Urinary tract

disorders
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 Disorders 0f urinary system

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1)Urinary stones 2)Urinary infections 3)Prostate hypertrophy 4)Involuntary 5)Urinary frequency
urination
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 1)Urinary stones
 Urinary tract stones are solid concentration
or crystal aggregation formed in the kidney
 can be formed from many constituents in
urine including calcium, oxalate, uric acid and

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cysteine.
 A low urine volume favors supersaturation
and stone formation.
 Urinary stones are typically classified by
their location in the kidney (nephrolithiasis),
ureter (ureterolithiasis), or bladder
(cystolithiasis), or by their chemical
composition (calcium-containing, struvite,
uric acid, or other compounds).

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• Investigations:
1. Urine analysis
2.Blood tests for calcium and uric acid
3.Imaging :abdominal x ray or CT

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4.Analysis of passed stones

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 Herbal treatment
1. Anti-spasmodic and eases the passage of renal calculi :
1)Ammi visnaga :
 Adverse effects:
1. Ammi visnaga is possibly unsafe when used orally in high doses. –
2. High doses can cause increases in liver enzymes and possible liver damage. - In some patients, it can

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cause elevated liver transaminases and alkaline phosphatase, probably due to the khellin constituent,
which is known to affect liver enzymes(Liver dysfunction and jaundice are typically reversible when khella
is discontinued)
3. Orally, prolonged use or use of high doses of khella can cause nausea, dizziness, constipation, lack of
appetite, headache, itching, and insomnia.
4. It might cause photosensitivity because of the constituents khellin and the furocoumarin.
 Contraindications :
1. Khellin, has uterine stimulant activity; therefore, is contraindicated in pregnancy.
2. In lactation insufficient reliable information is available, however, it is advised to avoid using it.

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 Ammi visnaga is used as a tea prepared either with cold water (macerate
for 3 hours )or boiling water (infusion).
 Also, khellin is available in capsules and effervescence dosage forms .
 Maceration is better since the active principle is affected by heat.

2)Halfabar(cymbopogen proximus)

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 Used as infusion in the form of tea &also available as tablets of pure proximadiol
(proximol)
Sekem renal : mixture of Achillea Millefolium, Ambrosia Leaves, Ammi Visnaga, Chicory
Leaves, Cymbopogon Proximus, Liquorice and Peppermint Oil .

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Cymbopogen+khellin

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Khellin 8
 2. Diuretic plants:
 Drinking large amounts of water and using herbal diuretics to enhance the action of water as
Taraxacum officinale.

3. Plants that prevent formation of kidney stones:

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and sometimes even to their disappearance.
 It contains citrates that decrease the acidity of urine; this prevents the formation of calcium
oxalate and uric acid stones.

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2)Urinary infections
1. Nephritis :It is inflammation of the upper urinary tract (UT)
 Swelling of the tissues (initially the face and around the eyes, later more prominent in the
legs).

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 Reduction in urine volume.
 Dark urine (contains blood which may not be visible).
 Increase in blood pressure.
 Headaches, drowsiness, visual disturbances, nausea.
 Tiredness and general malaise (feeling ill).
 In rapidly progressive disease, loss of appetite, vomiting, abdominal pain and joint pain may
occur.

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2)Cystitis :It is an inflammation of the lower urinary tract characterized by burning after urination
 Pain, burning or stinging sensations when passing urine.
 Need to urinate frequently and urgently but only passing small amounts of urine.
 Urine that is dark, cloudy or strong smelling.
 Pain directly above the pubic bone, or in the lower back or abdomen.
 Feeling unwell, weak or feverish.
3)Urethritis :It is an infection and inflammation of the lining of the urethra.

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 In men;  In women :
 Burning during urination.  Painful urination.
 Pus or whitish mucus discharge from the penis.  Unusual vaginal discharge.
 Burning or itching around the penile opening.  Abdominal pain.
 Blood in the urine or semen  Fever and chills.
 Frequent, urgent urination.
 Investigations :
1. Urine analysis (pus cells)
2. Urine culture

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 Core of treatment is antibiotic therapy ,herbal medicines are complementary
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 Herbal treatment
1)Cranberry

 Adverse effects:
1. Cause diarrhea if consumed in large quantity.
2. Contains salicylic acid. Salicylic acid is like aspirin and may cause allergic reaction for people who are allergic to
aspirin.

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3. Contains oxalate which may form into kidney stones if taken in large quantity. People who are at risk of kidney
stones are advised to limit cranberry intake to prevent kidney stones formation.
4. Commercially available cranberry juices are sweetened with sugar. People with diabetes are advised to read labels
and take cranberry that are processed with artificial sweeteners.

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2. Uva ursi

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3. Goldenrod
 Contraindications :
1. Pregnancy and breast-feeding.
2. Allergy : Goldenrod may cause an allergic reaction in people who are sensitive to the Asteraceae/Compositae
family.

 Irrigation therapy :a procedure that involves taking goldenrod with lots of fluids to increase urine flow to
treat inflammatory diseases of the lower urinary tract, as well as stones in the kidney or urinary tract, but its
contraindicated in :
 Fluid retention (edema) due to heart or kidney conditions.
 hypertension. 14
4. Cat's claw

 Adverse effects:
 cause miscarriage and should not be taken by pregnant or nursing women.

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3)Prostate hypertrophy

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 Herbal treatment
3)Pumpkin seed 4)Pygeum bark
1)Saw palmetto 2)Nettle
 oil  extract
 oil  extract

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Pumpkin seed Pumpkin seed+saw palmetto
+pygeum extract+uva ursi

Pumpkin
seed +saw
palmetto 17

Saw palmetto+pumpkin seed

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Pumpkin +pygeum +saw
+nettle palmetto

Pygeum extract
Pumpkin+ saw palmetto 18
 4)Urinary frequency
 Increased frequency of urination without increase in the volume of the urine passed .

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5) Involuntary urination
 Any uncontrolled leakage of urine
 Causes:
 Overactive bladder
 Poorly functional urethral sphincter muscle
 Lifestyle interventions
1. Weight loss
2. Exercise
3. Avoidance of caffeinated, carbonated and alcoholic drinks
4. Modification of fluid intake
5. Treatment of chronic constipation(Chronic constipation causing increased intra-abdominal pressure
during straining )

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6. Smoking cessation(smoking increase systolic bladder contractions)
7. Pelvic floor muscle training(Kegels)https://www.youtube.com/watch?v=T4nITptaA78
8. Bladder training (aims to increase the time intervals between voids)
.https://www.youtube.com/watch?v=lg3PnVQ21Bs

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 UT Cases
Case 1
Theresa Mitch is a 53- years old woman with a history of asthma, GERD and
HTN. She reports that she has had pain in her left flank region over the last 3

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days, as well as pain in her abdomen. She complains of some nausea and
reports four episodes of vomiting over the past 3 days. She has recently
skipped several meals as a result. The patient reports urinary burning and
frequency. She states the often she feels feverish and at times has chills. She
reports no substernal chest pain, shortness of breath, cough, or sputum
production. She denies any diarrhea.
 Case report
A 50-year-old man was referred with chief complaints of flank pain with dysuria for 3 h before
admission. In detailed history, patient was known hypertensive since 10 years using only
antihypertensive medication. He has a history of urolithiasis for the past 3 years and underwent
regular medical treatment previously but not well-benefitted. At the time of admission to the ED,

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physical examination revealed tenderness on costovertebral angel was observed on both sides and
burning micturition while passing the urine. He had a body temperature of 37.5°C. On ultrasound
examination, it was observed two stones observed on right ureter (3–5 mm diameter) and one on
the left kidney (3 mm diameter). Pain relief was provided in the ED and advised to have surgical
removal of three stones.

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Thank
you