Question

1. Review the terms used to describe and classify urinary tract disorders

2. Discuss UTI diagnosis, management, nursing care, and prevention.

3. Describe the external defects of the genitourinary tract, including phimosis, hydrocele, cryptorchidism, hypospadias, exstrophy-epispadias complex (EEC), and the disorders of sex development.

4. Differentiate among the most common conditions of pituitary dysfunction in terms of causes, clinical manifestations, and therapeutic management.

5. Antidiuretic hormone (ADH) is critical in the cause of diabetes insipidus and SIADH. Review how the secretion of ADH relates to these two conditions

6. Discuss the surgical treatment of congenital adrenal hyperplasia in female children

Answer 1

Kidney and urinary tract disorders can involve one or both kidneys, one or both ureters, the bladder, or the urethra, and in men, the prostate, one or both testes, or the epididymis. Problems with the male reproductive system often manifest as persistent erection, scrotal pain, scrotal swelling, or blood in the semen.

Some urinary tract disorders rarely cause symptoms until the problem is very advanced. These include

• Kidney failure

• Tumors

• Stones that do not block urine flow

• Some low-grade infections

Sometimes, symptoms occur but are very general or vague and are not always obviously related to the kidneys. For example, a general feeling of illness (malaise), loss of appetite, or nausea may be the only symptoms of advanced kidney failure. In older people, mental confusion may be the first recognized symptom of infection or kidney failure.

Symptoms that are more suggestive of a kidney or urinary problem include

• Pain in the side (flank)

• Swelling of the feet or legs

• Problems with urination (including blood in urine, changes in the color or odor of urine, excessive or frequent urination, gas in urine, pain or burning with urination, urgency, and hesitating, straining, and dribbling)

Incontinence is an uncontrollable loss of urine, which can have a variety of causes.

Renal Vascular Disease

Renal vascular disease affects the blood flow into and out of the kidneys. It may cause kidney damage, kidney failure, and high blood pressure.

Analgesic Nephropathy

Taking one or a mix of painkiller medicines daily over a long time may cause chronic kidney problems. This is called analgesic nephropathy. Painkillers that combine 2 or more medicines (such as, aspirin and acetaminophen together) with caffeine or codeine are the most likely to harm the kidneys.

Anatomy of the Urinary System

Detailed anatomical description of the urinary system, including simple definitions an

Benign Prostatic Hyperplasia (BPH)

Benign prostatic hyperplasia (BPH) is also called benign prostatic hypertrophy. It’s when the prostate gland becomes very large and may cause problems passing urine. BPH is not cancer, and is a common part of aging.

Cystocele

When the wall between the bladder and the weakens, the bladder may drop or sag into the vagina. This disorder in women is called cystocele.

Urogenital Disorders

Detailed information on the most common urogenital disorders, including bladder cancer, cystocele (fallen bladder), hematuria, blood in the urine, impotence, erectile dysfunction, interstitial cystitis, male factor infertility, prostate disease, benign prostatic hyperplasia, BPH, prostate cancer, urinary incontinence, urinary tract infection, vesicoureteral reflux

Glomerulosclerosis

Glomerulosclerosis is scarring in the tiny blood vessels in the kidneys called the glomeruli. These are the tiny units in the kidneys that filter urine from the blood.

Blood in the Urine

Blood in the urine means there are red blood cells (RBCs) in the urine. Often, the urine looks normal to the naked eye. But when checked under a microscope, it contains a high number of red blood cells. In some cases, the urine is pink, red, or the color of tea, which you can see without a microscope.

Hemolytic Uremic Syndrome

A urinary tract infection (UTI) is an infection from microbes. These are organisms that are too small to be seen without a microscope. Most UTIs are caused by bacteria, but some are caused by fungi and in rare cases by viruses. UTIs are among the most common infections in humans.

2: A urinary tract infection, or UTI, is an infection in any part of your urinary system, which includes your kidneys, bladder, ureters, and urethra.

Symptoms of UTIs

The symptoms of a UTI can include:

• A burning feeling when you pee
• A frequent or intense urge to pee, even though little comes out when you do
• Cloudy, dark, bloody, or strange-smelling pee
• Feeling tired or shaky
• Fever or chills (a sign that the infection may have reached your kidneys)
• Pain or pressure in your back or lower abdomen
• prevention ::

  Following some tips can help you avoid getting another UTI:

• Empty your bladder often as soon as you feel the need to pee; don't rush, and be sure you've emptied your bladder completely.
• Wipe from front to back after you use the toilet.
• Drink lots of water.
• Choose showers over baths.
• Stay away from feminine hygiene sprays, scented douches, and scented bath products; they'll only increase irritation.
• Cleanse your genital area before sex.
• Pee after sex to flush out any bacteria that may have entered your urethra.
• If you use a diaphragm, unlubricated condoms, or spermicidal jelly for birth control, you may want to switch to another method. Diaphragms can increase bacteria growth, while unlubricated condoms and spermicides can irritate your urinary tract. All can make UTI symptoms more likely.
• Keep your genital area dry by wearing cotton underwear and loose-fitting clothes. Don’t wear tight jeans and nylon underwear; they can trap moisture, creating the perfect environment for bacteria growth.
• Diagnosis

• Diagnostic studies for UTI consist of dipstick, urinalysis, and culture. No imaging studies are indicated in the routine evaluation of cystitis.

  Current emphasis in the diagnosis of UTI rests with the detection of pyuria, as follows:

• A positive leukocyte esterase dipstick test suffices in most instances

• In females with clinical findings suggestive of UTI, urine microscopy may be indicated even if the leukocyte esterase dipstick test is negative

• Pyuria is most accurately measured by counting leukocytes in unspun fresh urine using a hemocytometer chamber; more than 10 white blood cells (WBCs)/mL is abnormal

• treatment:

  Treatment of UTIs depends on the cause. Your doctor will be able to determine which organism is causing the infection from the test results used to confirm the diagnosis.

  In most cases, the cause is bacteria. UTIs caused by bacteria are treated with antibiotics.

  In some cases, viruses or fungi are the causes. Viral UTIs are treated with medications called antivirals. Often, the antiviral cidofovir is the choice to treat viral UTIs. Fungal UTIs are treated with medications called antifungals.

  Commonly used antibiotics include:

• Nitrofurantoin
• Sulfonamides (sulfa drugs)
• Amoxicillin
• Cephalosporins
• Trimethoprim/sulfamethoxazole (Bactrim®)
• Doxycycline
• Quinolones (such as ciprofloxacin [Cipro®])

  

Nursing Interventions

Nurses care for patients with urinary tract infection in all settings.

• Relieve pain. Antispasmodic agents may relieve bladder irritability and analgesics and application of heat help relieve pain and spasm.
• Fluids. The nurse should encourage the patient to drink liberal amounts of fluids to promote renal blood flow and to flush bacteria from the urinary tract.
• Voiding. Encourage frequent voiding every 2 to 3 hours to empty the bladder completely because this can significantly lower urine bacterial counts, reduce urinary stasis, and prevent reinfection.
• Irritants. Avoid urinary irritants such as coffee, tea, colas, and alcohol.