Aashish PariharNursing Tutor
College of NursingAIIMS, Jodhpur
contentReview of anatomy and physiology of genitourinary systemNursing assessment: history, and physical examinationEtiology, pathophysiology, clinical manifestations, diagnosis,
medical and surgical treatment modalities, alternative therapies, dietetics and nursing management (nursing process including nursing procedures).
Urological obstructions-Urethral stricturesRenal calculiNephrosis
content Disorders of kidney-GlomerulonephritisNephrotic syndromeNephrosisAcute renal failureChronic renal failureEnd stage renal diseaseDialysis, renal transplantCancer of kidneyCongenital disorder
contentDisorders of Ureters, urinary bladder and urethra-UTICystitisUrinary incontinenceUrinary retentionUrinary refluxBladder neoplasmUrinary bladder calculiUrethirtisUrethral tumorsUreteritisUreteral calculiTrauma of Ureters, bladder, urethraNeoplasm of ureters, bladder and urethraCongenital disorders of ureters, bladder and urethra
anatomy and physiology of genitourinary system
anatomy and physiology of genitourinary system
anatomy and physiology of genitourinary system
anatomy and physiology of genitourinary system
physiology of genitourinary system
anatomy and physiology of genitourinary system
Ureters, Bladder, and Urethra -Urine, which is formed within the nephrons, flows into the
ureter, a long fibromuscular tube that connects each kidney to the bladder.
The ureters are narrow, muscular tubes, each 24 to 30 cm long, that originate at the lower portion of the renal pelvis and terminate in the trigone of the bladder wall.
There are three narrowed areas of each ureter: the ureteropelvic junction, the ureteral segment near the sacroiliac junction, and the ureterovesical junction.
The angling of the ureterovesical junction is the primary means of providing antegrade, or downward, movement of urine, also referred to as efflux of urine.
This angling prevents vesicoureteral reflux, which is the retrograde, or backward, movement of urine from the bladder, up the ureter, toward the kidney.
anatomy and physiology of genitourinary system
Ureters, Bladder, and Urethra -During voiding (micturition), increased intravesical pressure
keeps the ureterovesical junction closed and keeps urine within the ureters. As soon as micturition is completed, intravesical pressure returns to its normal low baseline value, allowing efflux of urine to resume.
Therefore, the only time that the bladder is completely empty is in the last seconds of micturition before efflux of urine resumes.
The three areas of narrowing within the ureters have a propensity toward obstruction because of renal calculi (kidney stones) or stricture.
Obstruction of the ureteropelvic junction is the most serious because of its close proximity to the kidney and the risk of associated kidney dysfunction
anatomy and physiology of genitourinary system
Ureters, Bladder, and Urethra -During voiding (micturition), increased intravesical pressure
keeps the ureterovesical junction closed and keeps urine within the ureters. As soon as micturition is completed, intravesical pressure returns to its normal low baseline value, allowing efflux of urine to resume.
Therefore, the only time that the bladder is completely empty is in the last seconds of micturition before efflux of urine resumes.
The three areas of narrowing within the ureters have a propensity toward obstruction because of renal calculi (kidney stones) or stricture.
Obstruction of the ureteropelvic junction is the most serious because of its close proximity to the kidney and the risk of associated kidney dysfunction
anatomy and physiology of genitourinary system
Nursing assessment: history, and physical examination Multiparous women delivering their children vaginally are
at high risk for stress urinary incontinenceElderly women and persons with neurologic disorders such
as diabetic neuropathy, multiple sclerosis, or Parkinson’s disease often have incomplete emptying of the bladder with urinary stasis, which may result in-
urinary tract infection increasing bladder pressure leading to overflow
incontinence, hydronephrosis, pyelonephritis, renal insufficiency.
anatomy and physiology of genitourinary system
Nursing assessment: history, and physical examination The patient’s chief concern or reason for seeking health
care, the onset of the problem, and its effect on the patient’s quality of life
The location, character, and duration of pain, if present, and its relationship to voiding
Factors that precipitate pain, and those that relieve it History of urinary tract infections, including past treatment
or hospitalization for urinary tract infection Fever or chills Previous renal or urinary diagnostic tests or use of
indwelling urinary catheters
anatomy and physiology of genitourinary system
Nursing assessment: history, and physical examination Dysuria and when it occurs during voiding (at initiation or
termination of voiding) Hesitancy, straining, or pain during or after urination Urinary incontinence (stress incontinence, urge
incontinence, overflow incontinence, or functional incontinence)
Hematuria or change in color or volume of urine Nocturia and its date of onset Renal calculi (kidney stones), passage of stones or gravel in
urine
anatomy and physiology of genitourinary system
Nursing assessment: history, and physical examination Female patients: number and type (vaginal or cesarean) of
deliveries; use of forceps; vaginal infection, discharge, or irritation; contraceptive practices
Presence or history of genital lesions or sexually transmitted diseases
Habits: use of tobacco, alcohol, or recreational drugs Any prescription and over-the-counter medications
(including those prescribed for renal or urinary problems)
anatomy and physiology of genitourinary system
Nursing assessment: history, and physical examination
anatomy and physiology of genitourinary system
Nursing assessment: history, and physical examination
anatomy and physiology of genitourinary system
Nursing assessment: history, and physical examination
During physical examination for genitourinary dysfunction areas of emphasis include the abdomen, suprapubic region, genitalia and lower back, and lower extremities.
Direct palpation of the kidneys may help determine their size and mobility
The right kidney is easier to feel because it is somewhat lower than the left one
anatomy and physiology of genitourinary system
Nursing assessment: history, and physical examination Renal dysfunction may produce tenderness over the
costovertebral angle, which is the angle formed by the lower border of the 12th, or bottom, rib and the spine.
The abdomen is auscultated to assess for bruits (low-pitched murmurs that indicate renal artery stenosis or an aortic aneurysm).
The abdomen is also assessed for the presence of peritoneal fluid, which may occur with kidney dysfunction.
anatomy and physiology of genitourinary system
Nursing assessment: history, and physical examination The bladder should be percussed after the patient voids to
check for residual urine Percussion of the bladder begins at the midline just above
the umbilicus and proceeds downward. The sound changes from tympanic to dull when percussing
over the bladder.The bladder, which can be palpated only if it is moderately
distended, feels like a smooth, firm, round mass rising out of the abdomen, usually at midline
Dullness to percussion of the bladder following voiding indicates incomplete bladder emptying.
anatomy and physiology of genitourinary system
Nursing assessment: history, and physical examination
anatomy and physiology of genitourinary system
Nursing assessment: history, and physical examination The prostate gland is palpated by digital rectal examination
(DRE) Blood is drawn for PSA before the DRE because
manipulation of the prostate can cause the PSA level to rise temporarily.
The inguinal area is examined for enlarged nodes, an inguinal or femoral hernia, or varicocele (varicose veins of the spermatic cord)
anatomy and physiology of genitourinary system
Nursing assessment: history, and physical examination In female, the vulva, urethral meatus, and vagina are
examinedThe patient is assessed for edema and changes in body
weight. Edema may be observed, particularly in the face and dependent parts of the body, such as the ankles and sacral areas
An increase in body weight commonly accompanies edema. A 1-kg weight gain equals approximately 1,000 mL of fluid.
urological obstructionsurethral strictures
A urethral stricture is a scar in or around the urethra, which can block the flow of urine, and is a result of inflammation,
injury or infection.
Anatomy of the Male Reproductive System
urological obstructions
urological obstructionsurethral strictures
Risk factors-Urethral strictures are more common in men because
their urethras are longer than those in women. Thus men's urethras are more susceptible to disease
or injury. A person is rarely born with urethral strictures and
women rarely develop urethral strictures.
urological obstructionsurethral strictures
Etiology -Stricture disease may occur anywhere from the
bladder to the tip of the penis. The common causes of stricture are trauma to the
urethra and infections such as sexually transmitted diseases and damage from instrumentation.
Trauma such as straddle injuries, direct trauma to the penis and catheterization can result in strictures of the anterior part of the urethra.
urological obstructionsurethral strictures
Etiology -In adults, urethral strictures from instrumentation
trauma may occur after prostate surgery and urinary catheterization.
In children, urethral strictures most often follow reconstructive surgery for congenital abnormalities of the penis and urethra, cystoscopy and occasionally may be congenital.
urological obstructionsurethral strictures
Clinical features -painful urination.slow urine stream.decreased urine output.spraying of the urine stream.blood in the urine.abdominal pain.urethral discharge.urinary tract infections in men.infertility in men.
urological obstructionsurethral strictures
Diagnostic evaluation-Evaluation of patients with urethral stricture
includes a physical examination.Urethral imaging (X-rays or ultrasound).The retrograde urethrogram is an invaluable test
to evaluate and document the stricture and define the stricture recurrence. Combined with antegrade urethrogram, length of the stricture can be determined.
Normal Urethrogram Obstructive Urethrogram
urological obstructionsurethral strictures
urological obstructionsurethral strictures
Treatment-Treatment options for urethral stricture disease are
varied and selection depends upon the length, location and degree of scar tissue associated with the stricture.
The main treatment options include enlarging the stricture by gradual stretching (dilation).
urological obstructionsurethral strictures
Treatment-Cutting the stricture with a endoscopic equipment
(urethrotomy) and surgical repair of the stricture with reconnection and reconstruction called urethroplasty.
Urethral Stents where a biocompatible hollow tube is placed on the inside of the stricture to allow for free passage of urine.
urological obstructionsrenal calculi
Urolithiasis refers to stones (calculi) in the urinary tract.
Stones are formed in the urinary tract when urinary concentrations of substances such as calcium oxalate, calcium phosphate, and uric acid increase.
This is referred to as supersaturation and is depen- dent on the amount of the substance, ionic strength, and pH of the urine.
urological obstructionsrenal calculi
Incidence-The occurrence of urinary stones occurs predomi-
nantly in the third to fifth decades of life and Affects men more than women. About half of patients with a single renal stone have
another episode within 5 years. Most stones contain calcium or magnesium in
combination with phosphorus or oxalate. Most stones are radiopaque and can be detected by
x-ray studies
urological obstructionsrenal calculi
Types of stone-Calcium stoneOxalate stoneCystiene stone Struvite stone
urological obstructionsrenal calculi
Types of stone-Calcium stoneMost stones (75%) are composed mainly of calcium
oxalate crystals.Increased calcium concentrations in blood and urine
promote precipitation of calcium and formation of stones.
Causes of hypercalcemia (high serum calcium) and hypercalciuria (high urine calcium) include the following:
urological obstructionsrenal calculi
Types of stone-Calcium stone Hyperparathyroidism Renal tubular acidosis Cancers Granulomatous diseases (sarcoidosis, tuberculosis), which
may cause increased vitamin D production by the granulomatous tissue
Excessive intake of vitamin DExcessive intake of milk and alkali Myeloproliferative diseases (leukemia, polycythemia vera,
multiple myeloma), which produce an unusual proliferation of blood cells from the bone marrow
urological obstructionsrenal calculi
Types of stone-Uric acid stones 5% to 10% of all stones gout myeloproliferative disordersDiet high in purines and abnormal purine
metabolism
urological obstructionsrenal calculi
Types of stone-Struvite stones 15% of urinary calculi form in persistently alkaline, ammonia-rich urine caused by the presence of urease splitting bacteria
such as Proteus, Pseudomonas, Klebsiella, Staphy- lococcus, or Mycoplasma species.
Predisposing factors for struvite stones (commonly called infection stones) include neurogenic bladder, foreign bodies, and recurrent UTIs.
urological obstructionsrenal calculi
Types of stone-Cystine stones 1% to 2% of all stones occur in patients with a rare inherited defect in renal
absorption of cystine (an amino acid).
Urological obstrUctionsrenal calcUli
Causes and predisposing factors:Chronic dehydration, poor fluid intake, and immobilityLiving in mountainous, desert, or tropical areasInfection, urinary stasis, and periods of immobilityInflammatory bowel disease and in patients with an
ileostomy or bowel resection because these patients absorb more oxalate.
Medications- antacids, acetazolamide (Diamox), vitamin D, laxatives, and high doses of aspirin
Urological obstrUctionsrenal calcUli
Location of stones-KidneyUreterBladderUrethra
Urological obstrUctionsrenal calcUli
Site of obstruction-
Urological obstrUctionsrenal calcUli
Clinical features-PainHeamturiaDysuriaOedemaPyuria Associated symptoms-Nausea, vomiting, diarrhea, abdominal discomfortChills and fever (may)
Urological obstrUctionsrenal calcUliClinical features-
Pain- Stones in the renal pelvis may be associated with an
intense, deep ache in the costovertebral region Pain originating in the renal area radiates anteriorly
and downward toward the bladder in the female and toward the testis in the male.
If the pain suddenly becomes acute, with tenderness over the costovertebral area, and nausea and vomiting appear termed as renal colic
Urological obstrUctionsrenal calcUliClinical features-
Pain- Stones lodged in the ureter (ureteral obstruction) cause
acute, excruciating, colicky, wavelike pain, radiating down the thigh and to the genitalia
It is called ureteral colic Colic is mediated by prostaglandin E, a substance that
increases ureteral contractility and renal blood flow and that leads to increased intraureteral pressure and pain
If the stone present in the bladder and obstruct he urine flow, produces the pain at suprapubic region along with bladder distension
Urological obstrUctionsrenal calcUli
Clinical features-Hematuria- Hematuria is often present because of the abrasive
action of the stone.Dysuria- Painful micturition is termed as dysuria. Obstruction in urine flow tend to cause the dysuria.
Urological obstrUctionsrenal calcUli
Clinical features-Oedema- When the stones block the flow of urine, obstruction
develops, producing an increase in hydrostatic pressure and distending the renal pelvis and proximal ureter.
Thereby GFR decreases leads to sodium and water retetion and gives rise to oedema.
Pyuria- Obstruction in urine flow, urinary retention and urinary
stasis may cause the UTI and featured as pyuria.
Urological obstrUctionsrenal calcUliClinical features-
Associated symptoms-Nausea, vomiting, diarrhea, abdominal discomfort due to renointestinal reflexes and shared nerve supply
(celiac ganglion) between the ureters and intestine. and the anatomic proximity of the kidneys to the stomach,
pancreas, and large intestine. Features of infection- Due to UTI. These features may be chill, high grade fever dysuria
etc.
Urological obstrUctionsrenal calcUli
Diagnostic evaluation-History Physical examinationUrinanalysisBlood studiesStone chemistryRadiographic studies
Urological obstrUctionsrenal calcUli
Diagnostic evaluationHistory -DietWaterOccupation medication Past and recent medical historyCollect the informations regarding the reasons for
seeking health care services
Urological obstrUctionsrenal calcUli
Diagnostic evaluationPhysical examination -Locate, nature and characteristics of painAssess the level of pain ,tenderness etc.Observe for the associated symptoms.
Urological obstrUctionsrenal calcUli
Diagnostic evaluationUrinanalysis-hematuria and pyuriapH < 5.5 indicates uric acid stonepH > 7.5 indicates struvite stoneurine culture and drug sensitivity studies to detect
infection.24-hour urine test for measurement of calcium, uric
acid, creatinine, sodium,citrate and oxalate
Urological obstrUctionsrenal calcUli
Diagnostic evaluationBlood studies-HyperuracemiaHypercalcemiaNeutrophilia Elevated serum parathyroid hormone
Urological obstrUctionsrenal calcUli
Diagnostic evaluationStone chemistry-Collection of stone through a strainer is useful.Analyze the stone chemically to find out the
composition which helps in therapeutic management.
Urological obstrUctionsrenal calcUli
Diagnostic evaluationRadiographic studies-Kidney, ureters, and bladder radiography may show
stone.Intra venous urogram (intravenous pyelogram) to
determine site and evaluate degree of obstruction Retrograde pyelographyUltrasound Helical or axial CAT Scan
Urological obstrUctionsrenal calcUli
Management General PrinciplesIf small stone (< 4 mm) and able to treat as outpatient,
80% will pass stone spontaneously with hydration, pain control, and reassurance.
Hospitalized for intractable pain, persistent vomiting, high-grade fever, obstruction with infection, and solitary kidney with obstruction.
Medical managementSurgical managementNursing management
Urological obstrUctionsrenal calcUli
Management Medical managementGoal-Immediate goal- To relieve the pain until its causes can be eliminated.Long term goal (basic goal)-To eradicate the stoneTo determine the stone type To prevent nephron destructionTo control infectionTo relieve any obstruction
Urological obstrUctionsrenal calcUli
Management Medical management Opioid analgesics or NSAIDs are administered to
prevent shock and syncope that may result from the excruciating pain.
NSAIDs provide specific pain relief because they inhibit the synthesis of prostaglandin E.
Hot baths or moist heat to the flank areas may also be useful.
Urological obstrUctionsrenal calcUli
Management Medical managementFluids are encouraged. This increases the
hydrostatic pressure behind the stone, assisting it in its downward passage.
A high, around-the-clock fluid intake reduces the concentration of urinary crystalloids, dilutes the urine, and ensures a high urine output.
Urological obstrUctionsrenal calcUli
Management Medical managementCalcium stone-Cellulose sodium phosphate (Calcibind) may be effective in
preventing calcium stones. It binds calcium from food in the intestinal tract, reducing the
amount of calcium absorbed into the circulation. restrict calcium in dietTherapy with thiazide diuretics may be beneficial in reducing the
calcium loss in the urine and lowering the elevated paratharmone levels.
The urine may be acidified by use of medications such as ammonium chloride or acetohydroxamic acid
Sodium and protein restriction diet
Urological obstrUctionsrenal calcUli
Management Medical management
Uric acid stone-low-purine diet such as shellfish, anchovies,
asparagus, mushrooms, and organ meats are avoidedAllopurinol may be prescribed to reduce serum uric
acid levels and urinary uric acid excretion.Proteins may be limited in diet
Urological obstrUctionsrenal calcUli
Management Medical management
Cystine stone -Low-protein dietPenicillamine is administered to reduce the amount
of cystine in the urineurine is alkalinized.
Urological obstrUctionsrenal calcUli
Management Medical management
Oxalate stone -Encourage the increased fluid intakeAvoid the food contains oxalate such as- spinach,
strawberries, tea, peanuts, wheat bran
Urological obstrUctionsrenal calcUli
Management Non surgical management-UreteroscopyESWL (Extra Corporeal Shock wave lithotripsy)Endoscopic proceduresElectrohydrolic lithotripsyChemolysis
Urological obstrUctionsrenal calcUli
Management Non surgical management-Ureteroscopy Ureteroscopy involves visualizing the stone and then destroying it. Access to the stone is accomplished by inserting a ureteroscope into the
ureter and then inserting a laser, electrohydraulic lithotriptor, or ultrasound device through the ureteroscope to fragment and remove the stones.
A stent may be inserted and left in place for 48 hours or more after the procedure to keep the ureter patent
Urological obstrUctionsrenal calcUli
Management Non surgical management-ESWL-ESWL is a noninvasive procedure used to break up stones in
the calyx of the kidneyIn ESWL, a high-energy amplitude of pressure, or shock wave,
is generated by the abrupt release of energy and transmitted through water and soft tissues.
When the shock wave encounters a substance of different intensity (a renal stone), a compression wave causes the surface of the stone to fragment.
Repeated shock waves focused on the stone eventually reduce it to many small pieces. These small pieces are excreted in the urine, usually without difficulty.
Urological obstrUctionsrenal calcUli
Management Non surgical management-ESWL-
Urological obstrUctionsrenal calcUli
Management Non surgical management-Endoscopic procedures-A percutaneous nephrostomy or a percutaneous nephrolithotomy
may be performed, and a nephroscope is introduced through the dilated percutaneous tract into the renal parenchyma.
Depending on its size, the stone may be extracted with forceps or by a stone retrieval basket. Alternatively, an ultrasound probe may be introduced through the nephrostomy tube.
Urological obstrUctionsrenal calcUli
Management Non surgical management-Electrohydraulic lithotripsy-an electrical discharge is used to create a hydraulic
shock wave to break up the stone.A probe is passed through the cystoscope, and the
tip of the lithotriptor is placed near the stoneThis procedure is performed under topical
anesthesia.
Urological obstrUctionsrenal calcUli
Management Non surgical management-Chemolysis-Chemolysis, stone dissolution using infusions of
chemical solutions (eg, alkylating agents, acidifying agents)
A percutaneous nephrostomy is performed, and the warm irrigating solution is allowed to flow continuously onto the stone.
Urological obstrUctionsrenal calcUli
Management Surgical management- Nephrolithotomy - Incision into the kidney with
removal of the stone Nephrectomy – removal of kidney Pyelolithotomy - removal of stone from renal pelvisUreterolithotomy - removal of stone from ureter Cystostomy – removal of stone from bladderCystolitholapaxy - an instrument is inserted through
the urethra into the bladder, and the stone is crushed in the jaws of this instrument
DisorDers of kiDneyglomerUlonephritis ,acUte
(acUte nephritic synDrome )
Definition –
Acute glomerulonephritis refers to a group of kidney diseases in which there is an inflammatory reaction in the glomeruli.
It is not an infection of the kidney, but rather the result of the immune mechanisms of the body
DisorDers of kiDneyglomerUlonephritis , acUte(acUte nephritic synDrome )
Risk factors –Group A beta- hemolytic streptococcal infection of the
throat Impetigo (infection of the skin) Acute viral infections- upper respiratory tract infections,
mumps, varicella zoster virus, Epstein-Barr virus, hepatitis B, and human immunodeficiency virus [HIV] infection).
Antigens outside the body (eg, medications, foreign serum) In other patients, the kidney tissue itself serves as the
inciting antigen.
DisorDers of kiDneyglomerUlonephritis , acUte(acUte nephritic synDrome )
Categories –Primary: Disease is mainly in glomeruli Secondary: Glomerular diseases that are the
consequence of systemic disease Idiopathic: Cause is unknown Acute: Occurs over days or weeks Chronic: Occurs over months or years Rapidly progressing: Constant loss of renal function
with minimal chance of recovery
DisorDers of kiDneyglomerUlonephritis , acUte
(acUte nephritic synDrome )
Categories –Diffuse: Involves all glomeruli Focal: Involves some glomeruli Segmental: Involves portions of individual
glomeruli Membranous: Evidence of thickened glomerular
capillary walls Proliferative: Number of glomerular cells involved
is increasing
DisorDers of kiDneyglomerUlonephritis , acUte
(acUte nephritic synDrome)
DisorDers of kiDneyglomerUlonephritis , acUte
(acUte nephritic synDrome)
Clinical features-Hematuria - The urine may appear cola-colored be- cause of
red blood cells (RBCs) and protein plugs or casts; RBC casts indicate glomerular injury.
Edema and hypertension OliguriaAnemia from loss of RBCs into the urine
DisorDers of kiDneyglomerUlonephritis , acUte
(acUte nephritic synDrome)
Clinical features-In the more severe form of the disease, patients also
complain of headache, malaise, and flank pain. Elderly patients may experience circulatory overload
with dyspnea, engorged neck veins, cardiomegaly, and pulmonary edema.
Atypical symptoms include confusion, somnolence, and seizures, which are often confused with the symptoms of a primary neurologic disorder
DisorDers of kiDneyglomerUlonephritis , acUte(acUte nephritic synDrome)
Diagnostic evaluation-HistoryOn examination- kidney is large, tender, edematous and congestedUrinanalysis- protienuria, hematuria , oliguriaBlood studies-Serum creatinine, BUN increasedHypoalbuminemia, hyperlipidemiaElevated serum IgA levelAntistreptolysin O titers are usually elevated in post streptococcal
glomerulonephritisElectron microscopy and immunofluorescent analysis help identify the
nature of the lesionKidney biopsy may be needed for definitive diagnosis.
DisorDers of kiDneyglomerUlonephritis , acUte
(acUte nephritic synDrome)
Complications-Hypertensive EncephalopathyHeart FailurePulmonary EdemaESRD
DisorDers of kiDneyglomerUlonephritis , acUte
(acUte nephritic synDrome)
Management-Goal-To conserve renal functionTo treat complication adequatelyTypes of management-Non pharmacological managementDietary managementPharmacological managementNursing management
DisorDers of kiDneyglomerUlonephritis , acUte
(acUte nephritic synDrome)
Non pharmacological management-Complete bed rest – as excessive activity may increase the
protienuria and hematuria. It should be encouraged until the urine clears and BUN, creatinine and BP return to normal.
Strict intake out put charting.Fluid restrictionsPlasmapheresis to decrease the serum anti body level Dialysis if, uremic symptoms are severe.
DisorDers of kiDneyglomerUlonephritis , acUte
(acUte nephritic synDrome)
Dietary management- Protein restricted diet as the level of BUN and creatinine is
high in bloodLow fat diet due to hyperlipidemiaSodium restriction if hypertension, edema or congestive
heart failure are present.Increased carbohydrate diet to provide energy and to
prevent the catabolism of protein.
DisorDers of kiDneyGlomerulonephritis , acute(acute nephritic synDrome)
Pharmacological management- Residual streptococcal infection is suspected, penicillin is
the agent of choice.Diuretics and antihypertensive agents may be given to
control hypertension.Corticosteroids and cytotoxic agents are used to reduce
the inflammation.H2 blockers (to prevent stress ulcers)Phosphate binding agents (to reduce phosphate and
elevate calcium).
DisorDers of kiDneyGlomerulonephritis , acute
(acute nephritic synDrome)
Nursing management- Monitor vital signs, intake and output, and maintain dietary
restrictions during acute phase.Encourage rest during the acute phase as directed until the
urine clears and BUN, creatinine, and blood pressure normalize. (Rest also facilitates diuresis.)
Administer medications as ordered, and evaluate patient's response to antihypertensives, diuretics, H2 blockers, phosphate-binding agents, and antibiotics (if indicated).
DisorDers of kiDneyGlomerulonephritis , acute(acute nephritic synDrome)
Nursing management- Carefully monitor fluid balanceReplace fluids according to the patient's fluid losses (urine,
respiration, feces) Daily body weight as prescribed.Monitor pulmonary artery pressure and CVP, if indicated.Monitor for signs and symptoms of heart failure: distended neck
veins, tachycardia, gallop rhythm, enlarged and tender liver, crackles at bases of lungs.
Observe for hypertensive encephalopathy, any evidence of seizure activity.
DisorDers of kiDneyGlomerulonephritis , acute
(acute nephritic synDrome)
Nursing management-
Regular monitoring of blood pressure, urinary protein, and BUN concentrations to determine if there is exacerbation of disease activity.
Encourage patient to treat any infection promptly.Tell patient to report any signs of decreasing renal
function and to obtain treatment immediately.
DisorDers of kiDneyacute pyelonephritis
Definition-
Pyelonephritis is a bacterial infection of the renal pelvis, tubules, and interstitial tissue of one or both
kidneys.
DisorDers of kiDneyacute pyelonephritis
Etiology- upward spread of bacteria from the bladder or spread from
systemic sources reaching the kidney via the bloodstream.Systemic infections (such as tuberculosis) can spread to the
kidneys and result in abscesses. Pyelonephritis can result from urinary obstruction such as
vesicoureteral reflux (incompetence of ureterovesical valve, which allows urine to regurgitate into ureters, usually at time of voiding), other renal disease, trauma, or pregnancy
DisorDers of kiDneyacute pyelonephritis
Commonest microorganism- Enteric bacteria, such as E. coli, is most common pathogenother gram-negative pathogens include Proteus species,
Klebsiella, and Pseudomonas. Gram-positive bacteria are less common, but include
Enterococcus and Staphylococcus aureus
DisorDers of kiDneyacute pyelonephritis
Pathophysiology-
DisorDers of kiDneyacute pyelonephritis
Clinical features- Fever, chills, headache, malaise Flank pain (with or without radiation to groin)Nausea, vomiting, anorexiaCostovertebral angle tendernessUrgency, frequency, and dysuria may be present
DisorDers of kiDneyacute pyelonephritis
Diagnostic evaluation- History – urinary obstruction, systemic infectionPhysical examination- pain and tenderness in the area of the
costovertebral angle Urinalysis- pyuria, bactriuria, RBCs and WBCs in urineHematology- elevated WBC countAn ultrasound study or a CT scan may be performed to
locate any obstruction in the urinary tract. An IV pyelogram may be indicated with pyelonephritis if
functional and structural renal abnormalities are suspected Urine culture and sensitivity tests are performed to
determine the causative organism
DisorDers of kiDneyacute pyelonephritis
Management- For severe infections (dehydrated, cannot tolerate oral
intake) or complicating factors (suspected obstruction, pregnancy, advanced age), inpatient antibiotic therapy is recommended.Usually immediate treatment is started with a penicillin or
aminoglycoside I.V. to cover the prevalent gram-negative pathogens; subsequently adjusted according to culture results.
An oral antibiotic may be started 24 hours after fever has resolved and oral therapy continued for 3 weeks.
DisorDers of kiDneyacute pyelonephritis
Management-
Oral therapy antibiotic therapy is acceptable for outpatient treatment.Co-trimoxazole (Bactrim, Septran) or a
fluoroquinolone is used; 10 to 14 days is the usual length of treatment.
Repeat urine cultures should be performed after the completion of therapy.
Supportive therapy is given for fever and pain control and hydration.
DisorDers of kiDneyacute pyelonephritis
Complication-
Bacteremia with sepsisPapillary necrosis leading to renal failureRenal abscess requiring treatment by percutaneous
drainage or prolonged antibiotic therapyPerinephric abscessParalytic ileus
DisorDers of kiDneyacute pyelonephritis
Nursing Management-
Administer or teach self-administration of antibiotics as prescribed, and monitor for effectiveness and adverse effects.
Assess vital signs frequently, and monitor intake and output; administer antiemetic medications to control nausea and vomiting.
Administer antipyretic medications as prescribed and according to temperature.
DisorDers of kiDneyacute pyelonephritis
Nursing Management- Report fever that persists beyond 72 hours after initiating
antibiotic therapy; further testing for complicating factors will be ordered.
Use measures to decrease body temperature if indicated; cooling blanket, application of ice to armpits and groins, and so forth.
Correct dehydration by replacing fluids, orally if possible, or I.V.
Monitor CBC, blood cultures, and urine studies for resolving infection.
DisorDers of kiDneynephrotic synDrome
Definition-
Nephrotic syndrome is a clinical disorder characterized by marked increase of protein in the urine (proteinuria), decrease in albumin in the blood (hypoalbuminemia),
edema, and excess lipids in the blood (hyperlipidemia).
These occur because of increased permeability of the glomerular capillary membrane.
DisorDers of kiDneynephrotic synDrome
Classification of nephrotic syndrome-ETOLOGICAL CLASSIFICATIONPrimary NEPHROTIC syndrome. Disease limited to kidneySecondary NEPHROTIC syndrome. Other systems involvedHISTOLOGICAL CLASISIFICATIONMCD (Minimal change disease )FSGN (Focal segmental glomerulosclerosis )MN (Membranous nephropathy)MPGN (membranous proliferative glomerulonephrosclerosis)
DisorDers of kiDneynephrotic synDrome
Etiology-Membranous nephropathy (MN)Hepatitis B Sjogren's syndrome Systemic lupus erythematosus (SLE) Diabetes mellitus Sarcoidosis Syphilis Drugs Malignancy (cancer)
DisorDers of kiDneynephrotic synDrome
Etiology-Focal segmental glomerulosclerosis (FSGS)Hypertensive Nephrosclerosis Human immunodeficiency virus (HIV) Diabetes mellitus Obesity Kidney loss Minimal change disease (MCD)Drugs Malignancy, especially Hodgkin's lymphoma
DisorDers of kiDneynephrotic synDrome
pathophysiology-
DisorDers of kiDneynephrotic synDrome
Clinical features-The major manifestation of nephrotic syndrome is
edema. It is usually soft and pitting and commonly occurs
around the eyes (periorbital), in dependent areas (sacrum, ankles, and hands), and in the abdomen (ascites).
Patients may also exhibit irritability, headache, and malaise.
DisorDers of kiDneynephrotic synDrome
Diagnostic evaluation-Urinalysis- marked proteinuria, microscopic hematuria, 24-hour urine for protein (increased) and creatinine
clearance (decreased)Protein electrophoresis and immunoelectrophoresis of
the urine to categorize the proteinuriaNeedle biopsy of kidney for histologic examination of
renal tissue to confirm diagnosisSerum chemistry- decreased total protein and albumin,
normal or increased creatinine, increased triglycerides, and altered lipid profile
DisorDers of kiDneynephrotic synDrome
Complications-Complications of nephrotic syndrome include- Infection (due to a deficient immune response)Thromboembolism (especially of the renal vein)Pulmonary emboliARF(due to hypovolemia) Accelerated atherosclerosis (due to hyperlipidemia)
DisorDers of kiDneynephrotic synDrome
Management-Treatment of causative glomerular diseaseDiuretics (used cautiously) and angiotensin converting
enzyme inhibitors to control proteinuriaCorticosteroids or immunosuppressant agents to decrease
proteinuriaGeneral management of edema
Sodium and fluid restriction; liberal potassiumInfusion of salt-poor albuminDietary protein supplements
Low-saturated-fat diet
DisorDers of kiDneynephrotic synDrome
Nursing Management-Monitor daily weight, intake and output, and urine specific
gravity.Monitor CVP (if indicated), vital signs, orthostatic blood
pressure, and heart rate to detect hypovolemia.Monitor serum BUN and creatinine to assess renal function.Administer diuretics or immunosuppressants as prescribed,
and evaluate patient's response.Infuse I.V. albumin as ordered.Encourage bed rest for a few days to help mobilize edema;
however, some ambulation is necessary to reduce risk of thromboembolic complications.
DisorDers of kiDneyacute renal failure
Definition-
Acute renal failure is a sudden and almost complete loss of kidney function caused by failure of renal
circulation or by glomerular or tubular dysfunction.
DisorDers of kiDneyacute renal failure
Etiology-Pre – renal (hypoperfusion of kidney)Intra – renal (actual damage to the kidney tissue) Post – renal (obstruction to urine flow)
DisorDers of kiDneyacute renal failure
Etiology-Pre – renal Volume depetionHemorrhageRenal losesGI lossesImpaired cardiac efficiencyVasodilationsepsisAnaphylaxisAntihypertensive medications
DisorDers of kiDneyacute renal failure
Etiology-Intra – renal Prolonged renal ischemiaPigment nephropathyMyoglobinuriaHemoglobinuriaNephrotoxic agentsAminoglycosides agentsRadiopaque contrast agentsHeavy metalsSolvents and chemicalsNSAIDsRenal infections
DisorDers of kiDneyacute renal failure
Etiology-Post – renal Urinary tract obstructionsRenal calculiTumorsBPHBlood clotsStrictutres
DisorDers of kiDneyacute renal failure
RISK FACTORSAdvanced ageBlockages in the blood vessels in your arms or legsDiabetesHigh blood pressureHeart failureKidney diseasesLiver disease
DisorDers of kiDneyacute renal failure
RISK FACTORSAdvanced ageBlockages in the blood vessels in your arms or legsDiabetesHigh blood pressureHeart failureKidney diseasesLiver disease
DisorDers of kiDneyacute renal failure
PHASES OF ARF Initiating phaseOliguric phase Diuretic phaseRecovery phase
DisorDers of kiDneyacute renal failure
PHASES OF ARF Initiating phase
Begins with the initial insult and ends when oliguria developsOliguric phase
Urine output less than 400 ml/dayDiuretic phase
Urine out put become normal but nitrogenous waste products still remain elevated in blood
Recovery phase
It signifies the improvement of renal function
It takes 3-12 months to return normal
DisorDers of kiDneyacute renal failure
Clinical features-Vomiting and/or diarrhea, which may lead to dehydration.Nausea. Weight loss. Nocturnal urination.pale urine. Less frequent urination, or in smaller amounts than usual,
with dark coloured urineHaematuria. Pressure, or difficulty urinating. Itching.
DisorDers of kiDneyacute renal failure
Clinical features-Bone damage. Non-union in broken bones. Muscle cramps (caused by low levels of calcium which can
cause hypocalcaemia)Abnormal heart rhythms. Muscle paralysis.Swelling of the legs, ankles, feet, face and/or hands. Shortness of breath due to extra fluid on the lungsPain in the back or sideFeeling tired and/or weak.
DisorDers of kiDneyacute renal failure
Clinical features-Memory problems. Difficulty concentrating.Dizziness.Low blood pressure. AnorexiaPruritusSeizures (if blood urea nitrogen level is very high)
DisorDers of kiDneyacute renal failure
Diagnostic evaluation-History regarding the etiological factors and risk factors.Physical symptomsUrine out put – scanty, bloody, and low specific gravityIncreased BUN and creatinine level in blood HyperkalemiaMetabolic acidosisHyperphoshatemiaHypocalcemiaAnemia
DisorDers of kiDneyacute renal failure
Prevention-
Provide adequate hydration to patient at high risk for dehydration
Prevent and treat shock with blood and fluid replacement therapy
Manage hypotensionMonitor critically ill patient for central venous and
arterial pressures and hourly urine output to detect the onset of renal failure as early as possible.
Continuously assess the renal function
DisorDers of kiDneyacute renal failure
Prevention-
Prevent and treat infectionsCautiously administer the bloodClosely monitor the all medications that
metabolized and excreted by the kidney for dosage and blood levels for the toxic effects.
Pay special attention to wound, burns and other precursors of sepsis.
DisorDers of kiDneyacute renal failure
COMPLICATIONS
ARF can affect the entire body in the form of –InfectionHyperkalaemia, Hyperphosphataemia, HyponatraemiaWater overloadPericarditisPulmonary oedema.Reduced level of consciousness.Immune deficiency
DisorDers of kiDneyacute renal failure
Management-
To correct fluid and electrolyte balance. To correct dehydration. To Keep other body systems working properly
DisorDers of kiDneyconGenital DisorDers of Genitourinary system
Common Renal anomalies
• Abnormal number: agenesis
• Abnormal form or position: horseshoe kid.
Common ureteral & renal pelvis anomalies
• UPJ obstruction.
• Vesico-uretral reflux.
• Duplication.
• Uretrocele.
• Ectopic ureter.
DisorDers of kiDneyconGenital DisorDers of Genitourinary system
Common Bladder anomalies
• Bladder Extrophy.
Common Urethral & penile anomalies
• Hypospadias.
• Epispadias.
DisorDers of kiDneyCongenital DisorDers of
genitourinary system
Renal agenesis
Bilateral renal agenesis
• both mesonephric ducts fail to develop.
• Incompatible with life.
Unilateral renal agenesis
• the mesonephric duct fails to develop.
• Usually there is absent ureter, trigone, kidney and (in boys) vas deferens.
DisorDers of kiDneyCongenital DisorDers of genitourinary system
Horseshoe kidney
• both metanephros are fused together.
• both kidneys rotated & their lower poles are joined in the shape of a horseshoe.
• As the fetus grows, the joined kidneys are held up by the inferior or superior mesenteric arteries at L3.
DisorDers of kiDneyCongenital DisorDers of
genitourinary system
Pelviureteric junction obstruction
Obstruction of the junction between the renal pelvis & ureter.
Aetiology
• aperistaltic segment of ureter due to absent muscles.
or
• crossing vessels over UPJ.
DisorDers of kiDneyCongenital DisorDers of genitourinary system
Pelviureteric junction obstruction
Clinical features-
may present at any time (before birth, in childhood, or in adulthood) by:
• abdominal mass.
• abdominal pain.
• Haematuria after fairly minor abdominal trauma.
Diagnostic evaluation-IVU - shows delay in appearance of contrast and dilated renal
pelvis and calices. Renal scan -shows differential renal function and confirms
obstruction.
DisorDers of kiDneyCongenital DisorDers of genitourinary system
Pelviureteric junction obstruction
Management-
Surgery is indicated for:
1. obstructive symptoms,
2. stone formation,
3. recurrent urinary infection,
4. progressive renal impairment.
• Pyeloplasty is the treatment of choice
• Nephrectomy is performed if the affected kidney is <10% of total renal function.
DisorDers of kiDneyCongenital DisorDers of genitourinary system
Pelviureteric junction obstruction
Management-
alternative techniques:
1.Antegrade endopyelotomy .
2.Laparoscopic pyeloplasty
DisorDers of kiDneyCongenital DisorDers of genitourinary system
Vesicoureteric junction reflux
• Reflux can be defined as the retrograde flow of urine into upper urinary tract.
• incidence of reflux is equal in both sexes.
• Reflux can be classified into 5 grades -
DisorDers of kiDneyCongenital DisorDers of genitourinary system
Vesicoureteric junction reflux
• Evaluation
•Micturating cystourethrography is the gold standard for diagnosis and evaluation of VUR grade.
•Diuretic Renal scan (DMSA) is used to visualize scarring and quantify differential renal function.
DisorDers of kiDneyCongenital DisorDers of genitourinary system
Vesicoureteric junction reflux
Management
•antibiotic prophylaxis is recommended for children with reflux of grades I-II.
•Surgery (uretro - vesical reimplantation or endoscopic injection) is recommended in reflux of grades III-V and persistent reflux despite a trial of antibiotics.
DisorDers of kiDneyCongenital DisorDers of genitourinary system
Duplication of urinary system
• Ureteral duplication is the most frequent anomaly of urinary tract
• Female: male = 2 : 1
• The orifice draining the upper segment is often obstructed.
• The orifice of the lower segment generally refluxes.
• Duplication is usually discovered on an IVU .
• Management is according to segment affected and its function.
DisorDers of kiDneyCongenital DisorDers of
genitourinary system
Ectopic ureter
• An ectopic ureter is one that opens in some location other than the bladder.
80% associated with duplicated system.
20% associated with single system.
• Most common sites (in female): urethra, vestibule, and vagina
• In female present as urinary incontinence.
• Most common sites (in male): posterior urethra and seminal vesicles.
DisorDers of kiDneyCongenital DisorDers of
genitourinary system
Uretrocele
• A congenital cystic ballooning of the terminal submucosal ureter.
• It is classified as simple or ectopic.
• Simple ( Orthotopic ) Ureterocele : in trigone.
•Ectopic Ureterocele : can obstruct bladder neck or even prolapse from female urethra.
DisorDers of kiDneyCongenital DisorDers of genitourinary system
Hypospadias
• It is a condition in which the opening of the urethra is on the underside of the penis, instead of at the tip.
• congenital condition results in underdevelopment of urethra.
• affects 3 per 1000 male infants.
• Consists of 3 anomalies:
( 1 ) Abnormal ventral opening of the urethral meatus.
( 2 ) Ventral curvature of the penis ( chordee ).
( 3 ) Deficient prepuce ventrally
DisorDers of kiDneyCongenital DisorDers of genitourinary system
Hypospadias
• Site Of the meatus
DisorDers of kiDneyCongenital DisorDers of genitourinary system
Hypospadias
Treatment • The child should be referred for urological assessment and surgical treatment. • The ideal age for surgery is 6–12 months.
DisorDers of kiDneyCongenital DisorDers of genitourinary system
Epispadias
• Congenital condition in which the urethra opens on dorsal surface of penis..
• Usually associated with bladder extrophy (ectopia vesicae).
DisorDers of kiDneyCongenital DisorDers of genitourinary system
Bladder Extrophy (Ectopia vesicae)
• Failure of development of the lower abdominal wall.
• Anomaly include defect in anterior abdominal wall, defect in anterior bladder wall and epispadias (dorsal penile opening).
DisorDers of kiDneyCanCer of kiDney
Incidence-Cancer of the kidney accounts for about 3.7% of all cancers
in adults. It affects almost twice as many men as women. The most common type of renal tumor is renal cell or renal
adenocarcinoma, accounting for more than 85% of all kid- ney tumors.
These tumors may metastasize early to the lungs, bone, liver, brain, and contralateral kidney.
The incidence of all stages of kidney cancer has increased in last two decades.
DisorDers of kiDneyCanCer of kiDney
Risk factors-Gender: Affects men more than women Tobacco use Occupational exposure to industrial chemicals, such as petroleum products,
heavy metals, and asbestos Obesity Unopposed estrogen therapy Polycystic kidney diseaseregular use of NSAIDs such as ibuprofen and naproxen, faulty genes; a family history of kidney cancer; having kidney disease that needs dialysis; being infected with hepatitis C; previous treatment for testicular cancer or cervical cancer.
DisorDers of kiDneyCanCer of kiDney
Types-Most ocuuring renal cancer are renal cell carcinoma and renal pelvis
carcinoma, other, less common types of kidney cancer include:Squamous cell carcinomaJuxtaglomerular cell tumors (reninoma)angiomyolipomaRenal ancocytomaBellini duct carcinomaClear cell sarcoma of the kidneyMesoblastic nephromaWilm’s tumor, usually is reported in children under the age of 5.Mixed epithilial stromal cell tumors
DisorDers of kiDneyCanCer of kiDney
Clinical features-Many renal tumors produce no symptoms and are discovered on a
routine physical examination as a palpable abdominal mass. The classic triad of signs and symptoms, comprises hematuria, pain,
and a mass in the flank. The usual sign that first calls attention to the tumor is pain- less
hematuria, which may be either intermittent and microscopic or continuous and gross.
There may be a dull pain in the back from the pressure produced by compression of the ureter, extension of the tumor into the perirenal area, or hemorrhage into the kidney tissue.
Colicky pains occur if a clot or mass of tumor cells passes down the ureter.
weight loss, increasing weakness, and anemia.
DisorDers of kiDneyCanCer of kiDney
Assessment and Diagnostic Findings-
The diagnosis of a renal tumor may require intravenous urography, cystoscopic examination, nephrotomograms, renal angiograms, ultrasonography, CT scan.
DisorDers of kiDneyCanCer of kiDney
Management-
Goal-
The goal of management is to eradicate the tumor before metastasis occurs.
DisorDers of kiDneyCanCer of kiDney
Management-
Surgical management-A radical nephrectomy is the preferred treatment if the
tumor can be removed. This includes removal of the kidney (and tumor), adrenal gland, surrounding perinephric fat and Gerota’s fascia, and lymph nodes.
Radiation therapy, hormonal therapy, or chemotherapy may be used along with surgery.
ImmunotherapyNephron-sparing surgery
DisorDers of kiDneyCanCer of kiDney
Management-
pharmacological management-use of biologic response modifiers such as interleukin-2 (IL-
2) and topical instillation of bacillus Calmette-Guerin (BCG) Patients may be treated with IL-2, a protein that regulates
cell growth. This may be used alone or in combination with lymphokine-activated killer cells
Interferon, another biologic response modifier, appears to have a direct antiproliferative effect on renal tumors.
DisorDers of kiDneyCanCer of kiDney
Management-
Renal Artery Embolization-In patients with metastatic renal carcinoma, the renal artery
may be occluded to impede the blood supply to the tumor and thus kill the tumor cells.
DisorDers of kiDneyCanCer of blaDDer
Cancer of the urinary bladder is more common in people aged 50 to 70 years.
It affects men more than women (3:1) There are two forms of bladder cancer: superficial (which
tends to recur) and invasive. About 80% to 90% of all bladder cancers are transitional cell (which means they arise from the transitional cells of the bladder);
the remaining types of tumors are squamous cell and ade- nocarcinoma.
DisorDers of kiDneyCanCer of blaDDer
Risk factors- Cigarette smoking: risk proportional to number of packs
smoked daily and number of years of smoking Environmental carcinogens: dyes, rubber, leather, ink, or
paint Recurrent or chronic bacterial infection of the urinary tract Bladder stones High urinary pH High cholesterol intake Pelvic radiation therapy Cancers arising from the prostate, colon, and rectum in
males
DisorDers of kiDneyCanCer of blaDDer
Clinical ManifestationsBladder tumors usually arise at the base of the bladder and
involve the ureteral orifices and bladder neck. Visible, painless hematuria is the most common symptom of
bladder cancer. Infection of the urinary tract is a common complication,
producing frequency, urgency, and dysuria. Any alteration in voiding or change in the urine, however,
may indicate cancer of the bladder. Pelvic or back pain may occur with metastasis.
DisorDers of kiDneyCanCer of blaDDer
Assessment and Diagnostic Findings
The diagnostic evaluation includes –cystoscopy (the mainstay of diagnosis), excretory urography, a CT scan, ultrasonography, bimanual examination with the patient anesthetized. Biopsies of the tumor and adjacent mucosa
DisorDers of kiDneyCanCer of blaDDer
Management- surgical Transurethral resection or fulguration (cauterization) may be per-
formed for simple papillomas (benign epithelial tumors). eradicate the tumors through surgical incision or electrical current with the use of instruments inserted through the urethra.
After this bladder-sparing surgery, intravesical administration of BCG is the treatment of choice.
A simple cystectomy (removal of the bladder) or a radical cystectomy is performed for invasive or multifocal bladder cancer.
Radical cystectomy in men involves removal of the bladder, prostate, and seminal vesicles and immediate adjacent perivesical tissues.
DisorDers of kiDneyCanCer of blaDDer
Management- pharmacologicalChemotherapy with a combination of methotrexate, 5-fluorouracil,
vinblastine, doxorubicin (Adriamycin), and cisplatin Intravenous chemotherapy may be accompanied by radiation therapy. Topical chemotherapy (intravesical chemotherapy or instillation of
antineoplastic agents into the bladder, resulting in contact of the agent with the bladder wall) is considered when there is a high risk for recurrence, when cancer in situ is present, or when tumor resection has been incomplete.
Topical chemotherapy de- livers a high concentration of medication (doxorubicin, mitomycin, ethoglucid, and BCG) to the tumor to promote tumor destruction.
BCG is now considered the most effective intravesical agent for recurrent bladder cancer because it enhances the body’s immune response to cancer.
DisorDers of kiDneyCanCer of blaDDer
Management- radiation therapyRadiation of the tumor may be performed preoperatively to reduce
microextension of the neoplasm and viability of tumor cells,
DisorDers of kiDneyCanCer of ureter
Ureteral cancer is usually transitional cell carcinoma. Transitional cell carcinoma is "a common cause of ureter
cancer and other urinary (renal pelvic) tract cancers.“Cancer of the ureter begins in the cells that line the inside of
the tubes (ureters) that connect your kidneys to your bladder.Cancer of the ureter is uncommon. It occurs most often in older adults and in people who have
previously been treated for bladder cancer.Men>womenWhitish>black
DisorDers of kiDneyCanCer of ureter
Risk factors-Increased ageTreatment of bladder cancerTobacco smokingAnalgesics nephropathyIndustrial exposures
DisorDers of kiDneyCanCer of ureter
Clinical features-Symptoms of ureteral cancer may include –blood in the urine (hematuria); diminished urine stream and straining to void (caused by urethral stricture);
frequent urination and increased nighttime urination (nocturia); hardening of tissue in the perineum, labia, or penis; itching;incontinence; pain during or after sexual intercourse (dyspareunia); painful urination (dysuria); recurrent urinary tract infection; urethral discharge and swelling.
DisorDers of kiDneyCanCer of ureter
Diagnostic evaluation-Diagnosis may include- computed tomography urography (CTU), magnetic resonance urography(MRU), intravenous pyelography (IVP) x-ray, Ureteroscopy biopsy
DisorDers of kiDneyCanCer of ureter
Management-Treatment methods include -surgery Chemotherapy radiation therapy medication.
DisorDers of kiDneyCanCer of urethra
Urethral cancer is cancer originating from the urethra. Cancer in this location is rare, and the most common type is papillary transitional cell carcinoma
Having a history of bladder cancerHaving conditions that cause chronic, swollen, reddened part in the urethra.
Being 60 or older.Being a white female.
DisorDers of kiDneyCanCer of urethra
Clinical features-Bleeding from the urethra or blood in the urine.Weak or interrupted flow of urine.Urination occurs often.A lump or thickness in the perineum or penis.Discharge from the urethra.Enlarged lymph nodes in the groin area.Most common site being bulbomembranous urethra
DisorDers of kiDneyCanCer of urethra
Diagnostic evaluation-Diagnosis is established by transurethral biopsyTypes-transitional cell carcinoma squamous cell carcinoma adenocarcinoma melanoma
DisorDers of kiDneyCanCer of urethra
Management-Surgery-Open excision surgery.Electro-resection with flash surgery.Laser surgeryCystourethrectomy surgery.Cystoprostatectomy surgery.Anterior body cavity surgery.Incomplete or basic penectomy surgery.
DisorDers of kiDneyCanCer of urethra
Management-chemotherapy-Chemotherapy involves using drugs to destroy urethral cancer cells.
It is a systemic urethral cancer treatment (i.e., destroys urethral cancer cells throughout the body) that is administered orally or intravenously (through a vein; IV).
Medications are often used in combination to destroy urethral cancer that has metastasized.
Commonly used drugs include vincristine, cisplatin and methotrexate
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