Medical Terminology: A Living Language
Seventh Edition
Chapter 9
Urinary System
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Urinary System at a Glance
• The urinary system is responsible for four things:
– Maintaining a stable internal environment.
– Removing waste products.
– Adjusting water and electrolyte levels.
– Maintaining the correct pH.
• Organs of the urinary system are two kidneys, two ureters, one bladder, and one
urethra.
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Urinary System Illustrated
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Anatomy and Physiology of the Urinary
System (1 of 2)
• The urinary system is also called the genitourinary or GU system.
• Its main function is to filter and remove wastes from the blood via urine.
• Every metabolic process produces waste, and waste becomes toxic if not removed
promptly.
• A build-up of wastes is called uremia.
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Anatomy and Physiology of the Urinary
System (2 of 2)
• Wastes are removed from the body by a system of blood vessels and tubules.
• Filtration of the blood takes place in the nephrons.
• Millions of nephrons make the kidneys.
• Urine drains from the kidney and the ureters carry it to the bladder.
• When the bladder empties, urine moves through the urethra and out.
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Kidneys (1 of 2)
• The two kidneys are behind the peritoneum and are retroperitoneal.
• The concave hilum is the entry point for the renal artery and exit point for the renal vein.
– The artery brings in waste-filled blood.
– The vein takes out clean blood.
– The ureter also exits at the hilum.
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Kidneys (2 of 2)
• The outer portion of the kidney is the cortex and is like the kidney’s shell.
• The inner area is the medulla.
• The medulla contains pyramids that point inward toward the hilum.
• The tip or papilla of each pyramid opens into a calyx.
• The calyces collect urine and empty into the renal pelvis.
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Figure 9.1
Kidney structure. Longitudinal section showing the renal artery entering and the
renal vein and ureter exiting at the hilum of the kidney.
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Figure 9.2
Longitudinal section of a kidney illustrating the internal structures.
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Nephrons (1 of 2)
• The nephron is the working unit of the kidney.
• Each nephron has a renal corpuscle and a renal tubule.
• The corpuscle filters the blood using a glomerular capsule and glomerulus.
– Afferent arterioles carry blood to the glomeruli.
– Efferent arterioles carry blood away.
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Nephrons (2 of 2)
• Water and substances removed from the blood in the corpuscle flow into the renal
tubules.
• The tubules complete urine production.
• The tubules are divided into four parts: the proximal convoluted tubule, the nephron
loop, the distal convoluted tubule, and the collecting tubule.
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Figure 9.3
The structure of a nephron, illustrating the nephron structure in relation to the
circulatory system.
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Ureters
• The ureters carry urine from the renal pelvis to the urinary bladder.
• The ureters are tubes less than a quarter inch wide and between 10 and 12 inches long.
• They are lined with mucous membrane.
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Urinary Bladder (1 of 2)
• The bladder is an elastic muscular sac in the base of the pelvis.
• It is composed of three layers of smooth muscle lined with rugae.
• It receives and stores urine from the ureters.
• It can hold between 300 and 400 mL of urine.
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Urinary Bladder (2 of 2)
• The bladder signals the urge to empty.
• Involuntary muscles cause the bladder to contract and the internal sphincter to relax.
• Voluntary muscles control the external sphincter for intentional emptying.
• Bladder control is developed sometime after a person reaches age two.
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Figure 9.4
The ureters extend from the kidneys to the urinary bladder.
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Figure 9.5
The structure of the urinary bladder. (Note the prostate gland.)
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Urethra
• The urethra is a tubular canal that carries urine out of the bladder.
• It is lined with mucous membrane.
– The female urethra is 1 to 2 inches long.
– The male urethra is 8 inches long.
• In women, the urethra serves only to carry urine out of the body.
• In men, it carries both urine and semen out of the body.
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Figure 9.6A
The male urethra extends from the urinary bladder in the floor of the pelvis through
the penis to the urinary meatus.
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Figure 9.6B
The much shorter female urethra extends from the urinary bladder to the floor of
the pelvis and exits just in front of the vaginal opening.
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Role of the Kidneys in Homeostasis (1 of 2)
• The kidneys are responsible for homeostasis—balance in the body.
• The urinary system continually maintains the proper balance of water and chemicals in
the body.
– If the body has too little water, the kidneys conserve it.
– If the body has excess water, the kidneys excrete it.
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Role of the Kidneys in Homeostasis (2 of 2)
• The kidneys also regulate the level of electrolytes—small, biologically important
molecules.
• The kidneys also help maintain the correct pH within the body.
• All of these tasks are accomplished through urine production.
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Stages of Urine Production (1 of 4)
• As nephrons remove wastes, many desirable molecules are also initially removed from
the blood.
• To prevent these molecules being excreted, urine is produced in stages:
– Filtration
– Reabsorption
– Secretion
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Stages of Urine Production (2 of 4)
• Filtration is the first stage.
• It occurs in the renal capsule as pressure forces material out of the blood and into the
renal tubules.
• The material is a fluid called glomerular filtrate.
• Filtrate contains water, electrolytes, nutrients, wastes, and toxins.
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Stages of Urine Production (3 of 4)
• Reabsorption is the second stage.
• It occurs as filtrate passes through the four sections of the renal tubule.
• Most of the water, electrolytes, and nutrients are reabsorbed.
• They return to the blood via the peritubular capillaries.
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Stages of Urine Production (4 of 4)
• Secretion is the third stage.
• It occurs as special cells of the renal tubules secrete ammonia, uric acid, and wastes
directly into the renal tubules.
• Urine formation is finished at this point, and urine proceeds through the kidneys and
eventually out of the body.
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Figure 9.7
The three stages of urine production: filtration, reabsorption, and secretion.
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Urine (1 of 2)
• Urine is deep gold to clear in color.
• It is sterile during production and collection but becomes contaminated as it exits the
body.
• It contains water, electrolytes, toxins, and nitrogenous wastes.
• Glucose, blood, or albumin in urine indicates a disease process.
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Urine (2 of 2)
• Normal urine output is 1,000 to 2,000 mL in a 24-hour period.
• Normal urine is acidic.
• Specific gravity of urine indicates the amount of dissolved substances.
– Concentrated urine has a high specific gravity.
– Dilute urine has a low specific gravity.
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Table 9-1
Element Normal Findings
Color Straw-colored, pale yellow to deep gold
Odor Aromatic
Appearance Clear
Specific Gravity 1.001–1.030
pH 5.0–8.0
Protein Negative to trace
Glucose None
Ketones None
Blood Negative
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Table 9-2 (1 of 3)
Element Implications
Color Color varies depending on patient’s fluid intake and
output or medication; brown or black urine color
indicates a serious disease process
Odor Fetid or foul odor may indicate infection, while fruity
odor may be found in diabetes mellitus, dehydration,
or starvation; other odors may be due to medication
or foods
Appearance Cloudiness may mean that infection is present
Specific Gravity Concentrated urine has a higher specific gravity;
dilute urine, such as can be found with diabetes
insipidus, acute tubular necrosis, or salt-restricted
diets, has a lower specific gravity
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Table 9-2 (2 of 3)
Element Implications
pH pH value below 7.0 (acidic) is common in urinary
tract infections, metabolic or respiratory acidosis,
diets high in fruits or vegetables, or administration
of some drugs; pH higher than 7.0 (basic or
alkaline) is common in metabolic or respiratory
alkalosis, fever, high-protein diets, and taking
ascorbic acid
Protein Protein may indicate glomerulonephritis or
preeclampsia in a pregnant woman
Glucose Small amounts of glucose may be present as result
of eating a high-carbohydrate meal, stress,
pregnancy, and taking some medications, such as
aspirin or corticosteroids; higher levels may indicate
poorly controlled diabetes, Cushing’s syndrome, or
infection
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Table 9-2 (3 of 3)
Element Implications
Ketones Presence of ketones may indicate poorly controlled
diabetes, dehydration, starvation, or ingestion of
large amounts of aspirin
Blood Blood may indicate glomerulonephritis, cancer of
urinary tract, some types of anemia, taking of some
medications (such as blood thinners), arsenic
poisoning, reactions to transfusion, trauma, burns,
and convulsions
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Additional Combining Forms (1 of 4)
Combining Form Definition
azot/o
bacteri/o
bi/o
carcin/o
corpor/o
cyst/o
glomerul/o
glycos/o
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Additional Combining Forms (2 of 4)
Combining Form Definition
hem/o
hemat/o
hydr/o
iatr/o
idi/o
keton/o
lith/o
meat/o
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Additional Combining Forms (3 of 4)
Combining Form Definition
necr/o
nephr/o
neur/o
noct/i
olig/o
peritone/o
protein/o
py/o
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Additional Combining Forms (4 of 4)
Combining Form Definition
pyel/o
ren/o
tox/o
ur/o
ureter/o
urethr/o
urin/o
ven/o
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Additional Suffixes (1 of 5)
Suffix Definition
-al
-algia
-ar
-ary
-cele
-eal
-ectasis
-ectomy
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Additional Suffixes (2 of 5)
Suffix Definition
-emia
-genic
-gram
-graphy
-ic
-itis
-lith
-lithiasis
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Additional Suffixes (3 of 5)
Suffix Definition
-logy
-lysis
-malacia
-megaly
-meter
-oma
-ory
-osis
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Additional Suffixes (4 of 5)
Suffix Definition
-ostomy
-otomy
-ous
-pathy
-pexy
-plasty
-ptosis
-rrhagia
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Additional Suffixes (5 of 5)
Suffix Definition
-sclerosis
-scope
-scopy
-stenosis
-tic
-tripsy
-uria
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Additional Prefixes
Prefix Definition
an-
anti-
dys-
extra-
intra-
poly-
retro-
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Adjective Forms of Anatomical Terms
Term Definition
cystic
glomerular
meatal
pyelitic
renal
ureteral
urethral
urinary
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Medical Specialties
Term Definition
Branch of medicine involved in diagnosis
nephrolog
and treatment of diseases and disorders of
y
the kidney. Physician is a nephrologist.
Branch of medicine involved in diagnosis
and treatment of diseases and disorders of
urology
the urinary system (and male reproductive
system). Physician is a urologist.
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Signs and Symptoms (1 of 6)
Term Definition
complete lack of urine production and lack
anuria
of urine excretion
azotemia nitrogenous wastes in the bloodstream
bacteriuri
presence of bacteria in the urine
a
stone formed within an organ from mineral
calculus
salts
cystalgia urinary bladder pain
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Figure 9.8
Photograph of sectioned kidney specimen illustrating extensive renal calculi.
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Signs and Symptoms (2 of 6)
Term Definition
cystolith bladder stone
cystorrhag abnormal bleeding from the urinary
ia bladder
diuresis increased formation and secretion of urine
dysuria difficult or painful urination
involuntary discharge of urine; also called
enuresis
bed-wetting at night
greater-than-normal urge to urinate; no
frequency
increase in total volume of urine
glycosuria presence of sugar in the urine
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Signs and Symptoms (3 of 6)
Term Definition
hematuria presence of blood in the urine
decrease in force of urine stream, often
hesitancy
with difficulty initiating the flow
presence of ketones in the urine; occurs
ketonuria when body burns fat instead of glucose
for energy
nephrolith kidney stone
nephromalaci
kidney is abnormally soft
a
nephromegal
kidney is enlarged
y
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Signs and Symptoms (4 of 6)
Term Definition
nephrosclerosi
kidney tissue has become hardened
s
having to urinate frequently during the
nocturia
night
oliguria producing too little urine
producing an unusually large volume
polyuria
of urine
proteinuria presence of protein in the urine
pyuria presence of pus in the urine
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Signs and Symptoms (5 of 6)
Term Definition
renal colic pain caused by a kidney stone
narrowing of a passageway in the
stricture
urinary system
accumulation of waste products in the
uremia
bloodstream
ureterectasis ureter is stretched out or dilated
ureterolith stone in the ureter
ureterostenos
ureter has become narrow
is
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Signs and Symptoms (6 of 6)
Term Definition
urethralgia urethral pain
urethrorrhagia abnormal bleeding from the urethra
urethrostenosis urethra has become narrow
feeling the need to urinate
urgency
immediately
urinary
involuntary release of urine
incontinence
urinary retention inability to fully empty the bladder
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Figure 9.9
Healthcare worker draining urine from a bladder catheter bag.
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Kidney Pathology (1 of 4)
Term Definition
acute tubular damage to renal tubules due to
necrosis (ATN) toxins in the urine; results in oliguria
damage to glomerular capillaries
diabetic
due to high blood sugar of diabetes
nephropathy
mellitus
glomerulonephri inflammation of the kidney; more
tis permeable to protein and blood cells
distention of renal pelvis due to
hydronephrosis
accumulation of urine in the kidney
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Kidney Pathology (2 of 4)
Term Definition
nephritis kidney inflammation
nephrolithias presence of calculi in the kidney;
is solidification of salts in the urine
nephroma kidney tumor
general term for presence of kidney
nephropathy
disease
downward displacement of the kidney;
nephroptosis
floating kidney
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Kidney Pathology (3 of 4)
Term Definition
nephrotic damage to the glomerulus; protein
syndrome (NS) appears in the urine
polycystic formation of multiple cysts within the
kidneys kidney; destroys normal kidney tissue
pyelitis renal pelvis inflammation
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Figure 9.10
Photograph of a polycystic kidney on the left compared to a normal kidney on the
right.
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Kidney Pathology (4 of 4)
Term Definition
inflammation of renal pelvis and
pyelonephritis kidney; common type of kidney
disease
renal cell
cancerous tumor of renal tubule cells
carcinoma
inability of kidneys to filter wastes;
renal failure
results in uremia
malignant kidney tumor; most often
Wilms’ tumor
found in children
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Urinary Bladder Pathology (1 of 2)
Term Definition
cancerous tumor arising from cells
bladder cancer lining bladder; primary symptom is
hematuria
bladder neck
obstruction blockage of bladder outlet; often
caused by enlarged prostate gland
(BNO)
cystitis urinary bladder inflammation
protrusion of the urinary bladder
cystocele
into wall of vagina
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Urinary Bladder Pathology (2 of 2)
Term Definition
interstitial inflammation and irritation of
cystitis bladder
neurogenic loss of nervous control; leads to
bladder retention
urinary tract infection of any organ of urinary
infection system, usually by bacteria; begins
with cystitis and may ascend into
(UTI) ureters and kidneys
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Clinical Laboratory Tests (1 of 2)
Term Definition
albumin/ urine test that measures the amount of
creatinine albumin and creatinine present; an increased
ratio (ACR) ratio indicates disease
blood urea blood test to evaluate kidney function by
nitrogen measuring level of nitrogenous waste (urea) in
(BUN) the bloodstream
clean catch urine sample obtained after cleaning off the
specimen urinary meatus and collecting sample in
(CC) midstream
test of kidney function; amount of creatinine
creatinine
in bloodstream is compared to amount in the
clearance
urine
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Clinical Laboratory Tests (2 of 2)
Term Definition
estimated
glomerular Test to measure kidney function; measures
filtration level of creatinine in urine
rate (eGFR)
urinalysis physical, chemical, and microscopic
(U/A, UA) examination of urine
urine culture test for bacterial infection; attempt to grow
and sensitivity bacteria on a culture medium in order to
identify it; then determine to which antibiotics
(C&S) it is sensitive
urinometer instrument to measure specific gravity of urine
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Diagnostic Imaging (1 of 2)
Term Definition
cystogram X-ray record of the bladder
cystograph contrast dye is placed in bladder and then
y X-ray is taken; outlines bladder
excretory dye is injected into bloodstream; X-ray
urography traces the dye as it moves through organs
(EU) of the urinary system
intravenou
s
pyelograph injecting a dye into a vein and then taking
y an X-ray to outline the renal pelvis
(IVP)
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Diagnostic Imaging (2 of 2)
Term Definition
kidneys, ureters, abdominal X-ray showing the
bladder (KUB) kidneys, ureters, and bladder
nephrogram X-ray record of the kidney
pyelogram X-ray record of the renal pelvis
retrograde dye is inserted through the urethra
pyelography to outline the bladder, ureters, and
(RP) renal pelvis
voiding dye is placed in the bladder; X-ray
cystourethrograp taken to visualize the urethra while
hy (VCUG) patient is voiding
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Figure 9.11
Retrograde pyelogram X-ray. Radiopaque dye outlines urinary bladder, ureters,
and renal pelvis. Bladder, right kidney, and both ureters appear normal. Left kidney
appears abnormal.
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Endoscopic Procedures
Term Definition
instrument used to visually examine the
cystoscope
urinary bladder
cystoscopy visual examination of the urinary bladder
(cysto) using a cystoscope
urethroscop instrument used to visually examine the
e urethra
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Medical Treatments (1 of 2)
Term Definition
flexible tube inserted into the body;
catheter commonly through the urethra into
the bladder
catheterization insertion of a tube through the urethra
(cath) and into the urinary bladder
extracorporeal
shockwave use of ultrasound waves to break up
lithotripsy renal calculi
(ESWL)
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Figure 9.12
Extracorporeal shockwave lithotripsy, a non-invasive procedure using high
frequency sound waves to shatter kidney stones.
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Medical Treatments (2 of 2)
Term Definition
hemodialysis use of artificial kidney machine to
(HD) filter the blood
removes wastes using chemically
peritoneal
balanced solutions placed into
dialysis
peritoneal cavity
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Figure 9.13
Patient undergoing hemodialysis. Patient's blood passes through hemodialysis
machine for cleansing and is then returned to the body.
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Figure 9.14
Peritoneal dialysis. Chemically balanced solution is placed into the abdominal cavity
to draw impurities out of the bloodstream. It is removed after several hours.
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Surgical Treatments (1 of 2)
Term Definition
cystectomy surgical removal of the bladder
cystopexy surgical fixation of the bladder
cystoplasty surgical repair of the bladder
surgical creation of a new opening into
cystostomy
the bladder
cystotomy cutting into the bladder
lithotomy cutting into an organ to remove a stone
lithotripsy physical destruction of a stone
meatotomy incision into the meatus to enlarge it
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Surgical Treatments (2 of 2)
Term Definition
nephrectomy surgical removal of a kidney
nephrolithotom incision to remove stones from the
y kidney
nephropexy surgical fixation of a kidney
Surgical creation of a new opening
nephrostomy
into a kidney
nephrotomy cutting into a kidney
pyeloplasty surgical repair of the renal pelvis
renal transplant surgical placement of a donor kidney
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Figure 9.15
Figure illustrates location utilized for implantation of donor kidney.
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Urinary System Pharmacology (1 of 2)
Term Definition
a substance that neutralizes poisons or
antidote
their side effects
usually unfavorable response by the
iatrogenic body to a physician’s actions, a
medication, or a medical treatment
an unusual or abnormal response to a
idiosyncrasy
drug or food
response to a drug other than the
side effect
desired effect; an adverse reaction
the extent or degree to which something
toxicity
is poisonous
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Urinary System Pharmacology (2 of 2)
Drug Type Use Examples
treats bacterial
antibiotic Cipro, Macrobid
infections
prevents or reduces
antispasmodic bladder muscle Ditropan
spasms
increases volume of
diuretic Lasix, Aldactone
urine
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Urinary System Abbreviations (1 of 5)
Term Definition
ACR albumin/creatinine ratio
AGN acute glomerulonephritis
AKI acute kidney injury
ARF acute renal failure
ATN acute tubular necrosis
BNO bladder neck obstruction
BUN blood urea nitrogen
continuous ambulatory peritoneal
CAPD
dialysis
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Urinary System Abbreviations (2 of 5)
Term Definition
cath catheterization
CC clean catch urine specimen
Cl– chloride
CRF chronic renal failure
C&S culture and sensitivity
cysto cystoscopy
eGFR estimated glomerular filtration rate
ESRD end-stage renal disease
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Urinary System Abbreviations (3 of 5)
Term Definition
ESWL extracorporeal shockwave lithotripsy
EU excretory urography
GU genitourinary
HCO3– bicarbonate
HD hemodialysis
H 2O water
I&O input and output
IPD intermittent peritoneal dialysis
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Urinary System Abbreviations (4 of 5)
Term Definition
IVP intravenous pyelogram
K+ potassium
KUB kidneys, ureters, bladder
mcg microgram
mEq milliequivalent
mg milligram
mL milliliter
Na+ sodium
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Urinary System Abbreviations (5 of 5)
Term Definition
NS nephrotic syndrome
pH acidity or alkalinity of urine
RP retrograde pyelogram
SG, sp. gr. specific gravity
U/A, UA urinalysis
UC urine culture
UTI urinary tract infection
VCUG voiding cystourethrography
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Copyright
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