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Genitourinary system (Male and Female)

• When the say Reproductive System (Male and Female) – they mean Female genitals and reproduction. We cover the female breast, pregnancy, the cervix, mensuration the ovary and uterine and vaginal problems.
• When they say Genitourinary system (Male and Female) they mean urinary system and male genitals. We cover the bladder, the ureter, the testes and the penis.

I think breaking the information up this way makes more sense and helps your brain to hold onto it. I just think the names the aren’t 100% accurate.

So what are we talking about here in the Genitourinary section of the blueprint?

In this section we cover the urinary system minus the kidney. The NCCPA blueprint puts the kidney under renal.

Urinary system

• ureter
• bladder
• Urethra

Male reproductive system

• Penis
• Prostate
• Testicles

Nephrolithiasis/urolithiasis

• 85% of kidney stones are made of calcium
• 10% of kidney stones are uric acid
• Stones may stay in the kidney or travel down the ureter into the bladder
• Stones may become lodged in the ureter causing pain and obstruction

Clinical Presentation

• Severe flank pain known as renal colic
  • Intensity varies and is cyclical
  • Can be excruciating
• Nausea and vomiting may be present
• Fever
• Blood in urine

Labs, Studies and Physical Exam Findings

• Diaphoretic
• Patients are often unable to sit still
• No signs of peritoneal inflammation (rebound tenderness, guarding etc.)
• Urinalysis
  • Blood
  • Bacteria
• Imaging
  • CT
  • U/S
  • Abdominal X-ray
• Stone Identification

Treatment

• Prevention
  • Increase in fluids to about 100 ounces per day – 128 ounces is a gallon
  • Thiazide diuretics will lower urinary calcium excretion
• Pain control – Morphine
• Increasing fluids does not help speed up passage.
• Alpha blockers – dilation of veins, arteries and ureters
• Removal of stones
  • Shock wave lithotripsy
  • Endoscopy

Bladder Disorders

Incontinence

• Types of incontinence
  • Stress incontinence – Leaking of urine secondary to an increase in intraabdominal pressure.  Coughing, jumping, laughing etc.  This is often due to urethral incompetence.
  • Urge incontinence – A sudden feeling of uncontrollable urgency and associated loss of urine.  Often associated with an overactive detrusor muscle.  This may be due to neurologic disease. Also known as overactive bladder.
  • Overflow incontinence – Involuntary voiding without an urge to urinate typically secondary to urinary retention.  Patients do not fully empty the bladder when voiding. This is often due to an outlet obstruction (think BPH) or an underactive detrusor muscle.
  • Functional Incontinence – leakage of urine to cognitive or physical barriers.

Clinical Presentation

• Involuntary release of urine
• Frequency
• Urgency
• Nocturia

Labs, Studies and Physical Exam Findings

• Good history – most patients won’t bring this up and are hesitant to discuss it
• U/A and culture looking for signs of infection
• U/S for postvoid residual volume
• Urinary stress test
  • Cough with a full bladder
• Cystoscopy

Treatment

• Schedule fluid intake
• Maintain a healthy weight
• Schedule for bladder emptying
• Reduce caffeine and alcohol
• Discontinue medications which may be the cause especially anticholinergics
• Kegel maneuvers
• Straight catheter
• Suprapubic pressure during voiding
• Medications
  • Topical estrogens may help with urethral incompetence
  • Alpha blockers may help for BPH
  • Anticocholinergics may help by relaxing the detrusor muscle
• Surgical
  • Sacral nerve stimulator for urge incontinence
  • Urethral sling for stress incontinence

Bladder prolapse

• Cystocele – bladder herniating into vagina

Clinical Presentation

• Feeling of pelvic pressure
• Protrusion or bulge in or from the vagina
• Dyspareunia
• Difficulty emptying the bladder
• Incontinence

Treatment

• Non Surgical
  • Vaginal Pessary
  • Kegal’s
• Surgical
  • Vaginal surgery either with or without the use of mesh depending on the extent of the prolapse.
  • More extensive surgery including hysterectomy, sacrocolpopexy or uterosacral ligament suspension may also be necessary.

Urethral Prolapse

• Urethrocele
  • May be surgically corrected