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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

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