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GASrROINTISTINAl SYSTEM
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9
Genitourinary System
Jaime C. Paz
lntroduction
The regulation of fluid and electrolyte levels by the genitourinary system is an essen rial component to cellular and cardiovascular function.
Imbalance of fluids, electrolytes, or both can lead to blood pressure
changes or impaired metabolism that can ultimately influence the
patient's activity tolerance (see Appendix II). Genitourinary structures
can also cause pain that is referred to the abdomen and back. To help
differentiate neuromuscular and skeletal dysfunction from systemic
dysfunction, physical therapists need to be aware of pain referral patterns from these structures (Table 9-1). The objectives for this chapter are to provide the following:
1.
A basic understanding of the structure and function of the
genirourinary system
2.
Information about the clinical evaluation of the genitouri-
nary system, including physical examination and diagnostic studies
3.
A basic understanding of the various diseases and disor-
ders of the genitourinary system
557
558
AClITE CARE HANDBOOK FOR PHYSICAL THeRAPISTS
Table 9-1. Segmental lnnervarion and Pain Referral Areas of the Urinary System
Segmental
Structure
Innervation
Possible Pain Referral Area
Kidney
Tl0-L l
Lumbar spine (ipsilateral flank)
Upper abdomen
Ureter
T I 1-L2, 52-54
Groin
Upper and lower abdomen
Suprapubic region
Scrotum
Medial and proximal thigh
Thoracolumbar region
Urinary bladder
TII-L2,52-54
5ac,,1 apex
Suprapubic region
Thoracolumbar region
Source: Wirh permission from we Boisson:Hlir, C B..1SS. Parhological origins of trunk and
neck pain: part I. Pelvic and abdominal visceral disorders. J Orthop Phys Ther 1990; 12: 194.
4.
Information about the management of genitourinary dis-
orders, including dialysis therapy and surgical procedures
5.
Guidelines for physical therapy intervention in patients
with genitourinary diseases and disorders
Structure and Function
The genitourinary system consists of two kidneys, two ureters, one
urinary bladder, and one urethra. The genitourinary system also
includes the reproductive organs: the prostate gland, testicles, and
epididymis in men and the uterus, fallopian tubes, ovaries, vagina,
external genitalia, and perineum in women. Of these reproductive
organs, only the prostate gland is discussed in this chapter.
The anatomy of the genitourinary system is shown in Figure 9-1.
An expanded, frontal view of the kidney is shown in Figure 9-2. The
structural and functional unit of the kidney is called the /lephro/l. The
nephron is located in the renal cortex and the medulla and has twO
parts: a renal corpuscle and a renal tubule. There are approximately 1
million nephrons in each kidney. Urine is formed in the nephron