Genitourinary System

What are the functions of the kidneys, ureters and bladder?
The kidneys are bean-shaped organs, each about the size of a fist. They are located near the middle of the back, just below the rib cage, one on each side of the spine. The kidneys are sophisticated reprocessing machines. Every day, a person’s kidneys process about 200 quarts of blood to filter out about 2 quarts of waste products and extra water. The wastes and extra water become urine, which flows to the bladder through tubes called ureters. The kidneys also produce hormones and are responsible for acid/base balance in the body.

The ureters are narrow tubes that carry urine from the kidneys to the bladder. About every 10 to 15 seconds, small amounts of urine are emptied into the bladder from the ureters. Muscles in the walls of the ureter continually tighten and relax forcing urine downward, away from the kidneys.

The bladder stores urine until releasing it through urination. The bladder is a triangle-shaped, hollow organ located in the lower abdomen. It is held in place by ligaments that are attached to other organs and the pelvic bones. The bladder’s walls (detrusor muscle) relax and expand to store urine, and contract and flatten to empty urine through the urethra.

The urethra is a tube which connects the urinary bladder to the outside of the body, and carries semen in men, and urine in women and men. In females, the urethra is shorter and emerges above the vaginal opening.

The external urethral sphincter is a muscle that allows voluntary control over urination.

Urinary System

COURSE OBJECTIVES:

The purpose of this course is to instruct the student on the basic anatomy and physiology of the urinary system, disorders of, changes in aging, nursing assessment and treatments.

LEARNING OBJECTIVES:

Upon completion of this course, the student should be able to:

1. The student will be able to identify and describe the basic parts of the urinary system and how they relate to her nursing care..
2. The student will be able to explain in l the functions of the urinary system and importance of proper function related to the nursing role..
3. The student will be able to verbalize the common disorders of urinary systems and the effects they have to the patient.
4. The student will have the knowledge and be able to identify the signs and symptoms associated with urinary disorders/disease and the nurses role in each.
5. The student will have knowledge of currant treatments and tests used for urinary disorders and their responsibilities in relationship to them.

INTRODUCTION:

The urinary system is a group of organs that produce and excrete urine from the body.

Urine is a transparent yellow fluid containing unwanted waste products, mostly water, salts and nitrogen. Urine is slightly acidic and has a pH of 4.6 to 8.0. Abnormal findings would be keytone bodies, pus, blood, bacteria, glucose and certain crystals.

The major organs of the urinary system are the kidneys; a pair of bean-shaped organs that filter out substances that are contained in the blood. The entire bodies blood supply which is approximately 7-8% of the persons body weight; filters through these bean-shaped organs every thirty seconds, this produces what we call urine. Urine flows from the kidneys through two long, thin tubes called ureters. With a constant wave like action the urine moves itself along a provided path. The ureters transport the urine to the bladder, a very large vascular muscular organ. The bladder can store large amounts of urine, which excrete through a tube shaped urethra, to the outer meatus, (opening of the body); and is held inside the body by a elastic ring like muscle called the urinary sphincter muscle, which allows for spontaneous emptying.

An average adult produces approximately 1.5 liters of urine each day; the body needs this much at a minimum to avoid dehydration. The body needs to excrete approximately .5 liters daily to rid it self of unwanted waste.

Excessive or inadequate production of urine may indicate illness and a urinalysis or twenty-four urine may be ordered to determine the cause.

The presence of glucose, or blood sugar, in the urine may be a sign of diabetes; bacteria in the urine signal an infection of the urinary system; and red blood cells in the urine may indicate cancer or other disease processes in the urinary tract.

STRUCTURE AND FUNCTION:

The kidneys are embedded in the dorsal portion of the abdomen. They are found in the fat tissue on either side of the back bone, the right kidney is slightly lower then the left, they both fall in at about waist level. The kidneys are reddish-brown in color. Each kidney is approximately 11cm long, 6 cm wide and 2 1/2 cm thick, each weighing in at 140 to 160 grams (5-6 oz) and as stated earlier are shaped like a kidney bean (hence the name).

On the inner border of the kidneys lies a border, or a depression called a hilum, this is where the renal artery, the renal vein, and the ureter connect with the kidney.

There are over 1700 liters (450 gal) of blood passing through the renal artery to the kidneys every day. The kidneys filter the blood and return it to the heart via the renal vein. The kidneys specialized tissue function to maintain balance, (homeostasis). The kidneys actually determine the water and chemical composition of the blood, which in turn determines the content of the tissue fluid that surrounds the cell.

Each kidney works as a complex filtratioetwork and reabsorption system. Each kidney consists of more then 2 million coiled channels called nephrons, which perform this critical blood-filtering function and produce urine in the process.

The top of the nephron is shaped like a cup and is called the Bowmens capsule, it surrounds a cluster of capillaries (the smallest blood vessel) called a glomerulus. Blood flows into each of the glomerulus by way of arterioles, (the smaller end of an artery), these run down long the descending and ascending tubes; these tubes merge into the kidney pelvis, a funnel- shaped area at center of the kidney.

The upper portion of the kidney is bulblike and filters water, urea (the nitrogen-containing breakdown product of protein), salts, glucose, amino acids, (the body’s building blocks of protein), yellow bile (compounds formed from the liver), and other trace elements from the blood.

As this material moves through the glomerulus many of these filtered materials are reabsorbed into the blood to be reused by the body. They help maintain the normal body functions. Less then 1% of the water and other materials remain behind to be secreted as waste/urine.

These waste materials then pass from the nephrons into the renal pelvis. From the renal pelvis, waste seeps out of the kidney into the ureter. The ureter is a tube that comes from each kidney down into the bladder. The ureter is approximately 25 to 30 cm (10 to 12 in) long and about .5 cm in diameter. The ureter empties into a hollow, muscular sac called the urinary bladder. There is a flap of tissue at the point where the ureter meets the bladder it acts as a valve to prevent the back flow of urine.

The urinary bladder is able to expand and contract according to how much urine it has in it. As the bladder fills with urine the walls become thinner, they can stretch to the size of 12.5 cm. (5in), or more.

As the bladder becomes full, receptors that are sensitive to pulling/stretching become stimulated and you know it is time to empty your bladder. When the person is ready to void the urine the sphincter muscle relaxes and urine is able to leave the body through the urethra. The urethra is a tube leading from the bladder to the outside of the body. It is 3.8cm (1 1/2 in) in the female and is strictly used for urinary output. In the male the urethra is approximately 20cm (8 in) long; it passes through the penis to excrete the urine and also serves as a passage way for semen during intercourse. When the penis is erect, the opening from the bladder cuts off blocking the probability of urine being passed on to the female.

The kidney is a very complex organ, they have three main functions

1.) To filter materials from the blood that are no longer needed, the body has in excess and then to return the useable products back into the blood system.

2.) To maintain water and electrolyte balance, ensuring that the amount of water in the body tissues remains at a constant level; IE; if a person drinks a lot of water one day, but a little water the next day, the kidneys are able to adapt by regulating the water balance in the tissues.

3.) To maintain acid base balance. In other words the function of the kidneys is to assist the body in maintaining homeostasis, which is the balance of blood and body fluids that is needed by the body to allow all processes to run smoothly. By controlling salt levels, the kidneys help regulate blood pressure.

These processes are vital and rely oormal functioning of the kidneys. If the kidneys are diseased so that they are not functioning, death will result. Each part of the urinary system has its own specialized function, but all of the parts must be working in unison for the whole system to work properly.

All vertebrates dispose of excess water and waste by means of kidneys. The kidneys of fish and amphibians are much simpler then mammals. Fish and amphibians absorb a great deal of water and, as a result must rid themselves of large quantities of urine. In comparison to the urinary system of a bird and reptile are designed to conserve water; these animals produce urine that is solid or semisolid.

DISORDERS OF THE URINARY SYSTEM

Urologists are physicians who specialize in treating urinary disorders and diseases.

Renal failure is one of the most serious disorders found in this system. Renal failure can be total or partial either way it is very serious. Renal failure slows or stops the filtration of blood, causing toxic waste products to build up in the blood.

Lets look at the differences between acute and chronic renal failure.

Acute renal failure is characterized by a sudden occurrence, decreased amount of urinary output, (less then 500cc qd)(oliguria) and rapid accumulation of nitrogenic wastes in the blood (azotemia). Acute type of failure can come from hemorrhage, trauma, burn, and toxic injury to the kidneys, severe infections or blockage to the lower urinary track. Many forms of acute renal failure are reversible when the cause is corrected.

Chronic renal failure is a progressive deterioration of kidney function over a long period of time. Chronic renal failure may result from many diseases such as diabetes, lupus, AIDS, and myeloma. If caught early enough the degenerative process can be slowed but not reversed. Early signs include sluggishness, fatigue, and mental dullness; later this disorder can progress to zero urine output, (anuria), convulsions, GI bleed, malnutrition, and various neuropathies, and the skin will becomes yellow. CHF and hypertension are complications that occur from the hypervolemia associated with increased volume from no urinary output. Treatment is restricted water and protein intake, diuretics. When all else fails the patient must begin long term hemodialysis and many times kidney transplant.

Urinary calculi, commonly known as kidney stones, results from a gradual build up of crystallized salts and minerals in the urine, (many times related to calcium, uric acid). They be found anywhere from the kidney to the bladder and vary in size, from fine grains of sand to the size of an orange. Certain factors add to the formation of these stones, including infection, urinary stasis and periods of immobility and hypercalciuria (to much calcium in the urine). This is a more common occurrence in men in their 50’s. If you have had one stone your chances of getting another is increased.

Urinary calculi can be very painful, mostly if they obstruct a passageway that carries urine. Usually, the stones pass through and out of the urinary tract on their own, scratching there way along the interior line of whatever area they come into contact with. When a large stone finds it way down the urethra it can be extremely painful. If they fail to pass themselves through they can be broken up using an ultrasound method called lithotripsy.

Urinary tract infection, (UTI) is an infection of one or more of the structures in the urinary tract. Most UTI’s happen from bowel organisms, (E-coli). Women are more prone to UTI’s because of the shortness of their urethra.

Infections of the lower urinary tract are called cystitis. This is an inflammation of the urinary bladder, most often caused by ascending infection from the urethra; it can also be caused by sexual intercourse. Signs and symptoms of a lower UTI are; frequency of urination, urgency of urination, burning upon urination. The urinalysis may show bacteria, pus and red blood cells. Treatment of antibiotics, fluids, and educating the patient on possible causes helps to avoid future episodes. Some people are more prone to reoccurring UTI’s.

Infections of the upper urinary tract are called pyelonephritis. This is an infection of renal pelvis, tubules, (tubes), in the kidneys. The bacteria may enter through the bladder via the ureters or through blood stream.

Many times this upper UTI is caused by reflux of urine up through the ureters from a faulty valve, that is suppose to prevent this from happening. Sign and symptoms are chills and fever; flank pain. A urinalysis will show bacteria, pus. The s/s are pretty much the same as for the lower UTI except the bacteria in the urine found on the urinalysis are coated with antibodies that happens only in the renal pelvis. An upper UTI is more serious due to the fact it can cause damage and death to tissues in the kidneys if not treated,

Kidney and bladder cancer has been on rise for the past thirty years. These cancers have been linked to various causative agents, primarily cigarette smoking, abuse analgesics, obesity and certain industrial chemicals. Treatment typically includes removal of cancer tissue, followed by radiation therapy.

INHERITED AND CONGENITAL DISORDERS

There are many inherited and congenital disorders of the urinary system.

Polycystic renal disease is a disease of many cysts that formed in the kidneys, reducing the amount of functioning that the renal tissue can do. Kidney dialysis or transplant is most ofteeeded to prevent kidney failure or even death. Hypospadias is a birth defect in which the male urinary opening is misplaced on the penis; it may be under the head of the penis or as far away as the scrotum. Surgery before the child reaches twenty-four months old can correct the defect, permitting normal urination and, later, sexual intercourse.

AGE RELATED CHANGES

There are a number of age-related changes that effect the urinary system. As an individual age, the kidneys function less efficiently. A person eighty years old will have half the nephrons as that of a newborn baby. If only half the nephrons are there then the kidneys decrease at least that much in their ability to filter and function. For this reason, an elderly person is much more likely to have a drug reaction then a middle aged or young person would. The kidney is less efficient in removing the drug from the bloodstream.

Arteriosclerosis, (thickening & loss of elasticity to arterial wall, decreasing blood flow) can affect the blood vessels that supply the urinary system. When circulation is poor, there is a greater chance of developing infection as well as decreased ability to recover from illness or injury.

There are age-related changes that decrease the elasticity of the ureters, bladder, and urethra. As muscle tone decreases, the amount of urine the bladder can hold is reduced. Many times the elderly person will not be aware of the need to void until their bladder is almost full or full. This leads to:

* Frequency– the need to urinate often

* Urgency– an immediate need to urinate

* Nocturia– waking at night to urinate

* Incontinence– inability to hold urine

The first three of the above definitions lead to the fourth; incontinence. Incontinence can also come from certain medications, but whatever the reason it is a serious problem. It is a physical problem with the potential of the skin to breakdown from the exposure to acidic urine on the skin. Many rashes and pressure sores, (decubitis ulcers), come from a patient being incontinent.

Incontinence also as a large effect on the psychological aspect of the patient health. Incontinence is very distressing and embarrassing; if you can remember ever wetting your pants as a child you know what I am talking about. Patients with neurological disorders (related to the nervous system), frequently have no control of their bladder functions because the brain is unable to receive signals to control urination. Many times this leads a person with a neurological disorder to have a urinary catheter inserted (a tube that is inserted into the bladder to drain urine into a collection bag).

Urinary tract infections, (reviewed previously), are a common thing in many people in different age groups, however, the elderly when confined to bed, or when they have a catheter, or when they are incontinent of bowel, have an increased chance of getting a UTI.

Immobility has serious effects on the urinary system primarily because of the incomplete emptying of the urine from the bladder and kidneys. When urine is retained too long as with any fluid standing still, it begins to grow bacteria, resulting in infection and development of kidney stones (calculi).

Incomplete emptying of the bladder may be related to patient positioning when urinating. When a patient is confined to bed and has to use a bedpan their positioning is extremely important. When placing a patient on a bed pan make sure it is placed correctly under them, also the patient should be returned to a sitting position on the bed pan to make it has natural as possible. Keep the patient covered up with a call light in reach. Respect privacy.

 

RENAL FAILURE

Definition

When you have kidney failure, one or both kidneys aren’t able to work normally. The kidneys remove waste (in the form of urine) from the body. They also balance the water and electrolyte content in the blood by filtering salt and water.
Kidney failure is divided into two categories:

·        Acute kidney failure —sudden loss of kidney function

·        Chronic kidney failure —slow, gradual loss of kidney function

Causes

Kidney disease causes the tiny filters in the kidneys (called nephrons) to lose their ability to filter. Damage to the nephrons may occur suddenly after an injury or poisoning. But, many kidney diseases take years or even decades to cause damage that is noticeable.
The two most commons causes are:

·        Diabetes —high blood sugar can damage nephrons

·        High blood pressure —severe high blood pressure can damage blood vessels in the kidneys

Others causes include:

·        Pyelonephritis

·        Glomerulonephritis

·        Polycystic kidney disease

·        Birth defects

·        Bilateral renal artery stenosis

·        Poisoning

·        Severe trauma

·        Viral infections (eg, hepatitis B, hepatitis C, HIV/AIDS)

·        Long-term use of medicines that contain aspirin, acetaminophen, ibuprofen

·        Abnormal build-up of substances within the kidneys (eg, amyloidosis, protein build-up)

·        Toxic reaction to drugs or x-ray dyes

·        Systemic diseases (eg, lupus, polyarteritis, Wegener’s granulomatosis

·        Conditions that severely decrease the amount of blood (eg, burns, pancreatitis, peritonitis) 

·        Conditions that make it difficult to urinate (eg, enlarged prostate, kidney stones, tumors) 

 

Risk

These factors increase your chance of developing kidney failure. Tell your doctor if you have any of these risk factors:

·        Diabetes

·        Genetics: polycystic kidney disease, type 1 diabetes

·        Race: African Americans

·        High blood pressure

·        Lupus or other autoimmune diseases

·        Long-term use of pain medications containing aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) in high doses

·        Liver failure, jaundice

·        Respiratory failure

·        HIV

·        Cancer

·        Recent open heart surgery

·        Recent surgery on an abdominal aortic aneurysm

·        Condition that obstructs urine flow

·        Enlargement of the prostate gland

Symptoms

Some kidney diseases begin without any symptoms. As the disease progresses, some of the following symptoms may develop:

·        Fluid retention

·        Swollen hands and feet, numbness of hands and feet, itchy skin

·        Fatigue, insomnia

·        Low urine output (or no urine output in severe cases), frequent urination

·        Altered consciousness

·        Loss of appetite, malnutrition

·        Sores, bad taste in the mouth

·        Nausea, vomiting

·        Muscle cramps and twitches

·        Shortness of breath

·        High blood pressure

·        Low temperature

·        Seizures, coma

·        Breath smelling like urine

·        Yellowish-brownish skin tone

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. Tests may include:
Blood Tests
If the kidneys are not working properly, the blood will show:

·        An increase in:

o       Potassium

o       Phosphorus

o       Parathyroid hormone

o       Creatinine

o       Blood urea nitrogen

·        A decrease in serum calcium

Other Tests

·        24-hour urine protein test —to see if your body is losing protein in the urine

·        Renal ultrasound —uses sound waves to study the renal system (kidneys, bladder, and ureters)

·        Biopsy —removal of a sample of kidney tissue to test for kidney cell functioning

Treatment

Most chronic kidney diseases are not reversible. But, there are treatments that may be used to help preserve as much kidney function as possible. In the cases of acute renal failure, treatment focuses on the illness or injury that caused the problem.
General Measures

·        Restricting fluids

·        Doing daily weight checks

·        Eating a high-carbohydrate, low-protein diet

Medications
Medications used in acute or chronic kidney failure may include:

·        Diuretics —to flush out the kidneys, increase urine flow, and rid the body of excess sodium (eg, furosemide, mannitol)

·        Blood pressure medications (eg, ACE inhibitors)

·        Medicine to treat anemia (eg, epoetin alfa [Epogen, Procrit], ascorbic acid [vitamin C])

·        Sodium polystyrene sulfonate or insulin in dextrose—to control high potassium levels

·        Calcium acetate —to control high phosphorus levels

Talk to your doctor other medications that your are taking. These include prescribed and over-the-counter medications, as well as herbs and supplements. Since the kidneys are no longer working properly, waste can build up in your body.
Dialysis
Dialysis is a process that takes over for the kidneys and filters waste from the blood. This may be done for short-term, until kidney function improves. Or, it may be done you have a kidney transplant.
Kidney Transplant
This may be the right option for some patients. Having a successful transp lant depends on many factors, such as what is causing the kidney damage and your overall health.
Blood Tests
Your doctor will monitor these blood levels:

·        Sodium

·        Potassium

·        Calcium

·        Phosphate

·        Red blood cells

·        Hematocrit

·        Platelets

Lifestyle Changes
The following are steps to help your kidneys stay healthy longer:

·        Have your blood pressure checked regularly. Take medication to control high blood pressure.

·        If you have diabetes, control your blood sugar. Ask your doctor for help.

·        Avoid the chronic use of pain medications.

·        If you have chronic kidney disease, you may need to limit how much protein you eat. Talk to a dietician.

·        Limit how much cholesterol and sodium you eat.

·        If you have severe kidney disease, limit how much potassium you eat. If your kidneys are failing, get help from a dietician.

If you are diagnosed with kidney failure, follow your doctor’s instructions .

Prevention

In some cases, you cannot prevent kidney failure. But there are some steps you can take that will lower your risk:

·        Maintaiormal blood pressure.

·        If you have diabetes, control your blood sugar.

·        Avoid long-term exposure to toxic substances, such as lead and solvents.

·        Do not abuse alcohol or over-the-counter pain medication.

·        Limit the amount of drugs toxic to the kidney.

·        If you have chronic kidney failure, talk to your doctor before you become pregnant.

 

Renal Transplantation

The kidneys have several important functions in the body.

• They filter wastes from your bloodstream and maintain the balance of electrolytes in your body.
• They remove chemical and drug by-products and toxins from your blood.
• They eliminate these substances and excess water as urine.
• They secrete hormones that regulate the absorption of calcium from your food (and thus bone strength), the production of red blood cells (thus preventing anemia), and the amount of fluid in your circulatory system (and thus blood pressure). 

 

When blood enters the kidneys, it is first filtered through structures called glomeruli. The second step is filtering through a series of tubules called nephrons.

• The tubules both remove unwanted substances and reabsorb useful substances back into the blood.
• Each of your kidneys contains several millioephrons, which cannot be restored if they are damaged.

Renal failure
Various conditions can damage your kidneys, including both primary kidney diseases and other conditions that affect the kidneys.

• If kidney damage becomes too severe, your kidneys lose their ability to function normally. This is called kidney failure.
• Kidney failure can happen rapidly (acute kidney failure), usually in response to a severe acute (sudden, short-term) illness in another body system or in the kidneys. It is a very common complication in patients hospitalized for other reasons. It is often completely reversible with resolution of the underlying condition.
• Kidney failure can also happen very slowly and gradually (chronic kidney failure), usually in response to a chronic (ongoing, long-term) disease such as diabetes or high blood pressure.
• Both types of kidney failure can occur in response to primary kidney disease as well. In some cases this kidney disease is hereditary.
• Infections and substances such as drugs and toxins can permanently scar the kidneys and lead to their failure.

People with the following conditions are at greater-than-normal risk of developing kidney failure and end-stage renal disease:

• Diabetes (type 1 or type 2)
• High blood pressure – Especially if severe or uncontrolled
• Glomerular diseases – Conditions that damage the glomeruli, such as glomerulonephritis
• Hemolytic uremic syndrome
• Systemic lupus erythematosus
• Sickle cell anemia
• Severe injury or burns
• Major surgery
• Heart disease or heart attack
• Liver disease or liver failure
• Vascular diseases – Conditions that block blood flow to different parts of your body, including progressive systemic sclerosis, renal artery thrombosis (blood clot), scleroderma
• Inherited kidney diseases – Polycystic kidney disease, congenital obstructive uropathy, cystinosis, prune belly syndrome
• Diseases affecting the tubules and other structures in the kidneys – Acquired obstructive nephropathy, acute tubular necrosis, acute interstitial nephritis
• Amyloidosis
• Taking antibiotics, cyclosporin, heroin, chemotherapy – Can cause inflammation of kidney structures
• Gout
• Certain cancers – Incidental carcinoma, lymphoma, multiple myeloma, renal cell carcinoma, Wilms tumor
• HIV infection
• Vesicoureteral reflux – A urinary tract problem
• Past kidney transplant (graft failure)
• Rheumatoid arthritis

Chronic kidney failure is associated with complications that can be debilitating or have a negative effect on quality of life.

• Anemia
• Fluid retention
• Pulmonary edema – Fluid retention in the lungs that can cause breathing problems
• High blood pressure – From chemical imbalances and fluid retention
• Renal osteodystrophy – Weakening of the bones from calcium depletion, can fracture easily
• Amyloidosis – Deposition of abnormal proteins in the joints, causes arthritislike symptoms
• Stomach ulcers
• Bleeding problems
• Neurological damage
• Sleeping problems – Related to dialysis

 

Kidney Transplant Symptoms

The symptoms of kidney failure vary widely by cause of the kidney failure, severity of the condition, and the other body systems that are affected.

• Most people have no symptoms at all in the early stages of the disease, because the kidneys are able to compensate so well for the early impairments in the their function. Others have symptoms that are mild, subtle, or vague.
• Generally, obvious symptoms appear only when the condition has become severe or even critical.
• Kidney failure is not painful, even when severe, although there may be pain from damage to other systems.
• Some types of kidney failure cause fluid retention. However, severe dehydration (fluid deficiency) can also cause kidney failure.
• Fluid retention – Puffiness, swelling of arms and legs, shortness of breath (due to fluid collection in the lungs, called pulmonary edema)
• Dehydration – Thirst, rapid heart rate (tachycardia), dry mucous membranes (such as inside the mouth and nose), feeling weak or lethargic

Other common symptoms of kidney failure and end-stage renal disease include the following:

• Urinating less than usual
• Urinary problems – Frequency, urgency
• Bleeding – Due to impaired clotting, from any site
• Easy bruising
• Fatigue
• Confusion
• Nausea, vomiting
• Loss of appetite
• Pain – In the muscles, joints, flanks, chest
• Bone pain or fractures
• Itching
• Pale skin (from anemia)

End-stage renal disease cannot be prevented in some cases. You may be able to prevent your kidneys from failing, or slow the progression of the failure, by controlling your underlying conditions.

• Kidney failure has usually progressed fairly significantly by the time symptoms appear. If you are at high risk of developing chronic kidney failure, see your health care provider as recommended for screening tests.
• If you have a chronic condition such as diabetes, high blood pressure, or high cholesterol, follow the treatment recommendations of your health care provider. See your health care provider regularly for monitoring. Aggressive treatment of these diseases is essential to preserving kidney function and preventing complications.
• Avoid exposure to alcohol, drugs, chemicals, and other toxic substances as much as possible.

To learn more about kidney failure, click here.

Kidney Transplantation

When your health care provider makes the diagnosis of end-stage renal disease, he or she will discuss your treatment options. Whether kidney transplantation is an option for you depends on your specific situation. If your health care provider thinks you may be eligible for a transplant, you will learn about the pros and cons of this treatment. If you are a potential candidate, you will undergo a thorough medical evaluation. In the meantime, you will be treated with dialysis.
Kidney transplantation is replacement of nonworking kidneys with a healthy kidney from another person (the donor). The healthy kidney (the “graft”) takes over the functions of your nonworking kidneys. You can live normally with only one kidney as long as it functions properly.
The transplantation itself is a surgical operation. The surgeon places the new kidney in your abdomen and attaches it to the artery that supplied blood to one of your kidneys and to the vein that carries blood away from the kidney. The kidney is also attached to the ureter, which carries urine from the kidney to the bladder. Your own kidneys are usually left in place unless they are causing you problems, such as infection.
Every operation has risks, but kidney transplantation is not a particularly difficult or complicated operation. It is the period after the surgery that is most critical. Your medical team will watch very carefully to make sure that your new kidney is functioning properly and that your body is not rejecting the kidney.
Are you eligible for a transplant?
Before you can receive a kidney transplant, you must undergo a very detailed medical evaluation.

• This evaluation may take weeks or months and require several visits to the transplant center for tests and examinations.
• The purpose of this thorough evaluation is to test whether you would benefit from a transplant and can withstand the rigors of the surgery and antirejection medications and the adjustment to a new organ.

Your medical team, which includes a nephrologist, a transplant surgeon, a transplant coordinator, a social worker, and others, will conduct a series of interviews with you and your family members.

• You will be asked many questions about your medical and surgical history, the medications you take and have taken in the past, and your habits and lifestyle.
• It will seem like they ask every imaginable question at least twice! It is important that they know every detail about you that could bear on a future transplant.
• They also want to make sure you are mentally prepared for following the necessary medication regimen.

You will also have a complete physical examination. Lab tests and imaging studies complete the evaluation.

• Your blood and tissue will be typed so that you can be matched to a donor kidney. This significantly lessens the chance of rejection.
• You will have blood and urine tests to monitor your creatinine level, other organ functions, and electrolyte levels.
• You will have x-rays, ultrasounds, CT/MRI scans, and other imaging tests as needed to make sure your other organs are healthy and functioning.

Any of the following conditions significantly increase your chance of rejecting the new kidney and may make you ineligible for transplant:

• Active cancer
• HIV infection
• Serious heart or lung disease
• Positive results for hepatitis C
• Severe infection

Potential kidney donors also must be in good health and undergo a thorough medical evaluation.
If you are considered eligible for a transplant, every effort will be made to find a donor among your family members (who are most likely to match) and friends. If no suitable donor can be found, your name will be added to the waiting list for a donor kidney.

• This list is administered by the Organ Procurement and Transplantation Network, which maintains a centralized database of everyone waiting for a transplant and of living donors.
• OPTC is run by the United Network for Organ Sharing, a private nonprofit organization.
• Every new kidney that becomes available is tested and checked against this list to find the most perfect match.

       

 

Kidney Transplant Medical Treatment

The most critical part of kidney transplantation is preventing rejection of the graft kidney.

• Different transplant centers use different drug combinations to fight rejection of a transplanted kidney.
• The drugs work by suppressing your immune system, which is programmed to reject anything “foreign,” such as a new organ.
• Like any medication, these drugs can have unpleasant side effects.
• Some of the most common immune-suppressing drugs used in transplantation are described here.
• Cyclosporine: This drug interferes with communication between the T cells of the immune system. It is started immediately after the transplant to suppress your immune system and continued indefinitely. Common side effects include tremor, high blood pressure, and kidney damage. These side effects are usually related to the dose and can often be reversed with proper dosing.
• Corticosteroids: These drugs block T-cell communication as well. They are usually given at high doses for a short period immediately after the transplant and again if rejection is suspected. Corticosteroids have many different side effects, including easy bruising of the skin, osteoporosis, avascular necrosis (bone death), high blood pressure, high blood sugar, stomach ulcers, weight gain, acne, mood swings, and a round face. Because of these side effects, many transplant centers are trying to reduce the maintenance dose of the drug as much as possible or even to replace it with other drugs.
• Azathioprine: This drug slows the production of T cells in the immune system.Azathioprine isusually used for long-term maintenance of immunosuppression. The most common side effects of this drug are suppression of the bone marrow, which produces blood cells, and liver damage. Many transplant centers are now using a newer drug called mycophenolate mofetil instead of azathioprine.
• Newer antirejection drugs include tacrolimus, sirolimus, and mizoribin, among others. These drugs are now being used to try to reduce side effects and to replace drugs after episodes of rejection.
• Other costly and experimental treatments include using antibodies to attack specific parts of the immune system to decrease its response.

 

Outlook After Kidney Transplantation

Self-care at home The period immediately following your transplant can be very stressful. You will not only be recovering from major surgery, you will also be anxious about organ rejection.

• You, your family, and the transplant coordinators must keep in contact and close follow-up with the transplant team.
• Before leaving the hospital, you will be given instructions on proper doses of and schedule for antirejection medication. Keeping track of these medications is extremely important, because they can actually harm your transplanted kidney if the doses are not appropriate.
• You will be taught how to measure your blood pressure, temperature, and urine output at home, and you should keep a log of these readings.
• Your social worker and dietitian will counsel you before you leave the hospital.

In the first few weeks after leaving the hospital, you will meet with members of your team frequently to monitor your recovery, review the logs, undergo blood tests, and adjust medication doses.
The outcome for kidney transplants continues to improve with advances in immune-suppressing medications.

• In the United States, the 3-year graft survival rate after transplantation is almost 80%.
• The earlier you can detect rejection, the better the chance it can be reversed and the new kidney’s function preserved.

Complications

• Rejection
• Infection
• Cancer: Certain cancers, such as basal cell carcinoma, Kaposi sarcoma, carcinoma of the vulva and perineum, non-Hodgkin lymphoma, squamous cell carcinoma, hepatobiliary carcinoma, and carcinoma in situ of the uterine cervix, occur more frequently in people who have undergone kidney transplantation.
• Relapse: A small number of people who undergo transplantation for certain kidney disease experience a return of the original disease after the transplant.
• High blood cholesterol level
• Liver disease
• Weakening of the bones

Women who wish to become pregnant are usually told to wait for 2 years after the operation. Many women have taken their pregnancies to term after transplantation, but there is an increased risk of kidney rejection and fetal complications.
Signs of kidney rejection
One of your greatest concerns as a transplant recipient will be that your body’s immune system will reject and attack the transplanted kidney. If not reversed, rejection will destroy the transplanted organ. For this reason, you and your family must keep aware of warning signs and symptoms of rejection. You must contact the transplant team immediately if any of these symptoms develop.

• Hypertension (high blood pressure) – An ominous sign that the kidney is not functioning properly
• Swelling or puffiness – A sign of fluid retention, usually in the arms, legs, or face
• Decreased urine output

If you are a kidney transplant recipient, any of the following symptoms warrant immediate care at a hospital emergency department, preferably the hospital where the transplant was done.

• Fever – A sign of infection
• Abdominal pain
• Tenderness, redness, or swelling at the surgical site
• Shortness of breath – A sign of fluid retention in the lungs

 

Follow-up

You must keep follow-up appointments with your transplant team to monitor for signs of rejection.

• You will have regular blood and urine tests to detect any signs of organ failure. One or more ultrasounds of the graft kidney may be done to see if there are structural abnormalities suggesting rejection.
• An arteriogram or nuclear medicine scan may be needed to confirm that blood is flowing to the transplanted kidney.

 

NURSING RESPONSIBILITIES:

One of the most important nursing roles involved in the urinary system is keeping I & O, (intake and output).

The fluid intake and output must be accurately measured for all patients with any urinary related issues. Unless a patient is on fluid restrictions they should be offered fluids frequently and have them fresh and readily available at their bedside. Fluids should include a variety of juices, tea, soups and most of all water. Adequate hydration keeps the urinary system clean and prevents urine from becoming concentrated. The fluid intake should be no less then 2500 cc every day. Unless fluids are being lost through excessive perspiration, vomiting or diarrhea the output should be approximately 2000 cc ( if their intake was 2500cc). There is always loss with breathing and normal body function. If the patient is dehydrated and not receiving enough fluids these body functions caot be performed correctly.

The intake part of I & O consists of any fluid taken in by the patient. This can be orally or IV. A fluid is anything that is liquid or turns back into liquid at room temperature. Ice cream, Jell-O, Soups. The output part of I & O is any thing out of the body in liquid form. This can be from any part of the body. Vomiting, severe perspiration, diarrhea, and of course urine. All of these must be written down and documented as soon as it occurs. Trying to remember what your patient drank all day or when and how much they urinated is not OK. Many patient are too confused or just to tired or confused to remember what they drank or how much they urinated.

If you have a mobile patient it is best to have a hat in the commode to catch the urine. For a man have him use a urinal. For things like excessive sweating this is more difficult to measure, you may say a chux soaked two times this shift.. This can also be used if the patient is incontinent and uses some sort of attends (adult diaper). Some people are on very strict I & O and the attends would have to be weighed. When doing I & O remember to notice the color and odor and any sentiment you may see.

Another nursing responsibility is collecting specimens related to the urinary system “A Urinalysis”. There are several different kinds of urine samples that may be needed:

1.) Clean catch, all urine specimen should be clean catch, if a urine specimen states:

2.) Routine, this means there is no special procedures for collection but bacteria collects around the urinary meatus all the time, so if we do not clean the area prior to collection of the specimen you are going to end up with a contaminated specimen. So be it routine or clean catch, please clean the area prior to collection.

3.) Sterile urine specimeeeds to come from a catheter. It is not OK to collect a specimen directly from a catheter bag!!! You must clamp the catheter off for approximately 20 – 30 minutes prior to collection and then clean the catheter tip with alcohol and then drip the urine into a sterile cup. If it is a patient who does not already have a catheter in place then you, (the license. nurse) must do a sterile straight catheter specimen.

4.) A 24 hour urine specimen is just that. You MUST save all urine for 24 hours to find out if there is protein being spilled into the urine. If any of the urine is not added to the specimen it is of no value and must be done all over again.

All urine specimens must be labeled with the patients name, time and date, they must also be refrigerated until they are given to the lab.

CATHETER CARE

A nursing responsibility in any level of nursing is catheter care. No matter what level of nursing you do, there is a obligation to perform high levels of catheter care.

A Foley catheter is a sterile plastic tube that is inserted into the patient’s urethra, once it goes into the urethra it is guided carefully up into the bladder. In the female this is approximately 1 1/2 inches, in the male approximately 8 inches. Once the sterile plastic tube has been placed and has urine return, (to ensure proper placement), a balloon that lies at the top of the catheter is inflated. There are two ports at the external portion of the catheter, one is to hook the closed drainage bag and the other is to insert 5-8 cc of sterile water to inflate the balloon. Once this balloon is inflated with water it is VERY painful to be pulled on. To give you a visual; look at your pinkie finger, suppose this was the size of your urinary meatus, now; pull a good size tangerine through a hole that size inside your body. Think that would HURT? There are leg straps to avoid this from happen, make sure the catheter is secure in some way to the patient’s leg.

Once the catheter is in place and there has been a adequate urine return, the inflated balloon and leg strap with keep the catheter in place. There is a catheter bag that is attached to the open port. This bag is to stay on the catheter except for the BI-monthly changed, (each facility has their own rules for when the catheter and bags are changed). Infections (UTI’s) are just waiting to get up into the urinary system, please do not help them. If a patient has a bowel movement, the catheter needs to be wiped down. This is a direct line for the e-coli to travel. There is no reason to remove a catheter bag for showering it is a closed system and it can get wet, this is actually a good time to make sure everything gets clean. The tubing must hang freely, no kinks or obstruction.

Always remember fluids run down hill, so the catheter bag must always be below the bladder or the urine will back flow into the bladder and this can cause infection. There are many reasons patients have Foley catheters and most people do not enjoy them. Please keep this in mind when dealing with the patient with a Foley catheter. Patients may complain of pain around the urinary meatus while there is a catheter in place, this may be caused by spasms and needs to be dealt with as soon as possible, it can be very painful and cause urinary retention.

Many times patients with catheters are on I &O. When draining the urinary catheter bag, ( which should be emptied at the end of each shift), you need to use a graduate that is marked allowing you to measure the output. Do not measure urine for output while still in the catheter bag. There are several different kinds of drainage bags. Get to know your facilities bags to ensure their proper use. If you do not close the bag correctly after emptying, urine will drain all over the floor.

Catheters are a must with some patients even though they are a huge sources of infection and discomfort, so we as nurses need to do our part in helping the patient be comfortable and free of infection while they have a catheter. Once it has been decided that a patent is going to have a catheter removed it is time for bladder training. Bladder training: When a catheter is in place it causes the urinary meatus to remain open. The bladder has gotten use to urine just leaving as soon as it entered, there was no need to respond in any way as to empty or not. The sphincter muscle works like a hair tie, once the elastic is held open for a long time it does not have the ability to close tightly and quickly as it had before. With bladder training we want the bladder to respond again, we want the sphincter to open and close. Most facilities have a standardized form that is used for bladder training. The form is displayed in a private manner for all nursing staff to use when caring for the patient.

The forms are different in each facility but serve the same purpose. The catheter is clapped for a stated amount of time, the time is gradually increased as the patient is able to tolerate. all times of clamp and unclamp are documented on the form. Many times a patient becomes anxious and says they can’t hold it, ensure them the catheter is still in place and all is fine. Once the catheter has been removed bladder, training continues until we see everything is back on track. It is very important to monitor output after the catheter is removed to avoid retention and incontinence.

As you can see the urinary system is very complex and the nurse’s role is very important. One of the most important things you need to remember is privacy in all aspects of nursing.

When it comes to the patient and the urinary system put yourself in their place, provide privacy and dignity with all of your care. When you place a patient on a bedpan or get them up to use a commode; pull the curtain, shut the door, and encourage them to do as much for themselves as possible.

Stay near by so you can be readily available to assist them as needed. No one wants to have a catheter. No one wants to be incontinent. Smile and be professional. Keep yourself informed, there are always new things happening in the medical field.

You are special and you deserve the best, and that means to broaden your horizons, grow, learn…

Thank You and God Bless.

Male genital problems and injuries can occur fairly easily since the scrotum and penis are not protected by bones. Genital problems and injuries most commonly occur during:

• Sports or recreational activities, such as mountain biking, soccer, or baseball.
• Work-related tasks, such as exposure to irritating chemicals.
• Falls.

A genital injury often causes severe pain that usually goes away quickly without causing permanent damage. Home treatment is usually all that is needed for minor problems or injuries. Pain, swelling, bruising, or rashes that are present with other symptoms may be a cause for concern.

Male genital conditions

• Testicular cancer. This is the most common cancer in men 15 to 35 years old. Testicular cancer is more common in white men than in black men. Many growths in the scrotum or testicles are not cancer (benign). But a painless lump in a testicle may be a sign of cancer.
• An erection problem. This may occur when blood vessels that supply the penis are injured. A man may not be able to have an erection (erectile dysfunction), or the erection may not go away naturally (priapism), which is a medical emergency.
• Torsion of a testicle. This occurs when a testicle twists on the spermatic cord and cuts off the blood supply to the testicle. This is a medical emergency.
• Scrotal problems. These problems may include a painless buildup of fluid around one or both testicles (hydrocele) or an enlarged vein (varicose vein) in the scrotum (varicocele). Usually these are minor problems but may need to be evaluated by your doctor.
• Problems with the foreskin of an uncircumcised penis. Conditions that make it hard to pull the foreskin back from the head of the penis (phimosis) or that prevent a tightened, retracted foreskin from returning to its normal position over the head of the penis (paraphimosis) need to be evaluated.
• Hypospadias. This is a common birth defect where the urethra does not extend to the tip of the penis.
• Undescended testicles (cryptorchidism). This occurs when one or both testicles have not moved down into the scrotum.
• An inguinal hernia. A hernia occurs when a small portion of the bowel bulges out through the inguinal canal into the groin.
• A kidney stone. A stone forms from minerals in urine that crystallize and harden. Kidney stones are usually painless while they remain in the kidney, but they can cause severe pain as they break loose and travel through narrow tubes to exit the body.
• A sebaceous cyst. A cyst that is filled with a cheeselike, greasy material may develop beneath the outer layer of the skin in the scrotum.

Infections

Infections can occur in any area of the genitals, including:

• A testicle (orchitis).
• The epididymis (epididymitis).
• The urethra (urethritis).
• The prostate (prostatitis).
• The bladder (cystitis).
• A simple hair follicle (abscess) or deeper abscess in the scrotum that may involve the testicles, epididymis, or urethra.
• The genital area (Fournier’s gangrene).
• The head of the penis. The infection may occur under the foreskin. This is called balanitis.

Rashes

Rashes in the groin area have many causes, such as ringworm or yeast. Most rashes can be treated at home.

A rash may be the first symptom of a sexually transmitted infection (STI). If you may have been exposed to an STI, do not have sexual contact or activity until you have been evaluated by your doctor. This will reduce the risk of spreading a possible infection to your sex partner. Your sex partner may also need to be evaluated and treated.

Male genital problems may be related to whether the penis is circumcised or not. For more information, see the topic Circumcision.

Little boys may play with toys or other objects near their penis and accidentally cause an injury. Anything wrapped around the penis or an object in the penis needs immediate evaluation to avoid problems.

If you use a urinary catheter to drain your bladder, your doctor will give you instructions on when to call to report problems. Be sure to follow the instructions your doctor gave you.

Check your symptoms to decide if and when you should see a doctor.

Testicular Cancer

Testicular cancer is the most common cancer in men 15 to 35 years old. Testicular cancer is more common in white men than in black men.

The causes of testicular cancer are not completely understood. But the following conditions increase the risk of development:

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• Undescended testicle. Men with undescended testicles have the highest risk for developing testicular cancer. More study is needed to determine how much, if any, the risk decreases after surgical correction and whether age at the time of surgery is a significant factor.
• Abnormal testicular development.
• Klinefelter syndrome.
• Previous diagnosis of testicular cancer.

The main symptom of testicular cancer is swelling or a painless lump in the scrotum (in or on a testicle). Other symptoms include a dull ache in the belly or pelvis, pain or a feeling of heaviness in the testicles, and fluid collection (edema) in the scrotum.

Testicular cancer is treated with a combination of surgery, chemotherapy, and radiation therapy. The exact treatment depends on the type and extent of the testicular cancer. Most forms of testicular cancer are curable when detected early.

Erection Problems and Dysfunction

A man’s penis becomes erect when one of his senses-sight, sound, taste, touch, or smell-is stimulated and he becomes aroused. His central nervous system sends nerve impulses that increase blood flow to his penis. As blood flows into the penis, the penis gets larger and harder. The blood vessels that drain blood from the penis are blocked enough so that blood stays in the penis, maintaining the erection.

For a man to have a normal erection, he needs to have an intact nervous system that receives external stimulus signals and sends arousal signals to the penis and an intact system of arteries and veins (vascular system) that allows blood to flow in and out of the penis.

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Most erection problems are caused by a combination of both physical and psychological factors.

Physical causes of erection problems

Physical causes of erection problems may include illnesses, injuries, or complications of surgery (such as removal of the prostate for cancer) that interfere with nerve impulses or blood flow to the penis. When the nervous system cannot transmit arousal signals, or when the blood vessels in the penis cannot fill or stay filled with blood, a man cannot have an erection.

Physical causes of erection problems include:

• Problems with the blood vessels (vascular problems).
• Problems with the nerves (neurologic problems), such as with diabetes, multiple sclerosis, or after a stroke.
• Problems with the structure of the penis or surrounding tissues.
• Medicine side effects, such as from medicines taken for high blood pressure or depression.
• Hormone problems.
• A zinc deficiency.
• Age, particularly being older than age 50.

Psychological causes of erection problems

Psychological causes of erection problems include depression, anxiety, stress, grief, and problems with relationships. They interfere with the erection process by distracting the man from things that would normally arouse him or by lessening the effect they normally have on him.

Psychological issues account for about 40% of erection problems. Erection problems in men younger than 50 are more likely to be caused by psychological issues. Psychological causes of erection problems include the following:

• Relationship problems
• A man who loses sexual interest in or desire for a particular partner may develop erection problems.
• A man who has been widowed recently may have erection problems.
• Some men may have problems having sexual intercourse with their partner after she has given birth.

Erectile dysfunction

Erectile dysfunction (impotence) refers to a man’s inability to achieve or maintain an erection that is sufficient to have sexual intercourse. It does not mean lack of sexual interest or desire, and the man may or may not be able to have orgasms or ejaculate. Erectile dysfunction can occur at any age. Occasional episodes are considered normal and often do not mean there is a serious problem. Doctors prefer the term erectile dysfunction over impotence.

Erectile dysfunction can also be related to another medical condition, such as:

• Diabetes.
• Heart disease.
• High blood pressure (hypertension).
• Liver or kidney disease.
• Alcohol or drug abuse or withdrawal.
• Pelvic injury or surgery.

Many medicines can cause erectile dysfunction.

Medicines used for erection problems

Medicines that cause an erection may be used for erectile dysfunction from physical problems. They also may be used along with counseling to treat erection problems that have psychological causes. Most men do not have serious side effects from these medicines. But if you have an erection that lasts longer than 3 hours, call your doctor immediately.

Torsion of a Testicle

Torsion of a testicle is a condition in which the blood supply to the testicle is cut off. This occurs when a testicle twists on the spermatic cord.

Torsion of a testicle is most likely to occur in boys around the time they reach puberty, but it may occur in younger and older males as well. Torsion of a testicle may occur for no apparent reason, even during sleep. It may also occur after strenuous physical activity.

Symptoms of torsion of the testicle include:

• Severe pain in the scrotum.
• Nausea and vomiting.
• Abdominal pain.

This conditioeeds to be corrected as soon as possible to restore normal blood flow. If left too long, the tissue of the testicle can die from lack of blood. Often emergency surgery is needed.

Hydrocele

A hydrocele is a buildup of fluid around one or both testicles that causes the scrotum or groin area to swell. The swelling may be unsightly or uncomfortable, but it is not painful.

Hydroceles may be present at birth (congenital) or may develop after birth (acquired). Congenital hydroceles usually go away by age 2. Acquired hydroceles may be caused by an injury to the groin area. Or the cause may be unknown. An acquired hydrocele can occur at any age, but it is most common in men older than 40.

If a hydrocele stays the same size or gets smaller as the body reabsorbs the fluid, generally no treatment is needed. If the hydrocele varies in size or gets bigger and becomes uncomfortable, surgery may be needed to remove the fluid.

Varicocele

A varicocele is an enlarged, twisted vein (varicose vein) in the scrotum, most often on the left side. It feels like a “bag of worms” and may occasionally cause discomfort.

A large varicocele is thought by some to be related to some cases of abnormally low sperm count. While studies have not shown that varicocele repair has value for improving fertility, some doctors will repair a large varicocele, based on the belief that it may improve a man’s abnormally low sperm count. Otherwise, varicoceles are usually left alone.

Phimosis

Phimosis is a tightening of the foreskin that normally folds over the penis. This tightening may squeeze the penis, which may swell until it cuts off blood flow, damaging the tissue.

Correcting phimosis often requires surgery to remove the foreskin (circumcision).

Paraphimosis

Paraphimosis is a condition in which the skin that normally folds over the penis-the foreskin-tightens and retracts, and cannot return to its normal position over the head of the penis. If not corrected, the penis will swell, and the blood flow to the head of the penis may be cut off, damaging the tissue.

Paraphimosis is caused by inflammation or infection of the foreskin, and may be linked with poor personal hygiene. Paraphimosis can only occur in uncircumcised men. Treatment may include circumcision and antibiotics.

Hypospadias and Undescended Testicles

Hypospadias is a common birth defect where the urethra does not extend to the tip of the penis. Instead, the opening of the urethra is located somewhere along the underside of the penis, running along a soft groove. The scrotum may also be incompletely formed or divided into separate sacs or lobes. In many cases of hypospadias, particularly when the genitals are incompletely formed, the testicles do not descend.

Hypospadias can usually be corrected with reconstructive surgery, which is usually performed when the boy is between 6 months and 2 years of age. A boy who has hypospadias should not be circumcised because the foreskin may be needed during surgery.

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Hypospadias may be caused by an intersex disorder, which is a condition that is caused by abnormalities in the chromosomes or endocrine system that can produce female characteristics in a male baby.

Undescended Testicle (Cryptorchidism)

An undescended testicle (cryptorchidism) is one that remains inside the body and has not moved down into the scrotum. Normally the testicles, which form inside the abdomen of an unborn baby boy, descend into the sac beneath the penis (scrotum) by the time the baby is born.

One or both testicles may be affected. In most cases, the testicle will descend without treatment by the time the baby is 3 months old. If this does not happen, a doctor may advise surgery-laparoscopy or orchiopexy-to move the testicle into the scrotum.

A male who has undescended testicles has an increased risk of testicular torsion, hernia formation, infertility, and testicular cancer.

nguinal Hernia

An inguinal hernia occurs when a small portion of the bowel bulges out through the inguinal canal-a passage or opening through the muscles of the abdominal wall-into the groin. The bulge usually contains tissue lining the inside of the abdomen as well as fatty tissue from inside the abdomen or a loop of intestine.

There are two types of inguinal hernias:

• Direct inguinal hernias occur when a weak spot develops in the lower abdominal muscles. Often the cause of the hernia is not known, but lifting, straining, or coughing or being obese, pregnant, or constipated are often thought to be causes of hernias.
• Indirect inguinal hernias occur when the inguinal canal fails to close before birth. The hernia may appear in a male’s scrotum or in the fold of skin at the opening of a female’s vagina. This is the most common type of inguinal hernia, and it may occur at birth or later in life. Indirect hernias are more common in males.

Symptoms of an inguinal hernia may come on gradually or suddenly and may include a bulge in the groin or scrotum and discomfort, pain, or a feeling of heaviness. Other symptoms may develop if tissue in the hernia becomes trapped (incarcerated) or if the blood supply to the trapped tissue is cut off (strangulated).

An inguinal hernia may require surgery. In some cases, hernias that are small and painless may never need to be repaired.

Kidney Stones

Kidney stones are made of salts and minerals in the urine that stick together to form small “pebbles.” They are usually painless while they remain in the kidney, but they can cause severe pain as they travel through the ureters (narrow tubes that connect the kidneys and the bladder) to exit the body during urination.

Symptoms of a kidney stone include severe pain on one side of the back, just below the rib cage (flank pain). The pain may spread to the lower abdomen, groin, and genital area. Other symptoms include blood in the urine (hematuria), painful or frequent urination (dysuria), and nausea and vomiting.

A kidney stone is usually treated at home with pain medicine until it has passed. Make sure you drink enough fluid so that you don’t get dehydrated. Most of the time, the stone will pass in a few days. If the stone seems unlikely to pass on its own or is causing severe pain, treatment options include a shock wave treatment (lithotripsy), which can break up a large stone into smaller pieces that are easier to pass, or, in very rare cases, surgery.

If a stone is stuck in a ureter, a long, thin viewing tool (ureteroscope) can be passed through the urethra and bladder to the ureter. The stone may be taken out using a tiny basket on a wire passed through the ureteroscope. The stone can also be broken up using laser and then flushed out of the ureter with fluids inserted through the ureteroscope.

There are four main types of kidney stones, and they can be as small as grains of sand or as large as a golf ball. Kidney stones occur most often in adults and are rare in children.

Orchitis

Orchitis is an inflammation or infection of the testicle, often caused by a virus or bacteria. Symptoms of orchitis include pain, swelling, or a feeling of heaviness in the scrotum.

Orchitis occurs most often in men who have mumps. Influenza, tuberculosis, and sexually transmitted diseases may also cause orchitis.

Pain and swelling in the scrotum should be evaluated by a doctor. Treatment of orchitis caused by bacteria includes antibiotics. Orchitis caused by a virus, such as mumps, is treated with rest and pain medicine.

Epididymitis

Epididymitis is inflammation and infection of the long, tightly coiled tube that lies behind each testicle and collects sperm (epididymis). Epididymitis can be caused by a urinary tract infection, a sexually transmitted disease, an enlarged prostate, or a urologic procedure.

Epididymitis usually starts suddenly. Symptoms can include pain, scrotal swelling, painful or frequent urination, and fever or chills.

Bacterial epididymitis is treated with antibiotics. Other treatments for epididymitis may include bed rest, ice packs, scrotal support with a jock strap, and pain medicine.

A person with symptoms of epididymitis should avoid sexual intercourse until he sees a doctor. This will reduce the risk of spreading a possible infection to his sex partner or partners. It is important for sex partners to be evaluated and treated for a possible infection.

Urethritis

Urethritis is inflammation of the tube that carries urine from the bladder to outside of the body (urethra). It can be caused by a bacterial or viral infection (like some sexually transmitted infections), irritation from soap or spermicide, or injury.

Symptoms of urethritis can include:

• Pain or burning during urination (dysuria).
• An urgent need to urinate.
• A need to urinate more often than usual.
• A clear, yellow, or green discharge from the urethra.

When urethritis is caused by a bacterial infection, antibiotic medicine is used to treat it.

Prostatitis

Prostatitis is a usually painful condition of the prostate gland, the small walnut-shaped organ that lies just below a man’s bladder. The prostate gland produces most of the fluid in semen.

Often the cause of prostatitis is not known. Many men with prostatitis have no signs of inflammation, so no exact cause can be determined. Prostatitis may be caused by an infection or by inflammatioot related to infection. It may be acute (short-term) or chronic (long-term).

Symptoms of prostatitis include:

• An urge to urinate often but passing only small amounts of urine; feeling an urgent need to urinate; a burning sensation when urinating; and the inability to empty the bladder completely.
• Difficulty starting urination, interrupted flow (urinating in waves instead of in a steady stream), weaker-than-normal urine flow, and dribbling after urinating.
• Pain or discomfort in the lower back; in the area between the scrotum and the anus; in the lower abdomen, scrotum, or upper thighs; or above the pubic area.
• Excessive urinating at night.
• Prostate pain or vague discomfort on ejaculation.

Treatment for prostatitis varies according to the cause. In many cases, medication is needed.

Bladder Infection (Cystitis)

Bladder infection (cystitis) is the most common infection of the lower urinary tract. Bladder infection is usually caused by bacteria that get into the bladder by traveling up the urethra.

Bladder infections are more common in women than in men.

Symptoms of a bladder infection can range from mild to severe, and may include:

• Burning pain with urination (dysuria).
• The frequent need to urinate without being able to pass much urine (frequency).
• Blood in the urine (hematuria).

Symptoms of a bladder infection in children depend on the age of the child. A very young child may cry when urinating or may vomit due to the bladder infection. It may be hard to know if the symptoms are a result of urinary problems or another cause.

If untreated, bladder infections can lead to more serious kidney infections that cause fever and lower back (flank) pain, and may damage the kidneys. Bladder infections are treated with antibiotics.

Abscess

An abscess is a pocket of pus that forms at the site of infected tissue. An abscess can form on the skin or on tissues within the body and cause pain, swelling, and tenderness.

Bacteria are a common cause of the infections that form abscesses.

Depending on the size and location of the abscess, your doctor may treat the abscess by:

• Using a needle to drain it.
• Cutting open the abscess to remove the pus and infectious material.
• Prescribing antibiotics (pills or a shot). This may be adequate treatment if the abscess is small and treatment is not delayed.

Fournier’s Gangrene – Topic Overview

Fournier’s gangrene is a serious, life-threatening infection of the male genital area. The infection usually starts in the skin of the genitals (penis or scrotum), the urethra, or the rectal area.

There are several conditions that may lead to this infection. Frequently an injury or burn to the area occurred before the infection. Genital surgery, a sexually transmitted infection (STI), or a problem with the urethra also may precede this infection. Men with certain conditions are at higher risk for developing Fournier’s gangrene. These conditions include:

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• Being older than age 50.
• Having diabetes.
• Having a suppressed immune system.

Symptoms include:

• Swelling and redness.
• Tissue that looks deeply bruised but is actually dead (necrotic).
• Drainage of pus with a bad odor.
• Pain.
• Fever.
• Pain with urination.
• Problems passing urine.
• Possible shock.

This infection is a medical emergency. It is treated with antibiotics, and surgery is usually needed to remove dead (necrotic) tissue.

Gynecological Disorders

The NICHD (National Institute of Child Health and Human Development) funds and conducts research on many disorders that affect the organs in a woman’s abdominal and pelvic areas. In general, most of these disorders don’t directly affect a woman’s changes of getting pregnant naturally. Some of these conditions include:

• Vulvodynia
• Vaginitis
• Pelvic Floor Disorders
• Pelvic Pain

Vulvodynia

Vulvodynia (vul-voh-DINN-nee-uh) is the term used to describe chronic discomfort or pain of the vulva, especially burning, stinging, irritation, or rawness of the area. Health care providers don’t agree on the exact definition of vulvodynia. Currently, the term is used to describe a variety of conditions.

The NICHD is also supporting other research on vulvodynia.

Vaginitis

Vaginitis (va-jinn-EYE-tiss) is a term used to describe any disorder that causes swelling or infection of both the vulva and the vagina. Vaginitis is different from vulvodynia because it affects the vagina, which is inside the woman’s body; vulvodyina only affects the vulva, which is outside the woman’s body.

The most common types of vaginitis include:

• “Yeast” infections–Infections caused by the fungus Candida. The most apparent symptom of a yeast infection is a thick, white vaginal discharge; some women also experience a red, itchy vulva. There are many over-the-counter and prescription treatments for yeast infections. If you think you have a yeast infection, talk to your health care provider about how to treat it.
• Bacterial vaginosis–Caused by an overgrowth of bacteria that are normally present in the vagina. This type of vaginosis is the most common vaginal infection for women of reproductive age. The most common symptom is a vaginal discharge, which is usually thin and milky; it may also have a “fishy” odor. Your health care provider can recommend medications to treat bacterial vaginosis.
• Sexually transmitted forms of vaginitis–These types of vaginitis are most often spread through sexual contact (vaginal, oral, or anal intercourse or intimate contact), and are also called sexually transmitted diseases (STDs) or sexually transmitted infections (STIs). Some types of sexually transmitted vaginitis include:

• Trichomoniasis–Is a curable infection. Many women with this condition don’t have any symptoms; but some women do. Common symptoms include: vaginal discharge that is bubbly, greenish-yellow, and has an odor; itching and soreness of the vulva and the vagina; and burning when you urinate. Most health care providers will prescribe an antibiotic to treat and cure trichomoniasis; however, for treatment to work properly, sexual partners should be treated at the same time.
• Chlamydia–Is a curable infection. Because chlamydia does not make most people sick, you can have the infection and not even know it. Symptoms of chlamydia include a mucus-like or pus-like vaginal discharge or pain when you urinate. But these symptoms can be mild. The bacteria can also infect your throat, if you’ve had oral physical contact with an infected partner. A pregnant woman infected with chlamydia can transmit the infection to her infant during delivery. In the infant, the infection can cause the lining of the eye to become swollen and red (often called pink eye). If left untreated, chlamydia can move inside the body and cause pelvic inflammatory disease (PID), which can be serious. Health care providers will prescribe an antibiotic to treat and cure chlamydia; however, penicillin, an antibiotic used to treat other infections, won’t cure chlamydia.
• Herpes simplex virus (HSV)–Also called “genital herpes,” is caused by a virus. Genital herpes can be controlled, but not cured. Most women with genital herpes will have sores or lesions on the vulva, or on the outside of the vagina; sometimes these sores are found within the vagina, and can only be seen during a gynecological exam. The sores are often the source of pain for women infected with genital herpes. Your health care provider can recommend ways to control the symptoms of genital herpes.
• Human papilloma virus (HPV)–Is caused by a virus. It can be controlled, but not cured. Some women with HPV don’t have any symptoms; they don’t find out they have the virus until they get the results of their annual pap smear. Other women with HPV have genital warts, usually gray, white, or purple, that grow in their vagina or rectum, or on their vulva or groin. Genital warts can be painful. Some types of HPV are known to lead to certain types of cervical cancer and other cervical problems. Efforts are now underway to develop a vaccine to protect women from HPV, which could also prevent certain types of cervical cancer.

• Noninfectious vaginitis–Is typically the result of an allergic reaction or an irritation to vaginal sprays, creams, and spermacides, or to soaps, detergents, and fabric softeners. Once you stop using the product that caused the reaction, your symptoms should go away. But, your health care provider may suggest a medicated cream to reduce the symptoms until the reaction goes away.

NICHD is currently conducting a one-year longitudinal study on bacterial vaginosis and the factors associated with the condition. Results from the study are expected in 2005.

The National Vaginitis Association also provides patient information on these types of infections.

Pelvic Floor Disorders

The term “pelvic floor” refers to the group of muscles that form a sling or hammock across the opening of the pelvis. These muscles, together with their surrounding tissues, keep all of the pelvic organs (bladder, uterus, and rectum) in place so that the organs function correctly. A “pelvic floor disorder,” then, is a problem with these muscles or the surrounding tissues that leads to dysfunction of one or more of the pelvic organs.

 

What is vaginitis?

Vaginitis is inflammation of the vagina that arises from any cause. Infections with bacteria, yeast, or Trichomonas organisms are common causes of vaginitis, but physical or chemical irritation can also lead to inflammation and vaginitis. Some of the infections that cause vaginitis are sexually transmitted diseases (STDs), but not all forms of vaginitis are due to STDs. Often, the vulvar area is also inflamed along with vaginitis, a condition that is referred to as vulvovaginitis.

What is a Pap smear?

A Pap smear (also known as the Pap test) is a medical procedure in which a sample of cells from a woman’s cervix (the end of the uterus that extends into the vagina) is collected and spread (smeared) on a microscope slide. The cells are examined under a microscope in order to look for pre-malignant (before-cancer) or malignant (cancer) changes.

A Pap smear is a simple, quick, and relatively painless screening test. Its specificity – which means its ability to avoid classifying a normal smear as abnormal (a “false positive” result) – while very good, is not perfect. The sensitivity of a Pap smear – which means its ability to detect every single abnormality — while good, is also not perfect, and some “false negative” results (in which abnormalities are present but not detected by the test) will occur. Thus, a few women develop cervical cancer despite having regular Pap screening.

In the vast majority of cases, a Pap test does identify minor cellular abnormalities before they have had a chance to become malignant and at a point when the condition is most easily treatable. The Pap smear is not intended to detect other forms of cancer such as those of the ovary, vagina, or uterus. Cancer of these organs may be discovered during the course of the gynecologic (pelvic) exam, which usually is done at the same time as the Pap smear.

Who should have a Pap smear?

Pregnancy does not prevent a woman from having a Pap smear. Pap smears can be safely done during pregnancy.

Pap smear testing is not indicated for women who have had a hysterectomy (with removal of the cervix) for benign conditions. Women who have had a hysterectomy in which the cervix is not removed, called subtotal hysterectomy, should continue screening following the same guidelines as women who have not had a hysterectomy.

The screening guidelines of several key medical organizations are summarized in the table below.

Genital warts (HPV) facts

• Genital warts are caused by infection with a subgroup of the human papillomaviruses (HPVs).
• Another subgroup of the HPVs that infect the anogenital tract can lead to precancerous changes in the uterine cervix and cause cervical cancer.
• HPV infection is now considered to be the most common sexually-transmitted infection (sexually transmitted disease, STD) in the U.S., and it is believed that at least 75% of the reproductive-age population has been infected with sexually-transmitted HPV at some point in life.
• HPV infection is common and does not usually lead to the development of warts, cancers, or even symptoms.
• HPV infection of the genital tract is transmitted through sexual contact, although non-sexual transmission is also possible.
• In many cases genital warts do not cause any symptoms, but they are sometimes associated with itching, burning, or tenderness.
• Condom use seems to decrease the risk of transmission of HPV during sexual activity but does not completely prevent HPV infection.

What are human papillomaviruses (HPVs)?

There are over 100 types of human papillomaviruses (HPVs) that infect humans. Of these, more than 40 types can infect the genital tract and anus (anogenital tract) of men and women and cause genital warts known as condylomata acuminata or venereal warts. A subgroup of the HPVs that infect the anogenital tract can lead to precancerous changes in the uterine cervix and cause uterine, cervical cancer. HPV infection also is associated with the development of other anogenital cancers in women. The HPV types that cause cervical cancer also have been linked with both anal and penile cancer in men as well as a subgroup of head and neck cancers in both women and men. Genital warts and HPV infection are transmitted primarily by sexual intimacy, and the risk of infection increases as the number of sexual partners increase.

The most common HPV types that infect the anogenital tract are HPV types 6, 11, 16, and 18 (HPV-6, HPV-11, HPV-16, and HPV-18), although other HPV types can also infect the anogenital tract. Among these, HPV-6 and HPV-11 are most commonly associated with benign lesions such as genital warts and mild dysplasia of the cervix (potentially precancerous changes in the appearance of cervical cells under a microscope) and are termed “low-risk” HPV types. In contrast, HPV-16 and HPV-18 are the types found in the majority of cervical and anogenital cancers as well as severe dysplasia of the cervix. These belong to the so-called “high-risk” group of HPVs.

Other, different HPV types infect the skin and cause common warts elsewhere on the body. Some types of HPVs (for example, HPV 5 and 8) frequently cause skin cancers in people who have a condition known as epidermodysplasia verruciformis.

Cervical cancer facts

• Causes and risk factors for cervical cancer have been identified and include human papillomavirus (HPV) infection, having many sexual partners, smoking, taking birth control pills, and engaging in early sexual contact.
• HPV infection may cause cervical dysplasia, or abnormal growth of cervical cells.
• Regular pelvic exams and Pap testing can detect precancerous changes in the cervix.
• Precancerous changes in the cervix may be treated with cryosurgery, cauterization, or laser surgery.
• The most common symptoms and signs of cervical cancer are abnormal bleeding and pelvic pain.
• Cervical cancer can be diagnosed using a Pap smear or other procedures that sample the cervix tissue.
• Chest X-rays, CT scan, MRI, and a PET scan may be used to determine the stage of cervical cancer.
• Cancer of the cervix requires different treatment than cancer that begins in other parts of the uterus.
• Treatment options for cervical cancer include radiation therapy, surgery, and chemotherapy.
• Two vaccines, Gardasil and Cervarix, are available to prevent HPV infection.
• The prognosis of cervical cancer depends upon the stage and type of cervical cancer and the tumor size.

 

 

BIBLIOGRAPHY

• Netter, Frank, H. MD, Atlas of Human Anatomy ( second edition) Novartis Pub. (1997)
• Scanlon, Valerie C., and Sansers Tina, Understanding Human Structure and Function. F.A. Davis Company (1996)
• Anderson, Kenneth, N., Editor Mosby’s Medical, Nursing, and Allied Health Dictionary. A Harcourt Health Sciences Company. (1998)