• an innermost mucous membrane seals off the remaining layers from exposure to urine
• A layer of connective tissue supports the mucous membrane
• Three layers of longitudinal and circular smooth muscle fibers are collectively called the detrusor muscle
• An outermost layer of fibrous connective tissue covers the detrusor layer

Kidneys produce urine at a rate of about 50 to 60 mL per hour, or 1500 mL to 2000 mL per day

• A measure of dissolved solutes in a solution.
• As the concentration of the urine solutes increases, specific gravity increases.
• The specific gravity of distilled water is 1.000 because there are no dissolved solytes.
• Normal specific gravity range for urine is 1.002 to 1.028

• Nocturnal enuresis: night-time bedwetting, occurs in 15% to 25% of 5-year-old children. By the age of 12 years, 8% of boys and 4% of girls still wet the bed.
• Primary nocturnal enuresis: is bedwetting in a child who has not achieved consistent dryness at night.
• Secondary enuresis: occurs in a child who has had at least 6 months of nighttime dryness.

• Used to treat high blood pressure by reducing the amount of sodium and water in the body.
• They also dilate blood vessels, thereby lowering blood pressure

• Reduce the amount of water in the body.
• Unlike other diuretic medicines, these medicines do not cause potassium loss

• Cause the kidney to excrete more urine by reabsorbing less water.
• This reduces the amount of water in the body and lowers blood pressure.

• Occurs as a result of impaired neurological funtion.
• The person cannot perceive bladder fullness or control the urinary sphincters.
• The bladder becomes flaccid or spastic, causing frequent involuntary loss of urine.

• Can determine pH and specific gravity and the presence of protein, glucose, ketones, and occult blood in urine.
• Prepared kits contain a reagent which may be a paper test strip, a fluid, or a tablet.

• An acute rise in the serum creatinine level of 25% or more.
• May be caused by inadequate blood flow to the kidney, injury to the kidney glomeruli or tubules, or obstruction of kidney outflow.

• The abscence of urine, often associated with kidney failure or congestive heart failure.
• This term is used when urine output is less than 100 mL in 24 hours.

• Painful or difficult urination
• May be associated with infection or partial obstruction of the urinary tract as well as medications that trigger urinary retention.

• A chronic rise in serum creatinine levels associated with loss of kidney function that must be treated with dialysis of transplantation.
• Also known as chronic renal failure.

A broad term meaning disease of the kidney

• A substance that damages kidney tissue.
• Some antibiotics (gentamicin, tobramycin, and amikacin), nonsteroidal anti-inflammatory drugs, lead, and contrast media have the potential to be nephrotoxic.

• Urine ouput of less than 400 mL in 24 hours.
• For pediatric patients, oliguria is < 0.5 - 1.0 mL/kg per hour.

• Pus in the urine.
• May be caused by lesion or infection in the urinary tract.

• Measures the extent to which a beam of light changes direction when it passes through the urine (the refractive index).
• If the concentration of solids is high, the light is refracted more.
• Is quick and easy to perform and requires only a few drops of urine.
• More precise, requires a much smaller specimen, is more compact, and poses less risk of spills and exposure to body fluids than does a urinometer, which for the most part is no longer used.

An infection limited to the urethra

• Occurs when bacteria travel up the urethra into the bladder, causing a bladder infection.
• If not treated promptly, the infection may progress superiorly (upward) to the ureters or kidney (pyelonephritis)

Is an inability to empty the bladder completely

• The involuntary loss of larger amounts of urine accompanied by a strong urge to void.
• Often referred to overactive bladder.

• An involuntary loss of small amounts of urine with increased intr-abdominal pressure.
• exercise, laughing, sneezing, etc...

A combination of urge and stress incontinence.

• The loss of urine in combination with a distended bladder.
• Causes include fecal impaction, neurological disorders, and enlarged prostrate.

• The untimely loss of urine when no urinary or neurological cause is involved.
• Occurs because of physical disbility, immobility, pain, external obstacles, or problems in thinking or communicating that prevent a person from reaching a toilet.
• Etiologies include confusion, disorientation, or mobility

• A short-term incontinence that is expected to resolve spontaneously.
• Causes include UTI and medications, especially diuretics.

• Loss of urine when the person does not realize the bladder is full and has no urge to void.
• Central nervous system disorders and multisystem problems are common causes.
• Tissue damage from radiation, cystitis, bladder inflammation, or radical pelvic surgery can also trigger reflex incontinence.

• Medications: topical estrogen for women who have UI associated with urogenital atrophy, and anticholinergic drugs such as oxybutynin (ditropan) and tolterodine (Detrol), which inhibit involuntary bladder contractions
• Devices: Indwelling intravaginal (e.g., pessary) or intraurethral devices to manage urinary incontinence are not to be used routinely, but instead reserved to prevent occasional leakage, for example, during exercise
• Sacral Nerve Stimulation: might be recommended for the treatment of certain types of urinary incontinence in women who have not responded to conservative treatment
• Surgical Treatment: Such as bladder suspension and prostate resection, relieve the pressure of other pelvic organs against the bladder

• A surgically created opening for elimination of urine.
• Used to treat patients who have conditions such a birth defects, cancer, trauma, or disease of the urinary system.
• Patient does not eliminate urine via urethra. Instead, urine bypasses the bladder and is expelled through the stoma or ostomy.
• Patient no longer has voluntary control of urination

Distention of the kidneys with urine, which results from obstruction of the ureter.

• Reroutes the ureter(s) directly to the surface of the abdoment, forming a small stoma.
• May be unilateral or bilateral.
• This procedure has limited use because it provides a pathway for pathogens on the skin to directly enter the kidney.
• The stomas are small and difficult to fit with a collection appliance.

• The most common type of urinary diversion.
• A small piece of ileum is removed with blood and nerve supply intact. The remainder of the ileum is reconnected to prevent disruption of flow through the bowel. The free segment of ileum is sutured closed at one end, and the other end is brought out to the abdominal wass to create a stoma.
• This procedure is preferable to a cutaneous ureterostomy because the mucous membrane lining the ileum protects the kidneys from ascending infection.
• The ileum creates a stoma that is easier fit with an appliance.

• A variation of the ileal conduit.
• Urine drains from the ureters into a surgically created ileal pouch.
• The stoma created on the abdomen contains a nipple valve to keep urine from leaking.
• Patient inserts a catheter into the stoma to drain urine through the valve.
• A second valve prevents reflux of urine back into the kidneys.

Applying manual pressure over the bladder to promote emptying

• Silver-alloy
• Coated catheters, found to reduce infection rates when catheters remained in place for less than 7 days, although they were less effective when used for longer than one week.
• Not routinely used for short-term catheterization because they are more costly than standard catheters; however, using standard catheters may be a false economy if the patient aquires infection.
• teflon-bonded latex
• Used for a short- to medium-term use (<28 days) because the coating reduces friction and tissue irritation during insetion and while the catheter remains in place.
• Polyvinyl chloride(PVC)
• Catheters are designed for long-term use (up to 6 weeks) because they soften and conform to the urethera.
• Silicon or hydrogel-coated
• For even longer periods (up to 3 months)
• May be used because these types help prevent encrustation around the urinary meatus and reduce friction with insertion, removal, and while in place.

• Width
• 8 and 10 Fr used for children
• 14 and 16 Fr used for adults
• 18 Fr for men
• Lenght
• 22-cm length for women
• 40-cm length for men

• A single lumen tube that is inserted for immediate drainage of the bladder
• To obtain a sterile urine specimen, to measure postvoidal residual volume, or to relieve temporary bladder distention
• After the bladder is empty or the sample obtained, the catheter is removed and the patient resumes voiding independently

• Also known as a Foley or retention catheter
• Used for continous bladder drainage
• When the bladder must be kept empty or when continuous urine measurement is needed.
• Usually a double-lemen tube
• Triple lumen is used when patient requires intermittent or continuous bladder irrigation.

• Used for continous urine drainage when the urethra must be bypassed.
• After gynecological surgery or where there is prostatic obstruction.
• Inserted through an incision above the symphysis pubis.
• Often sutured in place but may occasionally be a double-lumen catheter held in place by a balloon.

• Pelvic Floor Muscle Exercises (PFME)
• Kegel Exercises

• A mainstay of UI treatment for women.
• Strengthen perineal muscles and help to prevent and treat stress, urge, and mixed UI.
• Kegel exercises are the most commonly used method for preventing and reversing incontinence in women for the first year after giving birth.

• designed to reduce the incidence of UI or provide a pathway for urine flow.
• incontinence pessary
• Intravaginal support device.
• Is inserted into the vagina to reduce pelvic organ prolapse or pressure on the bladder.
• This helps to support the bladder neck and prevent UI.
• external occlusive device
• Is removed before voiding.
• For women, a urethral meatus covering is used.
• For men, a penis clamp is a reusable, soft spongy rubber device used to control stress incontinence or dribbling urine, common with enlarged prostate.
• internal urethral meatus plug
• May be used by men and women.
• A disposable, single-use Device, typically used for activities that cause stress incontinence.
• valved catheter
• Allows urine to be drained on a schedule
• indwelling urethral catheter
• Used as a last resort to control the flow of urine and protect the perineal skin
• external collection device
• Condom catheters, also known as uro-sheaths,are most commonly used for men who have adequate bladder emptying and intact genital skin.