BLADDER CARE

BY: RSZ

BLADDER URINARY SYSTEM CAREMALE FEMALE

Is one of the excretory systems of the body. It consist of the following structure: 2 Kidneys, which secret urine 2 Ureter, which convey the urine from the kidneys to the urinary bladder 1 urinary Bladder where urine collects and is temporarily stored 1 urethra through which the urine is discharged from the urinary bladder to the exterior

THE URINARY SYTEM

The excretory system consisting of the kidney, ureters, urinary bladder and urethra

Overview of the urinary systemThe urinary system plays a vital part in the maintaining homeostasis of the water and electrolyte concentrations in the body. The kidney produce urine that contains metabolic waste products, including the nitrogenous compounds urea and uric acid, excess ions and some drugs.

The KidneyRetroperitoneal organ surrounded by capsule and fats Right is lower than the left The substance is composed of renal cortex ( where nephrons are located) and renal medulla ( where collecting ducts are found)

Renal pelvisFunnel-shaped expanded portion of the ureter Formed by the calyces Collects urine from the kidney

The UreterLeft and right A long slender tube that propels urine from the kidney to the urinary bladder With smooth muscles and transitional epithelium With innervations from the sympathetic and parasympathetic

The urinary bladderHollow pyramid shaped organ located in the pelvis Lined with transitional epithelium With thick detrusor muscles Micturition reflex resulting from the distension of the organ Impulses are transmitted to the sacral parasympathetic segments to initiate urination

Main functions of the kidneys are: 1.formation and secretion of urine2.production and secretion of erythropoietin, the hormones responsible for controlling the rate of the formation of red blood cell

3.production and secretion of rennin, an important enzyme in the control of blood pressure The urine is stored and excreted by process of micturition.

The KidneyRetroperitoneal organ surrounded by capsule and fats Right is lower than the left The substance is composed of renal cortex ( where nephrons are located) and renal medulla ( where collecting ducts are found)

The NephronFunctional unit of the kidney that produces urine by filtration Composed ofEfferent arteriole Glomerulus Afferent arteriole Bowmans capsule Convoluted tubules- proximal, loop of Henle and distal

Blood supply of the kidney Renal artery- branch of the

abdominal aorta Renal vein- drains into the inferior venal cava

Fig. 18.12

Fig. 18.13

The bladder is a hollow organ in the lower abdomen that stores urine. Many conditions can affect bladder function.

Some common ones are:Infection - a urinary tract infection in the bladder is also known as cystitis Urinary incontinence - loss of bladder control Interstitial cystitis - a chronic problem in which the bladder wall can become inflamed and irritated, leading to frequent, painful urination Bladder cancer - the sixth most common cancer in the United States

Doctors diagnose bladder diseases using different tests These include urine tests x-rays Ultra Sonography examination of the bladder wall with a scope called a cystoscope.

Treatment varies depending on the cause of the problem. It may include medicines and, in severe cases, surgery.

Cystitis noninfectious Noninfectious cystitis is irritation of the bladder that is not caused by a urinary tract infection.

Causes Noninfectious cystitis is most common in women of childbearing years. The exact cause of noninfectious cystitis is often unknown. However, it has been associated with the use of bubble baths, feminine hygiene sprays, sanitary napkins, spermicidal jellies, radiation therapy to the pelvis area, certain types of chemotherapy medications, history of severe or repeated bladder infections, among other irritants. Certain foods, such as tomatoes, artificial sweeteners, caffeinated products, chocolate, and alcohol, can cause irritative bladder symptoms.

Symptoms Pressure in the lower pelvis Painful urination Urgent need to urinate Decreased ability to hold urine Need to urinate at night Abnormal urine color -- cloudy Blood in the urine Foul or strong urine odor Frequent need to urinate

Additional symptoms that may be associated with this disease: Pain during sexual intercourse Flank pain Penile pain Fatigue

Exams and Tests A urinalysis may reveal red blood cells (RBCs) and some white blood cells (WBCs). A microscopic examination of the urine by a pathologist may be done to look for cancerous cells. A urine culture (clean catch) or catheterized urine specimen will reveal whether you have a bacterial infection. If the cystitis is related to radiation or chemotherapy, urine tests and cystoscopy (use of lighted instrument to look inside the bladder) may be needed.

Treatment The goal of treatment is to manage the symptoms. Medical Treatments: Anticholinergic drugs can help improve bladder contraction and emptying. Possible side effects include slowed heart rate, low blood pressure, increased thirst, and constipation. Muscle relaxants (such as diazepam) and alpha-1 blockers (prazosin) may be used to reduce the strong urge to urinate or need to urinate frequently. Surgery is rarely performed unless a person has severe urinary retention or significant blood in the urine.

Diet: Avoid fluids that irritate the bladder such as alcohol citrus juices caffeine.

Other therapies: Bladder exercises to re-establish a pattern of regular and complete urination may help. Bladder training exercises involve developing a schedule of times when you should try to urinate, while trying to delay urination at all other times. One method is to force yourself to urinate every 1 to 1 and 1/2 hours, despite any leakage or urge to urinate in between these times. As you become skilled at waiting this long,

gradually increase the time intervals by 1/2 hour until you are urinating every 3 to 4 hours. Pelvic muscle strengthening exercises called Kegel exercises are used primarily to treat people with stress incontinence. However, these exercises may also help relieve symptoms of urgency related to long-term (chronic) noninfectious cystitis. Performing the exercises properly and regularly increases the method's success. Electrical stimulation to the pelvis may be used as a treatment for noninfectious cystitis, but this is controversial.

Outlook (Prognosis) Although most cases of cystitis are uncomfortable, they usually resolve over time.

Possible Complications Ulceration of bladder wall Urethral stricture Diminished bladder capacity Bladder cancer AnemiaPrevention Avoid using items that may be irritants such as bubble baths, feminine hygiene sprays, sanitary napkins or tampons (especially scented products), and spermicidal jellies.

Interstitial cystitis Interstitial cystitis is a long-term (chronic) inflammation of the bladder wall. Causes Interstitial cystitis (IC) is a painful condition due to inflammation of the tissues of the bladder wall. The cause is unknown. The condition is usually diagnosed by ruling out other conditions (such as sexually transmitted disease, bladder cancer, and bladder infections).

IC is frequently misdiagnosed as a urinary tract infection. Patients often go years without a correct diagnosis. On average, there is about a 4year delay between the time the first symptoms occur and the diagnosis is made. The condition generally occurs around age 30 to 40, although it has been reported in younger people. Women are 10 times more likely to have IC than men.

Symptoms Pain during intercourse Pelvic pain Urinary discomfort Urinary frequency (up to 60 times a day in severe cases) Urinary urgency

Exams and Tests

Diagnosis is made by ruling out other causes. Tests include: Bladder biopsy Cystoscopy (endoscopy of bladder) Urine analysis Urine culture Urine cytology Video urodynamics (shows how much urine must be in the bladder before you feel the need to urinate)

Treatment There is no cure for IC, and there are no standard or consistently effective treatments. Results vary from person to person. As long as the cause is unknown, treatment is based on trial and error until you find relief. Elmiron is the only medication taken by mouth that is specifically approved for treating IC. This medicine coats the bladder like Pepto-Bismol coats the stomach.

Other medicines may include: Opioid painkillers for severe pain Tricyclic antidepressants such as Elavil (amitriptyline) to relieve pain and urinary frequency Vistaril (hydroxyzine pamoate), an antihistamine that causes sedation, helps reduce urinary frequency

Other therapies include: Bladder hydrodistention (over-filling the bladder with fluid while under general anesthesia) Bladder training (using relaxation techniques to train the bladder to go only at specific times) Instilled medications - medicines are placed directly into the bladder. Medicines that are given this way include dimethyl sulfoxide (DMS), heparin, Clorpactin, lidocaine, doxorubicin, or bacillus Calmette-Guerin (BCG) vaccine.

Physical therapy and biofeedback (may help relieve pelvic floor muscle spasms) Surgery, ranging from cystoscopic manipulation to bladder removal (cystectomy)

Diet modification Some patients find that changes in their diet can help control symptoms. The idea is to avoid foods and beverages that can cause bladder irritation. Below are some of the foods that the Interstitial Cystitis Association says may cause bladder irritation. Aged cheeses Alcohol Artificial sweeteners Chocolate Citrus juices

Coffee Cranberry juice (Note: Although cranberry juice is often recommended for urinary tract infections, it can make IC symptoms worse.) Fava and lima beans Meats that are cured, processed, smoked, canned, aged, or that contain nitrites Most fruits except blueberries, honeydew melon, and pears Nuts except almonds, cashews, and pine nuts Onions Rye bread Seasonings that contain MSG Sour cream Sourdough bread Soy Tea Tofu Tomatoes Yogurt Experts suggest that you do not stop eating all of these foods at one time. Instead, try eliminating one at a time to see if that helps relieve your symptoms.

Outlook (Prognosis) Treatment results vary. Some people respond well to simple treatments and dietary changes. Others may require extensive treatments or surgery.

Possible Complications Chronic depression Chronic pain that may cause a change in lifestyle Emotional trauma High costs associated with frequent medical visits Side effects of treatments (depending on the treatment)

Bladder cancer Diagnosis and classification Various types of cancers can arise in the urinary bladder, of which one particular variety, known as urothelial carcinoma, is the commonest. This type of cancer is associated with cigarette smoking and various chemicals which affect the bladder, but may also occur in people without these risk factors.

Bladder cancer is often diagnosed as a result of bleeding in the urine or irritable symptoms such as painful, urgent or frequent urination. Such symptoms should always be taken seriously and assessed medically. On occasion, bladder cancer may be found incidentally on scans performed for other reasons. Definitive diagnosis requires visualization by cystoscopy, with biopsies which are assessed by a pathologist.

Bladder cancer is classified according to its stage and grade. Stage measures the extent of cancer spread through the bladder wall and beyond, as assessed by the pathologist and on scans. In broad terms, bladder cancer can be characterized as non-invasive (if it is restricted

to the lining or the epithelium of the bladder) or invasive (if it has grown beyond the lining) or metastatic (if spread to other parts of the body). Grade is reported by the pathologist, and can be divided into high grade (more aggressive) or low grade (less aggressive) cancers.

Treatment Treatment of bladder cancer is dependant on its classification. Low-grade, non-invasive cancers can be completely removed by cystoscopic surgery. They have a very low likelihood of spread, although they frequently recur within the bladder. Thus, periodic check-ups including cystoscopic examination of the bladder, are required.

Non-invasive cancers which are high grade, large or multiple, or keep recurring frequently, require additional treatment in the form of medications put into the bladder on a weekly basis for a six or eight week course. Various medications, including some chemotherapy drugs are available for this purpose, but the most effective treatment uses the tuberculosis vaccine (BCG). More information on this treatment is available from your urologist.

Invasive cancers which do not extend into the bladder muscle may also be treated using BCG treatments, although this may fail in a proportion of cases. In such cases, or if a more definitive early treatment is desired, surgery to remove the bladder (cystectomy) is required.

Cancers that extend into or through the bladder muscle are generally treated by surgical removal of the bladder and lymph glands draining the bladder (cystectomy), which offers a high rate of cure. Surgical reconstruction of the urinary system is carried out using parts of the small intestine, either with the formation of a stoma or a pouch

neobladder) that replaces the bladder. If pathologic findings indicate, chemotherapy may be considered. As an alternative to surgery, radiation with or without chemotherapy may be considered, as it provides the advantage of preserving the bladder. However, in some cases, bladder symptoms persist or worsen following radiation, Metastatic even necessitateis usuallyof and may bladder cancer removal treated by chemotherapy, with bladder the bladder. treatments reserved to control local(

Procedures on the urinary bladder Cystoscopy This is a minor surgical procedure in which the interior of the bladder is examined using an endoscope passed through the eye of the penis (for men) or the external urinary opening (for women). The instrument used may be small and flexible, in which case local anaesthetic is sufficient. In many instances, a larger, rigid instrument may be used (under anaesthesia), since this allows additional procedures to be performed as necessary.

Additional procedures that may be carried out during cystoscopy include biopsy or removal of abnormal areas, such as bladder tumours (which is often the first step in treating bladder tumours). If required and planned, cystoscopy may lead onto a TURP.

The kidneys can be assessed using xrays by injecting dye up to them through the cystoscope(retrograde pyelogram). If required, retrograde pyelograms may lead onto further procedures, for example the placement of an internal tube to drain the kidneys (known as a ureteric stent). Foreign material, such as a bladder stone or a previously placed stent, may be removed during

Cystectomy with ileal conduit

or neobladder

This is a major surgical procedure in which the bladder is removed, along with the prostate, seminal vesicles and vas (in men) and the uterus and part of the vagina (in women). Usually cystectomy is performed to treat suitable bladder cancers, most often with an intention to cure, but occasionally to relieve symptoms even if the cancer is incurable. Removal of draining lymph glands is usually carried out at the same time.