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GENrrOURINARY SYSTF..M

559

Adrenal

Gland

Ouadratus

Lumborum

Vena

cava

Psoas

Major

Aorta

and

Minor

Figure 9-1. Schematic il/ustration of the genitourinary system, including

trunk musculature. (Artwork by Marybeth Cuaycollg.)

through a process conslstmg of glomerular filtration, tubular reabsorpcion, and tubular sccrecion.1

The following arc the primary functions of the genitourinary system 1,1:

• Excrecion of cellular wasce products (e.g., urea, creacinine [Cr],

and ammonia) through urine formacion and micturition (voiding)

• Regulation of blood volume by conserving or excreting fluids

• Electrolyce regulacion by conserving or cxcrecing minerals

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ACIJrE CARE HANDBOOK FOR PHYSICAL THFRAPIST�

Papilla

calyces

MajOr

Calyx

Renal

Petvis

Figure 9-2. Renal cross section. (Artwork by Marybeth Cuaycong.)

•

Acid-base balance regulation (H' [acidJ and HeOJ Jbase] ions

are reabsorbed or excreted to maintain homeostasis.)

•

Arterial blood pressure regulation (sodium excretion and renin

secretion to maintain homeostasis. Renin is secreted from the kidneys during states of hyporension, which results in formation of angiotensin. Angiotensin causes vasoconstriction to help increase

blood pressure.)

•

Erythropoietin secretion (necessary for stimularing red blood

cell production)

•

Gluconeogenesis (formation of glucose)

GENITOURINARY SYSTEM

561

The brain stem controls micturition through the autonomic nervous

system. Parasympathetic fibers stimulate voiding, whereas sympathetic

fibers inhibit it. The internal urethral sphincter of the bladder and the

external urethral sphincter of the urethra control flow of urine.2

Clinical Evaluation

Evaluation of the genitourinary system involves the integration of

physical findings with laboratory data.

Physical Examillatioll

History

Patients with suspected genitourinary pathology often present with

characteristic complaints or subjective reports. Therefore, a detailed

history, thorough patient interview, review of the patient's medical

record, or a combination of these provides a good beginning to the

diagnostic process for possible genitourinary system pathology. Renal

and urinary pains can vary according to their structural origins; however, they are generally described as pain that is colicky, wave-like, or burning, or occurring as dull aches in the abdomen, back, or buttocks]

Changes in voiding habits or a description of micturition patterns

are also noted and are listed below2-4:

• Decreased force of urinary flow (can indicate obstruction in the

urethra or prostate enlargement)

• Increase in urinary frequency (can indicate obstruction from

prostate enlargement or an acutely inflamed bladder)

• Nocturia (urinary frequency at night, can indicate congestive

heart failure or diabetes mellitus)

• Polyuria (large volume of urine at one time, can indicate diabetes mellitus, chronic renal failure I CRFJ, or excessive fluid intake)

• Oliguria (usually less than 400 ml of urine in a 24-hour period,

can indicate acute renal failure [ARF] or end-stage renal disease

lESRD])

• AliI/ria (less than J 00 ml of urine in a 24-hour period, can indicare severe dehydration, shock, transfusion reaction, kidney disease, or ESRD)

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AClITE CARE HANDBOOK FOR PHYSICAL THERAPISTS

• Dysuria (pain with voiding, can indicate a wide variety of disorders, including urinary tract infection)

• Hematuria (the presence of blood in urine, can indicare serious

pathology, e.g., cancer or traumatic Foley catheterization. In either

case, the physician should be notified. Refer to Appendix Table