UROLOGY

EMERITA C. MENDOZA, R.N., M.D.

Functions of the Urinary System
• To produce urine • To store urine • To discharge urine • To maintain homeostasis by:
– excreting metabolic wastes – ridding the body of excess H2O & salts – helping to regulate pH

Excretion
• Metabolic wastes in the form of urine • Deaminates N-compounds -> ammonia -> urea • Also nucleic acid -> uric acid, and sends to kidneys • Muscular system – phosphocreatine metabolized to creatinine and sent to kidneys

LOCATION OF THE KIDNEYS

T12-L3, in Gerota’s fascia

LOCATION OF THE KIDNEYS
• It is known as a RETROPERITONEAL organ.

CROSS SECTION OF THE KIDNEY
• Outer renal cortex • Inner renal medulla • pyramids • papilla • columns • collecting ducts • Hilus • minor calyx • major calyx • renal pelvis (pyelo-)

The Ureters
• 28-34 cm Which is longer, R or L ? • renal pelvis -> • proximal ureter (renal artery, vein) -> • mid ureter (testicular/ovarian artery, vein) • -> distal ureter (superior vesical artery, vein) -> • ureterovesical (UVJ) junction -> urinary bladder

Sites of Ureteral Narrowing
• 1) At the ureteropelvic junction • 2) At the pelvic inlet • 3) At the bladder in the ureterovesical junction Note: The ureters descend anterior to the psoas muscle.

The Urinary Bladder
• Ureteral orifices • Areas: • fundus - apex • body • trigone - base • neck • Urachus = median umbilical ligament • Volume: 500 ml • Composed of the detrusor muscle

The Micturition Reflex

• “trampoline effect” • Urinary bladder stretch receptors initiate reflex to CNS • Causes the external urethral sphincter to relax to allow urination • Occurs when the bladder fills up to 300ml

The Prostate
• • • • • • lobular gland 2 prostatic ducts fascia of Denonvilliers secretes lubricant What is BPH ? Diagnostics via DRE, PSA • Surgery: TURP

The Spadias
• • • • • • Congenital : Hypospadias dorsal hood, chordee, proximal meatus Epispadias (defect in the dorsal urethra) Sx: e.g., Magpi repair (Meatal advancement with glansplasty)

Trace the path of urine

• • • •

renal pelvis -> ureter -> urinary bladder -> urethra

FUNCTIONAL UNIT OF THE KIDNEY
• Nephron • renal corpuscle
– – glomerulus Bowman’s capsule


renal tubule
Proximal convoluted tubule (PCT) – Loop of Henle – Distal convoluted tubule (DCT)

Formation of Urine
• Glomerular filtration • Tubular reabsorption • Tubular secretion

GLOMERULAR FILTRATION RATE (GFR)
• Blood from renal arcuate artery -> afferent arterioles -> glomerular capillaries -> glomerulus -> Bowman’s • Filtrate: plasma with dissolved substances is filtered into Bowman’s • Glomerular filtration is not selective

TUBULAR REABSORPTION
• 99% of filtrate is returned to the blood • -> renal tubules (PCT -> loop of Henle -> DCT) -> collecting ducts • Reabsorption is highly selective for glucose, amino acids, other needed substances • Filtrate retains wastes, excess H2O & salts

TUBULAR SECRETION
• Occurs in the collecting ducts • Important for regulating • [K+] in blood • [H+] in blood  collecting ducts  (as urine) minor calyx  major calyx  renal pelvis  ureter  urinary bladder

Note that the filtrate flows opposite to the direction of blood flow This is called countercurrent flow

FILTRATE FLOW
• Bowman’s capsule  • Proximal convoluted tubule  Descending loop of Henle  • Ascending loop of Henle  • Distal convoluted tubule  • Collecting tubule

The Juxtaglomerular Complex (JG Complex)

Functions related to pressure via renin production & Na metabolism (secondary controls of urine volume)

Primary Regulation of Urine Volume
• ADH from pituitary gland (posterior lobe) • ADH makes the DCT & collecting ducts more permeable to H2O

Blood Pressure Regulation

The Glomerulus
• Filtration unit of the kidney. • Electron microscopy is needed for diagnosis • Main pathologic signs are:
– – – – proteinuria hypoalbuminemia edema hyperlipidemia

Principal Waste Products in the Urine Filtrate
• Waste products are • H2O cleared through the • CO2 glomerulus but not • Nitrogenous wastes: reabsorbed in the • urea tubules • uric acid • Lab measurements are • creatinine BUN, creatinine

Composition of Urine
• • • • • • • • • H2O (96%) Nitrogenous wastes: urea (2.5%) uric acid creatine creatinine ammonia (rash) Salts(1.5%): Cl, Ca, P Traces of other substances • The following should NOT be present: – blood – glucose – albumin – ketones – pus – bacteria – casts

REMEMBER THE FF:
• Basic anatomy of the kidneys: nephron, glomerulus • Location of the kidneys • Substances produced by the kidneys • Sites of narrowing in the ureters • Processes of urine formation: filtration (GFR), reabsorption, secretion • Abnormal substances in urine • Renin-angiotensin mechanism