Genito-urinary Disease
- How a HEALTHY 'Genito-urinary System' works
- Urological Disease
- Urinary Incontinence
- BPH (Benign Prostatic Hyperplasia)
- Glossary of Terms
1. HOW A HEALTHY 'GENITO-URINARY SYSTEM' WORKS
When we talk about Urology, it is often referred to as the 'Urinary Tract', or 'Urinary System'. In men it is also referred to as the 'genito-urinary system'. This is simply because urine flows through the structures of the genitals, and therefore they are part of the urinary system. The main parts of this system include the two kidneys, two ureters, the bladder and the urethra.
The two kidneys are located in the upper part of the abdomen, with one on each side of the body. Blood enters the kidney through the Renal Artery, and leaves via the renal vein. While passing through the kidney, blood is filtered by the microscopic units in the kidney called 'nephrons' (hence the term Nephrology, meaning the study of the kidneys) to remove impurities and waste products. The kidney also helps to regulate the amount of fluid that is retained in the body, and controls the body's electrolytes.
Waste products are collected in the nephrons, and directed into the ureter. This is a long tube that extends from the kidney and allows urine to drain into the bladder. Ringlike bands of muscle ('sphincters') located at the entrance to the bladder (from the ureters) prevent urine from flowing back up to the kidneys. The urine containing the waste products gets stored in the bladder until it gets disposed through urination. The bottom of the bladder empties into another tube called the urethra. In a male the urethra is situated along the length of the penis, and has its opening at the tip; in the female, the urethra is generally shorter than in the male, and its opening is just above the vagina.
When the volume of urine starts to build up in the bladder, you will feel a sense of fullness, and hence the need to empty your bladder. The healthy person is able to exert conscious control over the urge to urinate. Normally, adults urinate 4 to 6 times a day, and anything between 700m and 2 litres a day. There are also sphincters in the urethra, which are subconsciously kept in a constricted (closed) position. When a person goes to the toilet, and is ready to urinate, the sphincter is consciously relaxed and flow proceeds until emptying has taken place.
In the male, there is an additional organ in the genito-urinary system, called the prostate. It is roughly the size of a chestnut, and is doughnut-shaped. It lies just below the bladder, and encircles the top section of the urethra. The prostate is a gland that secretes prostatic fluid, which makes up about 25% of the volume of semen. This fluid also enters the urethra and is disposed through the tip of the penis. From around the age of 45 the prostate starts to grow in size.
2. UROLOGICAL DISEASE
Kidney and urinary tract disorders can affect one or both kidneys, one or both ureters, the bladder or the urethra. Sometimes, there are no symptoms in the initial stages of genito-urinary disease, such as in some infections (UTI's), kidney stones, obstruction, and tumours. Even in chronic kidney failure, there are no symptoms until the disease has reached a critical stage. However, occasionally there will be some symptoms to warn you that all is not well with your plumbing! People may experience symptoms of fever, some weight loss, and a general feeling of fatigue ('malaise').
Changing patterns of urination may often be an indication that there may be an underlying disease. Frequent micturition (another word for urination), without an increase in the urine volume may mean that your bladder filling capacity has been reduced. Polyuria (urinating >2.5 litres a day) may be caused by many hormone disorders, as well as drinking large volumes of water. On the other hand, diminished urination (oliguria <500ml urine/day) can be due to kidney problems, or a blockage in the bladder outlet or urethra. Sometimes you may see an abnormal colour in your urine, which may relate to a certain food or fluid you will have ingested (eg. fizzy vitamin pills dissoled in water), but could also be because of a chemical imbalance in your blood. Other conditions include: anuria, nocturia, enuresis, dysuria, pneumaturia, haematuria, uraemia.
There are two common conditions involving the urinary tract that are being discussed here, and they are: Urinary Incontinence - passing urine without control (Over-active Bladder - OAB) and Benign Prostatic Hyperplasia (BPH) - BPH only occurs in males. The following is a brief overview of both diseases: For more detailed information click here...
3. URINARY INCONTINENCE
It is the involuntary or uncontrolled leaking of urine. Up to 1 in 3 elderly people will have incontinence, with the problem more common in women. There are different forms of incontinence:
- The bladder muscle may be overactive, causing involuntary contractions and leaking of urine; urination occurs when you exert yourself (coughing, lifting), without bladder contraction (also called Stress Incontinence)
- The bladder does not empty because of weak contractions, resulting in urinary retention
- An abrupt and intense urge to urinate, followed by the uncontrolled loss of urine
- Blockage that causes a full and distended bladder, and eventually small amounts of urine dribble out
- Urine leaks out because the person cannot, or is unwilling to, get to a toilet (referred to as Psychogenic/Functional Incontinence).
To make a diagnosis of incontinence, you will need to record the details of your urine flow, such as frequency, volume, urgency, colour, and other such information. Most importantly, the extent to which your problem may be affecting your quality of life and function, will determine how it should be managed. Treatment patterns vary depending on the type of incontinence you have. Behavioural changes regarding fluid intake and urination patterns are usually the first step, followed if and where necessary, by drug treatment.
4. BPH (BENIGN PROSTATIC HYPERPLASIA)
This is a condition only experienced by males, where the prostate gland becomes enlarged and makes urination difficult. It is increasingly common in men over the age of 50, and is thought to be as a result of hormonal changes, in particular testosterone. An enlarged prostate constricts the outer surface of the urethra, and obstructs the flow rate. Men with BPH find it difficult to fully empty their bladders, and tend to dribble at the end of urination. They also tend to urinate frequently, particularly at night. Urine remaining in the bladder may stagnate and cause an infection or even kidney stones. Diagnosis of BPH is confirmed by a generally painless rectal examination, and occasionally a blood test (prostate-specific antigen (PSA) to rule out prostate cancer. The doctor may also use ultrasound or a catheter to check for urinary retention. Obstruction can also lead to incontinence in the man with BPH, and even to complete blockage. Treatment is usually not necessary unless there are troublesome symptoms, such as UTI's, impaired kidney function, kidney stones, blood in the urine, or urinary retention. The primary form of treatment is the use of drugs to relax the muscles in the prostate and bladder, and ease the flow of urine. In the event that drug therapy proves inadequate, surgery becomes necessary to relieve symptoms, which may be associated with complications, such as bleeding and infection.
The following test will be useful if you suspect you may have BPH
(print questionnaire)
Once you have answered the questions and completed the exercise, take this to your doctor to discuss what course of action needs to be taken, if any at all.
5. GLOSSARY OF TERMS
Anuria - No urination
BPH/Benign Prostatic Hyperplasia - Abnormal enlargement of the prostate gland
Dysuria - Painful urination
Electrolytes - charged chemical particles in the blood (eg. calcium, magnesium, potassium)
Enuresis - Bed-wetting
Haematuria - Blood in the urine
Incontinence - Uncontrollable urination
Micturition - Urination
Nephron - Microscopic units of the kidney that filters the blood
Nephrology - The study of the kidneys
Nocturia - Urination at night (getting up often)
Oliguria - Infrequent (too little) urination
Polyuria - Excessive urination
Pneumaturia - Gas in the urine
Prostate - Gland in the male that produces a fluid used by sperms
Sphincter - Small, ringlike band of muscle
Transurethral Resection of the Prostate (TURP) - Surgical procedure, whereby small sections of the prostate can be cut out
Ureter - The tube connecting the kidney to the bladder
Urethra - The tube that goes from the bladder to the external environment
Urinary Tract Infections (UTI's) - Infections that occur in the urinary tract
Urination - The process of passing urine (medical term: micturition)
Urodynamic test - The flow rate of urine tested during urination
Disclaimer: The health information contained herein is provided for educational purposes only and is not intended to replace discussions with a healthcare provider. All decisions regarding patient care must be made with a healthcare provider, considering the unique characteristics of the patient.