Genitourinary System

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Genitourinary System

ICD-10-CM Example from Tabular

N30 Cystitis

Use additional code to identify infectious agent (B95-B97)

Excludes1 prostatocystitis (N41.3)

N30.0 Acute cystitis

Excludes1 irradiation cystitis (N30.4-)

trigonitis (N30.3-)

N30.00. Acute cystitis without hematuria

N30.1. Interstitial cystitis (chronic)

N30.2. Other chronic cystitis

N30.3. Trigonitis

N30.4. Irradiation cystitis

N30.8. Other cystitis

N30.9. Cystitis, unspecified

Urinary System

Functions of the Urinary System

The major function of the urinary system is to continually maintain a healthy balance of the amount and content of extracellular fluids within the body. Biologists use the term homeostasis to describe this important process. The process of metabolism changes food and liquid (with its requisite fats, carbohydrates, and proteins) into building blocks, energy sources, and waste products. To operate efficiently, the body needs to constantly monitor and rebalance the amounts of these substances in the bloodstream. The breakdown of proteins and amino acids in the liver leaves chemical wastes, such as urea, creatinine, and uric acid, in the bloodstream. These wastes are toxic, nitrogenous substances that must be excreted in the urine. The act of releasing urine is called urination, voiding, or micturition.

Anatomy and Physiology

The urinary system is composed of two kidneys, two ureters, a urinary bladder, and a urethra (Figs. 6-1 and 6-2). The work of the urinary system is done by a specialized tissue in the kidneys called parenchymal tissue. The kidneys function to filter the blood and eliminate waste through the passage of urine. The ureters are thin, muscular tubes that move urine in peristaltic waves from the kidneys to the bladder. The urinary bladder is the sac that stores the urine until it is excreted. The bladder is lined with an epithelial mucous membrane of transitional cells. Underneath, a layer termed the lamina propria is composed of connective tissue that holds the blood vessels and nerves. The detrusor muscle is the final coat; it normally contracts to expel urine. The urethra is the tube that conducts the urine out of the bladder. The opening of the urethra is called the urinary meatus. The triangular area in the bladder between the ureters’ entrance and the urethral outlet is called the trigone. The ureters, bladder, and urethra are all stromal tissue, which is a supportive tissue.

The Kidney

Because the kidneys are primarily responsible for the functioning of the urinary system, it is helpful to look at them in greater detail. Each of the two kidneys is located high in the abdominal cavity, tucked under the ribs in the back and behind the lining of the abdominal cavity (retroperitoneal). The normal human kidney is about the size of a fist. The tough outer covering of the kidney is the renal capsule. If a kidney were sliced open, the outer portion, the cortex (pl. cortices), and the inner portion, called the medulla (pl. medullae), would be visible (Fig. 6-3). The renal pelvis and calyces (sing. calyx) are an extension of the ureter inside the kidney. The renal pyramids are triangular sections that extend from the renal medulla toward the renal pelvis. The downward point of the pyramid is referred to as the papilla. The term renal means “pertaining to the kidneys.” The ureteropelvic junction (UPJ) is the area where the ureter joins the renal pelvis. It is a common site of obstruction of the outward flow of urine from the kidney.

The hilum (pl. hila) is the location on the kidney where the ureter and renal vein leave the kidney and the renal artery enters. The cortex contains tissue with millions of microscopic units called nephrons (Fig. 6-4). Here in the tiny nephrons, blood passes through a continuous system of urinary filtration, reabsorption, and secretion that measures, monitors, and adjusts the levels of substances in the extracellular fluid.

The Nephron

The nephrons filter all the blood in the body approximately every 5 minutes. The renal afferent arteries transport unfiltered blood to the kidneys. Once in the kidneys, the blood travels through small arteries called arterioles and finally into tiny balls of renal capillaries, called glomeruli (sing. glomerulus). These glomeruli cluster at the entrance to each nephron. It is here that the process of filtering the blood to form urine begins.

The nephron consists of four parts: (1) the renal corpuscle, which is composed of the glomerulus and its surrounding Bowman’s capsule; (2) a proximal convoluted tubule; (3) the nephronic loop, also known as the loop of Henle; and (4) the distal convoluted tubule. As blood flows through the capillaries, water, electrolytes, glucose, and nitrogenous wastes are passed through the glomerular membrane and collected. The most common electrolytes are sodium (Na), chloride (Cl), and potassium (K). Blood cells and proteins are too large to pass through the glomerular membrane. Selective filtration and reabsorption continue along the renal tubules, with the end result of urine concentration and subsequent dilution occurring in the renal medulla. From there, the urine flows to the calyces and exits the kidney, flowing through the ureter into the bladder, where it is stored until it can be expelled from the body through the urethra.

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Combining Forms for the Anatomy of the Urinary System

Meaning Combining Form
artery arteri/o
bladder cyst/o, vesic/o
calyx calic/o, cali/o, calyc/o
cell cellul/o
cortex cortic/o
glomerulus glomerul/o
hilum hil/o
kidney nephr/o, ren/o
meatus meat/o
medulla medull/o
parenchyma parenchym/o
peritoneum peritone/o
renal pelvis pyel/o
stroma strom/o
trigone trigon/o
ureter ureter/o
urethra urethr/o
urine, urinary system urin/o, ur/o

Prefixes for the Anatomy of the Urinary System

Prefix Meaning
extra- outside
en- in
par- beside, near
retro- backward

Suffixes for the Anatomy of the Urinary System

Suffix Meaning
-al, -ar, -ic pertaining to
-ation, -ion process of

Pathology

Terms Related to Symptoms and Signs Involving the Genitourinary System (R3Ø-R39)

Term Word Origin Definition
anuria an- without
-uria urinary condition
Condition of no urine.
dysuria dys- painful, abnormal
-uria urinary condition
Condition of painful urination.
enuresis en- in
ur/o urine
-esis state of
Also commonly known as “bed-wetting,” enuresis can be nocturnal (at night) or diurnal (during the day).
extrarenal uremia extra- outside
ren/o kidney
-al pertaining to
ur/o urine
-emia blood condition
Excessive urea in blood (uremia) due to kidney failure caused by disease outside of the kidney (e.g., congestive heart failure).
extravasation of urine extra- outside
vas/o vessel
-ation process of
Condition of urine leaking outside of the bladder and into surrounding tissues. May be due to trauma or a stone.
hematuria hemat/o blood
-uria urinary condition
Blood in the urine.
incontinence, urinary   Inability to hold urine.
nocturia noct/i night
-uria urinary condition
Condition of excessive urination at night.
oliguria olig/o scanty, few
-uria urinary condition
Condition of scanty urination.
polyuria poly- excessive, frequent
-uria urinary condition
Condition of excessive urination.
retention, urinary   Inability to release urine.
vesical tenesmus vesic/o bladder
-al pertaining to
Bladder spasms.

Terms Related to Glomerular Diseases (NØØ-NØ8)

Term Word Origins Definition
acute nephritic syndrome nephr/o kidney
-itic pertaining to
Hypertension, hematuria, and proteinuria (protein in the urine) resulting from damage to the glomeruli.
nephrotic syndrome nephr/o kidney
-tic pertaining to
Abnormal group of signs in the kidney, characterized by proteinuria, hypoalbuminemia (abnormally low levels of albumin in the blood), and edema; may occur in glomerular disease and as a complication of many systemic diseases (e.g., diabetes mellitus). Also called nephrosis.

Terms Related to Renal Tubulo-interstitial Diseases (N1Ø-N16)

Term Word Origin Definition
hydronephrosis hydr/o water
nephr/o kidney
-osis abnormal condition
Dilation of the renal pelvis and calices of one or both kidneys resulting from obstruction of the flow of urine.
pyelonephritis pyel/o renal pelvis
nephr/o kidney
-itis inflammation
Bacterial or viral infection of the kidneys and renal pelvis.
pyonephrosis py/o pus
nephr/o kidney
-osis abnormal condition
Pyogenic (pus-producing) infection of the kidney.
vesicoureteral reflux vesic/o urinary bladder
ureter/o ureter
-al pertaining to
re- back
-flux flow
Abnormal backflow of urine from the bladder to the ureter.

Terms Related to Acute Kidney Failure and Chronic Kidney Failure (N17-N19)

Term Word Origin Definition
renal failure ren/o kidney
-al pertaining to
Inability of the kidneys to excrete wastes, concentrate urine, and conserve electrolytes. May be acute or chronic.
acute renal failure (ARF)   Sudden inability of the kidneys to excrete wastes, resulting from hemorrhage, trauma, burns, toxic injury to the kidney, pyelonephritis or glomerulonephritis, or lower urinary tract obstruction. Characterized by oliguria and rapid azotemia.
chronic kidney disease (CKD) (formerly chronic renal failure)   CKD is measured in stages of increasing severity, from 1 (mild damage with a normal glomerular filtration rate) to 5 (complete kidney failure requiring either dialysis or a renal transplant). Stage 5 is also called end-stage renal disease (ESRD) and is the most extreme form of CKD.

image CM Guideline Alert

14a Chronic Kidney Disease

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Terms Related to Urolithiasis (N2Ø-N23)

Term Word Origin Definition
urolithiasis ur/o urine, urinary system
lith/o stone
-iasis condition, presence of
Stones (calculi) anywhere in the urinary tract, but usually in the renal pelvis or urinary bladder. Depending on where the stone is located, the term is nephrolithiasis (kidney), ureterolithiasis (ureter), cystolithiasis (urinary bladder), or urethrolithiasis (urethra). Usually formed in patients with an excess of the mineral calcium. Also called urinary calculi (Fig. 6-5).

Terms Related to Other Disorders of the Kidney and Ureter (N25-N29)

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Term Word Origin Definition
nephrogenic diabetes insipidus nephr/o kidney
-genic pertaining to producing
Diabetes insipidus caused by a defect in the renal tubules causing them to be unresponsive to antidiuretic hormone (ADH).
nephropathy nephr/o kidney
-pathy disease process
Disease of the kidneys; a general term that does not specify a disorder.
nephroptosis nephr/o kidney
-ptosis drooping, sagging
Prolapse or sagging of the kidney.