physician who studies and treats diseases of the kidney

urologist (ū-ROL-o-jist)

physician who studies and treats diseases of the urinary tract

hemodialysis (HD) (hē-mō-dī-AL-i-sis)

procedure for removing impurities from the blood because of an inability of the kidneys to do so (Fig. 6.19)

peritoneal dialysis (pār-i-tō-NĒ-al) (dī-AL-i-sis)

procedure for removing toxic wastes when the kidney is unable to do so; the peritoneal cavity is used as the receptacle for the fluid used in the dialysis (Fig. 6.20)

nephrosonography (nef-rō-so-NOG-ra-fē)

process of recording the kidney using sound (ultrasonography)

ureterocele (ū-RĒ-ter-ō-sēl)

protrusion of a ureter (distally into the bladder)

cystocele (SIS-tō-sēl)

protrusion of the bladder

pyuria (pī-Ū-rē-a)

pus in the urine

Diagnostic Terms Built From Word Parts DIAGNOSTIC IMAGING cystogram (SIS-tō-gram)

radiographic image of the bladder (Fig. 6.12)

urogram (Ū-rō-gram)

radiographic image of the urinary tract (Fig. 6.14)

retrograde urogram (RET-rō-grād) (Ū-rō-gram)

radiographic image of the urinary tract (retrograde means to move in a direction opposite from normal; contrast medium is instilled into the bladder, ureter, or renal pelvis through a ureteral catheter.) (Exercise Figure F)

cystography (sis-TOG-ra-fē) pg 214

radiographic imaging of the bladder

voiding cystourethrography (VCUG) (VOID-ing) (sis-tō-ū-rē-THROG-ro-fē)

radiographic imaging of the bladder and the urethra (Fig. 6.15). (Radiopaque contrast media is instilled in the bladder. Radiographic images are taken of the bladder before and during urination.)

nephrography (ne-FROG-ra-fē)

radiographic imaging of the kidney

renogram (RĒ-nō-gram)

radiographic record of the kidney (a nuclear medicine test, used to evaluate kidney function); (also called renal scan or nephrogram) (Fig. 6.13B)

urinal (Ū-rin-al)

receptacle for urine

Urinary tract infection

. A, Acute cystitis. The swollen and red mucosa demonstrates inflammation. Cystitis is more common in women because the urethra is short, allowing easy access of bacteria to the urinary bladder. B, Upper and lower urinary tract infections. If cystitis is not treated promptly, the infection can spread to the kidneys, causing pyelonephritis.

Peritoneal dialysis

A sterile dialyzing fluid is instilled into the peritoneal cavity by gravity and dwells there for a period of time ordered by the physician. The fluid, containing the nitrogenous wastes and excess water that a healthy kidney normally removes, is drained from the cavity.

Urologist/Nephrologist

A urologist treats diseases of the male and female urinary system and the male reproductive system both medically and surgically. A nephrologist treats kidney diseases and prescribes and manages dialysis therapy.

Renal Function Replacement Therapies

Hemodialysis • Peritoneal dialysis • Renal transplant

glomerulonephritis (glō-mer-ū-lō-ne-FRĪ-tis)

inflammation of the glomeruli of the kidney

pyelitis (pī-e-LĪ-tis)

inflammation of the renal pelvis

pyelonephritis (pī-e-lō-ne-FRĪ-tis

inflammation of the renal pelvis and the kidney (Fig. 6.5B, and Fig. 6.6)

urethrocystitis (ū-rē-thrō-sis-TĪ-tis

inflammation of the urethra and the bladder

ENDOSCOPY cystoscope (SIS-tō-skōp)

instrument used for visual examination of the bladder

enuresis (en-ū-RĒ-sis)

involuntary urination. Nocturnal enuresis, or bed-wetting, has been described in early literature and continues to be a problem affecting 15% to 20% of school-aged children. There is no one cause for bed wetting. Diurnal enuresis is daytime wetting, which may be caused by a small bladder. Various treatments are used to treat diurnal enuresis. Children generally outgrow daytime wetting

Bladder

is a derivative of the Anglo-Saxon blaeddre, meaning a blister or windbag.

Catheter

is derived from the Greek katheter, meaning a thing let down. A catheter lets down the urine from the bladder.

Glomerulus

is derived from the Latin glomus, which means ball of thread. It was thought that the rounded cluster of capillary loops at the nephron's entrance resembled thread in a ball

Meatus

is derived from the Latin meare, meaning to pass or to go. Other anatomic passages share the same name, such as the auditory meatus.

Micturate

is derived from the Latin mictus, meaning a making of water. The noun form of micturate is micturition. Note the spelling of each. Micturition is often misspelled as micturation.

Pyelos

is the Greek word for tub-shaped vessel, which describes the renal pelvis shape.

Stress Incontinence

is the involuntary intermittent leakage of urine as a result of pressure, from a cough or a sneeze, on the weakened area around the urethra and bladder. The Marshall-Marchetti Krantz technique, or vesicourethral suspension with a midurethral sling is a suspension surgery performed on patients with stress incontinence.

End-stage renal disease (ESRD)

is what chronic kidney disease is called when kidney function is too poor to sustain life.