Kidneys and Urogenital

Sistem

Department of Urology, MSU ‘’N.Testemitanu”

Chisinau, Moldova
 DEFINITION

UROLOGY - (from Greek uron - urine; logos –

study of) is the science about the etiology,
pathogenesis, diagnosis and treatment of
diseases of the urinary system, male
reproductive system, adrenal diseases and other
pathological processes in the retroperitoneal
space.
 Introduction
 Catabolism
 Waste products
 Gases form or / and soluble form (urea)
 Major function of the US :
- remove urea and waste products from
body fluids
- maintain the proper balance (water, salts,
acids in the body fluids)
 Position
Retroperitoneal,

Either side of Vert. Column

Lumbar region
 Cushion of adipos tissue
and surround by fibr. Capsule
 Renal Capsule

 Fibrous capsule
 Adipos capsule
Fibrous

Capsule
Adipos
capsule
 Kidney structure and blood supply
 Outer - Cortex region
 Inner - Medulla region
 Aorta and renal arteries
 Renal vein
Anterior Surface
of the kidney
 OTHER ORGANS OF URINARY
SISTEM

 Ureters

 Urinary bladder

 Uretra
 ureter
 Muscular tubes lined with mucous
membrane
 Convey urine in
peristaltic waves
Ureter is divided into 3 parts:
 ①abdominal part
 ②pelvis part
 ③intramural part

 28 to 34 cm
 3 narrowing sites
 Urinary bladder and uretra
1.Hollow, muscular,
distensible
2.Temporar reservoir
Exit aria close by
two sphincters
3.Uretra membranous
tube – urine discharged
4.Process of expelling of
urine - micturition
How the kidneys produce urine ?
 How the kidneys produce urine ?
 Aorta, kidney arteries, arterioles
 Special device for maintaining blood flow
 Renin stimulates contraction of arterioles
 Glomerulus
 Cuplike structure Bowman’s capsule
 Filtered out not only the wastes
 Not advantageous for the body to allow to pass valuable
substances
 Reabsorbtion or put back through the renal tubules
 Renal tubules carrying urine to cuplike divisions calyces
 Calyces form renal pelvis
2

3
Detail of Nephron structure
 Renal pelvis narrows
into ureter which carries
urine to the bladder
 Bladder
Fills up muscular contractions of the wall pressure is
placed on the base of urethra desire to urinate take
place urination
 Signs and simptoms
Clinical manifestations in urological diseases :

1. Pain of urogenital origin

2. Disorders of micturition

3. Quantitative and qualitative changes in urine

4. Pathological urinary elimination

 PAINS
Pains can be:
acute and dull (cronic);
permanent or periodic;
in rest or active exercise;

• Lombar pains - kidney damage, renal colic;

• groin – for ureteric diseases;
• suprapubic pain - for bladder diseases;
• in perineum – for prostate diseases.
 Micturition disorders
Physiological parameters

Diuresis - 1500 ml urine per 24 hours

(physiological condition of the body,
liquid quantity, ambient temperature,
physical effort).

Frequency of urination –3-5 micturitions per

24 hours.

Physiological capacity (bladder volume) –

250-300 ml.
 Micturition disorders

Pollakiuria (frequent urination) – often, but by little.

( lower urinary tract pathology).

• Daytime pollakiuria – it is characteristic for bladder

calculi

• Nighttime pollakiuria – an early symptom in the

diagnosis of of prostate adenoma;

• (Permanent) daytime and nighttime - cancer,

tuberculosis, inflammatory processes.
 Micturition disorders

Acute urinary retention – impossible to urinate; bladder is full,

painful.
Acute urinary retention need to be distinguished from anuria.

Paradox ischuria – occurs after retention of urine for a long

time,
Urine is evacuated involuntarily by drop.
It is met in prostate adenoma of 3rd degree.
 Quantitative changes in urine

Polyuria – Elimination of more 2000 ml of urine, usually with

relatively low density (1002-1012),.
It occurs in chronic pyelonephritis, prostate adenoma, various
kidney failure (glomerulonephritis, polycystosis, diabetes, etc

Oliguria – (less than 500 ml).

physiological (use of small quantity of liquid, fever, physical

effort, hyperhidrosis)

pathological (acute and chronic renal failure, nephrotic

syndrome, shock state, tubulointerstitial nephritis).
 Quantitative changes in urine

Anuria – the kidneys do not produce urine

Anuria is considered when the amount of urine is ≤ 50 ml/24 hours.
Anuria can be of the following forms:
Prerenal – acute renal failure (vascular thrombosis, shock, collapse,
massive dehydration).
Renal – kidneys damage after various diseases, (acute
glomerulonephritis, intoxication with various chemicals, drugs,
incompatible blood transfusion, etc.).
Postrenal (obstructive, mechanical) – occurs after an obstacle, that
makes impossible the urine passage from kidney into the lower
urinary tract. It occurs in bilateral nephrolithiasis, tumors,
ureteral ligation or their excision during gynecological surgery.
 Qualitative changes in urine

Proteinuria – appearance of protein in urine.

Ketonuria – occurs in diabet, (abnormal products from fat
catabolizm in cell).
Pyuria – presence of pus in the urine.
Leucocituria – presence of leukocytes in urine.
 Qualitative changes in urine
Haematuria – presence of red blood cells (erythrocyturia) in the
urine.
initial (urethro-prostatic), terminal (vesical), total (renal);
macrohematuria (viewed macroscopic) and microhematuria
(microscopic);

Bacteriuria – presence of bacteria in urine (E.coli, staphylococcus,

streptococcus, Proteus vulgaris, etc.). Normally the urine is sterile!
 Laboratory examination, urine
(presence of abnormal elements)
Macroscopic :
Volume (1000 – 1500 ml ), color (yell., amb. or red, brown) ;
• Urine reaction: test of acidity or alcallinity, neutral,
• Albumine (leak in renal membrane)
• Sugar (insulin is lacking and sugar cannot leave the blood)
• Specific gravity and ketone body (reflect amount of wastes,
minerals, solts; ex: diabets vs. nefritis)
•Microscopic:
leukocyturia, hematuria, proteinuria, crystalluria
 Radiological exploration

X-ray of renovezical sistem :

- Skeletal survey : Tm metastases, osteohondrosis,

scoliosis.
- Renal survey: size; deformation, renal contour
and psoas muscle.

Radiopaque images: tuberculosis and stones.

 Intravenous urography (IVU)

“queen of urinary explorations”

It is an anatomo-functional method :

• renal morphology (shape, contour, size);

• kidney function (secretion, renal excretion);
• stones;
• evaluation of urinary tract obstruction;
• evaluation of hematuria.
 Intravenous urography (IVU)

Urography in: tumors, tuberculosis,

pyelonephritis, hydronephrosis, urinary lithiasis,
adenoma and prostate cancer, obstruction , trauma

IVU contraindications:
•severe intolerance at iodinated products
•pregnancy
Acute Renal Failure (prerenal, renal)
•Advanced Chronic Kidney Failure
•Shock conditions
Complications:
•Allergic reactions (deaths 1 to 80 000)
•anuria
 Retrograde ureteropyelography

- ureteric catherization through cystoscope to

introduce the contrast substance, it is a dangerous invasive
explorations and requires strict indication.

Indications: a bad urography; when the urography

does not provide revealing information; sensitivity at
intravenous administering of radiopaque substances;
conducting special endourologic surgery (percutaneous
nephrolithotomy).
Contraindications are similar to those for cystoscope
and urethral cathetirism (urethritis, acute cystitis, pyrexia,
during the menstrual cycle, trauma of urethra and bladder).
Computed tomography and Nuclear Magnetic Resonance (NMR)

widely applied especially in the diagnosis and

establishing the stages of urogenital tumors.
-the location and size of tumor,
-degree of parietal penetration,
-metastasis.
 Ultrasound (ultrasonography)

The ultrasound has several advantages:

• absolutely safe
• easy to perform
• has no contraindications
• can always be performed in emergencies
• provides data about the entire urinary sistem
• it can be repeated as many times as it is necessary and at any time
interval
 Instrumental methods of exploration

• Uretro-bladder probes.
• Urethral probes.
• Metal tools.
• Tools used for endoscopic investigations and
treatments.
• Urological fibroscopy.
 Case A

A 55-year-old woman was found rolling on

her kitchen floor, crying out from agonizing
pain in her abdomen. The pain came in
waves and extended from the right loin to
the groin and to the front of the right thigh.
An anteroposterior radiograph of the
abdomen revealed a calculus in the right
ureter.
 Question

a. What causes the pain when a ureteral

calculus is present?
b. Why is the pain felt in such an extensive
area?
c. Why the pain is coming in peristaltic
waves ?
d. What other metods of diagnosis you can
propose ?
 Case B
An explorer in the Amazon jungle was found
alive after having lost contact with the
outside world for six months. On physical
examination, he was found to be in an
emaciated condition. On palpation of the
abdomen, a rounded, smooth swelling
appeared in the right loin at the end of
inspiration. On expiration, the swelling
moved upward and could no longer be felt.
 Questions
 What sistem and organs are involve in this
patology situation ?

 What metods of diagnosis can you use ?

 Case C

An intravenous pyelogram revealed that a

patient’s left kidney was in its normal position,
but the right kidney was situated in front of
the right sacroiliac joint.
-Can you explain this on embryological
grounds?
-What you can recommend to this pacient ?
 Case D

Afterexamination of a patient you

suppose that she had a horseshoe kidney.
How to establish correctly the final
diagnosis ?
What kind of treatment you will propose ?
 Case E
An intravenous pyelogram revealed that the
calyces and pelvis of a patient’s right kidney
were grossly dilated.
What diagnosis you suppose ?
How to investigate this pacient ?
What metods of treatment you will use ?
 Case F

Ifyou will find large molecules like proteins in urine what

pathology you will think about ?
Which is mecanism and patogenesis of this disease ?
What complications are characteristic for this disease ?
Hydronephrosis
Horseshoe kidney