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AClITE CARE HANDBOOK FOR PHYSICAL THERAPISTS

that is used to view the prostatitic urethra (in men), external urinary

sphincters, and anterior urethra.5-7

Clinical Tip

Patients may experience urinary frequency or dysuria

after cyStoscopic procedures; therefore, the therapist

should be prepared for sudden interruptions during a

therapy session that is conducted the same day after this

diagnostic procedure.

Urodynamic Studies

Uro(lowmetry

In IIro(lowmetry, voiding is analyzed graphically to determine the

rate, time, and volume of urinary Aow so that ureteral, urethral, and

bladder function can be examined and described. Increased flow rates

could be indicative of incontinence, whereas decreased flow rates may

indicate urethral or bladder neck obstruction.5•7

Cystometrogram

Cystometrogram is used to evaluate bladder tone, sensations of filling, and bladder stabiliry. The procedure consists of inserting a catheter into the bladder, followed by saline instillation and pressure measurements of the bladder wall'

Radioisotope Studies

Renography

Renography consists of injecting a radioisotope intravenously and

allowing it to circulate through the urinary system to be excreted in

the urine. A renogram (graphic record) is taken to assess renal blood

flow, glomerular filtration, and tubular secretion.'

Renal Scali

A renal scan consists of using an external scanning device, such as a

scintillator, to outline the kidneys and ureters after intravenous radioisotope injection. Blood flow, glomerular filtration, tubular function, and excretion can be examined during this procedure. Decreased

areas of kidney function, as with abscesses, cysts, or tumors, do not

appear on the scan.4-6

GENITOURINARY SYSfEM

569

Nllclear Cystogram (Radiollllclide Cystogram)

In a ,we/ear cystogram, radioisotope material and normal saline are

injected into the bladder through a catheter to assess bladder ftmction. This procedure requires less radiation than does cystography (which requires the use of contrast dye) but does not provide the

same anatomic detail.' Nuclear cystogram and cystography are indicated for cases in which the structure of the bladder needs to be visualized.

Ultrasonography Studies

Ultrasound is used to ( I ) evaluate kidney size, shape, and position;

(2) determine the presence of kidney stones, cyStS, and prerenal collections of blood, pus, lymph, urine, and solid masses; (3) identify the presence of a dilated collecring system; and (4) help guide needle

placement for biopsy or drainage of a renal abscess or for placement

of a nephrostomy tube.s.,

Computed Tomography

Indications for computed tomography of the genitourinary system

include defining renal parenchyma abnormalities and differentiating

solid mass densities as cystic or hemorrhagic. Kidney size and shape,

as well as the presence of cysts, abscesses, tumors, calculi, congenital

abnormalities, infections, hematomas, and collecting system dilation,

can also be assessed with computed tomography.3.s

Magnetic Resonance Imaging

Multiple lIses for magnetic resonance imaging include imaging the

renal vascular system without the potential adverse effects of COntraSt

dyes, staging of renal cell carcinoma, identifying bladder tumors and

their local metastases, and distinguishing between benign and malignant prostate tumors.s

Biopsies

Rellal Biopsy

A renal biopsy consists of examining a small portion of renal tissue

that is obtained percutaneously with a needle to determine the pathologic state and diagnosis of a renal disorder, monitor kidney disease progression, evaluate response to medical treatment, and assess for

rejection of a renal transplant. A local aneSthetic is provided during

the procedure4.5

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AClITE CARE. HANDBOOK FOR PHYSICAL THERAPISTS

Bladder, Prostate, and Urethral Biopsies

Bladder, prostate, and urethral biopsies involve taking tissue specimens

from the bladdet, prostate, and utethra with a cystoscope, panendoscope, or needle aspiration via the transreccal or transperineal approach. Biopsy of the prostate can also be performed through an

open biopsy procedure, which involves incising the perineal area and

removing a wedge of prostate tissue. Examinations of pain, hematuria,

and suspected neoplasm are indications for these biopsies.s·7

Pathophysiology

Renal System DysfUl,ction

Acute Renal Failure

Acute renal failure can result from a varicty of causes and is defined

as a sudden, rapid deterioration in renal function that results in

decreased urine outpur.' There arc three types of ARF, which are categorized by their etiology as prerenal, intra renal, or postrenal.

Prerenal ARF is caused by a decrease in renal blood flow from dehydration, hemorrhage, shock, burns, or trauma.

intrarenal ARF involves primary damage to kidneys and is caused by

glomerulonephritis, acute pyelonephritis, renal artery or vein

occlusion, bilateral renal cortical necrosis, nephrotoxic substances

(e.g., aminoglycoside antibiotics or contrast dye), or blood transfusion reactions.

Postrenal ARF involves obstruction distal to the kidney and can be

caused by urinary tract obstruction by renal stones, obstructive

tumors, or benign prostacic hypertrophy.8-',

Despite advances in therapies, the mortality rate from ARF is still

relatively high, ranging from 40% to 88%.'0.11

The following are five stages for all three rypes of ARF8.9:

1.

Onset is rhe rime from the precipitating event to the onset

of decreased urine output, or oliguria.

2.

O/iguric or antlric (110 urine) phase occurs when urine out-

put is less than 400 ml in 24 hours, which can last 8-15 days, with

prognosis worsening as rhe duration increases.