Urologic disease

Urologic diseases or conditions include urinary tract infections, kidney stones, bladder control problems, and prostate problems, among others. Some urologic conditions do not affect a person for that long and some are lifetime conditions.[1] Kidney diseases are normally investigated and treated by nephrologists, while the specialty of urology deals with problems in the other organs. Gynecologists may deal with problems of incontinence in women.

Diseases of other bodily systems also have a direct effect on urogenital function. For instance, it has been shown that protein released by the kidneys in diabetes mellitus sensitizes the kidney to the damaging effects of hypertension.[2] Diabetes also can have a direct effect on urination due to peripheral neuropathies, which occur in some individuals with poorly controlled diabetics.

Kidney diseaseEdit

Kidney disease, or renal disease, also known as nephropathy, is damage to or disease of a kidney. Nephritis is an inflammatory kidney disease and has several types according to the location of the inflammation. Inflammation can be diagnosed by blood tests. Nephrosis is non-inflammatory kidney disease. Nephritis and nephrosis can give rise to nephritic syndrome and nephrotic syndrome respectively. Kidney disease usually causes a loss of kidney function to some degree and can result in kidney failure, the complete loss of kidney function. Kidney failure is known as the end-stage of kidney disease, where dialysis or a kidney transplant is the only treatment option.

Chronic kidney disease causes the gradual loss of kidney function over time. Acute kidney disease is now termed acute kidney injury and is marked by the sudden reduction in kidney function over seven days. About one in eight Americans (as of 2007) suffer from chronic kidney disease.[3] Primary renal cell carcinomas as well as metastatic cancers can affect the kidney.

Kidney failureEdit

Kidney failure is defined by functional impairment of the kidney, that is when the kidneys are functioning at 15% or less than normal capability.[1] It is divided into acute kidney failure (cases that develop rapidly) and chronic kidney failure (those that are long term).[4] Symptoms may include leg swelling, feeling tired, vomiting, loss of appetite, and confusion.[1] Complications of acute disease may include uremia, high blood potassium, and volume overload.[5] Complications of chronic disease may include heart disease, high blood pressure, and anemia.[6][7]

Pre-renal kidney failure refers to impairment of supply of blood to the functional nephrons including renal artery stenosis. Intrinsic kidney diseases are the classic diseases of the kidney including drug toxicity and nephritis. Post-renal kidney failure is outlet obstruction after the kidney, such as a kidney stone or prostatic bladder outlet obstruction. Kidney failure may require medication, dietary lifestyle modifications, and dialysis.

Non-renal urinary tract diseaseEdit

Structural and or traumatic changes in the urinary tract can lead to hemorrhage, functional blockage or inflammation. Colonization by bacteria, protozoa or fungi can cause infection. Uncontrolled cell growth can cause neoplasia. The term "uropathy" refers to a disease of the urinary tract, while "nephropathy" refers to a disease of the kidney. For example:

TestingEdit

  • Biochemical blood tests determine the amount of typical markers of renal function in the blood serum, for instance serum urea, serum uric acid, and serum creatinine.[33] Biochemistry can also be used to determine serum electrolytes.[33] Special biochemical tests (arterial blood gas) can determine the amount of dissolved gases in the blood, indicating if pH imbalances are acute or chronic.[34]
  • Urinalysis is a test that studies urine for abnormal substances such as protein or signs of infection.[35] A Full Ward Test, also known as dipstick urinalysis, involves the dipping of a biochemically active test strip into the urine specimen to determine levels of tell-tale chemicals in the urine.[36] Urinalysis may also involve MC&S microscopy, culture and sensitivity
  • Urodynamic tests evaluate the storage of urine in the bladder and the flow of urine from the bladder through the urethra.[37] It may be performed in cases of incontinence or neurological problems affecting the urinary tract. However the American Urogynecologic Society does not recommend that urodynamics are part of initial diagnosis for uncomplicated overactive bladder.[38]
  • Ultrasound is routinely used in urology. In a pelvic sonogram, organs of the pelvic region are imaged. This includes the uterus and ovaries or urinary bladder. Males are sometimes given a pelvic sonogram to check on the health of their bladder, the prostate, or their testicles (for example to distinguish epididymitis from testicular torsion). In young males, it is used to distinguish more benign masses (varicocele or hydrocele) from testicular cancer, which is highly curable but which must be treated to preserve health and fertility. There are two methods of performing a pelvic sonography – externally or internally. The internal pelvic sonogram is performed either transvaginally (in a woman) or transrectally (in a man). Sonographic imaging of the pelvic floor can produce important diagnostic information regarding the precise relationship of abnormal structures with other pelvic organs and it represents a useful hint to treat patients with symptoms related to pelvic prolapse, double incontinence and obstructed defecation. It is used to diagnose and, at higher frequencies, to treat (break up) kidney stones or kidney crystals (nephrolithiasis).[39]

Radiology based testingEdit

  • KUB stands for Kidneys, Ureters, and Bladder. The projection does not necessarily include the diaphragm. The projection includes the entire urinary system, from the pubic symphysis to the superior aspects of the kidneys. The anteroposterior (AP) abdomen projection, in contrast, includes both halves of the diaphragm.[40][41] Despite its name, a KUB is not typically used to investigate pathology of the kidneys, ureters, or bladder, since these structures are difficult to assess (for example, the kidneys may not be visible due to overlying bowel gas.) In order to assess these structures radiographically, a technique called an intravenous pyelogram was historically utilized, and today at many institutions CT urography is the technique of choice.[42]
  • An intravenous pyelogram, also called an intravenous urogram (IVU), is a radiological procedure used to visualize abnormalities of the urinary system, including the kidneys, ureters, and bladder. Unlike a kidneys, ureters, and bladder x-ray (KUB), which is a plain (that is, noncontrast) radiograph, an IVP uses contrast to highlight the urinary tract.[43]
  • CT urography (CTU) is commonly used in the evaluation of hematuria, and specifically tailored to image the renal collecting system, ureters and bladder in addition to the renal parenchyma. Initial imaging includes a noncontrast phase to detect renal calculi as a source of hematuria. Note that dual energy CT may eventually allow the noncontrast phase to be eliminated. Contrast enhancement techniques for CTU vary from institution to institution. A common technique is a double bolus, single phase imaging algorithm. This technique is a hybrid contrast injection strategy that results in opacification of the renal parenchyma and the collecting system, ureters, and bladder. A small contrast bolus is administered initially, followed 10 minutes later with a larger bolus that is imaged in the corticomedullary phase. Excretory phase imaging allows for not only evaluation of the ureteral lumen, but also periureteral abnormalities including external masses and lymphadenopathy.[citation needed]
  • MRI is the investigation of choice in the preoperative staging of prostate cancer.[44]
  • A voiding cystogram is a functional study where contrast "dye" is injected through a catheter into the bladder. Under x-ray the radiologist asks the patient to void (usually young children) and will watch the contrast exiting the body on the x-ray monitor. This examines the child's bladder and lower urinary tract. Typically looking for vesicoureteral reflux, involving urine backflow up into the kidneys.[45]

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External linksEdit

Classification