Medical Terminology: The Genitourinary System

1. What are The Genitourinary System?
The genitourinary system refers to the parts of the body involved in the production and transport of urine, as well as the surrounding structures.
The kidneys are found in the posterior part of the upper abdominal area, relatively protected by the lower ribs. They are lateral to the spinal column. The left kidney is higher than the right kidney because of the location of the liver within the abdomen. The renal artery supplies blood to the kidneys. The nephron is the functional unit of the kidney, the area in which urine is formed. Within the nephron, there is a long tubule. This initially surrounds the glomerulus in an area called Bowman’s capsule.
Bowman’s capsule narrows into a proximal convoluted tubule that has many curves and eventually straightens into a downward loop of Henle, which makes a sharp turn to come back up into the cortex of the kidney. The initial upward portion of the loop of Henle is thin and then becomes thick, which is the distal convoluted tubule.
The kidneys are responsible for filtering wastes from the bloodstream; they aid in the control of fluid and electrolyte balance, acid-base balance, blood pressure control through production of renin, and red blood cell production through the production of erythropoietin.
As urine is produced within the kidneys, it travels through the ducts (ureters) to the bladder. Once the body senses the urge to empty the bladder, the detrusor muscles contract and the sphincter at the bladder neck relaxes to aid in emptying the urine.
The urine passes through the urethra to the outside. Male patients have a prostate gland located under the bladder, surrounding the urethra. Prostatic fluid is secreted from the gland into the urethra.

2. Benign Prostatic Hyperplasia (BPH)
The prostate gland is found just below the bladder in men, surrounding the urethra. As men age, the prostate enlarges, putting pressure on the surrounding structures and causing symptoms such as frequent urination and urinary retention. The enlargement of the prostate causes narrowing of the urethra and upward pressure on the lower border of the bladder. Urinary retention may develop, as the body has a harder time emptying the bladder. Hydronephrosis and dilation of the renal pelvis and ureter are complications of the urinary retention due to overgrowth of the prostate.

3. Bladder Cancer
Bladder cancer is typically a nonaggressive cancer that occurs in the transitional cell layer of the bladder. It is recurrent in nature. Less frequently, bladder cancer is found invading deeper layers of the bladder tissue. In these cases the cancer tends to be more aggressive. Exposure to industrial chemicals (paints, textiles), history of cyclophosphamide use, and smoking increase the risks for bladder cancer.

4. Acute Glomerulonephritis
Glomerulonephritis, also known as acute nephritic syndrome, is infection of the glomerulus and is typically preceded by an ascending infection or occurs secondary to another systemic disorder. Infectious causes include group A beta-hemolytic streptococcus, measles, mumps, cytomegalovirus, varicella, coxsackievirus, pneumonia caused by mycoplasma, Chlamydia psittaci, or pneumococcal infection. Systemic disorders include systemic lupus erythematosus, viral hepatitis B or C, thrombotic thrombocytopenia purpura, or multiple myeloma.

5. Kidney Cancer
Kidney cancer occurs when cancer cells create a tumor within the kidney. Exposure to chemicals, lead, and smoking all increase the risk of developing kidney cancer.

6. Kidney Stones
Kidney stones, also known as renal calculi or nephrolithiasis, occur within the kidneys. Stones can also form elsewhere within the urinary tract. The patient may not have any symptoms from kidney stones until the stone attempts to move down the ureter toward the bladder.
Patients develop crystals within the urine. A slow flow of urine gives the crystals time to form a stone. Crystals may be formed from calcium, uric acid, cystine, or struvite. Medications such as diuretics can increase the risk of kidney stone formation in some patients at risk.

7. Prostate Cancer
Cancer of the prostate typically is found in the peripheral area of the prostate gland. Nodules may be palpable on digital rectal exam. There is a greater incidence as men age. African American males and those with a family history of the disease have a higher risk for prostate cancer. The symptoms of prostate cancer are the same as those of benign prostatic hypertrophy.

8. Pyelonephritis
Pyelonephritis is an infection involving the kidneys. Inflammation of the tissue accompanies the infectious process. The most common bacteria are Escherichia coli, Klebsiella, Enterobacter, Proteus, Pseudomonas, and Staphylococcus saprophyticus. the infection begins in the lower urinary tract and ascends upward. Identification of infections and initiation of treatment are important to prevent the infection from getting worse.

9. Renal Failure
A decrease in renal function can occur in an acute (sudden) or chronic (progressive) progressive. Acute renal failure can be broken down into prerenal, renal, and postrenal.
- Prerenal Failure: This is caused from diminished renal perfusion. Hypovolemia due to blood or fluid losses, diuretic use, third-spacing of fluids, reduced renal perfusion due to nonsteroidal anti-inflammatory drug (NSAID) use or congestive heart failure (CHF) can cause prerenal failure.
- Renal Failure: In acute care patients, this most commonly results from acute tubular necrosis. Drug-related reactions, particularly to antibiotics, may cause an allergic interstitial nephritis. Pyelonephritis or glomerulonephritis may also cause renal failure.
- Postrenal Failure: This is caused by some type of urinary tract obstruction, bladder outlet obstruction, a stone, prostate hypertrophy, or compression of ureter resulting from abdominal mass.
Chronic renal failure is an irreversible renal disease because of damaging effects on the kidneys caused by diabetes mellitus, hypertension, glomerulonephritis, HIV infection, polycystic kidney disease, or ischemic nephropathy.

10. Testicular Cancer
Cancer involving the testicle typically occurs in males in their teens or twenties. The cancer is hormonally dependent and tends to metastasize fairly quickly to lungs or bone. A painless nodule may be found by the patient. There is an increased incidence in patients with a history of cryptorchism.

11. Urinary Tract Infection (UTI)
Urinary tract infection (UTI) occurs when an infecting organism, typically gram-negative bacteria such as E. coli, enters the urinary tract. Inflammation of the local area occurs, followed by infection as the organism reproduces.
Often the bacteria are present on the skin in the genital area and enter the urinary tract through the urethral opening. The organism can also be introduced during sexual contact. The infection occurs as an uncomplicated, community-acquired infection in this setting.
Patients with a urinary catheter in place may also develop an infection because of the presence of the catheter, which allows a pathway for the bacteria to enter the bladder.
Instrumentation of the urinary tract (e.g., cystoscopy), also allows a pathway for bacteria to enter the bladder. Some of the instruments are not completely sterilized between patients; they are treated with a high-level disinfectant because of fiberoptics and lenses within because they would not withstand the high temperatures needed to sterilize. These infections would be considered nosocomial.

Basic Questions
Genitourinary System

1. What is a nephron?
A nephron is the functional unit of the kidney, the area in which urine is formed.

2. What is Bowman’s capsule?
Within the nephron, there is a long tubule. This initially surrounds the glomerulus in an area called Bowman’s capsule.

3. What are ureters?
As urine is produced within the kidneys, it travels through the ducts (ureters) to the bladder.

4. What are detrusor muscles?
Once the body senses the urge to empty the bladder, the detrusor muscles contract and the sphincter at the bladder neck relaxes to aid in emptying the urine.

5. What is benign prostatic hypertrophy (BPH)?
BPH is enlargement of the prostate.

6. What is bladder cancer?
Bladder cancer is typically a nonaggressive cancer that occurs in the transitional cell layer of the bladder.

7. What increases the risk of bladder cancer?
Exposure to industrial chemicals (paints, textiles), history of cyclophosphamide use, and smoking increase the risks for bladder cancer

8. What increases the risk of kidney cancer?
Kidney cancer occurs when cancer cells create a tumor within the kidney. Exposure to chemicals, lead, and smoking all increase the risk of developing kidney cancer.

9. What is acute glomerulonephritis?
Glomerulonephritis, also known as acute nephritic syndrome, is infection of the glomerulus and is typically preceded by an ascending infection or occurs secondary to another systemic disorder.

10. What are kidney stones?
Patients develop crystals within the urine. A slow flow of urine gives the crystals time to form a stone.

11. What medication increases the risk of kidney stone formation?
Diuretics increase the risk of kidney stone formation.

12. What is prostate cancer?
Cancer of the prostate typically is found in the peripheral area of the prostate gland. Nodules may be palpable on a digital rectal exam. The symptoms of prostate cancer are the same as those of BPH.

13. What is pyelonephritis?
Pyelonephritis is an infection involving the kidneys.

14. How does pyelonephritis develop?
Typically the infection begins in the lower urinary tract and ascends upward.

15. What is renal failure?
A decrease in renal function can occur in an acute (sudden) or a chronic (progressive) manner.

16. What is prerenal renal failure?
Prerenal renal failure is caused by diminished renal perfusion. Hypovolemia due to blood or fluid losses, diuretic use, third-spacing of fluids, reduced renal perfusion caused by NSAID use or congestive heart failure (CHF) can cause prerenal failure.

17. What is hypovolemia?
Hypovolemia is decreased fluid volume.

18. What is postrenal failure?
Postrenal failure is caused by some type of urinary tract obstruction, bladder outlet obstruction, a stone, prostate hypertrophy, or compression of ureter resulting from abdominal mass.

19. What is chronic renal failure?
Chronic renal failure is an irreversible renal disease due to damaging effects on the kidneys caused by diabetes mellitus, hypertension, glomerulonephritis, HIV infection, polycystic kidney disease, or ischemic nephropathy.

20. What is a urinary tract infection (UTI)?
A UTI occurs when an infecting organism, typically gram-negative bacteria such as E. coli, enters the urinary tract. Inflammation of the local area occurs, followed by infection as the organism reproduces.

21. What is a common cause of urinary tract infection (UTI)?
Often the bacteria are present on the skin in the genital area and enter the urinary tract through the urethral opening.

22. Why is a patient with a urinary catheter at risk for a UTI?
Patients with a urinary catheter in place may also develop an infection because of the presence of the catheter which allows a pathway for the bacteria to enter the bladder.

23. How is nosocomial infection acquired?
Nosocomial infection is caused as a result of being hospitalized.

24. What causes hypovolemia?
Hypovolemia resulting from blood or fluid losses, diuretic use, third-spacing of fluids, reduced renal perfusion owing to NSAID use or congestive heart failure (CHF) can cause prerenal failure.

25. What is tubular necrosis?
Tubular necrosis is the death of tissues in the tubular portion of the kidney.