“Urinary system” is used below to describe diseases that fall into this category according to ICD-10 (N00-N08, N10-N16, N17-N19, N20-N23, N25-N29, N30-N39). The ICD-10 is used for the International Statistical Classification of Diseases and Related Health Problems and is recognized worldwide.
Urinary System
The urinary system includes the kidneys (ren, nephros), ureters (ureters), urinary bladder (vesica urinaria), and urethra.
Anatomy
Kidneys
Humans have two kidneys, located to the left and right of the spine, at the level of the 11th and 12th ribs. In appearance, they resemble kidney beans. They are each about 10 cm long and about 6 cm wide. Ureters
The ureters are paired hollow organs about 25-30 cm long. They connect the renal pelvis (Latin: pelvis renalis, Greek: pyelos) and the urinary bladder. Urinary bladder
The urinary bladder (lat. vesica urinaria) is an expandable hollow organ. It is located in the lesser pelvis and, together with the urethra, forms the lower urinary tract. The two ureters, which come from the kidneys, open laterally into the urinary bladder. The urinary bladder has a maximum capacity of 800 to 1,500 ml (bladder capacity). Urethra
The male urethra (urethra masculina) extends from the urinary bladder to the end of the penis. It is about 17-20 cm long.The female urethra (urethra feminina) is only 3-5 cm long. It begins at the bladder neck (lower end of the urinary bladder).
Physiology
KidneysThe kidneys have important filtering functions. Each day, the kidneys filter about 280 liters of blood, sorting out 1-2 liters of water and metabolic waste products that leave the body as urine. The filtering process takes place in the tiny filtering cells of the kidneys – the so-called nephrons – of which each kidney has about 1 million. The filtering process is best described by creatinine clearance. This is a test method for determining the clearance function of the kidneys. It allows a relatively accurate determination of the glomerular filtration rate (GFR) and thus the assessment of kidney function. Urine collects in the renal pelvis and flows continuously through the ureters into the urinary bladder. The kidneys are an important site of hormone production. Among other things, the hormones are responsible for the complex regulation of blood pressure. In addition to the sodium concentration of the blood, the hormone renin, which is produced in the kidneys, is also involved in this. Furthermore, the kidneys are also involved in bone metabolism: Vitamin D3 (calcitriol), which is produced in the kidney, enables the body to absorb calcium through the intestines and store it in the bones. In addition, the kidney produces the hormone erythropoietin, which stimulates the formation of red blood cells (erythrocytes). The kidneys also have an important role in the acid-base balance in keeping the pH value in the body constant. The kidneys are not only capable of excreting non-volatile acids, but depending on the metabolic situation, they can vary the buffer stock in the body, especially the stock of bicarbonate (HCO3-) in the bloodstream. Ureters
The ureters serve to transport urine from the renal pelvis to the urinary bladder. Urinary bladder
The urinary bladder serves to temporarily store urine produced in the kidneys and collected in the renal pelvises before passing through the ureters into the urinary bladder. When the bladder fills 250 ml in women and 350 ml in men, a strong urge to urinate sets in. This urge to urinate varies greatly from person to person and is strongly influenced by conditions such as urinary incontinence (uncontrolled loss of urine through the urethra), irritable bladder, etc. The urinary bladder has internal and external sphincters, of which the external one can be controlled voluntarily. Urethra
Urine is expelled and excreted through the urethra.In men, the urethra has a dual function: semen is also excreted through the urethra during ejaculation (→ urinary urethra).
Common diseases of the urinary system
The most common diseases of the urinary system include:
- Urinary bladder carcinoma (bladder cancer).
- Urinary incontinence
- Urinary transport disorders (urinary stasis / urinary retention).
- Urinary tract infection (UTI)
- Micturition disorder (bladder emptying disorder)
- Nephrolithiasis (kidney stones)
- Neurogenic bladder – dysfunction of the urinary bladder due to a disorder in the nervous system.
- Renal insufficiency, acute and chronic – renal failure or slowly progressive reduction in renal function.
- Renal cell carcinoma (hypernephroma; renal cell cancer; kidney cancer).
- Pyelonephritis (inflammation of the renal pelvis).
- Urolithiasis – urinary stones in the kidney and / or urinary tract.
- Cystitis (inflammation of the bladder)
The main risk factors for diseases of the urinary system
Behavioral causes
- Diet
- Inadequate fluid intake – the better the urinary bladder is “flushed”, the less likely it is to be inflamed
- High intake of oxalic acid-containing foods (chard, cocoa powder, spinach, rhubarb), high intake of calcium → kidney stones.
- Psycho-social situation
- Stress and constant tension – tense bladder walls increase the risk due to decreased mucus production.
- Cold drafts
- Wearing damp swimwear for a long time
- Lack of hygiene – but also exaggerated hygiene.
- Use of diaphragm and spermicides
Causes related to disease
- Diabetes mellitus – diabetes mellitus type 1, diabetes mellitus type 2
- Hypertension (high blood pressure)
Medication
- Analgesic abuse (misuse of painkillers), antibiotic therapy, cytostatics (drugs used in oncology/cancer therapy; e.g., methotrexate).
X-rays
- Radiatio (radiation therapy) in tumor diseases – so-called “radiation cystitis“.
Further
- Mechanical stimuli – e.g. indwelling catheter (urinary bladder catheter).
Please note that the enumeration is only an excerpt of the possible risk factors. Further causes can be found under the respective disease.
The main diagnostic measures for diseases of the urinary system
Laboratory Diagnostics
- Urine parameters – albumin, total urinary protein, microalbuminuria, urine cytology, and others
- Electrolytes (blood salts)
- Hormone parameters – aldosterone, renin.
- Serum parameters – cystatin C, urea, uric acid, creatinine and others
- Tumor markers
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Medical device diagnostics
- Sonography (ultrasound examination) of the kidneys, ureters and urinary bladder.
- Uroflowmetry (urine flow measurement) – procedure for objective detection of bladder emptying disorders.
- Urethrocystoscopy (urethral and bladder endoscopy).
- I. v. Pyelogram (IVP) – radiographic imaging of the urinary organs or the urinary tract system.
- Computed tomography (CT) – imaging method of radiological diagnostics.
- Magnetic resonance imaging (MRI)
- Renal scintigraphy – to assess functional renal parenchyma (kidney tissue), renal blood flow, and renal function.
Which doctor will help you?
For diseases of the urinary system, the first point of contact is the family doctor, who is usually a general practitioner or internist. Depending on the disease or severity, a presentation to a specialist, in this case the urologist, will be necessary.