Urogenital disorders

The urinary and reproductive systems develop in parallel in the fetus; the genitalia also have both reproductive and urinary functions. For these reasons, diseases of both systems are treated as urogenital disorders.

The male urinary system is more complicated than that of a female because of its conjunction below the bladder with the ducts that carry sperm and semen. In the photograph, the system has been made opaque to X rays by injecting an iodine compound into the bloodstream. From where blood is filtered by the kidneys at the top, urine flows down the two ureters to be stored in the bladder. From there it should flow along the urethra, but this man has an enlarged prostate gland (immediately below the bladder), which constricts the urethra and blocks the passage of urine. The condition requires urgent treatment, which usually takes the form of surgery to remove the prostate.

Kidney disorders

Kidneys may fail for many reasons, the commonest being complications of nephritis, infection, hypertension, and diabetes. Early diagnosis and treatment are important to prevent the development of renal failure. Infection is particularly common in children and pregnant women and must be treated vigorously with antibiotics.

Renal failure may be either acute or chronic. Acute renal failure is a temporary condition that can result from shock, poisoning, or infection. While the cause is being treated, the patient may need dialysis to remove toxic waste. Chronic renal failure requires regular dialysis with an artificial kidney machine or the surgical insertion of a donated transplant.

Stones (calculi) in the kidney may block the urine flow and cause acute pain. Their presence may be indicated by blood in the urine (hematuria). Stones can be removed from the kidney by crushing them (lithotripsy), or by surgery (lithectomy). Once done by physically using an endoscope, modern technology has now introduced lithotripsy, which shatters a calculus by focusing ultrasound on it from outside the body.

Renal insufficiency is usually investigated by ultrasonic scanning or by injecting a radiopaque substance such as iodine into the bloodstream. An X ray taken when the substance is passing through the kidneys reveals their internal silhouette and shows how well they are working. A kidney biopsy may be required to determine the cause of the disease. Dietary measures are important in the treatment of kidney disorders. It is also important to treat hypertension, which may cause either renal failure or be caused by it.

Bladder disorders

Infection of the bladder is particularly likely to affect women, because the female urethra is short. The main symptoms of bladder inflammation (cystitis) are frequent and painful urination. Treatment involves drinking large quantities of fluid to flush out the bladder and following a course of antibiotics.

A particularly troublesome form of cystitis, often called “honeymoon cystitis,” is caused by the bacteria introduced into the urethra during intercourse.

Bladder cancer is one of the best-documented examples of an environmental cause of cancer. The disease is much more common in petrochemical and rubber workers than in the rest of the population. It is also more common in cigarette smokers. The main symptom is blood in the urine (hematuria). Bladder cancer often takes a very slow course and may be controlled for years if monitored by regular cystoscopic examinations.

A dialysis machine removes waste products from a patient’s blood and so acts as an artificial kidney. In this design, blood from an artery is pumped through a coil of thin plastic membrane, which is bathed in a saline fluid. The waste materials pass through microscopic holes in the membrane, and the “cleaned” blood returns to the patient via a vein.

Prostate disorders

Enlargement (hyperplasia) of the prostate is part of the male aging process. Surgical treatment may be required if the enlarged gland prevents the normal passage of urine.

Cancer of the prostate, which is common among elderly men, is now generally treated by the oral administration of estrogen, combined with surgery as necessary. A blood test can screen for prostate cancer. Treatment may alter the body’s hormonal balance but effectively prohibits further cancerous growth.

Gonorrhea is a highly infectious disease transmitted by sexual contact. It is caused by the gonococcus bacterium Neisseria gonor-rhoeae, shown stained red in this photograph. It responds to prompt treatment with antibiotic drugs, but may remain undetected in females, in whom it produces few symptoms. Untreated, it can lead to sterility, and blindness in babies born to an infected mother.

Sexually transmitted disease (STD)

STD, or venereal disease (VD), describes a large and diverse group of disorders with little in common except the way in which they are spread and the parts of the body affected. Increased sexual freedom over the past 50 years has led to an increase of the three major forms: nonspecific urethritis, gonorrhea, syphilis, and AIDS.

Nonspecific urethritis (NSU) is an infection caused by a variety of organisms. One increasingly common form (chlamydia) is smaller than a bacterium, but larger than a virus. The disease causes pain on urination and, in men, a discharge from the penis. It may be difficult to treat because it does not always respond to antibiotics.

The main symptoms of gonorrhea are genital irritation and discharge. Treatment is with antibiotics, although resistant strains of the infection are an increasing problem.
Gonorrhea and NSU often produce no symptoms in women, so contact tracing is important both for their treatment and to prevent further spread.

Syphilis is a more serious disease, with a number of specific stages; the first is a sort of ulcer (a chancre), and the last can affect all parts of the body and may cause death. In the early stages, the development of the disease may be prevented by the use of antibiotics, normally penicillin.
Two other diseases associated with sexual intercourse—though neither is exclusively transmitted by this means—are herpes and acquired immune deficiency syndrome (AIDS).
Herpes is caused by a virus almost identical to the one that causes cold sores, Herpes simplex. In both cold sores and genital herpes, the symptoms small painful blisters at the affected site appear periodically, and are difficult to treat definitively, although some new antiviral drugs seem to show signs of being successful.

AIDS is a condition that occurs particularly among bisexuals, intravenous drug users, and homosexual men and appears to be spread by blood and body fluids such as semen. In AIDS, the body’s defense mechanisms are destroyed so that other infections and certain cancers find no natural resistance. At present, there is no consistently successful form of treatment.

STD’s affect homosexuals as readily as heterosexuals. Both AIDS and hepatitis B can be transmitted as STD’s by homosexuals, although neither is exclusively a sexually transmitted disease.