Section 13 Urinary System
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Urology Services in the ASC
Urology Services in the ASC Brad D. Lerner, MD, FACS, CASC Medical Director Summit ASC President of Chesapeake Urology Associates Chief of Urology Union Memorial Hospital Urologic Consultant NFL Baltimore Ravens Learning Objectives: Describe the numerous basic and advanced urology cases/lines of service that can be provided in an ASC setting Discuss various opportunities regarding clinical, operational and financial aspects of urology lines of service in an ASC setting Why Offer Urology Services in Your ASC? Majority of urologic surgical services are already outpatient Many urologic procedures are high volume, short duration and low cost Increasing emphasis on movement of site of service for surgical cases from hospitals and insurance carriers to ASCs There are still some case types where patients are traditionally admitted or placed in extended recovery status that can be converted to strictly outpatient status and would be suitable for an ASC Potential core of fee-for-service case types (microsurgery, aesthetics, prosthetics, etc.) Increasing Population of Those Aged 65 and Over As of 2018, it was estimated that there were 51 million persons aged 65 and over (15.63% of total population) By 2030, it is expected that there will be 72.1 million persons aged 65 and over National ASC Statistics - 2017 Urology cases represented 6% of total case mix for ASCs Urology cases were 4th in median net revenue per case (approximately $2,400) – behind Orthopedics, ENT and Podiatry Urology comprised 3% of single specialty ASCs (5th behind -
Vocabulario De Morfoloxía, Anatomía E Citoloxía Veterinaria
Vocabulario de Morfoloxía, anatomía e citoloxía veterinaria (galego-español-inglés) Servizo de Normalización Lingüística Universidade de Santiago de Compostela COLECCIÓN VOCABULARIOS TEMÁTICOS N.º 4 SERVIZO DE NORMALIZACIÓN LINGÜÍSTICA Vocabulario de Morfoloxía, anatomía e citoloxía veterinaria (galego-español-inglés) 2008 UNIVERSIDADE DE SANTIAGO DE COMPOSTELA VOCABULARIO de morfoloxía, anatomía e citoloxía veterinaria : (galego-español- inglés) / coordinador Xusto A. Rodríguez Río, Servizo de Normalización Lingüística ; autores Matilde Lombardero Fernández ... [et al.]. – Santiago de Compostela : Universidade de Santiago de Compostela, Servizo de Publicacións e Intercambio Científico, 2008. – 369 p. ; 21 cm. – (Vocabularios temáticos ; 4). - D.L. C 2458-2008. – ISBN 978-84-9887-018-3 1.Medicina �������������������������������������������������������������������������veterinaria-Diccionarios�������������������������������������������������. 2.Galego (Lingua)-Glosarios, vocabularios, etc. políglotas. I.Lombardero Fernández, Matilde. II.Rodríguez Rio, Xusto A. coord. III. Universidade de Santiago de Compostela. Servizo de Normalización Lingüística, coord. IV.Universidade de Santiago de Compostela. Servizo de Publicacións e Intercambio Científico, ed. V.Serie. 591.4(038)=699=60=20 Coordinador Xusto A. Rodríguez Río (Área de Terminoloxía. Servizo de Normalización Lingüística. Universidade de Santiago de Compostela) Autoras/res Matilde Lombardero Fernández (doutora en Veterinaria e profesora do Departamento de Anatomía e Produción Animal. -
Assessment of the Renal/Urinary System
Assessment of the Renal/Urinary System Professor Minodora Mazur Chisinau 2019 Why person has 2 eyes or 2 ears? And only one nose? How many kidneys does the person have? Urinary system • Kidneys • Ureters • Urinary bladder • Urethra Kidneys • Paired organs • Located retroperitoneally on the posterior wall of the abdomen from T12-L3 • The average adult kidney weighs 4.5oz = 125-150 gr • The right kidney sits is lower in the abdomen due to liver placement • An adrenal gland sits are on top of each kidney Kidney Anatomy Each kidney has two parts • The renal medulla is the inner portion – consists of renal pyramids which are collecting ducts that drain into renal pelvis – Once urine leaves the renal pelvis the composition or amount of urine does not change • The Cortex is the outer portion – contains nephrons Nephron • Each kidney has approximately 1 million nephrons • If the function is less than 20% replacement therapy is usually initiated • The nephron is responsible for the initial formation of urine Glomerulus Kidney functions • Urine formation • Excretion of waste products • Regulation of electrolytes • Regulation of acid-base balance • Control of water balance • Control BP • Regulation of RBC production • Synthesis of vitamin D to active form • Secretion of prostaglandins • Regulation of calcium and phosphorus balance Urine Formation • Urine is formed in the nephrons in a three step process – Glomerular filtration – Tubular reabsorption – Tubular secretion • Glomerular Filtration produces ultrafiltrate which enters the tubules • Selective -
Clinical and Functional Anatomy of the Urethral Sphincter
Review Article International Neurourology Journal Int Neurourol J 2012;16:102-106 http://dx.doi.org/10.5213/inj.2012.16.3.102 pISSN 2093-4777 · eISSN 2093-6931 INJ Clinical and Functional Anatomy of the Urethral Sphincter Junyang Jung, Hyo Kwang Ahn, Youngbuhm Huh Department of Anatomy, Kyung Hee University School of Medicine, Seoul, Korea Continence and micturition involve urethral closure. Especially, insufficient strength of the pelvic floor muscles including the urethral sphincter muscles causes urinary incontinence (UI). Thus, it is most important to understand the main mechanism causing UI and the relationship of UI with the urethral sphincter. Functionally and anatomically, the urethral sphincter is made up of the internal and the external sphincter. We highlight the basic and clinical anatomy of the internal and the external sphinc- ter and their clinical meaning. Understanding these relationships may provide a novel view in identifying the main mechanism causing UI and surgical techniques for UI. Keywords: Urethral sphincters; Pudendal nerve; Autonomic nervous system; Urinary incontinence; Urination INTRODUCTION tomical damage to the ligaments, facial support, and pelvic floor musculature, including the levator ani [8]. The pudendal nerve The urethral sphincter is crucial for the maintenance of urinary innervating the EUS is susceptible to injury during vaginal birth continence [1,2]. The urethral sphincter refers to one of the fol- because it travels between the sacrospinous and sacrotuberous lowing muscles [3]: 1) the internal urethral sphincter (IUS), ligaments [9]. In this article, we discuss the basic and clinical which consists of smooth muscle and is continuous with the anatomy of the urethral sphincter and the relationship between detrusor muscle and under involuntary control, and 2) the ex- the urethral sphincter and UI. -
EAU Guidelines on Urinary Incontinence in Adults
EAU Guidelines on Urinary Incontinence in Adults F.C . Burkhard (Chair), J.L.H.R. Bosch, F. Cruz, G.E. Lemack, A.K. Nambiar, N. Thiruchelvam, A. Tubaro Guidelines Associates: D. Ambühl, D.A. Bedretdinova, F. Farag, R. Lombardo, M.P. Schneider © European Association of Urology 2018 TABLE OF CONTENTS PAGE 1. INTRODUCTION 8 1.1 Aim and objectives 8 1.1.1 The elderly 8 1.2 Panel composition 8 1.3 Available publications 8 1.4 Publication history 9 1.4.1 Summary of changes. 9 2. METHODS 11 2.1 Introduction 11 2.2 Review 11 2.3 Future goals 11 3. DIAGNOSTIC EVALUATION 11 3.1 History and physical examination 11 3.2 Patient questionnaires 12 3.2.1 Questions 12 3.2.2 Evidence 12 3.2.3 Summary of evidence and recommendations for patient questionnaires 13 3.3 Voiding diaries 14 3.3.1 Question 14 3.3.2 Evidence 14 3.3.3 Summary of evidence and recommendations for voiding diaries 14 3.4 Urinalysis and urinary tract infection 14 3.4.1 Question 14 3.4.2 Evidence 14 3.4.3 Summary of evidence and recommendations for urinalysis 15 3.5 Post-void residual volume 15 3.5.1 Question 15 3.5.2 Evidence 15 3.5.3 Summary of evidence and recommendations for post-void residual 15 3.6 Urodynamics 15 3.6.1 Question 16 3.6.2 Evidence 16 3.6.2.1 Variability 16 3.6.2.2 Diagnostic accuracy 16 3.6.2.3 Question 16 3.6.2.4 Evidence 16 3.6.2.5 Question 16 3.6.2.6 Evidence 16 3.6.2.7 Question 17 3.6.2.8 Evidence 17 3.6.2.9 Question 17 3.6.2.10 Evidence 17 3.6.3 Summary of evidence and recommendations for urodynamics 17 3.6.4 Research priority 18 3.7 Pad testing 18 3.7.1 Questions 18 3.7.2 Evidence 18 3.7.3 Summary of evidence and recommendations for pad testing 18 3.7.4 Research priority 18 3.8 Imaging 18 3.8.1 Questions 19 3.8.2 Evidence 19 3.8.3 Summary of evidence and recommendations for imaging 19 3.8.4 Research priority 19 2 URINARY INCONTINENCE IN ADULTS - LIMITED UPDATE MARCH 2018 4. -
Invasive Treatments for Urinary Incontinence
Cigna Medical Coverage Policy Effective Date .......................... 12/15/2013 Subject Invasive Treatments for Next Review Date .................... 12/15/2014 Coverage Policy Number ................. 0365 Urinary Incontinence Table of Contents Hyperlink to Related Coverage Policies Coverage Policy .................................................. 1 Biofeedback General Background ........................................... 2 Botulinum Therapy Coding/Billing Information ................................. 15 Electrical Stimulators References ........................................................ 16 Extracorporeal Electromagnetic Stimulation for Urinary Incontinence Injectable Bulking Agents for Urinary Conditions and Fecal Incontinence Physical Therapy Sacral Nerve Stimulation for Urinary Voiding Dysfunction and Fecal Incontinence INSTRUCTIONS FOR USE The following Coverage Policy applies to health benefit plans administered by Cigna companies. Coverage Policies are intended to provide guidance in interpreting certain standard Cigna benefit plans. Please note, the terms of a customer’s particular benefit plan document [Group Service Agreement, Evidence of Coverage, Certificate of Coverage, Summary Plan Description (SPD) or similar plan document] may differ significantly from the standard benefit plans upon which these Coverage Policies are based. For example, a customer’s benefit plan document may contain a specific exclusion related to a topic addressed in a Coverage Policy. In the event of a conflict, a customer’s benefit plan document -
The Role of the External Sphincter
PARAPLEGIA REFERENCES Ross, J. COSBIE, GIBBON, N. O. K. & DAMANSKI, M. (1967). B.J.S. 54, NO. 7. STAMEY, T. (1968). J. Urol. 97, (May). VINCENT, S. A. (1959). Ulster med. Jour. 28, 176. VINCENT, S. A. (1960). Lancet, 2, 292. VINCENT, S. A. (1964). Dev. Med. and Child Neurol. 6, 23. VINCENT, S. A. (1966a). Lancet, Sept., 631-632. VINCENT, S. A. (1966b). Bio-Engineering, Sept., p. 1. THE ROLE OF THE EXTERNAL SPHINCTER By J. COSBIE Ross Director of Urological Studies, University of Liverpool Introduction. It must be acknowledged that as yet no one knows the precise role of the external sphincter and there should, by right, be a question mark after the word 'sphincter'. The problem is much more complex and obscure than the simple, easily understood mechanism of the anal sphincter. However, there is much that is already known, and perhaps recent work has shed some light on the problem. First, the traditional view. In the 32nd Edition of Gray's Anatomy (1958), the description is as follows. 'The sphincter urethrae surrounds the membranous portion of the urethra, and lies deep to the inferior fascia of the urogenital diaphragm. Its superficial or inferior fibres arise in front from the transverse perineal ligament and from the neighbouring fascia. They pass backwards on each side of the urethra and converge on the perineal body for their insertion. Its deep fibres, some of which arise from the fascial sheath of the pudendal vessels and pass medially, form a continuous circular investment for the membranous urethra.' Actions. 'The muscles of both sides act together as a sphincter, compressing the membranous part of the urethra. -
Coders' Desk Reference for ICD-10-PCS Procedures
2 0 2 DESK REFERENCE 1 ICD-10-PCS Procedures ICD-10-PCS for DeskCoders’ Reference Coders’ Desk Reference for ICD-10-PCS Procedures Clinical descriptions with answers to your toughest ICD-10-PCS coding questions Sample 2021 optum360coding.com Contents Illustrations ..................................................................................................................................... xi Introduction .....................................................................................................................................1 ICD-10-PCS Overview ...........................................................................................................................................................1 How to Use Coders’ Desk Reference for ICD-10-PCS Procedures ...................................................................................2 Format ......................................................................................................................................................................................3 ICD-10-PCS Official Guidelines for Coding and Reporting 2020 .........................................................7 Conventions ...........................................................................................................................................................................7 Medical and Surgical Section Guidelines (section 0) ....................................................................................................8 Obstetric Section Guidelines (section -
This Electronic Thesis Or Dissertation Has Been Downloaded from Explore Bristol Research
This electronic thesis or dissertation has been downloaded from Explore Bristol Research, http://research-information.bristol.ac.uk Author: Carter, Paul G Title: The role of nocturnal polyuria in nocturnal urinary symptoms in the healthy elderly male. General rights Access to the thesis is subject to the Creative Commons Attribution - NonCommercial-No Derivatives 4.0 International Public License. A copy of this may be found at https://creativecommons.org/licenses/by-nc-nd/4.0/legalcode This license sets out your rights and the restrictions that apply to your access to the thesis so it is important you read this before proceeding. Take down policy Some pages of this thesis may have been removed for copyright restrictions prior to having it been deposited in Explore Bristol Research. However, if you have discovered material within the thesis that you consider to be unlawful e.g. breaches of copyright (either yours or that of a third party) or any other law, including but not limited to those relating to patent, trademark, confidentiality, data protection, obscenity, defamation, libel, then please contact [email protected] and include the following information in your message: •Your contact details •Bibliographic details for the item, including a URL •An outline nature of the complaint Your claim will be investigated and, where appropriate, the item in question will be removed from public view as soon as possible. The role of Nocturnal Polyuria in Nocturnal Urinary Symptoms in the Healthy Elderly Male. PAUL G. CARTER A Dissertation submitted for the degree of Doctor of Medicine to the University of Bristol June 1992 The functions of the kidneys differ from those of all other secretory glands, in being exclusively depurative and excrementitious. -
Vaginal Reconstruction/Sling Urethropexy)
Patient Name: _ Date: _ New Jersey Urologic Institute Dr Betsy Greenleaf DO, FACOOG Pelvic Medicine and Reconstructive Surgery 10Industrial Way East, Suite 101, Eatontown, New Jersey 07724 732-963-9091 Fax: 732-963-9092 Findings: _ Post Operative Instructions (Vaginal Reconstruction/Sling Urethropexy) 1. Activity: May do as much as you feel up to. Your body will let you know when you are doing too much. Don't push yourself, however. Walking is ok and encouraged. If you sit too long you will become stiff and it will make it more difficult to move. Lying around can promote the formation of blood clots that can be life threatening. It is therefore important to move around. If you don't feel like walking, at least move your legs around in bed from time to time. Stairs are ok, just be careful of standing up too quickly and becoming light headed. Sitting still can also increase your risk of pneumonia. In addition to moving around, practice taking deep breaths ( 10 times each every hour or so) to keep your lungs properly aerated. Limitations: Avoid lifting or pushing/pulling any objects heavier than 1Olbs for at least 3 months. For patients with pelvic hernia or prolapse repairs it is recommended not to lift objects heavier than 25 Ibs for life. This may seem unrealistic. Try to put off lifting as long as possible. If you must lift, do not hold your breathe. Blow out as you lift to decrease abdominal and pelvic pressure. Also be aware that if you choose to lift objects heavier than recommended you risk forming another hernia 2. -
Urinary System A&P
URINARY SYSTEM A&P HS1 DHO8, CH. 7, PGS 217-220 OBJECTIVES EXPLAIN THE STRUCTURES AND FUNCTIONS OF THE URINARY SYSTEM AS THEY RELATE TO THE FORMATION, COMPOSITION, AND ELIMINATION OF URINE. A. IDENTIFY THE STRUCTURES COMPRISING THE URINARY SYSTEM. B. DESCRIBE THE ROLES OF EACH OF THE URINARY STRUCTURES AS IT RELATES TO THE PRODUCTION AND ELIMINATION OF URINE. URINARY SYSTEM • AKA EXCRETORY SYSTEM • REMOVES WASTES & EXCESS WATER • MAINTAIN ACID-BASE BALANCE • HELPS MAINTAIN BODY’S HOMEOSTASIS URINARY SYSTEM PARTS OF THE URINARY SYSTEM: ➢2 KIDNEYS ➢2 URETERS ➢1 BLADDER ➢1 URETHRA KIDNEYS • BEAN-SHAPED ORGANS • FOUND ON EITHER SIDE OF VERTEBRAL COLUMN • LOCATED IN RETROPERITONEAL SPACE • RETROPERITONEAL SPACE=AREA BEHIND UPPER PART OF ABD CAVITY; SEPARATED FROM ABD CAVITY BY PERITONEAL MEMBRANE KIDNEYS • PROTECTED BY RIBS & FAT CUSHION • HELD IN PLACE BY CONNECTIVE TISSUE • EACH KIDNEY IS ENCLOSED IN MASS OF FATTY TISSUE=ADIPOSE CAPSULE • EACH KIDNEY IS COVERED BY A TOUGH, FIBROUS TISSUE=RENAL FASCIA OR FIBROUS CAPSULE APPLY YOUR KNOWLEDGE CAN YOU THINK OF AN EXAMPLE OF THE URINARY SYSTEM’S ABILITY TO MAINTAIN HOMEOSTASIS? ➢A GOOD EXAMPLE IS WHEN A PERSON DRINKS A LARGE AMOUNT OF WATER AND URINARY OUTPUT INCREASES KIDNEYS DIVIDED INTO 2 MAIN SECTIONS: CORTEX & MEDULLA ➢CORTEX= • OUTER SECTION • CONTAINS MOST OF THE NEPHRONS (NEPHRONS AID IN PRODUCTION OF URINE) KIDNEYS ➢MEDULLA= • INNER SECTION • CONTAINS MOST OF THE COLLECTING TUBULES (COLLECTING TUBULES CARRY URINE FROM NEPHRONS THROUGH THE KIDNEY) KIDNEYS • EACH KIDNEY HAS A HILUM • HILUM=NOTCHED OR INDENTED AREA • THE URETER, NERVES, BLOOD VESSELS, & LYMPH VESSELS ENTER & LEAVE THE KIDNEY THROUGH THE HILUM TEST YOUR KNOWLEDGE SO, LET’S THINK THIS THROUGH….YOU HAVE TO PRODUCE THE URINE FIRST AND THEN SEND THE URINE OUT OF THE KIDNEY. -
Video Surgi Session 2 11:00Am - 1:00Pm Thursday, 29Th October, 2020
Video Surgi Session 2 11:00am - 1:00pm Thursday, 29th October, 2020 41 Holmium Laser Ureterocele Excision with Transurethral Incision of the Prostate Grant R. Pollock MD1, Kalpesh Patel MD2, Joel Funk MD1 1University of Arizona, Department of Urology, Tucson, AZ, USA. 2Arizona Institute of Urology, Tucson, AZ, USA Abstract Objectives: Ureteroceles present a diagnostic and treatment challenge in adults. With an estimated prevalence of 1/500 to 1/4000, it is not uncommon for any urologist to encounter a ureterocele in clinical practice. We present an interesting case of a 53-year-old male with a 20-year history of obstructive voiding symptoms who presented to clinic with urinary retention that was found to be secondary to an orthotopic ureterocele that was prolapsed into the prostatic urethra. The patient underwent holmium laser ureterocele excision with transurethral incision of the prostate with a successful outcome. We present a video demonstrating the technique. Materials and Methods: Preoperative evaluation included a transrectal ultrasound of the prostate which revealed a prostate volume of 20cc. Urodynamics was also performed and pressure flow studies revealed a high-pressure, low flow voiding pattern with a functional detrusor muscle. Cystourethroscopy was performed revealing that an orthotopic ureterocele on the left side was prolapsed into the prostatic urethra and the bladder neck was mildly elevated. Using MOSES technology and laser settings of 30 Hz and 1.5 J, the ureterocele was completely excised and a transurethral incision of the prostate was performed. Results: The patient was discharged home on the day of surgery in stable condition with a Foley catheter in place.