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bladder

Expandable reservoir for storing urine

Bowman's capsule

Sphere-shaped structure that surrounds the glomerulus and collects filtrate

calix

Ducts at the tip of each renal pyramid. The minor calices take urine to the major calices.

collecting duct

Common passageway that collects fluid from many nephrons. The final step of reabsorption takes place there and the fluid is known as urine.

cortex

Tissue layer of the kidney just beneath the renal capsule

creatinine

Waste product from muscle contractions. It is removed from the blood by the kidneys.

distal convoluted tubule

Tubule of the nephron that begins at the loop of Henle. It empties into the collecting duct. Reabsorption takes place there.

electrolytes

Substances that have a positive or negative charge and conduct electricity when dissolved in a solution. Excess amounts in the blood are removed by the kidneys. Examples: Sodium, potassium, chloride, bicarbonate.

erythropoietin

Hormone secreted by the kidneys when the number of red blood cells decreases. It stimulates the bone marrow to produce more red blood cells.

filtration

Process in which water and substances in the blood are pushed through the pores of the glomerulus. The resulting fluid is known as filtrate.

flank

Area of the back between the ribs and the pelvis that overlies the kidneys

fundus

Dome-shaped top of the bladder

glomerulus

Network of intertwining capillaries within Bowman's capsule in the nephron. Filtration takes place in the glomerulus.

hilum

Indentation in the medial side of each kidney where the renal artery enters and the renal vein and the ureter leave

kidney

Organ of the urinary system that produces urine

Word or Phrase

Description

loop of Henle

Tubule of the nephron that is U-shaped. It begins at the proximal convoluted tubule and ends at the distal convoluted tubule. Reabsorption takes place there.

medulla

Area of kidney tissue beneath the cortex. It contains the renal pyramids.

mucosa

Mucous membrane lining the inside of the bladder

nephron

Microscopic functional unit of the kidney

parenchyma

Functional area of the kidney that is made up of the cortex and medulla and contains the nephrons

penis

Structure that is part of the male reproductive system. In a man, the inferior part of the urethra passes through the center of the penis.

peristalsis

Process of smooth muscle contractions that propel urine through the ureter

prostate gland

Gland that is part of the male reproductive system. In a man, the superior part of the urethra passes through the center of the prostate gland.

proximal convoluted tubule

Tubule of the nephron that begins at Bowman's capsule and ends at the loop of Henle in the nephron. Reabsorption takes place there.

reabsorption

Process by which water and substances in the filtrate move out of the tubule and into the blood in a nearby capillary

renal capsule

Tough outer layer that surrounds the kidney

renal pyramids

Triangular-shaped areas of tissue in the medulla of the kidney

renin

Enzyme secreted by special cells near the nephron when the blood pressure decreases. Renin stimulates the production of angiotensin, a powerful vasoconstrictor.

retroperitoneal space

Area behind the peritoneum that lines the abdominal cavity. The retroperitoneal space contains the kidneys and fatty tissue.

rugae

Folds in the mucosa of the bladder that disappear as the bladder fills with urine

sphincter

Muscular ring around a tube. The sphincter in the bladder neck is not under conscious control. The external urethral sphincter at the end of the urethra is under voluntary, conscious control.

trigone

Triangular-shaped area in the bladder that is formed by the two ureteral orifices and the opening to the urethra

tubules

Small tubes within the nephron

urea

Waste product from protein metabolism. It is removed from the blood by the kidneys.

ureter

Tube that carries urine from the pelvis of the kidney to the bladder

ureteral orifice

Opening at the end of the ureter as it enters the bladder

urethra

Tube that carries urine from the bladder to the outside of the body

urethral meatus

The opening to the outside of the body that is at the end of the urethra

uric acid

Waste product from purine metabolism. It is removed from the blood by the kidneys.

urinary system

Body system that includes the kidneys, ureters, bladder, and urethra. Its function is to produce urine. It also helps regulate the internal environment of the body by secreting the enzyme renin and the hormone erythropoietin. Also known as the urinary tract, genitourinary system or tract, urogenital system or tract, or the excretory system.

urination

The process of producing urine and expelling it from the body. Also known as voiding and micturition.

urine

Water, waste products, and other substances excreted by the kidneys

glomerulonephritis

Complication that develops following an acute infection with streptococcus bacteria or viruses. The original infection, which is in the throat, causes the immune system to produce antibodies. Antibodies combine with bacteria or viruses to form antigen-antibody complexes that clog the pores of the glomeruli. The kidney becomes inflamed and urine production decreases. Treatment: Corticosteroid drugs to decrease inflammation. Renal dialysis, if necessary.

hydronephrosis

Enlargement of the kidney due to constant pressure from backed-up urine in the ureter because of an obstructing stone or stricture. In caliectasis, the calices of the kidney are grossly enlarged, in hydroureter, only the ureter is grossly enlarged. Treatment: Removal of the stone or stricture.

nephrolithiasis

Kidney stone or calculus formation in the urinary system. Kidney stones can vary in size from microscopic (often referred to as sand or gravel) (see Figure 11 -12 ■) to large enough to block the ureter or fill the renal pelvis (see Figure 11-1311). They are composed of magnesium, calcium, or uric acid crystals. Calculogenesis or lithogenesis is the process of forming stones. Many stones pass out of the body spontaneously, although in the process they can cause nausea and vomiting, hematuria, and renal colic. Renal colic is a spasm of the smooth muscle of the ureters or bladder as the kidney stone's jagged edges scrape the mucosa and cause pain. Stones that do not pass spontaneously can be removed surgically or destroyed by lithotripsy. Treatment: Analgesic drugs, lithotripsy, or the surgical procedures of stone basketing or percutaneous nephrolithotomy.

nephropathy

General word for any disease process involving the kidney. Diabetic nephropathy involves progressive damage to the glomeruli because of diabetes mellitus. The tiny arteries of the glomerulus harden (glomerulosclerosis) because of accelerated arteriosclerosis throughout the body. Treatment: Correct the underlying cause; manage the diabetes mellitus.

nephroptosis

Abnormally low position of a kidney. It sometimes requires surgery, but more often is mentioned as an incidental finding seen on an x-ray.

nephrotic syndrome

Damage to the pores of the glomeruli allows large amounts of albumin (protein) to leak into the urine, decreasing the amount of blood proteins. This changes the osmotic pressure of the blood and allows fluid to go into the tissues, producing edema in the extremities, and into the abdominal cavity, producing ascites (a grossly enlarged, fluid-distended abdomen). Treatment: Diuretic drugs to decrease edema. Correct the underlying cause.

polycystic kidney disease

Congenital disease characterized by cysts in the kidney that eventually obliterate the nephrons, causing kidney failure (see Figure 11-1411). The early stage of this progressive degenerative disease shows few symptoms and is not detected until hypertension and already-enlarged kidneys are detected on physical examination. Treatment: Dialysis or kidney transplanation.

pyelonephritis

Inflammation and infection of the pelves of the kidneys. Infection of the kidneys (nephritis) would also involve the renal pelves. Caused by a bacterial infection of the bladder that ascends the ureters to the kidneys.

renal cell cancer

Cancerous tumor (carcinoma) that arises from tubules in the nephrons. Treatment: Surgical removal of the kidney.

renal failure

Disease in which the kidneys progressively decrease and then stop producing urine. Symptoms do not appear until 80 percent of kidney function has been lost. Acute renal failure (ARF) occurs suddenly and is usually due to trauma, severe blood loss, or overwhelming infection. It is accompanied by acute tubular necrosis, the sudden destruction of large numbers of nephrons and their tubules. Chronic renal failure (CRF) begins with renal insufficiency, followed by gradual'worsening with progressive damage to the kidneys from diabetes mellitus, hypertension, or glomerulonephritis. End-stage renal disease (ESRD) is the final, irreversible stage of chronic renal failure in which there is little or no remaining kidney function. Treatment: Treat the underlying cause. Treat end-stage failure with dialysis.

uremia

Excessive amounts of urea in the blood because of renal failure. The kidneys are unable to remove the waste product urea. It reaches toxic levels in the blood and is excreted through the sweat glands, making white deposits on the skin that look like ice (uremic frost). Treatment: Dialysis.

Wilms' tumor

Cancerous tumor of the kidney that occurs in children and arises from residual embryonic or fetal tissue. Also known as a nephroblastoma. Treatment: Surgery, radiation therapy, chemotherapy.

bladder cancer

Cancerous tumor (carcinoma) of the epithelium of the bladder, most commonly seen in men over age 60. Hematuria is often a presenting sign. Treatment: Transurethral resection of the bladder tumor (TURBT), surgical excision of the bladder (cystectomy), radiation therapy, or intravesical instillation of chemotherapy drugs.

cystitis

Inflammation or infection of the bladder (see Figure 11-150). This is commonly caused by a bacterial infection of the urethra that ascends into the bladder, particularly in women because of the short length of the urethra. Interstitial cystitis is a chronic and progressive infection in which the mucosal lining becomes extremely irritated and red, with bleeding. Radiation cystitis is caused by the irritating effects of radiation therapy given to treat bladder cancer. Treatment: Correct the underlying condition.

cystocele

Hernia in which the bladder bulges through a weakness in the muscular wall of the vagina or rectum. This causes urinary retention in the part of the bladder that pouches into the vagina or rectum. Also known as a vesicocele. Treatment: Surgical repair of the vagina or rectum, if severe.

neurogenic bladder

Urinary retention due to a lack of innervation of the nerves of the bladder. Caused by a spinal cord injury, spina bifida, multiple sclerosis, or Parkinson's disease. The bladder must be catheterized intermittently because it does not contract to expel urine. Treatment: Catheterization.

overactive bladder

Urinary urgency and frequency due to involuntary contractions of the bladder wall as the bladder fills with urine. This sometimes causes incontinence. Treatment: Antispasmodic drugs to decrease bladder wall contractions.

urinary retention

Inability to empty the bladder because of an obstruction (enlargement of the prostate gland, kidney stone), nerve damage (neurogenic bladder), or as a side effect of certain types of drugs. Even when the bladder contracts, a large amount of postvoid residual remains in the bladder. Treatment: Correct the underlying cause.

vesicovaginal fistula

Formation of an abnormal passageway connecting the bladder to the vagina. Urine flows from the bladder into the vagina and is excreted through the vagina. Treatment: Surgical correction.

epispadias

Congenital condition in which the female urethral meatus is incorrectly located near the clitoris or the male urethral meatus is incorrectly located on the upper surface of the shaft of the penis rather than at the tip of the glans penis. Hypospadias is when the male urethral meatus is incorrectly located on the underside of the shaft of the penis rather than at the tip of the glans penis. Treatment: Surgery to reposition the urethral meatus.

urethritis

Inflammation or infection of the urethra. Gonococcal urethritis is a symptom of the sexually transmitted disease gonorrhea caused by the bacterium Neisseria gonorrhoeae. Nongonococcal urethritis is a sexually transmitted disease caused by the bacterium Chlamydia trachomatis. Nonspecific urethritis is an inflammation or infection of the urethra from bacteria, chemicals, or trauma; it is not a sexually transmitted disease. Treatment: Antibiotic drugs for bacterial infections.

albuminuria

Presence of albumin in the urine. Albumin is the major protein in the blood. Normally there is none in the urine because albumin molecules are too large to pass through the pores in the glomerulus; but if the membrane is damaged by kidney disease or infection, albumin passes through and is excreted in the urine. Albuminuria is an important first sign of kidney disease. It is also present in pregnant women who are developing preeclampsia. Also called proteinuria. Treatment: Correct the underlying cause.

anuria

Absence of urine production by the kidney. The underlying cause is acute or chronic renal failure. Treatment: Diuretic drugs or renal dialysis.

bacteriuria

Presence of bacteria in the urine. Normally, urine is sterile. Bacteria indicate a urinary tract infection. Treatment: Antibiotic drugs.

dysuria

Difficult or painful urination. It can be due to many factors (kidney stone, cystitis, and so forth). Treatment: Correct the underlying cause.

enuresis

Involuntary urination during sleep. Also known as nocturnal enuresis or bedwetting. It is only considered a disease in older children or adults who should have voluntary bladder control. Treatment: Antidiuretic hormone (ADH), a pituitary gland hormone; psychological therapy.

frequency

Urinating often, usually in small amounts. Can be caused by a kidney stone, enlargement of the prostate gland, or a urinary tract infection. Treatment: Correct the underlying cause. Frequency is also present during pregnancy when the enlarging uterus limits the capacity of the bladder; however, this is not considered a disease.

glycosuria

Glucose in the urine, an indication of elevated blood sugar levels seen in diabetes mellitus. Treatment: Correct the underlying cause.

hematuria

Blood in the urine. This may be gross or frank blood (easily seen with the naked eye) or microscopic blood (hemoglobinuria). Can be caused by a kidney stone, cystitis, bladder cancer, and so forth. In addition, menstrual blood can contaminate a urine specimen. Treatment: Correct the underlying cause.

hesitancy

Inability to initiate a normal stream of urine. There is dribbling, and the urinary stream has a decreased caliber. The volume of urine passed is less, and urine may remain in the bladder. Can be caused by blockage of the urethra by a kidney stone, a urinary tract infection, or an enlarged prostate gland. Treatment: Correct the underlying cause.

hypokalemia

Decreased amounts of potassium in the blood. Can be caused by diuretic drugs that cause the kidney to excrete excessive amounts of urine (and potassium). Treatment: Adjust the dose of the diuretic drug.

incontinence

Inability to voluntarily keep urine in the bladder. Can be caused by a spinal cord injury, surgery on the prostate gland, unconsciousness, or mental conditions such as dementia. Treatment: Correct the underlying cause.

ketonuria

Ketone bodies in the urine. Ketones are waste products produced when fat is metabolized. Patients with diabetes mellitus metabolize fat for energy because they cannot metabolize glucose; they have ketonuria. Also seen in malnourished patients. Treatment: Correct the underlying cause.

nocturia

Increased frequency and urgency of urination during the night. It can be due to cystitis, an enlarged prostate gland, or decreased capacity of the bladder due to aging. Expressed as the number of times the patient voids each night (example: nocturia x3). Treatment: Correct the underlying cause.

oliguria

Decreased production of urine associated with kidney failure, although dehydration can cause temporary oliguria. Treatment: Correct the underlying cause.

polyuria

Excessive production of urine associated with diabetes mellitus and diabetes insipidus. Treatment: Correct the underlying cause.

pyuria

White blood cells (WBCs) in the urine, indicating a urinary tract infection. Pyuria can be seen with the naked eye when the urine is cloudy or milky, or the number of white blood cells may be so few that only microscopic examination during urinalysis reveals them. Treatment: Antibiotic drugs.

urgency

Strong urge to urinate and a sense of pressure in the bladder. It is caused by obstruction from an enlarged prostate gland or a kidney stone or inflammation from a urinary tract infection. Treatment: Correct the underlying cause.

urinary tract infection (UTI)

General category of an infection anywhere in the urinary tract. Urinary tract infections are caused by bacteria, most often by Escherichia coli (E. coli), which is commonly found in the intestines and rectum. When the infection is only in the urethra, it is called urethritis. When the infection is in the bladder, it is called cystitis. When the infection is in the kidney, it is called pyelonephritis. Because of the short length of the urethra in women and its location close to the anus, women are more prone than men to develop urinary tract infections. Catheterization can also introduce bacteria into the urinary tract. Treatment: Antibiotic drugs.

blood urea nitrogen (BUN)

Blood test that measures the amount of urea. Used to monitor kidney function and the progression of kidney disease or watch for signs of nephrotoxicity in patients taking aminoglycoside antibiotic drugs.

creatinine

Blood test that measures the amount of creatinine. Used to monitor kidney function and the progression of kidney disease. Creatinine is measured in conjunction with the BUN to give a comprehensive picture of kidney function.

culture and sensitivity (C&S)

Urine test that puts urine onto culture medium in a Petri dish to identify the cause of a urinary tract infection (see Figure 11-16B). Microorganisms present in the urine grow into colonies. The specific disease-causing microorganism is identified and tested to determine its sensitivity to various antibiotic drugs.

drug screening

Urine test performed on a group of employees or athletes to detect any individual who is using illegal, addictive, or performance-enhancing drugs.

leukocyte esterase

Urine test to detect esterase, an enzyme associated with leukocytes and a urinary tract infection. This dipstick test gives a quick result so that antibiotic drugs can be started immediately. At the same time, a urine specimen is sent for C&S.

24-hour creatinine clearance

Urine test that collects all urine for 24 hours to measure the total amount of creatinine "cleared" (excreted) by the kidneys. The result is compared to the level of creatinine in the blood to determine the level of kidney function.

urinalysis (UA)

Urine test to describe the characteristics of the urine and detect substances in it. A quick urinalysis can be done with a dipstick test (see Figure 11-1711) or the urine specimen can be sent to the laboratory for a full analysis. Figure 11-17 ■ A urine dipstick. This plastic strip with chemical-impregnated pads can perform .jr several different laboratory tests (pH, protein, glucose, blood, and ketone bodies) at one time with -".""> a single dip in a urine specimen. \-.„,- The pads change color over the ''-tjflHF two-minute waiting period. The final color of each pad is com- i ^wr p31"^ t0 a c'iar1: on 'Dac'< a, the container that gives a range « of colors for each test and the tr associated test result numbers.

urin color

Normal urine is light yellow to amber in color, depending on its concentration. Pink or smoky-colored urine indicates red blood cells from bleeding. Turbid (cloudy or milky) urine indicates white blood cells and a urinary tract infection. The urinary antispasmodic drug Pyridium turns the urine bright orange.

urin odor

Urine has a faint odor due to the waste products in it. The urine of patients with uncontrolled diabetes mellitus has a fruity smell because of the glucose in it. When urine stands at room temperature, bacteria from the air grow in it, breaking down the urea into ammonia; this gives old urine its characteristic smell.

ruin PH

A test of how acidic or alkaline the urine is. Urine is normally slightly alkaline. Bacteria grow quickly and some types of kidney stones form readily in alkaline urine. Patients with urinary tract infections or kidney stones may be told to drink cranberry juice to make their urine more acidic.

urin protein

Protein (or albumin) is not normally found in the urine. Its presence (proteinuria or albuminuria) indicates damage to the glomerulus.

urin glucose

Glucose is not normally found in the urine. Its presence (glycosuria) indicates uncontrolled diabetes mellitus with excess glucose in the blood "spilling" over into the urine.

red blood cells (RBCs)

Microscopic examination of the urine under high-power magnification to count the number of erythrocytes (red blood cells). Even clear urine can contain occult blood. This microscopic hematuria is reported as the number of RBCs per high-power field (hpf). If the urine has visible blood, the red blood cell count is reported as "TNTC" (too numerous to count).

white blood cells (WBCs)

Microscopic examination of the urine under high-power magnification to count the number of leukocytes (white blood cells) to identify a urinary tract infection. If the specimen is milky or cloudy, the white blood cell count is reported as "TNTC."

ketones

Ketones are not normally found in the urine. They are produced when the body cannot use or does not have enough glucose and instead metabolizes fat. Seen in patients with uncontrolled diabetes mellitus, malnutrition, or in marathon runners.

specific gravity (SG)

Measurement of the concentration of the urine as compared to that of water (specific gravity 1.000). Dilute (not concentrated) urine has a specific gravity of 1.005, while concentrated urine is 1.030. Above 1.030 means the patient is dehydrated. Instruments used to measure specific gravity include a urinometer (see Figure 11-18 B) or a refractometer, a handheld instrument that uses light rays bent (refracted) by a thin layer of urine on glass. Figure 11-18 B Urinometer. This test tube-like container holds the urine. A calibrated glass weight floats in the urine. The specific gravity is measured where the surface of the urine touches the calibrated scale.

sediment

There are several types of sediment in the urine. Crystals (calcium oxalate, uric acid, and so forth) may become a kidney stone. Casts are protein molecules (hyaline casts) or blood (red cell casts) that have been molded by the cylindrical shape of the tubules before they enter the bladder. Epithelial cells are normal in the urine as they are shed continuously from the lining of the urinary tract.

other substances

Chemical compounds whose presence helps to diagnose certain disease conditions. Bence Jones protein is seen in multiple myeloma (cancer of the bone marrow), vanillylmandelic acid (VMA) is seen in pheochromo-cytoma and neuroblastoma, and 5-HIAA is seen in carcinoid syndrome.

intravenous pyelography (IVP)

Radiologic procedure that uses x-rays and radiopaque contrast dye (see Figure 11-19 B). The dye is injected intravenously and flows through the blood and into the kidneys. It outlines the renal pelves, ureters, bladder, and urethra. It shows any obstruction, blockage, kidney stone, or abnormal anatomy in the urinary tract. Also known as excretory urography. The x-ray image is known as a pyelogram or urogram. Alternatively, retrograde pyelography can be done in which a cystoscopy is performed first, and then a catheter is advanced into the ureter and dye is injected. The dye outlines the ureter, as well as the pelvis and calices of the kidney.

kidneys, ureters, bladder (KUB) x-ray

Radiologic procedure that uses x-rays of the kidneys, ureters, and bladder (KUB) without contrast dye. It is used to find kidney stones or as a preliminary x-ray (scout film) before performing a pyelogram.

nephrotomography

Radiologic procedure that uses a computerized axial tomography (CT) scan and radiopaque contrast dye injected intravenously. It takes x-ray images as multiple slices through the kidneys. The images can be examined layer by layer to show the exact location of tumors.

renal angiography

angiography Radiologic procedure that uses x-rays and radiopaque contrast dye. The (AN-jee-AWG-rah-fee) dye is injected intravenously and flows through the blood into the renal angi/o- blood vessel; artery. It outlines the renal artery and shows any obstruction or block-lymphatic vessel age. Also known as renal arteriography. The x-ray image is known as -graphy process of a renal angiogram or renal arteriogram. recording

renal scan

Nuclear medicine procedure that uses a radioactive isotope injected intravenously. It is taken up by the kidney and emits radioactive particles that are captured by a scanner and made into an image. Used after a kidney transplant to look for signs of organ rejection.

ultrasonography

ultrasonography Radiologic procedure that uses ultra high-frequency sound waves emit-(UL-trah-soh-NAWG-rah-fee) ted by a transducer or probe to produce an image of the kidneys, ultra- beyond; higher ureters, or bladder. The ultrasound image is known as a sonogram, son/o- sound -graphy process of recording sonogram (SAWN-oh-gram) son/o- sound -gram a record or picture

voiding cystourethrography (VCUG)

Radiologic procedure that uses x-rays and radiopaque contrast dye. The dye is inserted into the bladder through a cystoscope. It outlines the bladder and urethra. The x-ray image, taken while the patient is urinating, is known as a voiding cystourethrogram.

cystometry

Diagnostic procedure that evaluates the function of the nerves to the bladder. A catheter is used to inflate the bladder with liquid (or gas). A cystometer attached to the catheter measures the amount of liquid and the pressure in the bladder. The patient indicates when the first urge to urinate occurs. At that time, the cystometer makes a graphic recording known as a cystometrogram (CMG).

catheterization

Medical procedure in which a catheter (flexible tube) is inserted through the urethra and into the bladder to drain urine (see Figure 11 -2011). A i straight catheter is inserted each time the bladder becomes full, or it can j also be used to obtain a single urine specimen for testing. A Foley ; catheter is an indwelling catheter that drains urine continuously. It has j an expandable balloon tip that keeps it positioned in the bladder. A j suprapubic catheter is inserted through the abdominal wall (just above j the pubic bone) and into the bladder. It is sometimes inserted after bladder or prostate gland surgery. A condom catheter is shaped like a : condom (male contraceptive device). It fits snugly over the male penis and collects the urine as it leaves the urethra meatus. i

dialysis

Medical procedure to remove waste products from the blood of patients in renal failure. There are two types of dialysis: hemodialysis and peritoneal dialysis. Hemodialysis uses a fistula or a shunt in the patient's arm. A fistula is created by surgically joining an artery and vein. Over a few weeks, the vein enlarges enough to accommodate two needles, one that removes blood and sends it to the dialysis machine and another that receives purified blood from the dialysis machine and returns it to the body. In patients whose blood vessels are small, an external shunt (loop of tubing) is used instead to join the artery to the vein (see Figure 11-2IB). Peritoneal dialysis uses a permanent catheter inserted through the abdominal wall. Dialysate fluid flows through the catheter and remains in the abdominal cavity for several hours. During that time, the fluid pulls body wastes from the blood. Then the fluid is removed, carrying waste products with it. In continuous ambulatory peritoneal dialysis (CAPD), the patient is able to walk around between the three or four daily episodes of dialysis. In continuous cycling peritoneal dialysis (CCPD), a machine inserts and removes dialysate fluid several times a night while the patient sleeps.

intake and output (l&O)

Nursing procedure that documents the total amount of fluid intake (oral, nasogastric tube, intravenous line, and so forth) and the total amount of fluid output (urine, wound drainage, and so forth) (see Figure 11-22H). Used to monitor the body's fluid balance in patients with renal failure, burns, congestive heart failure, large draining wounds, dehydration, overdose of diuretic drugs, and so forth.

urine specimens

Medical procedure to obtain a urine specimen for testing. A clean-caught specimen (the urethral meatus is first cleansed) or a catheterized specimen (obtained directly from a catheter) is placed in a sterile container and used for culture and sensitivity testing.

bladder neck suspension

Surgical procedure to correct stress incontinence. A supportive sling of muscle tissue or synthetic material is inserted around the base of the bladder and the urethra to elevate them to a normal position.

cystectomy

Surgical procedure to remove the bladder because of bladder cancer. A radical cystectomy removes the bladder, surrounding tissues, and lymph nodes.

cystoscopy

Surgical procedure that uses a rigid or flexible cystoscope inserted through the urethra in order to examine the bladder (see Figure 11-23®. A wide-angle lens and a light allow a full view of the bladder. A video attachment can be used to create a permanent visual record.

kidney transplantation

Surgical procedure to remove a severely damaged kidney from a patient with end-stage kidney failure and insert a new kidney from a donor. The patient (the recipient) is matched by blood type and tissue type to the donor. The patient's diseased kidney is removed and the donor kidney is sutured in place. Kidney transplantation patients must take immunosuppressant drugs for the rest of their lives to keep their bodies from rejecting the foreign tissue that is their new kidney. Patients continue to undergo dialysis while waiting for a donor kidney.

lithotripsy

Medical or surgical procedure that uses sound waves to break up a kidney stone (see Figure 11-24H). After an x-ray pinpoints the location of the stone, a lithotriptor generates sound waves that break up the stone. Because the sound waves are generated by a source outside the body, the procedure is known as extracorporeal shock wave lithotripsy (ESWL). Alternatively, the surgical procedure percutaneous ultrasonic lithotripsy may be used. An endoscope is inserted through the flank skin and into the kidney. A lithotriptor probe is inserted • through the endoscope and into the kidney to break up large stones. Sometimes a holmium laser that generates a laser beam is used to break up very hard kidney stones.

nephrectomy

\ Surgical procedure to remove a diseased or cancerous kidney, j Alternatively, a healthy kidney may be removed from a donor so that it : can be transplanted into a patient with renal failure. £

nephrolithotomy

\ Surgical procedure in which a small incision is made in the skin and an j endoscope is inserted in a percutaneous approach into the kidney to j remove a kidney stone embedded in the pelvis or calices. j i I

nephropexy

; Surgical procedure to correct a kidney that is in an abnormally low ; position (nephroptosis) by suturing it back into anatomical position. | j

renal biopsy

Surgical procedure in which a small piece of kidney is excised for microscopic analysis. This is done to confirm or exclude a diagnosis of cancer or kidney disease.

stone basketing

Surgical procedure in which a cystoscope is inserted into the bladder. A stone basket (a long-handled instrument with several interwoven wires at its end) is then passed through the cystoscope to snare a kidney stone and remove it.

transurethral resection of a bladder tumor (TURBT)

Surgical procedure to remove a bladder tumor from inside the bladder. A special cystoscope known as a resectoscope is inserted through the urethra into the bladder. It has built-in cutting instruments and cautery to resect the bladder tumor and cauterize bleeding blood vessels. Pieces of tissue are then irrigated out of the bladder.

urethroplasty

Surgical procedure that involves plastic surgery to reposition the urethra. Used to correct congenital hypospadias or epispadias.

antibiotic drugs

Used to treat urinary tract infections. Urinary antibiotics have a special affinity for the urinary tract, although other types of antibiotics are also used to treat urinary tract infections.

chemotherapy drugs

Kill rapidly dividing cancer cells in the bladder or kidney. Intravesical chemotherapy drugs are instilled into the bladder to treat bladder cancer.

diuretic drugs

Block sodium from being absorbed from the tubule back into the blood. As the sodium is excreted in the urine, it brings water and potassium with it because of osmotic pressure. This process is known as diuresis. This decreases the volume of blood and is useful in the treatment of hypertension, congestive heart failure, and nephrotic syndrome.

potassium supplements

Used as a replacement for potassium lost due to diuretics. Diuretics increase sodium excretion but also potassium excretion because they are both positively charged electrolytes. The presence of K in the drug name refers to the chemical symbol for potassium (K+).

urinary analgesic drugs

Exert a pain-relieving effect on the mucosa of the urinary tract.

antispasmodic drugs

Relax the smooth muscle in the walls of the ureter, bladder, and urethra. Used to treat spasm from cystitis and overactive bladder. j

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