Urinary Diseases and basics.

1. Basics on
Urinary Tract Diseases

2. Urinary System
The urinary system or urinary tract (also
called the excretory system) is the organ
system that produces, stores, and
eliminates urine.
In humans it includes -
Two kidneys
Two ureters
A Urinary bladder
A urethra

3. Kidney:
• The kidneys are bean‐shaped organs that
lie in the abdomen.
• The main role of kidney is to filter water
soluble waste products from the blood.
Ureters:
• Ureters are a tube-like organ which is
made of smooth muscle
• Ureters carries urine from the kidney to
urinary bladder
Physiology of urinary system
Urinary Bladder
• A hollow muscular, and distensible (or
elastic) organ, which sits on the pelvic floor
• Collects urine excreted by the kidneys prior
to disposal by urination
• The urinary bladder usually holds 300‐350
mL of urine; a full adult bladder holds
about 500 mL of urine.
Urethra
• It is also a tube-like organ which is made of
smooth muscle
• Urine comes out the body through urethra

4. • In anatomy, the urinary bladder is the organ
that collects urine excreted by the kidneys
prior to disposal by urination.
• A hollow muscular, and distensible (or
elastic) organ, the bladder sits on the pelvic
floor.
• Urine enters the bladder via the ureters and
exits via the urethra.
• The urinary bladder usually holds 300-350
mL of urine; a full adult bladder holds about
500 mL of urine.
Urinary Bladder

5. The urinary bladder is composed of
four layers of muscles:
•The serosa
•The detrusor muscle
•A submucosal coat of connective
tissue, and
•The mucosa, which contains a layer of
epithelial cells, and connective tissue
that facilitate its contractility and allow
storage of urine at low pressure
Muscles of Urinary Bladder

6. • The detrusor muscle is a layer of the urinary bladder wall made of smooth muscle
fibers arranged in spiral, longitudinal, and circular bundles.
• Detrusor is innervated by sympathetic nervous system fibers from the lumbar
spinal cord and parasympathetic fibers from the sacral spinal cord.
• When the bladder is stretched, this signals the parasympathetic nervous system
to contract the detrusor muscle. This encourages the bladder to expel urine
through the urethra.
• For the urine to exit the bladder, both the autonomically controlled internal
sphincter and the voluntarily controlled external sphincter must be opened.
Problems with these muscles can lead to incontinence.
• If the amount of urine reaches 100% of the urinary bladder's capacity, the
voluntary sphincter becomes involuntary and the urine will be ejected instantly.
• The desire to urinate usually starts when the bladder reaches around 25% of its
working volume.
Detrusor Muscle

7. Role of Detrusor Muscle

8. Bladder Filling & Emptying Cycle
The cycle of
bladder filling
and emptying
1. Bladder fills
2. First desire to
urinate (bladder
half full)
Urination 3. Urination
voluntarily inhibited
until time and place
are right
Detrusor
muscle
contracts
Detrusor muscle relaxes
Urethral
sphincter
contracts
Urethral sphincter relaxes

9. Muscarinic receptors are acetylcholine receptors found in the plasma
membranes of certain neurons and other cells. They play several roles,
including acting as the main end-receptor stimulated by acetylcholine
released from postganglionic fibers in the parasympathetic nervous
system.
Distribution of Muscarinic Receptors:
M1: Brain, salivary glands, sympathetic ganglia
M2: Heart, hindbrain, smooth muscle (urinary bladder)
M3: Urinary bladder, smooth muscles, salivary glands, brain
M4: Brain
M5: Brain, eye
Receptors in Bladder-
Muscarinic Receptors

10. β receptors have the subtypes β1, β2 and β3.
Distribution of β Receptors in Bladder:
β1 : only 1.5% expression in the total bladder
β2 : only 1.4% expression in the total bladder
β3 : More than 97% expression in the total bladder
Receptors in Bladder-
β Adrenergic Receptors

11. Prostate Gland
Prostate Gland
Walnut‐shaped gland that forms part of the male
reproductive system.
Location
Prostate gland is located at the bladder neck surrounding
the urethra.
Functions
 Secretes semen which carries sperm
 During orgasm, prostate muscles contract and propel
ejaculate out of the penis
Structure
The mean weight of the "normal" prostate in adult males
is about 11 grams, usually ranging between 7 and 16
grams.

12. Zones of Prostate Gland
The prostate gland anatomy is divided into four
zones:
• Peripheral: The outermost part which
consists of 70% of the normal prostate.
• Central: Nearly 25% of the normal prostate
gland.
• Transition: Accounts for 5% of prostate
volume and this region is responsible for the
prostate enlargement problems.
• Periurethral or anterior fibro‐muscular zone

13. Cells of Prostate Gland
The prostate gland comprises of three types of
cell:
 Stroma
 Epithelium
 Ductal lumina
In a normal sized prostate, the ratio of stroma
and epithelium tissue is 2:1. But, in case of BPH
or in an enlarged prostate the ratio of stroma
and epithelium rises to 5:1

14. • The α1 adrenergic receptor is a G
protein‐coupled receptor
• There are three subtypes including
α1A, α1B, and α1D
• Norepinephrine and epinephrine
signal through the α1‐adrenergic
receptor in the central and peripheral
nervous systems
Receptors in Prostate-
Alpha‐1 adrenergic receptor

15. Location of α1A & α1D
adrenoceptors are as follows:
• α1A: Bladder neck &
• α1D: Detrusor muscle
Localization of α1‐adrenergic receptors

16. Major
Disorders

17. • Urinary incontinence is the involuntary leakage of urine. It is the inability to
hold urine in the bladder because voluntary control over the urinary sphincter
is either lost or weakened.
Urinary Incontinence
Symptoms
• Leakage of urine.
• Pain whenever your bladder fills or when you're urinating.
• Progressive weakness of your urine stream, down to "dribbling,"
• The feeling that you've not completely emptied your bladder.
• Increased rate of urination.
• Waking up often with the need to urinate.
• Bed-wetting or leaking urine in your sleep.
• Inability to urinate or straining to empty the bladder.
• Frequent urinary tract and bladder infections.

19. • Urge incontinence
Urge incontinence symptoms involve the sudden and uncontrollable need to
urinate i.e. the urge and can't make it to the bathroom in time.
• Stress incontinence
Stress incontinence involves urine leakage when physical stress places pressure on
the bladder i.e. leak when cough or sneeze, also might leak if laugh, lift heavy
weights, or take part in physical activity like running, jogging, or aerobic dance. This
type of urinary incontinence can be caused by damage to the muscles that control
the bladder.
• Mixed incontinence
Mixed incontinence, if a patient experiences both stress and urge incontinence
he/she has mixed incontinence.
Classification of Urinary Incontinence

20. • The term “Overactive Bladder” is used
to describe involuntary contractions of
the detrusor muscle.
• The International Continence Society
defines overactive bladder (OAB) as a
syndrome characterized by urgency
with or without urge incontinence,
and usually with frequency and
nocturia.
• Overactive bladder is a common
bladder condition (1 in 6 adults). It is
not a normal sign of aging. It can occur
at any age.
Overactive Bladder

21. The symptoms associated with Overactive Bladder are
• Urge urinary incontinence
• Urinary urgency and
• Urinary frequency
Clinically Overactive Bladder can present as
• Urgency: Frequently experiencing a strong, sudden and unpredictable
desire to urinate.
• Frequency: More than 8 micturitions in a 24 hour period.
• Urge Incontinence: Episodes of involuntary urine loss associated with a
sudden, strong desire to void.
• Nocturia: Waking up 2 or more times per night to urinate.
Symptoms of OAB

22. Benign Prostatic Hyperplasia (BPH)
• Benign prostatic hyperplasia is a non-
cancerous enlargement of the prostate.
• It is a progressive disease.
• It involves hyperplasia of prostatic
stromal and epithelial cells, resulting in
the formation of large prostate.
• The enlarged prostate cause partial or
sometimes complete obstruction of the
urethra, which interferes with the
normal flow of urine.

23. Pathophysiology of BPH
• Multifactorial
• Most experts consider Dihydrotestosterone (DHT), a metabolite of
testosterone, is a critical mediator of prostatic growth.
• DHT is synthesized in the prostate from circulating testosterone by the
action of the enzyme 5α‐reductase (5-AR). This enzyme is localized
principally in the stromal cells.
• An estimated 50% of men have BPH by age 50 years and 75% by age 80
years
• In 40–50% of these men, BPH becomes clinically significant.

24. Clinical Sign & Symptoms of BPH
Storage Symptoms
• Daytime urinary frequency
• Nocturia (Night time frequency)
• Urgency
• Dysuria (Painful Urination)

25. Clinical Sign & Symptoms of BPH
Voiding Symptoms
• Slow stream
• Splitting or spraying
• Intermittency
• Hesitancy
• Straining
• Terminal dribble (leak urine after
Urination has ceased)

26. Thank
You