Osteopathic considerations in the genitourinary patient Flashcards
Functional disorders of the GU patient involve
-poor posture and compromised body mechanics
Flexed posture can
- increase pressure in abdomen and put direct pressure on the liver
- compresses the right kidney
- renal fat pad compromised allowing drooping of kidney
- passive congestion, hydronephrosis, urinary stasis/stones, ureters “kinked”
Kidney position
- paravertebral
- Position standing depends on habits but in supine position they usually lie T12-L3
- right lower than left
- retroperitoneal
- adrenals lie on superor surface–in contact with the diaphragm
- medial border of kidneys contacts psoas
Kidney fascias
- retroperitoneal with associated fatty tissue
- tough, surrounds all sides except inferior pole (diaphragmatic motion)
- lymphatics rely heavily on optimal function of the diaphragm
Diaphragmatic dysfunction caused by
-lower thoracics, ribs, quadrates lumborum spasm, hyperlordosis of lumbar spine, and phrenic nerve dysfunction C3-5
Right kidney
- anterior surface covered by liver
- also contacted by descending duodenum
Left kidney
- anterior surface covered by stomach
- also spleen, colon, jejunum
Kidney function
- controls volume and body fluid composition
- forms urine
- bp control
- RBC production
Ureters
- drain kidney
- to bladder
- travel across psoas fascia
- cross genitofemoral nerve on way to bladder
- psoas contracture or spasm may contribute to ureteral dysfunction or vice versa
Bladder
- 3 orifices
- two incoming–ureteric ostia
- one outgoing–internal urethral orifice
Ureter musculature
- detrusor is most of bladder
- small pubovesical muscle slips descend to bladder neck toward urethra
Female Urethra
- 4 cm
- approximates the anterior vaginal wall
- passes through urogenital diaphragm
- exits just anterior (ventral) to vagina
Male Urethra
20 cm
-3 parts: prostatic, paras membranacea, pars spongiosa
Prostatic urethra
-just distal to bladder, prostate surrounds
Pars membranacea urethra
-passes through urogenital diaphragm
Pars spongiosa urethra
-travels through corpus spongiosum of penis
Bladder
- sphincter, trigone, and urethral orifice
- activated by sympathetics (T12-L2)
- inhibited by parasympathetics (S2-3)
Bladder wall
- activated by parasympathetics
- inhibited by sympathetic
Celiac plexus
- sympathetic fibers to renal artery (renal plexus)
- controls flow of blood to the kidneys
Ureteric plexus
- sympathetic afferent and efferent
- afferent (pain from stones) to T10-L1
- ureters
Sympathetics: kidney and upper ureter
- T10-L1
- synapse in the superior mesenteric ganglion
- fibers for lower ureter synapse in inferior mesenteric ganglion
Sympathetics: Bladder
T12-L2
-synapse at inferior mesenteric ganglion
PNS efferent control of micturation
- pelvic splanchnic–S2-4
- activation of nerves contracts bladder
- causes emptying
SNS efferent control of micturation
- hypogastric plexus–T10-L2
- activation of nerves relaxes bladder
- causes retention
- alpha adrenergic-relaxes detrusor
- beta-2 adrenergic-closes internal urethral sphincter