M17-18

• Renal systems


  Include the kidneys, renal pelvis, ureters, bladder and urethra
• Renal systems


  • Filters blood and create urine as a waste by-product
  • Help the body to eliminate liquid waste called urea, and to keep chemicals, such as potassium and sodium, and water in balance
• Suprapubic pain


  Bladder disorders may cause suprapubic pain
• Suprapubic pain characteristics


  • In bladder infection, pain in the lower abdomen is typically dull and pressure-like
  • In sudden overdistention of the bladder, pain is often agonizing
  • Chronic bladder distention is usually painless
  • Pain of sudden overdistention accompanies acute urinary retention
• Dysuria


  • Pain and burning sensation on urination
  • Difficulty voiding
• Dysuria characteristics


  • Women may report internal urethral discomfort, sometimes described as a pressure or an external burning from the flow of urine across irritated or inflamed labia
  • Men typically feel a burning sensation proximal to the glans penis
  • In contrast, prostatic pain is felt in the perineum and occasionally in the rectum
  • Painful urination accompanies cystitis or urethritis
• If dysuria


  Consider bladder stones, foreign bodies, tumors; also acute prostatitis
• In women, internal burning


  Occurs in urethritis
• In women, external burning


  Occurs in vulvovaginitis
• Urinary urgency


  An unusually intense and immediate desire to void, sometimes leading to involuntary voiding or urge incontinence
• Urinary urgency


  Suggests bladder infection or irritation
• In men, painful urination without frequency or urgency


  Suggests urethritis
• Urinary frequency


  Abnormally frequent voiding
• Ask about any related fever or chills, blood in the urine, or any pain in the abdomen, flank, or back
• Men with partial obstruction to urinary outflow often report hesitancy in starting the urine stream, straining to void, reduced caliber and force of the urinary stream, or dribbling as voiding is completed
• Polyuria


  Refers to a significant increase in 24-hour urine volume, roughly defined as exceeding 3 liters
• Polyuria should be distinguished from urinary frequency, which can involve voiding in high amounts, seen in polyuria, or in small amounts, as in infection
• Nocturia


  Refers to urinary frequency at night, sometimes defined as awakening the patient more than once; urine volumes may be large or small
• Clarify the patient's daily fluid intake
• Urinary incontinence


  An involuntary loss of urine
• Up to 30% of older patients are concerned about urinary incontinence
• Urinary incontinence may become socially embarrassing or cause problems with hygiene
• Questions to ask about urinary incontinence


  • When does it happen? How often?
  • Do you leak small amounts of urine with increased intra-abdominal pressure from coughing, sneezing, laughing, or lifting?
  • Is it difficult to hold the urine once there is an urge to void?
  • Is a large amount of urine lost?
  • Is there a sensation of bladder fullness? Frequent leakage?
  • Do you void small amounts of urine but have difficulty emptying the bladder?
• Stress incontinence


  With increased intra-abdominal pressure suggests decreased contractility of urethral sphincter or poor support of bladder neck
• Urge incontinence


  If unable to hold the urine, suggests detrusor overactivity
• Overflow incontinence


  When the bladder cannot be emptied until bladder pressure exceeds urethral pressure, indicates anatomic obstruction by prostatic hypertrophy or stricture, or neurogenic abnormalities
• Functional incontinence


  May arise from impaired cognition, musculoskeletal problems, or immobility
• Hematuria


  Blood in the urine
• Hematuria is an important cause for concern
• Gross hematuria


  When visible to the naked eye. The urine may appear frankly bloody
• Microscopic hematuria


  Blood may be detected only during microscopic urinalysis. Smaller amounts of blood may tinge the urine with a pinkish or brownish cast
• In women, be sure to distinguish menstrual blood from hematuria. If the urine is reddish, ask about ingestion of beets or medications that might discolor the urine
• Test the urine with a dipstick and microscopic examination before you settle on the term hematuria
• Kidney pain


  A visceral pain usually produced by distention of the renal capsule and typically dull, aching, and steady
• Kidney pain, fever, and chills


  Occur in acute pyelonephritis
• Ureteral pain


  Usually severe and colicky, originating at the costovertebral angle and radiating around the trunk into the lower quadrant of the abdomen, or possibly into the upper thigh and testicle or labium
• Ureteral pain results from sudden distention of the ureter and associated distention of the renal pelvis
• Ask about any associated fever, chills, or hematuria
• Renal or ureteral colic


  Caused by sudden obstruction of a ureter, for example, from urinary stones or blood clots
• The breast


  • An organ whose structure reflects its special function: the production of milk for lactation
  • The male breast structure is nearly identical to the female breast, except that the male breast tissue lacks the specialized lobules, since there is no physiologic need for milk production by males