The Urinary System

The human´s urinary system consists of two kidneys, two ureters, a urinary bladder
and a urethra. Its function is to secrete and excrete the urine, and it is connected with the
renal tract.
The kidneys
The kidneys are situated in the posterior abdomen behind the peritoneal cavity at the
level of the first lumbar vertebra. The right kidney is slightly lower than the left one due to
the presence of the liver on the right side. They are encapsulated by a fibrous membrane
called the capsule surrounded by the peritoneal fat.

Each kidney consists of an outer layer called the cortex and the inner portion called
the medulla, which is made up of many structures called nephrons. They are the tubular
microscopic structures lined by specialized tubular cells. Each nephron consists of the
glomerulus, which is a network of capillaries within the Bowman´s capsule. The blood supply
to the kidney is from the abdominal aorta via the renal artery and drainage is through the
renal vein. It is important in relation to the formation of urine. After entering the kidney, the
renal artery branches into smaller vessels and arterioles that form each glomerulus, where
filtration of waste from arterial blood occurs.
The average volume of filtrate in both kidneys is about 180 litres each day. Much of it
is reabsorbed (mainly glucose and amino acids), which is achieved by the presence of the
capillary network surrounding the tubular cells, that also have the ability to secrete certain
substances (like toxic substances, drugs and excess acids) into the glomerular filtrate and
remove them from the body. Re-absorption of the inorganic substances is dependent on their
levels in the plasma - that is if they are required by the body, they will be reabsorbed. If not,
they will be excreted in the urine (mainly the waste products of protein metabolism such as
urea, uric acid, creatinine and inorganic salts), which is a fluid of varying shades of yellow in
90 – 95 % of its component containing water. Normal functioning produces approximately 1
ml of urine per minute. Sometimes it contains some abnormal constituents such as blood,
pus, casts, glucose, plasma proteins or ketone bodies, which are signs of some disorder.
Ureters
Each of the two ureters is a tube 25 – 30 cm long, extending from the kidneys to the
bladder. Contractions of the ureteral muscular tissue produce peristaltic waves, which move
the urine along the tube into the bladder.
Bladder
The urinary bladder is a muscular sac, which lies in the lower pelvis behind the pubic
symphysis. Elastic fibres in the wall of the bladder allow expansion for the storage of urine
(about 500ml). Urine leaves the bladder through the urethra.
Urethra
It is a slender tube that conveys urine from the bladder to the exterior. In the female it
is about 4 cm long and lies anterior the vagina. The male urethra is approximately 20cm long
and, on leaving the bladder, passes through the prostate gland. As well as conveying the
urine, the male urethra receives the semen from ejaculatory ducts, transmitting it through
the urinary hiatus, which is the external opening in the urethra.

Urinary disorders
The sections of medicine that deals with the urinary disorders is called urology.
Urologic disease can involve congenital or acquired dysfunction of the urinary system.
Diseases of the kidney tissue are normally treated by nephrologists, while disease of the
urinary tract are treated by urologists. Gynaecologists may also treat female urinary
incontinence.
Diseases of other bodily systems also have a direct effect on urogenital function. For instance
it has been shown that protein released by the kidneys in diabetes mellitus sensitises the
kidney to the damaging effects of hypertension.
Diabetes also can have a direct effect in urination due to peripheral neuropathies which
occur in some individuals with poorly controlled diabetes.
A term to describe the elimination of urine from the blood is the urinary output. Any
change in amount or type of output can indicate a disorder of the urinary system as:
a, Anuria – no urine is produced
b, Uraemia – suppressed urine production, waste products remain in circulating blood
c, Polyuria – excessive secretion of urine
d, Nocturia – elimination of urine several times during the night
e, Incontinence – inability to control urination. Urinary incontinence can result from a
weakening of the pelvic floor muscles caused by factors such
as pregnancy, childbirth, aging and being overweight. Pelvic floor exercises known as Kegel
exercises can help in this condition by strengthening the pelvic floor. There can also be
underlying medical reasons for urinary incontinence which are often treatable. In children the
condition is called enuresis.
f, Retention of urine – failure to eliminate urine from the bladder.
Urinary disorders can be diagnosed by the tests of urine, blood chemistry, radiological
examinations, e. g. cystoscopy, (which is an insertion of a light scope into the urethra and
bladder to allow direct visualisation under a local or general anaesthetic and is used to
identify stones, tumours or strictures) or a renal biopsy (removal of renal tissue for
microscopic study, as surgical procedure done by a nephrologist), ultrasound and
tomography.
Cystitis – is an inflammation of the bladder lining caused by bacteria or by injury. Bacteria
can enter the bladder through the urethra and pathogens grow in urine that is retained in
the bladder for a long period. Cystitis is more common in females than in males because their
urethra is shorter and pathogens from the vulva and anus can gain entrance more easily. The
symptoms are more frequent desire to void and elimination of a small amount of urine, a
burning sensation that accompanies urination and blood-tinged urine. Bacteria in the
bladder can travel upward in the tract and cause the infection of the ureter (ureteritis) or the
kidney. Also the reoccurrence rate of cystitis is common so it must be treated long and
carefully with antibacterial medications of the sulphonamide group or urinary antiseptics.
Pyelonephritis – is a term for bacterial invasion (E.coli) of the pelvic part of the kidney. It
causes oedema of the renal tissue, fever, chills, nausea and vomiting: the patient usually has
dysuria and high frequency of urination. A symptomatic and bacterial cure may be achieved
within a few days, but histological evidence compatible with acute disease has been found in
biopsies performed many weeks later. The damaged kidney is vulnerable to re-infection and
so it is suggested that treatment should be gives as long as six months, since recurrences are
so common. Antibiotics should be given for a minimum of three weeks or longer.
Glomerulonephritis - is an inflammation of the glomeruli, usually caused by a streptococcal
or pneumococcal infection elsewhere in the body (often in the throat). The organisms have
not been isolated in the kidney or urine and it is thought that the disease is an antigen/
antibody reaction following the infection, most commonly affecting children and adolescents.
90% of children who develop acute glomerulonephritis make a complete recovery but some
patients may develop renal failure. It is not a single process and the pathologists distinguish
many sub-groups. The onset is usually sudden with a reduced output, haematuria and the
development of oedema, initially of the face. The patient may complain of pain and
tenderness in the loins and headache. There also may be a loss of appetite, nausea, vomiting
and hypertension. Complications include cerebral and pulmonary oedema, uraemia and
cardiac failure.

Possible discussion: specimen in labs, different examinations and investigations, healthy

lifestyle, pr.evention

Sources:
Maxerová,M., Buldov, S.: English for Nurses. Informatorium. Praha
Topilová. V.: Medical English. Tobiáš. Havlíčkův Brod. 2011
https://en.wikipedia.org/wiki/Urinary_system
http://www.theherbspecialist.com/13_1.html
https://www.macmillan.org.uk/information-and-support/kidney-renal-cancer/
understanding-cancer/the-kidneys.html
https://www.slideshare.net/RohitPaswan/urethra-76436720