Catherine Goodman

Teresa Snyder

Chapter

10 Screening for Urogenital Disease

DR FATIMA AMJAD PT
The Urinary Tract
SIGNS AND SYMPTOMS OF GENITOURINARY DISEASE
Constitutional Symptoms
• Fever, chills
• Fatigue, malaise
• Anorexia, weight loss
Musculoskeletal
• Unilateral costovertebral tenderness
• Low back, flank, inner thigh, or leg pain
• Ipsilateral shoulder pain
SIGNS AND SYMPTOMS OF GENITOURINARY DISEASE
Urinary Problems
• Dysuria (painful burning or discomfort with urination)
• Nocturia (getting up more than once at night to urinate)
• Feeling that bladder has not emptied completely but unable to urinate more
• Hematuria (blood in urine; pink or red-tinged urine)
• Dribbling at the end of urination
• Frequency (need to urinate or empty bladder more than every 2 hours)
• Hesitancy (weak or interrupted urine stream)
• Proteinuria (protein in urine; urine is foamy)
Other
• Skin hypersensitivity (T10-L1)
• Infertility
RENAL AND UROLOGIC PAIN
Upper Urinary Tract (Renal/Ureteral)
Lower Urinary Tract (Bladder/Urethral)
Pseudorenal Pain
Upper Urinary Tract (Renal/Ureteral)
Renal sensory innervation is not completely understood, the capsule (covering of the kidney)
and the lower portions of the collecting system seem to cause pain with stretching (distention)
or puncture. Information transmitted by renal and ureteral pain receptors is relayed by
sympathetic nerves that enter the spinal cord at T10 to L1.
Concurrent stimulation of cutaneous fibers.
Renal pain is typically felt in the posterior subcostal and costovertebral regions.
Ureteral pain is felt in the groin and genital area.
With either renal pain or ureteral pain, radiation forward around the flank into the lower
abdominal quadrant.
Abdominal rebound tenderness results when the adjacent peritoneum becomes inflamed.
Lower Urinary Tract (Bladder/Urethra)
Bladder or urethral pain is felt above the pubis (suprapubic) or low in the abdomen.
The sensation is usually characterized as one of urinary urgency, a sensation to void, and dysuria
(painful urination).
Irritation of the neck of the bladder or the urethra can result in a burning sensation localized to
these areas, probably caused by the urethral thermal receptors.
EXTRAUROLOGIC CONDITIONS CAUSING
URINARY TRACT SYMPTOMS
Acute or chronic conditions affecting other viscera outside the urologic system can refer pain
and symptoms to the upper or lower urinary tract. These can include
• Perforated viscus (any large internal organ)
• Intestinal obstruction
• Cholecystitis (inflammation of the gallbladder)
• Pelvic inflammatory disease
• Tubo-ovarian abscess
• Ruptured ectopic pregnancy
• Twisted ovarian cyst
• Tumor (benign or malignant)
Pseudorenal Pain
It may occur secondary to radiculitis or irritation of the costal nerves caused by mechanical
derangements of the costovertebral or costotransverse joints. most common sites are T10 and
T12.
Irritation of these nerves causes costovertebral pain that can radiate into the ipsilateral lower
abdominal quadrant. The onset is usually acute with some type of traumatic history
The pain is affected by body position, and although the client may be awakened at night when
assuming a certain position (e.g., sidelying on the affected side), the pain is usually absent on
awakening and increases gradually during the day. It is also aggravated by prolonged periods of
sitting, especially when driving on rough roads in the car. It may be relieved by changing to
another position.
Radiculitis may mimic ureteral colic or renal pain, but true renal pain is seldom affected by
movements of the shoulder or spine.
RENAL AND URINARY TRACT PROBLEMS
Early screening and detection is recommended based on the presence of these risk factors.
• Age over 60
• Personal or family history of diabetes or hypertension
• Personal or family history of kidney disease, heart attack, or stroke
• Personal history of kidney stones, urinary tract infections, lower urinary tract obstruction, or
autoimmune disease
• African, Hispanic, Pacific Island, or Native American descent
• Exposure to chemicals (e.g., paint, glue, degreasing solvents, cleaning solvents), drugs, or
environmental conditions
• Low birth weight
Inflammatory/Infectious Disorders
Upper urinary tract infections (UTIs) include kidney or ureteral infections.
◦ Renal infections, such as pyelonephritis (renal parenchyma, i.e., kidney tissue)
◦ Acute or chronic glomerulonephritis (glomeruli)
◦ Renal papillary necrosis
◦ Renal tuberculosis

Lower UTIs include cystitis (bladder infection) or urethritis (urethral infection).

Obstructive Disorders
Urinary tract obstruction can occur at any point in the urinary tract
◦ primary urinary tract obstructions (obstructions occurring within the urinary tract)
◦ secondary urinary tract obstructions (obstructions resulting from disease processes outside the urinary
tract)
A primary obstruction might include problems such as acquired or congenital malformations, strictures,
renal or ureteral calculi (stones), polycystic kidney disease, or neoplasms of the urinary tract (e.g.,
bladder, kidney).
Secondary obstructions produce pressure on the urinary tract from outside and might be related to
conditions such as prostatic enlargement (benign or malignant); abdominal aortic aneurysm; gynecologic
conditions such as pregnancy, pelvic inflammatory disease, and endometriosis; or neoplasms of the pelvic
or abdominal structures.
Obstructive Disorders of the Upper
Urinary Tract
CLINICAL SIGNS AND SYMPTOMS
• Pain (depends on the rapidity of onset and on the location)
• Acute, spasmodic, radiating
• Mild and dull flank pain
• Lumbar discomfort with some renal diseases or renal back pain with ureteral obstruction
• Hyperesthesia of dermatomes (T10 through L1)
• Nausea and vomiting
• Palpable flank mass
• Hematuria
• Fever and chills
• Urge to urinate frequently
• Abdominal muscle spasms
Obstructive Disorders of the Lower
Urinary Tract
Prostatitis:
Prostatitis is a relatively common inflammation of the prostate causing prostate enlargement.
Acute bacterial prostatitis occurs most often in men under age 35.
The National Institutes of Health (NIH) Consensus Classification of Prostatitis includes four distinct
categories:
Type I Acute bacterial prostatitis
Type II Chronic bacterial prostatitis
Type III Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)
◦ A. Inflammatory
◦ B. Noninflammatory
Type IV Asymptomatic inflammatory prostatitis
CLINICAL SIGNS AND SYMPTOMS
• Sudden moderate-to-high fever
• Chills
• Low back, inner thigh, and perineal pain
• Urinary frequency and urgency
• Nocturia (unusual voiding during the night)/sleep disturbance
• Dysuria (painful or difficult urination)
• Weak or interrupted urine stream (hesitancy)
• Unable to completely empty bladder
• General malaise
• Arthralgia
• Myalgia
Incontinence
Urinary incontinence (UI) is the involuntary leakage of urine.
UI is not a disease but rather a symptom of other underlying health conditions, including trauma
(e.g., childbirth, incest), diabetes, multiple sclerosis, Parkinson’s disease, spinal injury, spina
bifida, surgery, hormonal changes, medications, stroke dysfunction, UTIs, neuromuscular
conditions, constipation, or even dietary issues, including caffeine intake.
Types of Urinary Incontinence
Four primary types of UI recognized in adults.
These are based on the underlying anatomic or physiologic impairment and include stress, urge,
mixed (combination of urge and stress), and overflow.
Stress incontinence occurs when the support for the bladder or urethra is weak or damaged, but
the bladder itself is normal.
Urge incontinence, now more commonly called overactive bladder, is the involuntary contraction
of the detrusor muscle (smooth muscle of the bladder wall) with a strong desire to void
(urgency) and loss of urine as soon as the urge is felt.
Overflow incontinence is overdistention of the bladder and the bladder cannot empty
completely. Urine leaks or dribbles out so the client does not have any sensation of fullness or
emptying.
Functional incontinence describes another type of UI that occurs when the bladder is normal
but the mind and body are not working together. Functional incontinence occurs from mobility
and access deficits such as being confined to a wheelchair or needing a walker to ambulate.
RISK FACTORS FOR URINARY
INCONTINENCE
Advancing age Alzheimer’s disease or dementia Arthritis or other musculoskeletal problems
Overweight/obese Chronic cough Chronic constipation History of recurrent urinary tract
infections History of sexually transmitted diseases Enlarged abdomen (e.g., ascites, pregnancy,
obesity, tumor) Diabetes mellitus Neurologic disorders
Medications Sedatives Diuretics Estrogens Anticholinergics Antibiotics Alpha-adrenergic blockers
(antihistamines, decongestants)
Specific to Women
Pregnancy (multiparity) Vaginal or cesarean* birth Previous bladder or pelvic surgery Pelvic
trauma or radiation Bladder or bowel prolapse Menopause (natural or surgically induced;
estrogen deficiency)† Tobacco use
Specific to Men Enlarged prostate gland Prostate or pelvic surgery Radiation (acute and late
complications), especially when combined with brachytherapy
Chronic Kidney Disease
Acute renal failure refers to the abrupt cessation of kidney activity, usually occurring over a
period of hours to a few days. Acute renal failure is often reversible, with return of kidney
function in 3 to 12 months.
Chronic renal failure, or irreversible renal failure (also known as end-stage renal disease [ESRD]),
is defined as a state of progressive decrease in the ability of the kidney to filter fluids,
metabolites, and electrolytes from the body, resulting in eventual permanent loss of kidney
function. ESRD is the final stage (stage 5) of chronic kidney disease; it can develop slowly over a
period of years or can result from an episode of acute renal failure that does not resolve.
Cancers of Urinary Tract
Bladder Cancer
Renal Cancer
Testicular Cancer
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