Urologic disease

From WikiProjectMed
Jump to navigation Jump to search

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 disease

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) has chronic kidney disease.[3] Primary renal cell carcinomas as well as metastatic cancers can affect the kidney.

Kidney failure

Kidney failure is defined by functional impairment of the kidney, whereas 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 disease

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:

Testing

  • 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 testing

  • 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]

References

  1. ^ a b c "Kidney Failure". National Institute of Diabetes and Digestive and Kidney Diseases. 2017-10-01. Retrieved 2019-06-17.
  2. ^ Baba, T; Murabayashi, S; Tomiyama, T; Takebe, K (1990). "Uncontrolled hypertension is associated with a rapid progression of nephropathy in type 2 diabetic patients with proteinuria and preserved renal function". The Tohoku Journal of Experimental Medicine. 161 (4): 311–8. doi:10.1620/tjem.161.311. PMID 2256104.
  3. ^ Coresh, Josef; Selvin, Elizabeth; Stevens, Lesley A.; Manzi, Jane; Kusek, John W.; Eggers, Paul; Van Lente, Frederick; Levey, Andrew S. (2007-11-07). "Prevalence of chronic kidney disease in the United States". JAMA. 298 (17): 2038–2047. doi:10.1001/jama.298.17.2038. ISSN 1538-3598. PMID 17986697.
  4. ^ "What is renal failure?". Johns Hopkins Medicine. Retrieved 18 December 2017.
  5. ^ Blakeley, Sara (2010). Renal Failure and Replacement Therapies. Springer Science & Business Media. p. 19. ISBN 9781846289378.
  6. ^ Liao, Min-Tser; Sung, Chih-Chien; Hung, Kuo-Chin; Wu, Chia-Chao; Lo, Lan; Lu, Kuo-Cheng (2012). "Insulin Resistance in Patients with Chronic Kidney Disease". Journal of Biomedicine and Biotechnology. 2012: 1–5. doi:10.1155/2012/691369. PMC 3420350. PMID 22919275.
  7. ^ "Kidney Failure". MedlinePlus. Retrieved 11 November 2017.
  8. ^ a b c "Urinary Tract Infection". CDC. April 17, 2015. Archived from the original on 22 February 2016. Retrieved 9 February 2016.
  9. ^ a b Lane, DR; Takhar, SS (August 2011). "Diagnosis and management of urinary tract infection and pyelonephritis". Emergency Medicine Clinics of North America. 29 (3): 539–52. doi:10.1016/j.emc.2011.04.001. PMID 21782073.
  10. ^ Salvatore S, Salvatore S, Cattoni E, Siesto G, Serati M, Sorice P, Torella M (June 2011). "Urinary tract infections in women". European Journal of Obstetrics, Gynecology, and Reproductive Biology. 156 (2): 131–6. doi:10.1016/j.ejogrb.2011.01.028. PMID 21349630.
  11. ^ Woodford, HJ; George, J (February 2011). "Diagnosis and management of urinary infections in older people". Clinical Medicine. 11 (1): 80–3. doi:10.7861/clinmedicine.11-1-80. PMC 5873814. PMID 21404794.
  12. ^ a b c "Interstitial cystitis/bladder pain syndrome fact sheet". OWH. 16 July 2012. Archived from the original on 5 October 2016. Retrieved 6 October 2016.
  13. ^ Hanno, PM; Erickson, D; Moldwin, R; Faraday, MM; American Urological, Association (May 2015). "Diagnosis and treatment of interstitial cystitis/bladder pain syndrome: AUA guideline amendment". The Journal of Urology. 193 (5): 1545–53. doi:10.1016/j.juro.2015.01.086. PMID 25623737. Archived from the original on 20 April 2014.
  14. ^ Ackley, Betty (2010). Nursing diagnosis handbook : an evidence-based guide to planning care (9th ed.). Maryland Heights, Mo: Mosby. ISBN 9780323071505.
  15. ^ Venes, Donald (2013). Taber's cyclopedic medical dictionary. Philadelphia: F.A. Davis. ISBN 9780803629776.
  16. ^ "Enuresis". medicaldictionaryweb.com.
  17. ^ a b "Prostate Enlargement (Benign Prostatic Hyperplasia)". NIDDK. September 2014. Archived from the original on 4 October 2017. Retrieved 19 October 2017.
  18. ^ Kim, EH; Larson, JA; Andriole, GL (2016). "Management of Benign Prostatic Hyperplasia". Annual Review of Medicine (Review). 67: 137–51. doi:10.1146/annurev-med-063014-123902. PMID 26331999.
  19. ^ Kirby, Roger; Carson, Culley C. (January–February 2015). "Editor's Comment on Diagnosis and treatment of chronic prostatitis/chronic pelvic pain syndrome". Trends in Urology and Men's Health. 6 (1): 17. doi:10.1002/tre.434.
  20. ^ Collins MM, Stafford RS, O'Leary MP, Barry MJ (1998). "How common is prostatitis? A national survey of physician visits". J. Urol. 159 (4): 1224–8. doi:10.1016/S0022-5347(01)63564-X. PMID 9507840.
  21. ^ a b c d e f g h i j "Urinary Retention". National Institute of Diabetes and Digestive and Kidney Diseases. Aug 2014. Archived from the original on 4 October 2017. Retrieved 24 October 2017.
  22. ^ Sliwinski, A; D'Arcy, FT; Sultana, R; Lawrentschuk, N (April 2016). "Acute urinary retention and the difficult catheterization: current emergency management". European Journal of Emergency Medicine. 23 (2): 80–8. doi:10.1097/MEJ.0000000000000334. PMID 26479738. S2CID 26988888.
  23. ^ a b "Bladder Cancer Treatment". National Cancer Institute. 1 January 1980. Archived from the original on 14 July 2017. Retrieved 18 July 2017.
  24. ^ "Cancer Fact sheet N°297". World Health Organization. February 2014. Archived from the original on 29 December 2010. Retrieved 10 June 2014.
  25. ^ "Defining Cancer". National Cancer Institute. 17 September 2007. Archived from the original on 25 June 2014. Retrieved 10 June 2014.
  26. ^ Curti, B; Jana, BRP; Javeed, M; Makhoul, I; Sachdeva, K; Hu, W; Perry, M; Talavera, F (26 February 2014). Harris, JE (ed.). "Renal Cell Carcinoma". Medscape Reference. WebMD. Archived from the original on 7 March 2014. Retrieved 7 March 2014.
  27. ^ "Prostate Cancer". National Cancer Institute. January 1980. Archived from the original on 12 October 2014. Retrieved 12 October 2014.
  28. ^ a b c d "Prostate Cancer Treatment (PDQ) – Health Professional Version". National Cancer Institute. 2014-04-11. Archived from the original on 5 July 2014. Retrieved 1 July 2014.
  29. ^ "Chapter 5.11". World Cancer Report. World Health Organization. 2014. ISBN 978-9283204299.
  30. ^ Ruddon, Raymond W. (2007). Cancer biology (4th ed.). Oxford: Oxford University Press. p. 223. ISBN 978-0195175431. Archived from the original on 2015-09-15.
  31. ^ "Prostate Cancer Treatment (PDQ) – Patient Version". National Cancer Institute. 2014-04-08. Archived from the original on 5 July 2014. Retrieved 1 July 2014.
  32. ^ a b Chowdhury SH, Cozma AI, Chowdhury JH. Urinary Tract Obstruction. Essentials for the Canadian Medical Licensing Exam: Review and Prep for MCCQE Part I. 2nd edition. Wolters Kluwer. Hong Kong. 2017.
  33. ^ a b Gowda S, Desai PB, Kulkarni SS, Hull VV, Math AA, Vernekar SN (2010). "Markers of renal function tests". N Am J Med Sci. 2 (4): 170–3. PMC 3354405. PMID 22624135.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  34. ^ Po, Henry N.; Senozan, N. M. (2001). "The Henderson-Hasselbalch Equation: Its History and Limitations". Journal of Chemical Education. American Chemical Society (ACS). 78 (11): 1499. Bibcode:2001JChEd..78.1499P. doi:10.1021/ed078p1499. ISSN 0021-9584.
  35. ^ Simerville, Jeff A. (2005-03-15). "Urinalysis: A Comprehensive Review". American Family Physician. 71 (6): 1153–1162. ISSN 0002-838X. PMID 15791892. Retrieved 2019-06-17.
  36. ^ Yetisen, Ali Kemal; Akram, Muhammad Safwan; Lowe, Christopher R. (2013-05-21). "Paper-based microfluidic point-of-care diagnostic devices". Lab on a Chip. 13 (12): 2210–2251. doi:10.1039/C3LC50169H. ISSN 1473-0189. PMID 23652632.
  37. ^ Rosier, Peter (2019-05-09). "Contemporary diagnosis of lower urinary tract dysfunction". F1000Research. F1000 ( Faculty of 1000 Ltd). 8: 644. doi:10.12688/f1000research.16120.1. ISSN 2046-1402. PMC 6509958. PMID 31119030.
  38. ^ American Urogynecologic Society (May 5, 2015), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation, American Urogynecologic Society, retrieved June 1, 2015, which cites: *Gormley, EA; Lightner, DJ; Faraday, M; Vasavada, SP (May 2015). "Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline Amendment". The Journal of Urology. 193 (5): 1572–80. doi:10.1016/j.juro.2015.01.087. PMID 25623739.
  39. ^ Piloni, Vittorio Luigi; Spazzafumo, Liana (June 2007). "Sonography of the female pelvic floor:clinical indications and techniques". Pelviperineology. 26 (2): 59–65.
  40. ^ Frank, Eugene D.; Long, Bruce W.; Smith, Barbara J. (2012). Merrill's Atlas of Radiographic Positioning & Procedures (12 ed.). St. Louis, MO: Mosby Inc. ISBN 978-0-323-07334-9.
  41. ^ Bontrager, Kenneth L.; Lampignano, John P. (2005). Textbook of Radiographic Positioning and Related Anatomy (6 ed.). St. Louis, MO: Mosby, Inc. ISBN 978-0-323-02507-2.
  42. ^ Paul Schmitz, MD, et al. Medscape. Kidneys, ureters, and bladder imaging: plain films of the abdomen. Updated 27 Aug 2015.
  43. ^ "Intravenous pyelogram". Mayo Clinic. 2018-05-09. Retrieved 2019-06-17.
  44. ^ Husband J (2008). Recommendations for Cross-Sectional Imaging in Cancer Management: Computed Tomography – CT Magnetic Resonance Imaging – MRI Positron Emission Tomography – PET-CT (PDF). Royal College of Radiologists. ISBN 978-1-905034-13-0.
  45. ^ Frimberger, Dominic; Bauer, Stuart B.; Cain, Mark P.; Greenfield, Saul P.; Kirsch, Andrew J.; Ramji, Faridali; Mercado-Deane, Maria-Gisela; Cooper, Christoper S. (2016-12-01). "Establishing a standard protocol for the voiding cystourethrography". Journal of Pediatric Urology. 12 (6): 362–366. doi:10.1016/j.jpurol.2016.11.001. ISSN 1477-5131. PMID 27939178. S2CID 21041368.

External links