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568
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
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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.