Urology: follow urine production, storage and emptying
Urology considers the urinary tract and related conditions, including parts of the male reproductive system. A useful starting point is the route urine takes. Production, transport, storage and emptying are connected processes, but a problem with one does not automatically explain a problem with another.
Kidneys, ureters, bladder and urethra have different roles
The kidneys’ role is to produce urine as a component of maintaining the body's internal environment. Ureters transport the urine produced to the bladder where it is stored until emptying. From the bladder, the urine exits the body via the urethra. Although similar sounding, a ureter is not the same organ as the urethra. Identifying the differences based upon the order of urine flow helps differentiate these organs from one another.
Identify one continuous path and indicate the direction of travel. Next cover up the labels and explain each organ's function. If a case presents a challenge at one location along this path, identify what information relates to this portion of the path. Do not assume because a person notices a symptom when they are voiding urine that the problem must arise from either their kidneys or that they must have a specific disease process.
Muscles and nerve signals coordinate bladder function
The bladder increases in volume while storing urine. To empty the bladder, there must be coordination between muscle contraction and relaxation of the bladder walls, outlet and neural transmission. Therefore, both filling and storing urine and emptying urine pose unique physiological questions. Frequent urination, incontinence (urinary leakage) or difficulty urinating describe experiences or symptoms; they are not synonymous terms for one underlying cause.
Separate frequency of urination from amount of urine passed per visit and difficulty with urinating from a patient perspective (including pattern). These will assist in defining your clinical question. However, a study exercise cannot determine a cause. There may be several contributing factors such as medications, co-existing diseases, additional evaluation etc.
A sample and an image provide different evidence
An initial evaluation may include aspects of history, physical examination and selected studies. For instance, urine analysis may evaluate for specific substances or signs of infection, while imaging studies may be used to evaluate structural anatomy. Additional evaluations may assess bladder function or structural integrity within the urinary tract. The clinical question determines which evidence is useful; not all urinary-related complaints require the same type of diagnostic testing.
To reinforce your learning regarding what is measured by a potential study and what it cannot independently measure; define what each study evaluates and what each study cannot independently evaluate. Additionally, results from samples require consideration in relation to the patient's presenting symptoms and the sampling method. Images must similarly be interpreted to understand functional implications of findings; images alone cannot serve as a total understanding of function.
Management depends on the problem and personal circumstances
There are many methods of managing urologic disorders. Patients may receive education or advice, medications, follow-up evaluations or undergo surgical procedures. Urgent evaluations may be required if patients present with inability to urinate or severe symptoms. Non-urgent assessments will typically follow a predetermined course. Ultimately, the chosen course of action will depend on clinical presentation and individual circumstance.
Recommendations made regarding daily intake of fluids, medication usage or utilization of a catheter should come from an appropriate healthcare professional who can consider that person’s circumstances. Daily intake goals for fluids may not apply equally to all individuals due to existing health conditions. When developing educational materials, connect each recommended action with the proposed rationale and necessary follow-up evaluation to demonstrate why an intervention was suggested and facilitate understanding of the rationale behind an action without providing personal treatment recommendations.
Check your understanding
A short quiz, with an explanation after each answer.
Which structure carries urine from a kidney to the bladder?
Return to the section you found hardest and explain its example without looking at the page. Check the explanation, then repeat the quiz later. Being able to describe the reasoning is more useful than remembering the position of a correct answer.