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Genitourinary Disorders

Approach to the Genitourinary Patient
- Evaluation of the Renal Patient
- Evaluation of the Urologic Patient
Symptoms of Genitourinary Disorders
Genitourinary Tests and Procedures
Acute Kidney Injury
- Acute Kidney Injury (AKI)
Benign Prostate Disease
Chronic Kidney Disease
- Chronic Kidney Disease
Cystic Kidney Disease
Genitourinary Cancer
Glomerular Disorders
Male Reproductive Endocrinology and Related Disorders

Male Sexual Dysfunction
- Overview of Male Sexual Function
- Erectile Dysfunction
Obstructive Uropathy
- Obstructive Uropathy
Penile and Scrotal Disorders
Renal Replacement Therapy
Renal Transport Abnormalities
Renovascular Disorders
Tubulointerstitial Diseases
Urinary Calculi
- Urinary Calculi
Urinary Tract Infections (UTIs)
Voiding Disorders

Although there is some degree of overlap, medical disorders of the kidneys and urinary tract are typically managed by nephrologists, who are internal medicine subspecialists. Genitourinary disorders requiring operative management are handled by urologists, who are surgical subspecialists. Urologists also are involved in the diagnosis and treatment of disorders that involve the male reproductive system, including erectile dysfunction.

Genitourinary DisordersSections (A-Z)

Acute Kidney Injury

Acute kidney injury is a rapid decrease in renal function over days to weeks, causing an accumulation of nitrogenous products in the blood (azotemia). It often results from inadequate renal perfusion due to severe trauma, illness, or surgery but is sometimes caused by a rapidly progressive, intrinsic renal disease. Symptoms include anorexia, nausea, and vomiting. Seizures and coma may occur if the condition is untreated. Fluid, electrolyte, and acid-base disorders develop quickly. Diagnosis is based on laboratory tests of renal function, including serum creatinine. Urinary indices, urinary sediment examination, and often imaging and other tests are needed to determine the cause. Treatment is directed at the cause but also includes fluid and electrolyte management and sometimes dialysis.

Acute Kidney Injury (AKI)

Approach to the Genitourinary Patient

In patients with renal disorders, symptoms and signs may be nonspecific, absent until the disorder is severe, or both. Findings can be local (eg, reflecting kidney inflammation or mass), result from the systemic effects of kidney dysfunction, or affect urination (eg, changes in urine itself or in urine production).

Evaluation of the Renal Patient
Evaluation of the Urologic Patient

Benign Prostate Disease

Benign prostatic hyperplasia (BPH) is nonmalignant adenomatous overgrowth of the periurethral prostate gland. Symptoms are those of bladder outlet obstruction—weak stream, hesitancy, urinary frequency, urgency, nocturia, incomplete emptying, terminal dribbling, overflow or urge incontinence, and complete urinary retention. Diagnosis is based primarily on digital rectal examination and symptoms; cystoscopy, transrectal ultrasonography, urodynamics, or other imaging studies may also be needed. Treatment options include 5 alpha-reductase inhibitors, alpha-blockers, tadalafil, and surgery.

Benign Prostatic Hyperplasia (BPH)
Prostatitis
Prostate Abscess

Chronic Kidney Disease

Chronic kidney disease (CKD) is long-standing, progressive deterioration of renal function. Symptoms develop slowly and in advanced stages include anorexia, nausea, vomiting, stomatitis, dysgeusia, nocturia, lassitude, fatigue, pruritus, decreased mental acuity, muscle twitches and cramps, water retention, undernutrition, peripheral neuropathies, and seizures. Diagnosis is based on laboratory testing of renal function, sometimes followed by renal biopsy. Treatment is primarily directed at the underlying condition but includes fluid and electrolyte management, blood pressure control, treatment of anemia, various types of dialysis, and kidney transplantation.

Chronic Kidney Disease

Cystic Kidney Disease

Cystic kidney disease may be congenital or acquired. Congenital disorders may be inherited as autosomal dominant disorders or autosomal recessive disorders or have other causes (eg, sporadic mutations, chromosomal abnormalities, teratogens). Some are part of a malformation syndrome (see Table: Major Groups of Cystic Nephropathies ).

Overview of Cystic Kidney Disease
Acquired Renal Cysts
Autosomal Dominant Polycystic Kidney Disease (ADPKD)
Congenital Renal Cystic Dysplasia
Medullary Sponge Kidney
Nephronophthisis and Autosomal Dominant Tubulointerstitial Kidney Disease (ADTKD)

Genitourinary Cancer

GU cancers (bladder, penile, prostate, kidney and renal pelvic, testicular, ureteral, and urethral) account for about 40% of cancers in men (primarily as prostate cancer) and 5.6% in women (see Gynecologic Tumors ).

Introduction to Genitourinary Tract Cancer
Bladder Cancer
Penile Cancer
Prostate Cancer
Renal Cell Carcinoma
Renal Metastases
Renal Pelvic and Ureteral Cancers
Testicular Cancer
Urethral Cancer

Genitourinary Tests and Procedures

Bladder catheterization is used to do the following:

Bladder Catheterization
Biopsy of the Kidneys, Bladder, and Prostate
Cystoscopy
Genitourinary Imaging Tests
Urethral Dilation

Glomerular Disorders

The hallmark of glomerular disorders is proteinuria , which is often in the nephrotic range (≥ 3 g/day).

Overview of Glomerular Disorders
Overview of Nephritic Syndrome
Hereditary Nephritis
Immunoglobulin A Nephropathy
Postinfectious Glomerulonephritis
Rapidly Progressive Glomerulonephritis (RPGN)
Thin Basement Membrane Disease
Overview of Nephrotic Syndrome
Congenital Nephrotic Syndromes
Diabetic Nephropathy
Focal Segmental Glomerulosclerosis
HIV-Associated Nephropathy
Membranous Nephropathy
Minimal Change Disease
Fibrillary and Immunotactoid Glomerulopathies
Membranoproliferative Glomerulonephritis
Lupus Nephritis

Male Reproductive Endocrinology and Related Disorders

Male sexual development and hormonal function depend on a complex feedback circuit involving the hypothalamus-pituitary-testes modulated by the central nervous system. Male sexual dysfunction (see Male Sexual Dysfunction ) can be secondary to hypogonadism, neurovascular disorders, drugs, or other disorders.

Male Reproductive Endocrinology
Male Hypogonadism
Gynecomastia

Male Sexual Dysfunction

There are 4 main components of male sexual function

Overview of Male Sexual Function
Erectile Dysfunction

Obstructive Uropathy

Obstructive uropathy is structural or functional hindrance of normal urine flow, sometimes leading to renal dysfunction (obstructive nephropathy). Symptoms, less likely in chronic obstruction, may include pain radiating to the T11 to T12 dermatomes and abnormal voiding (eg, difficulty voiding, anuria, nocturia, and/or polyuria). Diagnosis is based on results of bladder catheterization, cystourethroscopy, and imaging (eg, ultrasonography, CT, pyelography), depending on the level of obstruction. Treatment, depending on cause, may require prompt drainage, instrumentation, surgery (eg, endoscopy, lithotripsy), hormonal therapy, or a combination of these modalities.

Obstructive Uropathy

Penile and Scrotal Disorders

Balanitis, Posthitis, and Balanoposthitis
Cutaneous Penile Lesions
Epididymitis
Orchitis
Peyronie Disease
Phimosis and Paraphimosis
Testicular Torsion
Urethral Stricture

Renal Replacement Therapy

Renal replacement therapy (RRT) replaces nonendocrine kidney function in patients with renal failure and is occasionally used for some forms of poisoning. Techniques include intermittent hemodialysis , continuous hemofiltration and hemodialysis , and peritoneal dialysis . All modalities exchange solute and remove fluid from the blood, using dialysis and filtration across permeable membranes.

Overview of Renal Replacement Therapy
Hemodialysis
Continuous Hemofiltration and Hemodialysis
Peritoneal Dialysis
Medical Aspects of Long-Term Renal Replacement Therapy

Renal Transport Abnormalities

Many substances are secreted or reabsorbed in the renal tubule system, including electrolytes, protons, bicarbonate molecules, glucose, uric acid, amino acids, and free water. Dysfunction of these processes can result in clinical syndromes.

Introduction to Renal Transport Abnormalities
Fanconi Syndrome
Liddle Syndrome
Nephrogenic Diabetes Insipidus
Pseudohypoaldosteronism Type I
Renal Glucosuria
Renal Tubular Acidosis

Renovascular Disorders

Benign hypertensive arteriolar nephrosclerosis is progressive renal impairment caused by chronic, poorly controlled hypertension. Symptoms and signs of chronic kidney disease may develop (eg, anorexia, nausea, vomiting, pruritus, somnolence or confusion), as may signs of end-organ damage secondary to hypertension. Diagnosis is primarily clinical, supported by ultrasonography and routine laboratory test findings. Treatment is strict BP control and support of renal function.

Benign Hypertensive Arteriolar Nephrosclerosis
Renal Artery Stenosis and Occlusion
Renal Atheroembolism
Renal Cortical Necrosis
Renal Vein Thrombosis

Symptoms of Genitourinary Disorders

Dysuria : A Merck Manual of Patient Symptoms podcast

Dysuria
Hematospermia
Isolated Hematuria
Polyuria
Priapism
Proteinuria
Painless Scrotal Mass
Scrotal Pain
Urinary Frequency

Tubulointerstitial Diseases

Tubulointerstitial diseases are clinically heterogeneous disorders that share similar features of tubular and interstitial injury. In severe and prolonged cases, the entire kidney may become involved, with glomerular dysfunction and even renal failure. The primary categories of tubulointerstitial disease are

Overview of Tubulointerstitial Diseases
Acute Tubular Necrosis
Analgesic Nephropathy
Contrast Nephropathy
Heavy Metal Nephropathy
Metabolic Nephropathies
Myeloma-Related Kidney Disease
Tubulointerstitial Nephritis
Vesicoureteral Reflux and Reflux Nephropathy

Urinary Calculi

Urinary calculi are solid particles in the urinary system. They may cause pain, nausea, vomiting, hematuria, and, possibly, chills and fever due to secondary infection. Diagnosis is based on urinalysis and radiologic imaging, usually noncontrast helical CT. Treatment is with analgesics, antibiotics for infection, medical expulsive therapy, and, sometimes, shock wave lithotripsy or endoscopic procedures.

Urinary Calculi

Urinary Tract Infections (UTIs)

Urinary tract infections (UTIs) can be divided into upper tract infections, which involve the kidneys ( pyelonephritis ), and lower tract infections, which involve the bladder ( cystitis ), urethra ( urethritis ), and prostate ( prostatitis ). However, in practice, and particularly in children, differentiating between the sites may be difficult or impossible. Moreover, infection often spreads from one area to the other. Although urethritis and prostatitis are infections that involve the urinary tract, the term UTI usually refers to pyelonephritis and cystitis.

Introduction to Urinary Tract Infections (UTIs)
Bacterial Urinary Tract Infections (UTIs)
Catheter-Associated Urinary Tract Infections (CAUTIs)
Chronic Pyelonephritis
Fungal Urinary Tract Infections

Voiding Disorders

Voiding disorders affect urine storage or release because both are controlled by the same neural and urinary tract mechanisms. The result is incontinence or retention .

Overview of Voiding
Interstitial Cystitis
Neurogenic Bladder
Urinary Incontinence in Adults
Urinary Retention

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Also of Interest

Test your knowledge

Which of the following is the most common risk factor for bladder cancer?

Chronic bladder irritation Industrial chemical exposure Long-term cyclophosphamide use Smoking

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