GENETOURINARY SYSTEM

GENITOURINARY SYSTEM
 
In anatomy, the genitourinary system or
urogenital system is the organ system of the
reproductive organs and the urinary
system.These are grouped together because of
their proximity to each other, their common
embryological origin and the use of common
pathways, like the male urethra. Also, because
of their proximity, the systems are sometimes
imaged together.
GENITOURINARY SYSTEM
GENITOURINARY SYSTEM
Development
The urinary and reproductive organs are developed from the
intermediate mesoderm. The permanent organs of the adult are
preceded by a set of structures that are purely embryonic, and that,
with the exception of the ducts, disappear almost entirely before the
end of fetal life. These embryonic structures are on either side: the
pronephros, the mesonephros and the metanephros of the kidney,
and the Wolffian and Müllerian ducts of the sex organ. The
pronephros disappears very early; the structural elements of the
mesonephros mostly degenerate, but the gonad is developed in their
place, with which the Wolffian duct remains as the duct in males,
and the Müllerian as that of the female. Some of the tubules of the
mesonephros form part of the permanent kidney.
GENITOURINARY SYSTEM
Pathology
Pathology of the urinary system includes a range of
disorders from those that are asymptomatic to those
that manifest an array of signs and symptoms. Causes
for these disorders include congenital anomalies,
infectious diseases, trauma, or conditions that
secondarily involve the urinary structure.
To gain access to the body, pathogens can penetrate
mucous membranes lining the genitourinary tract.
GENITO URINARY SYSTEM AND
DISORDERS
The major role of urinary system is to maintain
homeostasis by maintaining body fluid
composition and volume.
The components of urinary system are as follows:
kidney, ureters, urinary bladder and urethra.
KIDNEYS
 The kidneys are two bean-shaped organs located
retroperitoneally at the level of the twelfth
thoracic and third lumbar vertebra.
GENITO URINARY SYSTEM AND
DISORDERS
 The right kidney is slightly lower than the left
kidney due the presence of the liver on the
right side of the abdomen.
 The kidneys are divided into renal cortex;
medulla and pelvis. The medulla is composed
of series of pyramids.
 The functional units of the kidney are the
nephrons. The nephrons are composed of
glumerrulus and the renal tubules.
GENITO URINARY SYSTEM AND
DISORDERS
 The glumerulus is tuft of semi permeable
capillaries, surrounded by the bowmans
capsule.
 The three regions of the renal tubules are as
follows: proximal convoluted, tubules, loop of
henle and the distal convoluted tubules.
 The function of nephron is formation of
tubules.
GENITO URINARY SYSTEM AND
DISORDERS
URETERS
 The ureters are the two small tubes about 25cm
long. They transport urine from the renal pelvis
to the urinary bladder.
 The ureters enter the urinary bladder obliquely
and are guided by ureterovesicular sphincter.
These two factors prevent reflux of urine as the
bladder contracts.
GENITO URINARY SYSTEM AND
DISORDERS

URINARY BLADDER
 Serves as reservoir of urine.
 Composed of three layers of detrusor
muscles. Contractions of these muscles
 Expels urine from the bladder.
 The bladder is guarded by internal
urethral sphincter in the junction of its
opening into the urethra.
GENITO URINARY SYSTEM AND
DISORDERS
 The approximate  maximum capacity of the bladder
is 1000mls of urine.
URETHRA
 Passage way of urine into the external environment.
 The internal urethral sphincter is an involuntary
muscle, while the external urethral sphincter is a
voluntary muscle.
 The female urethral is 1 ½ to 2 ½ inches , while the
male urethral is 5 ½ to 6 ½  up to 8 inches in length.
THE URINE FORMATION
1. GLUMERULAR FILTRATION- water and solutes
move from the blood to the glomerular capsule. The
fluid that enters the capsule is called glomerular
filtrate.
2. TUBULAR REABSORPTION –it is the movement
of the substances from the filtrate in the kidney
tubules into the blood in the  peritubular capillaries.
Water and other substances that are useful to the
body are reabsorbed. Water is reabsorbed by osmosis
,while most solutes are reabsorbed by active
transport.
THE URINE FORMATION

3. TUBULAR SECRETION- it is the transport of

substances from the blood into the renal tubules.
DIAGNOSTIC TEST FOR GENITO-URINARY
DISORDERS

1. Routine Urinalysis
2. Creatine clearance
3. Blood studies
4. Cystoscopy -direct visualization of the
urethra , bladder wall, trigone, urethral opening
through a lighted instrument.
DIAGNOSTIC TEST FOR GENITO-URINARY
DISORDERS
5. KUB
-X-RAY visualization of the kidneys, ureters 
and bladder.
6. EXCRETORY UROGRAM
7. RETROGRADE PYCLOGRAM
-Outlines renal pelvis and ureters
-Contrast medium through cystoscope.
8. VOIDING CYSTOURETHROGRAM
- Films are taken
DIAGNOSTIC TEST FOR GENITO-URINARY
DISORDERS
9. CYSTOMETROGRAM
-Records pressure exerted at varying
phases of filling of the bladder.
-Helps evaluate neuro-sensory status
and tonicity.
10. RENAL ARTERIOGRAM
11. RENAL BIOPSY
Renal Disorders
Renal Failure or Kidney Failure
-(formerly called renal insufficiency)
describes a medical condition in which the
kidneys fail to adequately filter toxins and
waste products from the blood. The two forms
are acute (acute kidney injury) and chronic
(chronic kidney disease); a number of other
diseases or health problems may cause either
form of renal failure to occur.
Renal Failure or Kidney Failure
Renal failure is described as a decrease in the
glomerular filtration rate. Biochemically, renal failure is
typically detected by an elevated serum creatinine level.
Problems frequently encountered in kidney malfunction
include abnormal fluid levels in the body, deranged acid
levels, abnormal levels of potassium, calcium,
phosphate, and (in the longer term) anemia. Depending
on the cause, hematuria (blood loss in the urine) and
proteinuria (protein loss in the urine) may occur. Long-
term kidney problems have significant repercussions on
other diseases, such as cardiovascular disease.
Polycystic kidney disease: 55-year-old-
man died of renal failure.
Renal Failure or Kidney Failure
Classification
Renal failure can be divided into two
categories: acute kidney injury or chronic
kidney disease. The type of renal failure is
determined by the trend in the serum creatinine.
Other factors which may help differentiate acute
kidney injury from chronic kidney disease include
anemia and the kidney size on ultrasound. Chronic
kidney disease generally leads to anemia and small
kidney size.
Acute Kidney Injury
Acute kidney injury (AKI), previously called acute renal
failure (ARF), is a rapidly progressive loss of renal
function, generally characterized by oliguria (decreased
urine production, quantified as less than 400 mL per day
in adults, less than 0.5 mL/kg/h in children or less than 1
mL/kg/h in infants); body water and body fluids
disturbances; and electrolyte derangement. AKI can
result from a variety of causes, generally classified as
prerenal, intrinsic, and postrenal. An underlying cause
must be identified and treated to arrest the progress, and
dialysis may be necessary to bridge the time gap required
for treating these fundamental causes.
Chronic Kidney Disease

Chronic kidney disease (CKD) can develop

slowly and initially, show few symptoms. CKD
can be the long term consequence of
irreversible acute disease or part of a disease
progression.
Acute-on-Chronic Renal Failure
Acute kidney injuries can be present on top of
chronic kidney disease, a condition called acute-on-
chronic renal failure (AoCRF). The acute part of
AoCRF may be reversible, and the goal of treatment,
as with AKI, is to return the patient to baseline renal
function, typically measured by serum creatinine.
Like AKI, AoCRF can be difficult to distinguish
from chronic kidney disease if the patient has not
been monitored by a physician and no baseline (i.e.,
past) blood work is available for comparison.
 1a 1b

1c

1d 1e
Acute on Chronic Renal Failure
Image 1a, 1b, 1c (Right Kidney - Ultrasound), 1d and 1e (Left Kidney - Ultrasound): Both kidneys are small and
echogenic. The right kidney measures 7.8cm and the left kidney measures 8.9cm. There is no evidence of
hydronephrosis and no renal calculi are seen. No vascular flow could be demonstrated within the parenchyma
one either side. No collection is seen around either kidney. The bladder which is not illustrated here is well
distended without focal abnormality. Vesicoureteric jets could not be visualised. These images are consistent
with a chronic process such as a vasculitis.
Symptoms
Symptoms can vary from person to person. Someone
in early stage kidney disease may not feel sick or
notice symptoms as they occur. When kidneys fail to
filter properly, waste accumulates in the blood and
the body, a condition called azotemia. Very low
levels of azotaemia may produce few, if any,
symptoms. If the disease progresses, symptoms
become noticeable (if the failure is of sufficient
degree to cause symptoms). Renal failure
accompanied by noticeable symptoms is termed
uraemia.
Symptoms of Kidney Failure
 High levels of urea in the blood, which can
result in:
-Vomiting and/or diarrhea, which may lead to
dehydration
-Nausea
-Weight loss
-Nocturnal urination
-Foamy or bubbly urine
-More frequent urination, or in greater amounts
than usual, with pale urine
Symptoms of Kidney Failure
-Less frequent urination, or in smaller amounts than
usual, with dark coloured urine
-Blood in the urine
-Pressure, or difficulty urinating
A build up of phosphates in the blood that
diseased kidneys cannot filter out may cause:
-Itching
-Bone damage
-Muscle cramps (caused by low levels of calcium which
can cause hypocalcaemia)
Symptoms of Kidney Failure
A build up of potassium in the blood that diseased
kidneys cannot filter out (called hyperkalemia)
may cause:
-Abnormal heart rhythms
-Muscle paralysis
 Failure of kidneys to remove excess fluid may
cause:
-Swelling of the legs, ankles, feet, face and/or hands
-Shortness of breath due to extra fluid on the lungs
(may also be caused by anemia)
Symptoms of Kidney Failure
 Polycystic kidney disease, which causes large, fluid-
filled cysts on the kidneys and sometimes the liver, can
cause:
-Pain in the back or side
 Healthy kidneys produce the hormone erythropoietin
which stimulates the bone marrow to make oxygen-
carrying red blood cells. As the kidneys fail, they
produce less erythropoietin, resulting in decreased
production of red blood cells to replace the natural
breakdown of old red blood cells.
Symptoms of Kidney Failure
As a result, the blood carries less
hemoglobin, a condition known as
anemia. This can result in:
-Feeling tired and/or weak
-Memory problems
-Difficulty concentrating
-Dizziness
-Low blood pressure
Symptoms of Kidney Failure

 Other symptoms include:

-Appetite loss, a bad taste in the mouth
-Difficulty sleeping
-Darkening of the skin
Causes
Acute Renal Failure
Acute kidney failure usually occurs when the
blood supply to the kidneys is suddenly interrupted or
when the kidneys become overloaded with toxins.
Causes of acute failure include accidents, injuries, or
complications from surgeries in which the kidneys are
deprived of normal blood flow for extended periods of
time. Heart-bypass surgery is an example of one such
procedure.
Causes (Acute Renal Failure)
Drug overdoses, whether accidental or from
chemical overloads of drugs such as antibiotics or
chemotherapeutics, may also cause the onset of
acute kidney failure. Unlike in chronic kidney
disease, however, the kidneys can often recover
from acute failure, allowing the patient to resume
a normal life. People suffering from acute failure
require supportive treatment until their kidneys
recover function, and they often remain at
increased risk of developing future kidney failure
Causes (Chronic Kidney Disease)
Chronic kidney disease
CKD has numerous causes. The most common is diabetes
mellitus. The second most common is long-standing,
uncontrolled, hypertension, or high blood pressure.
Polycystic kidney disease is another well-known cause of
CKD. The majority of people afflicted with polycystic
kidney disease have a family history of the disease. Other
genetic illnesses affect kidney function as well.
Overuse of common drugs such as aspirin, ibuprofen,
codeine and acetaminophen can also cause chronic kidney
damage
Measurement for CKD
Stages of Kidney Failure
Chronic kidney failure is measured in five stages, which
are calculated using a patient’s GFR, or glomerular
filtration rate. Stage 1 CKD is mildly diminished renal
function, with few overt symptoms. Stages 2 and 3 need
increasing levels of supportive care from their medical
providers to slow and treat their renal dysfunction. Patients
in stages 4 and 5 usually require preparation of the patient
towards active treatment in order to survive.Stage 5 CKD
is considered a severe illness and requires some form of
renal replacement therapy (dialysis) or kidney transplant
whenever feasible.
Glomerular Filtration Rate
A normal GFR varies according to many
factors, including sex, age, body size and
ethnicity. Renal professionals consider the
glomerular filtration rate (GFR) to be the best
overall index of kidney function. The National
Kidney Foundation offers an easy to use on-line
GFR calculator. For anyone who is interested in
knowing their glomerular filtration rate.(A serum
creatinine level, a simple blood test, is needed to
use the calculator)
Nursing Management

 Maintain fluid and electrolyte imbalance

 Prevent infection and injury
 Provide adequate nutrition high carbohydrates,
low protein, low sodium and low potassium.
Male & Female Urinary Tract
A urinary tract infection is an infection of any of
the organs in the urinary tract, which consist of
the bladder, the ureter, the urethra, and the
kidneys.
A urinary tract infection (UTI) may occur in the:
Bladder - Cystitis is an infection of the bladder.
This is the most common form of UTI; it can be
aggravated if the bladder does not empty
completely when you urinate.
Male & Female Urinary Tract
Urethra - Urethritis is infection/inflammation of
the urethra. This can be due to other things besides
the organisms usually involved in UTI’s; in
particular, many sexually transmitted diseases
(STD’s) appear initially as urethritis.
Ureter – Ureteritis is infection of a ureter. This
can occur if the bacteria entered the urinary tract
from above, or if the ureter-to-bladder valves
don’t work properly and allow urine to “reflux”
from the bladder into the ureters.
Male & Female Urinary Tract

Kidney – Pyelonephritis is an infection of the kidney

itself. This can happen with infection from above, or if
reflux into the ureters is so bad that infected urine refluxes
all the way to the kidney.
People more susceptible to UTI’s:
 Diabetics because of changes in the immune system
 Infants who are born with abnormalities of the urinary tract
 Women who use a diaphragm
 Women whose partners use a condom with spermicidal foam
 A person who has already had a UTI
 Pregnant women
 Post-menopausal women
 Women on birth control pills
 Women with lowered immunity
 Women with prolapsed urethra or bladder
 Women with obstructions in the urinary tract
Symptoms
 Symptoms depend on age of person and where the
UTI is located .
 Symptoms of urethritis often include:

-Burning sensation at the start of urination

 Symptoms of cystitis often include:

-Burning sensation in the middle of urination

-Fever
-Lower abdominal pain
-Funny smell, color, or appearance (cloudy, dark,
blood tinged) of urine
Symptoms

 Symptoms of Pyelonephritis often include:

-Pain in back, flanks, or abdomen
-Fever
-Nausea
-Vomiting
Other symptoms of UTI’s:

 Uncomfortable pressure above pubic bone

 Fullness in rectum (in men only)
 Small amount of urine, despite urge to urinate
 Irritability (in children only)
 Abnormal eating (in children only)
Nursing Intervention
 Increase fluid intake 3-4 liter a day
 Acidify urine. Give cranberry juice
 Hot sitz bath. To relieve pelvic discomfort
 Wash hand before and after using the bathroom
 Avoid wearing tight clothing’s
 Empty the bladder before and immediately
after sexual intercourse
Urolithiasis

Urolithiasis is the condition where urinary

calculi are formed in the urinary tract.
The term kidney stone (or "renal calculus")
is sometimes used to refer to urolithiasis in any
part of the urinary tract, however it is more
properly reserved for stones that are actually in
the collecting duct of the kidney itself.
Urolithiasis
The term nephrolithiasis can be used to
describe the condition of having kidney stones,
and ureterolithiasis can be used to describe the
condition of having stones in the ureter.
Obstruction of the ureter by the kidney
stones causes a renal colic attack which is why
intense pain is felt in groin and back.
Causes
 Renal stones occur as a result of the following
3 factors:
-Supersaturation of stone-forming compounds
in urine
-Presence of chemical or physical stimuli in
urine that promote stone formation
-Inadequate amount of compounds in urine that
inhibit stone formation (eg, magnesium,
citrate)
Causes
 Additional risk factors include the following:
 Habitually low urine volume
 High urine excretion of calcium
 High urine excretion of uric acid
 High urine excretion of oxalate
 Low urine pH: Uric acid and cysteine are less
soluble in acid urine.
Causes

 High urine pH: Struvite and calcium

phosphate are less soluble in alkaline urine.
 Nidus for crystal precipitation: A nidus for
crystal precipitation (eg, uroepithelial surface
properties that affect crystal retention) occurs
when the crystalline lattice structure of one
crystal is similar to another crystal and the
second crystal grows on the first.
Causes

 Factorssuch as developmental abnormalities of

the urinary tract, urinary obstruction, urinary
stasis, and infection with urea-splitting
microorganisms may also be important.
Treatment
The treatment of bladder stones is simple.
One needs to start drinking a lot of fluids.
While any fluids can be consumed, water is
considered to be the ideal solution. Excess
fluid can help pass the small stones. Large
stones or those that fail to pass may require
other methods of treatment
Treatment
Breaking up of bladder stones is also done
with a camera (cystoscope) which is inserted into
the bladder. The surgeon visualizes the stone and
use ultrasound or another mechanical device to
break the stones into small pieces which are then
flushed out. The procedure does require some type
of anesthesia and may require admission to a
hospital for several days. Complications of this
treatment include infections, small tear of the
bladder or bleeding in the urine.
Nursing Management
 Increase fluid intake
 Straine all urine
 Encourage ambulation
 Relieve pain
Manifestations

-Colicky pain
-Nausea, vomiting, diarrhea or constipation
-Hematuria, dysuria, frequency
-Fever and chills
Bladder Cancer
Bladder cancer refers to any of several types of
malignant growths of the urinary bladder. It is a
disease in which abnormal cells multiply
without control in the bladder. The bladder is a
hollow, muscular organ that stores urine; it is
located in the pelvis. The most common type of
bladder cancer begins in cells lining the inside
of the bladder and is called transitional cell
carcinoma (sometimes urothelial cell
carcinoma).
Bladder cancer : gross pathology : the bladder wall is massively infiltered by
an ulcerated and hemorrhagic tumor.
Causes
Tobacco smoking is the main known contributor to urinary
bladder cancer bladder cancer might partly be caused by
the bladder directly contacting carcinogens that are
excreted in urine, although this has not yet been confirmed
in other studies. Thirty percent of bladder tumors probably
result from occupational exposure in the workplace to
carcinogens such as benzidine. 2-Naphthylamine, which is
found in cigarette smoke, has also been shown to increase
bladder cancer risk. Occupations at risk are bus drivers,
rubber workers, motor mechanics, leather workers,
blacksmiths, machine setters and mechanics.
Causes
Hairdressers are thought to be at risk as well
because of their frequent exposure to permanent hair
dyes. A 2008 study comissioned by the World
Health Organisation concluded that "specific fruit
and vegetables may act to reduce the risk of bladder
cancer." Fruit and yellow-orange vegetables,
particularly carrots and selenium, are probably
associated with a moderately reduced risk of bladder
cancer. Citrus fruits and cruciferous vegetables were
also identified as having a possible protective effect.
Diagnosis

The gold standard for diagnosing bladder cancer is biopsy

obtained during cystoscopy. Sometimes it is an incidental
finding during cystoscopy.
Urine cytology can be obtained in voided urine or at the time
of the cystoscopy ("bladder washing"). Cytology is very
specific (a positive result is highly indicative of bladder
cancer) but suffers from low sensitivity (inabilty of a negative
result to reliably exclude bladder cancer). There are newer
urine bound markers for the diagnosis of bladder cancer.
These markers are not currently used routinely in clinical
practice due to absence of clear professional guidelines. They
are much more expensive as well.
Diagnosis

Many patients with a history, signs, and

symptoms suspicious for bladder cancer are
referred to a urologist or other physician
trained in cystoscopy, a procedure in which a
flexible tube bearing a camera and various
instruments is introduced into the bladder
through the urethra. Suspicious lesions may be
biopsied and sent for pathologic analysis.
Signs and Symptoms
The following are signs and symptoms of bladder
cancer:
 Blood in the urine: This is the most common symptom of
bladder cancer and occurs in the vast majority of people with
bladder cancer. Having blood in the urine does not necessarily
mean a person has cancer, since other conditions (including
infections) can lead to bloody urine, but blood in the urine is
never normal and should always be evaluated by a doctor.
 Urinary urgency or pain on urination
 Back or abdominal pain
 Loss of appetite and weight
Treatment
 Flow chart of the Bladder Cancer Treatment
GuideThe treatment of bladder cancer depends
on how deep the tumor invades into the bladder
wall. Superficial tumors (those not entering the
muscle layer) can be "shaved off" using an
electrocautery device attached to a cystoscope.
Immunotherapy in the form of BCG instillation
is also used to treat and prevent the recurrence
of superficial tumors.
Treatment

 BCG immunotherapy is effective in up to 2/3

of the cases at this stage. Instillations of
chemotherapy, such as valrubicin (Valstar) into
the bladder can also be used to treat BCG-
refractory CIS disease when cystectomy is not
an option.
Treatment

A combination of radiation and chemotherapy

can also be used to treat invasive disease. It has
not yet been determined how the effectiveness
of this form of treatment compares to that of
radical ablative surgery.
Benign Prostatic Hyperplasia
The prostate is a male gland that secretes the fluid
(a part of the semen) which carries sperm from the
testicles during ejaculation.
The prostate is located just below the bladder and
in front of the rectum. It surrounds the first inch of the
urethra (the tube through which urine and sperm exit
the body).
Usually, the prostate gland starts to enlarge after
middle age. When the prostate becomes enlarged, the
condition is called benign prostatic hyperplasia
(BPH), or benign prostatic hypertrophy.
The prostate is on the bottom, and the bladder, with its front opened, is on top.
You can see the enlarged central lobe of the prostate gland protruding into the
bladder cavity. The prostate gland obstructed outflow from the bladder, forcing
the bladder wall to become thicker and stronger.
Causes and Risk Factors of Benign Prostatic
Hyperplasia
As the urethra is squeezed more tightly by
the enlarged prostate, the bladder may not be
able to completely empty. Rarely, this
blockage may cause repeated urinary tract
infections and start the process of bladder or
kidney damage. It may also cause acute urinary
retention (a sudden inability to urinate ) which
requires a visit to the emergency room.
Causes and Risk Factors of Benign Prostatic
Hyperplasia
 Thecause of BPH is not well understood, but
researchers theorize that BPH could be caused
by:
 the aging process
 testosterone levels - As men age, the amount of
active testosterone in the blood decreases, leaving a
higher proportion of estrogen. Studies with animals
suggest that BPH may occur when a higher amount
of estrogen (in the gland) increases the activity of
substances that promote cell growth.
Causes and Risk Factors of Benign Prostatic
Hyperplasia
 Dihydrotestosterone (DHT) - DHT is a substance
derived from testosterone in the prostate, which may
help control its growth. Most animals lose their
ability to produce DHT as they age, however, some
research indicates that with a drop in blood
testosterone level, older men continue to produce
and accumulate high levels of DHT in the prostate.
This accumulation of DHT may encourage the
growth of cells. Scientists have also noted that men
who do not produce DHT do not develop BPH.
Causes and Risk Factors of Benign Prostatic
Hyperplasia
 cell"instructions" - Some researchers suggest
that BPH may develop as a result of
"instructions" given to cells early in life.
According to this theory, BPH occurs because
cells in one section of the gland follow these
instructions and "reawaken" later in life. These
"reawakened" cells then deliver signals to other
cells in the gland, instructing them to grow or
making them more sensitive to hormones that
influence growth.
Symptoms of Benign Prostatic Hyperplasia
 The obstructive (problems with urethra and
urination) symptoms of BPH are:
 difficulty initiating a urine stream
 a hesitant, interrupted and weak stream
 urgency and leaking or dribbling
 blood in the urine
Symptoms of Benign Prostatic Hyperplasia
 Asthe urethra becomes narrower, the bladder
wall becomes thicker and the bladder itself
becomes smaller, causing:
 more frequent urination
 bladder irritability
 a sudden strong urge to urinate, especially at night
 urge incontinence - (occurs when bladder muscles
are too active. People with urge incontinence lose
urine as soon as they feel a strong desire to go to the
bathroom.)
Treatment of Benign Prostatic Hyperplasia
 If the score on the Symptom Index is low, the
symptoms are considered mild and the usual
procedure is "watchful waiting." No pharmaceutical
or surgical treatment is recommended. Continue to
have an annual exam so that the doctor can monitor
the growth. The doctor will suggest the following
lifestyle adjustments to ease symptoms:
 Reduce the intake of coffee, tea and cola drinks.
 Eat dinner in the early evening so you have a chance to
eliminate fluids.
Treatment of Benign Prostatic Hyperplasia
 After 7 p.m., cut down on fluids.
 Drink 8 glasses of water per day to help prevent
accumulation of bacteria.
 Avoid over-the-counter (OTC) cold remedies
that contain pseudoephedrine and antihistamines.
 Avoid spicy and salty foods.
 Stay regular - constipation may aggravate the
urinary tract.
 Ejaculate regularly.
Treatment of Benign Prostatic Hyperplasia
 Take hot baths.
 Avoid prolonged sitting.
 Sometimes drinking cranberry juice is
recommended to increase the acidity of the
urinary tract.
Treatment of Benign Prostatic Hyperplasia

 If the score on the Symptom Index is in the

mid-range, symptoms are considered
moderate and the usual procedure is
pharmaceutical intervention. There are two
types of prescription drugs commonly used to
treat BPH; alpha-receptor blockers and 5-
alpha-reductase inhibitors.
Treatment of Benign Prostatic Hyperplasia

 If the score on the Symptom Index is high,

the symptoms are considered severe and the
usual procedure is the use of invasive
techniques. There are two types of invasive
techniques, non-surgical and surgical.
Non-Surgical Invasive Treatments

 Non-surgical invasive treatments include

transurethral microwave thermotherapy
(TUMT) and transurethral needle ablation
(TUNA).
TUMT

TUNA
Surgical Treatments

 Surgical treatments include transurethral

resection of the prostate (TURP),
transurethral incision of the prostate
(TUIP), laser prostatectomy and an open
prostatectomy. TURP is the gold standard for
prostate surgeries performed for BPH.
TUIP
TURP
Risks and Benefits of Invasive Treatments
Risks and benefits exist with all forms of
treatment for BPH. They are as follows:
 TUMT is considered to be less effective than surgery,
particularly when obstruction is at the center of the
prostate. There is a risk of impotence, incontinence
and retrograde ejaculation, where the amount of
ejaculate is lessened because most or all of it is
retained in the bladder. Though no hospitalization is
required with this procedure and relief can be
experienced within in three to eight weeks, another
TUMT may be necessary at a later date.
Risks and Benefits of Invasive Treatments
 TUNA is less effective than surgery. There is the
possibility of impotence, incontinence and retrograde
ejaculation. Though no hospitalization is required with this
procedure and relief can be experienced within in three to
eight weeks, another TUNA may be necessary in the
future.
 TURP presents a risk of retrograde ejaculation 80 percent
of the time. There is the possibility of impotence,
incontinence, blood loss and urinary tract infection. This
procedure provides instant relief of BPH and improved
urination. One week of recovery time is needed. This is
considered to be better than the other treatments.
Risks and Benefits of Invasive Treatments
 Laser ablation is less invasive. There is a 20
percent risk of retrograde ejaculation. Some
burning with urination may occur. There is
virtually no bleeding from the surgery.
 TUIP surgery leaves the possibility of
impotence, incontinence, blood loss, urinary
tract infection and retrograde ejaculation. This
procedure provides instant relief of BPH.
There is the possibility of a hospital stay with
a short recovery time.
Bacterial Vaginosis (BV)
BV is caused by an overgrowth of bacteria that
normally live in the vagina in small numbers.
Although this condition is not strictly speaking
sexually transmitted, BV is uncommon in virgins.
The more sexual partners you have had, the more
likely you are to get it. Sexual intercourse may
produce symptoms or worsen the symptoms.
Products that affect bacteria in the vagina can cause
the condition or encourage recurrences, including
products added to baths (bubble baths, antiseptics),
douches, or forgetting to remove tampons.
Symptoms

A greyish white discharge with an offensive

fishy smell.
 A burning sensation or soreness is more
common than itching although this can also
occur.
 There is usually no redness of the genital skin.
How is it treated?
The condition can resolve by itself but often
antibiotics from a doctor are generally needed.
Washing the genital area in mild salt water (1
teaspoon per ½ litre of water) can reduce the soreness
and amount of bacteria present on the vulva (external
female genital area) and in the vagina. Unfortunately
even with antibiotic treatment the condition can recur.
Treating the sexual partner makes no difference.
Occasionally male partners of women get infection
under the foreskin that gives a strong smell and excess
smegma, which may need treatment.
Chlamydia Trachomatis
Infection with bacteria called Chlamydia
trachomatis can cause different GU conditions,
including pelvic inflammatory disease in
women and non-gonococcal urethritis in men.
The infection is often called 'chlamydia',
although there are other types of chlamydia
that affect other parts of the body (eg, lung and
heart).
Chlamydia trachomatis bound to epithelial cells after neutralization by antibodies
against polymorphic membrane protein D (PmpD). Anti-PmpD antibodies were
detected by colloidal gold immunolabeling and appeared as bright spheres on the
pathogen's surface. PmpD is a pan-neutralizing antigen, implicating the protein as a
vaccine candidate for preventing chlamydial disease.
Chlamydia Trachomatis
 In women, the bacterium can infect the
cervix and/or the urethra (urine tube). It can
also spread up into the uterus (womb) and
Fallopian tubes (which conduct eggs from the
ovaries to the womb), where it causes
complications of pelvic infection (pelvic
inflammatory disease - see PID).
 Pelvic infection with Chlamydia trachomatis
can lead to infertility (see PID).
What are the symptoms?
 In women:
 often women have no symptoms.
 there may be a change in the quality and
quantity of vaginal discharge.
 there is sometimes stinging on passing urine.
 lower abdominal pain is often the first
symptom of pelvic infection (see PID).
What are the symptoms?
 In men:
 Urethral discharge and/or stinging on passing
urine or mild irritation at the end of the penis
(see non-gonococcal urethritis). Most often,
no symptoms are present.
 Occasionally, chlamydia can cause
inflamed joints - this is more common in
men.
How is it treated?
 Antibiotics from a doctor are essential. These
can be either single-dose treatment with
azithromycin (Zithromax) or a course, usually
a tetracycline antibiotic (such as doxycycline
(eg Vibramycin) for a week).
 If one partner in a sexual relationship is
infected, it is very important that the other
partner is seen and treated to prevent
complications and avoid re-infection.
Cystitis
This is a term that means inflammation of
the bladder, and is another name for lower
urinary tract infection. It occurs more in
women than men and the usual cause is
infection with bacteria that are normally found
in the rectum (back passage). When these
bacteria get into the urethra and then the
bladder they cause symptoms.
What are the symptoms?
 There is pain, stinging and burning when
passing urine, sometimes only at the beginning
or end.
 There may be a desire to pass urine but only a
small dribble comes out. Afterwards there can
still be the feeling that you need to pass urine.
 Sometimes the urine has blood in it which
gives it a red colour (you should always
consult your doctor if this happens).
How is it treated?
 Products are available over the counter from the
pharmacist that alter the acidity of the urine. An attack of
cystitis can be stopped by using this medication and
drinking plenty of fluid (3L a day) to keep the bladder
flushed out.
 If the symptoms do not settle within a few hours then go to
your doctor. A urine sample might be sent off for further
tests and a course of antibiotics is usually prescribed.
 During a severe episode, it is often more comfortable to
pass urine while in the bath. This tends to avoid the severe
stinging.
How is it treated?
 Some women are prone to get repeated attacks of
cystitis. To avoid these:
 try to drink plenty of fluid (not tea, coffee, or diet
drinks).
 do not put off going to the toilet.
 make sure that you completely empty your bladder
when you pass urine.
 some women find drinking cranberry juice helps. A
severe attack can be stopped by taking an over-the-
counter preparation to reduce urine acidity as soon as
there is any symptom.
Gonorrhoea

This is a sexually transmitted bacterial

infection caused by Neisseria gonorrhoeae. It
is less common than chlamydia, the incidence
of gonorrhoea increased by about 30 per cent
between 1998 and 1999, particularly in teenage
males.
 diagnosis localization lesions additional descriptions

Gonorrhea, Chronic meatus of the urthra   coating

What are the symptoms?
Often women have no symptoms but the
following may indicate infection:
 a change in vaginal discharge, particularly a change
in the colour from the normal colour of 'off-white' to
yellow.
 pain on passing urine.
 abdominal pain.
 like chlamydia, gonorrhoea can get into the uterus
and Fallopian tubes and cause pelvic infection, with
longer-term consequences of infertility.
How is it treated?
 A single dose of antibiotics prescribed by a doctor.
Commonly, ciprofloxacin (eg Ciproxin) or a penicillin
called amoxicillin (eg Amoxil) are prescribed by
GUM clinics. It is important to have a repeat test after
you have taken the course to make sure that you have
been cured of gonorrhoea.
 As gonorrhoea is sexually transmitted, it is vital that
your present sexual partners get treated to avoid re-
infection and subsequent complications. To avoid
spread of infection, other recent sexual partners
should also be contacted and treated.
Genital Herpes
Herpes simplex virus is the cause of genital herpes and of
cold sores. There are two types of virus, type one and type
two; both can affect the genital area.
Genital herpes is sexually transmitted but full penetration
is not required to transmit infection. Close contact is all
that is necessary when ulcers are present (though
occasionally the infection is transmitted when ulcers have
not occurred). The virus can be transmitted through oral
sex, especially men to women. Your partner does not
necessarily need to have an attack of oral herpes (cold
sore) to transmit the infection to your genitals but this
makes it more likely.
What are the symptoms?

 The first sign can be a tingling in the skin followed by

small blisters that burst quickly to form ulcers which
then scab over. The ulcers are usually extremely
painful and lumps in the groin (swollen lymph nodes)
are noticeable in most patients. In a first attack, there
are often several ulcers and you can feel unwell. An
attack can also begin with pain on passing urine and a
change in vaginal discharge, sometimes with back and
leg pain.
What are the symptoms?

 Ina first attack passing urine can sometimes be

extremely painful. By doing this in bath water
it can be more comfortable. Very occasionally
you might find it difficult or impossible to pass
urine. Attend a doctor immediately if this is the
case.
How is it treated?

 Inrecurrent attacks, there is usually no point in

giving treatment because the five-day
treatment course usually reduces the symptoms
by only 12 to 24 hours. Keep the genital skin
clean by washing in mild salt water (a teaspoon
full of salt to a pint of water). This will avoid
'superinfection' of the ulcers with skin bacteria.
How is it treated?
 Genital herpes cannot be cured, which
unfortunately means that it can be transmitted to
sexual partners at any time. Avoid sex if you
have any symptoms that suggest a recurrence.
Condoms can cut down the risk of transmission
but do not eliminate it. Herpes simplex virus can
less commonly shed from the skin surface
without ulcers being present (asymptomatic
shedding) so you cannot rely on symptoms to
avoid transmitting the infection.
Non-gonoccocal (non-specific) urethritis
(NGU or NSU)
NGU is an inflammation of the urethra (urine
tube) in men that is NOT caused by gonorrhoea.
The commonest cause is Chlamydia
trachomatis. However, in about half of affected
men no specific infection is found - hence the
term 'non-specific urethritis' (NSU).
The infections that cause NSU are usually
transmitted by vaginal or anal sex although oral
sex can sometimes transmit infection.
What are the symptoms?
 Men can have NGU without knowing - if
symptoms are present they are tingling or
burning during urination, and urethral
discharge.
 Men can also suffer complications such as
swelling of the testicles (epididymitis).
Occasionally, joints can also become inflamed.
How it is it treated?
A course of antibiotics - usually doxycycline (eg
Vibramycin) for one week to cover chlamydial
infection - can cure the problem.
 If a man has this condition, his female partner
should be checked and treated. It is often not
possible to detect a specific infection in women.
But women need treatment because some bacteria
that cause NGU in men can lead to pelvic
infection in women. Also, if the woman is not
treated then the man can get re-infected.
Pubic lice ('crabs')
Lice are small insects that are particularly
adapted to living on pubic (genital) hair
because the width of their gripping 'legs' are
the same width as the pubic hair. This means
that pubic lice cannot infect head hair but can
be found on other body hair such as chest and
armpit hair. You need close contact to transmit
pubic lice, not necessarily full penetrative sex.
What are the symptoms?

 Lice cause itching of the hair in the pubic

region, especially at night. Sometimes you can
see the lice moving and when the eggs are laid
you can see specks that look like dandruff
stuck onto the hairs. Lice live by sucking blood
so sometimes you can see blood spots on your
underwear.
How is it treated?
 You need specific insecticide treatment in the
form of shampoo or lotion applied to the pubic
area and other hairy areas. The shampoo or lotion
kills the lice and eggs. You can buy this treatment
at the chemist but follow the instructions carefully.
Normal washing in soap and water does not work.
 Shaving the hair can also get rid of the lice
provided all the affected areas are shaved.
Pelvic Inflammatory Disease (PID)
This condition that affects women is
usually a result of a sexually transmitted
infection that is present in the vagina or the
cervix but goes up into the uterus and Fallopian
tubes causing inflammation. It is often a
complication of untreated infection,
particularly chlamydia and more rarely
gonorrhoea, which can be present for months
before resulting in this complication.
What are the symptoms?
 The symptoms can vary from mild to severe. Pain in
the lower abdomen that is often crampy and like
period pains, especially if made worse by sex, can
indicate PID. The pain can come and go and the
tummy may be tender to the touch. Sometimes you
can feel tired and unwell and have a temperature. You
may have noticed a change in your vaginal discharge
and/or abnormal bleeding over the preceding weeks.
This bleeding can be between periods (spotting) or
your periods can be heavier, longer or more irregular
than normal.
How is it treated?
 IfPID is likely, a course of antibiotics
should be taken to treat the most common
cause of PID, Chlamydia trachomatis.
Rest and take painkillers to control the
pain and cut down inflammation. You
must finish the course of antibiotics and
avoid sexual contact until your partner has
been seen and treated.
How is it treated?
 After a single episode of pelvic infection, you
have a small chance of becoming infertile from
blocked Fallopian tubes (about 1 in 10 women
have trouble getting pregnant). After a second
episode, the risk of infertility is much higher.
Also there is a greater chance of being left with
continuing discomfort in the abdomen. So, you
must ensure your partner gets treated to avoid
re-infection.
Scabies
This infection, also known as 'The itch', can be
transmitted by close contact and therefore is not
necessarily sexually transmitted. However, sharing a
bed is a very efficient way of transmitting this infection!
Scabies presents itself as a skin problem caused by
scabies mites that burrow into the skin to lay eggs under
the skin surface. The eggs hatch into larvae and grow
into adults that then lay eggs again. The itching is due
to an allergic reaction to the mites. Mites prefer
particular areas of skin such as wrists, finger webs or
genitals but can burrow anywhere.
What are the symptoms?
 The main symptom is intense itching, worse at
night and especially after a hot bath. Small
lumps appear, which are due to the mites'
burrows. Scratching can cause damage that
allows bacterial infections to develop. This can
alter the appearance of scabies and make the
diagnosis more difficult.
How is it treated?
 An insecticide lotion (such as malathion) should be
applied from the neck downwards over the whole
skin surface and kept on for 12 to 24 hours before
washing. A repeat application may be necessary,
depending on the product used.
 The itch may continue for up to a month after
satisfactory treatment. This is due to continuing
allergy rather than continuing infestation. There is no
need to use more treatment but a course of
antihistamines can dampen down the itch until it
eventually goes away.
Thrush (candida)
Thrush is a very common infection. It is
not normally sexually transmitted; you can get
it without ever having sex. It is caused by yeast
called candida that is normally found in the
vagina. Yeast grows well in warm and moist
places. Most women have a small amount of
this yeast in the vagina but do not get
symptoms. When the yeast overgrows,
symptoms can develop.
What are the symptoms?
 The most usual symptom is itching that can be
very intense and can affect the anus as well as
the vulva. A lot of women notice an increase in
vaginal discharge. This can vary from thin and
watery with white flecks in it to thick 'cottage-
cheese-like' discharge. You may notice a smell
that is different to normal although not
unpleasant. The vulva can become red and
swollen in a bad attack. As you urinate the urine
may sting as it touches the lips of the vulva.
How is it treated?
 Simple measures like washing in slightly
saltly warm water can reduce the itchiness
and soreness until you can get to see a
doctor. For women, treatment is a choice
of antifungal pessaries or cream, both of
which are inserted into the vagina (eg
clotrimazole), or antifungal medicine
taken by mouth (eg fluconazole).
Trichomoniasis
This infection is caused by a small
parasite called Trichomonas vaginalis
(TV) that infects the vagina and urethra. It
is almost always transmitted by sexual
contact.
A second form of vaginitis is Trichomoniasis, characteristically associated with a malodorous
yellow-green discharge and often a burning sensation, itching, redness, and swelling. The
majority of women with such vaginitis have severe symptoms at some time. The infection may be
transmitted by either heterosexual or homosexual contact.
What are the symptoms?
 Inwomen, the usual symptoms are a yellow or
greeny discharge that smells unpleasant. There
is often a lot of discharge, which can be frothy.
Itching and irritation of the skin of the vulva
are very common with TV. Symptoms can start
within a few days of catching the infection or
can take a few weeks to develop.
How do you treat it?
 Antibiotics are required - you should get
these from your doctor.
 As TV is sexually transmitted, partners
must take treatment. Men usually have no
symptoms, although occasionally they get
stinging on passing urine. If your partner
is not treated, you are at risk of getting re-
infected.
Genital Warts

Genital warts are a condition of the

genital skin caused by a virus called
human papillomavirus (HPV). There are
many different types of HPV, some of
which prefer particular areas of skin (e.g.
hands and feet). Other wart virus types
prefer the genitals.
This is a picture of genital warts on the labia. Warts in this area can look different depending
on the type of skin they are growing in. The warts that are growing on the moist inside skin are
pink and more flat. The warts on the edge of the regular and moist skin look almost white.
Finally the warts on the regular skin look a little more like what we see on other parts of the
body but they stick out more.
Genital Warts
Genital warts are transmitted by close contact
between the genitals of an infected person and those
of a non-infected person, usually during sex. The
wart virus can be caught and then lie dormant in the
skin without causing any problems. Later, the wart
virus may start to divide and produce a wart. This
can take from six weeks to many months, or even
years. Because the time from catching the virus to
getting warts is very variable, a previous partner
could have infected you a long time before warts
appear.
What are the symptoms?
 Warts often go unnoticed because they do not
produce many symptoms and are difficult to
see. Occasionally they itch or bleed.
Sometimes you can feel them as lumps that are
gritty to the touch. Some warts are flat and
others are fleshier. Warts can be found on any
part of the genital skin including around the
anus even if you have never had anal sex.
How are they treated?
 Many different treatments are available, which
include applying solutions directly onto the
wart, freezing, burning or surgically removing
the warts. It is important to consult your doctor
before applying any solutions. Sometimes the
solutions can cause the skin to become sore.
Keep the area clean by washing in very dilute
salt water (1 teaspoon to a pint of water).
How are they treated?

 While you have warts you are infectious.

Condoms offer some protection but obviously
they cover only the penis and there are other
areas of the skin that come into contact during
sex.