PUBLIC HEALTH

ASPECTS OF
UROGENITAL
SYSTEM DISEASES

IRWIN ARAS/ ANDI ALFIAN ZAINUDDIN

URINARY TRACT INFECTIONS

Overview ;
UTI is a common infection
Bacteria enter the opening of urethra
& multiply in the urinary tract
Kidneys, ureters, bladder and urethra
UPJ (urethropelvic junction) prevent
urine from backing up into the kidneys
The flow of urine through the urethra
helps to eliminate bacteria
Men, women and children develop UTIs

URINARY TRACT INFECTIONS

Epidemiology ;
8-10 million people in US develop UTI
each year
Women develop the condition much
more often than men (US ; 20% and 20%
have a reccurence)
The most common in the age group
between 20 to 50 years
Rare in boys and young men
UTI more common in under the age of 2

URINARY TRACT INFECTIONS

Prevention ;
Avoid products that may irritate the urethra
Always clean the genital area
Drink plenty of water
Do no routinely resist the urge to urinate
Women and girls should wipe from front to back after
voiding

URINARY TRACT STONES

Overview ;
Stones (calculi) are hardened mineral
deposits that form in the UT
When waste materials in the urine do
not dissolve completely, crystals and
UT stones are likely to form
Stones can cause some discomfort or
severe pain as they pass out of the
body

URINARY TRACT STONES

Overview ;
A lodged stone can block the
flow of urine
Etiology and location varies
around the world;
West : upper tract and of caoxalate or struvite composition
Developing : lower tract and of
ca-oxalate and ammonia acid
urate.

URINARY TRACT STONES

Epidemiology ;
Greeks and Romans recorded urolithiasis as
early 4800 BC
Common disorder affecting 0.2% of
population
More commons in males 3 : 1 ratio

URINARY TRACT STONES

Epidemiology ;
US National Institutes of Health ; 1 person in
10 develops kidney stones
Renal stones disease accounts for 7-10 of
every 1000 hospital admission
Most prevalent in between the ages of 30
and 45, and decline after age 50

URINARY TRACT STONES

Prevention ;
Drink plenty of water to dissolve waste
products
Avoid water contain high calcium
Prevent from UTI

ORCHIO-EPIDIDYMITIS
(Epididymo-orchitis)
Overview ;
OE is an inflammation of the epididymis and the
testicle
Chronic epididymitis refers to epididymal pain and
inflamation (usually without scrotal swelling)
Hippocrates first described mumps orchitis during
the fifth century BC

ORCHIO-EPIDIDYMITIS
(Epididymo-orchitis)
Epidemiology ;
In the US ; estimated 1 in 1000 men is
affected yearly. More than 600,000
medical visits /year for acute epididymitis
(AE)
In the UK ; 13,000 medical visits /year for
acute epididymitis
OE have no predilection for any racial or
ethnic group
AE most commonly occurs in patient aged
15-30 years older than 60 years.
Mumps orchitis occurs in 20-40% of
postpubertal boys with the mumps, it is
rare in prepubertal boys

ORCHIO-EPIDIDYMITIS
(Epididymo-orchitis)

Prevention ;
Prevent from UTI
Avoid the scrotum from trauma ; a
precipitating event
Get health sex ; prevent from STDs

SEXUALLY TRANSMITTED DISEASE (STD)

The name of this group of diseases was changed

from venereal diseases to sexually transmitted
diseases or STDs
Now many persons call them sexually transmitted
infections or STIs.
A STI is an infection that is transmitted through
sexually activity

SEXUALLY TRANSMITTED DISEASE (STD)

Overview ;
A disease caused by pathogen (e.g., virus, bacterium,
parasite, fungus) that is spread from P to P primarily
through sexual contact
STDs can be painful, irritating, debilitating and lifethreatening
More than 20 STDs have been identified
A person infected with an STD is more likely to
become infected with HIV, and a person infected with
HIV and another STD is more likely to transmit HIV

SEXUALLY TRANSMITTED DISEASE (STD)

STDs are a Significant Problem

The consequences of untreated STDs
Ectopic pregnancy (7-10 times increased risk in
women with history of PID)
Increased risk of cervical cancer
Chronic abdominal pain (18% of females with a
history of PID)

Source: Lande 1993.

SEXUALLY TRANSMITTED DISEASE (STD)

STDs are a Significant Problem

Infertility:
20-40% of males with untreated chlamydia
and gonorrhea
55-85% of females with untreated PID
(8-20% of females with untreated gonorrhea
develop PID)
Increased risk of HBV and HIV/AIDS transmission
Source: Lande 1993.

SEXUALLY TRANSMITTED DISEASE (STD)

Epidemiology ;
Occur most commonly in sexual active in
teenagers and young adults (especially with
multiple sex partners)
An estimated 200-400 million people worldwide
are infected
Representing men and women of all economic
class
In the US, more than 13 million people are
infected each year

SEXUALLY TRANSMITTED DISEASE (STD)

Prevention ;
Sexual abstinence is the only 100% effective method to
prevent sexually transmitted diseases
MONOGAMY WITH AN UNINFECTED PARTNER
The risk for transmission is dramatically reduce with the
use of condoms
Drugs

SEXUALLY TRANSMITTED DISEASE (STD)

STDs and Family Planning; What Can Be Done:

Most STDs (e.g., gonorrhea, syphilis) can be
treated.
All STDs can be prevented.
If not prevented, early diagnosis and treatment
can decrease the possibility of serious
complications such as infertility in both women
and men.

SEXUALLY TRANSMITTED DISEASE (STD)

A Final Word on STI control;

Contraceptive pills and injections and surgery
for preventing pregnancy
DO NOT PREVENT TRANSMISSION OF STIs !

One of many reasons why STI

control is difficult is that many
persons have these infections or are
carrying the micro-organisms
without knowing it.

Nefrotic Syndrome
Nephrotic syndrome is kidney
disease with proteinuria,
hypo-albuminemia, and
edema.
Nephrotic range protein-uria
is 3 grams per day or more.
On a single, "spot" urine
collection, it is 2 grams of
protein per gram of urine
creatinine.

Nefrotic Syndrome
Epidemiology
US Diabetic nephropathy with
nephrotic syndrome is most common, at an
estimated rate of at least 50 cases per
million population.
In children, nephrotic syndrome may
occur at a rate of 20 cases per million
children

Nefrotic Syndrome
Epidemiology
International Biopsystudies in children with
nephrotic syndrome have shown similar types of
histology in India, Pakistan, and Turkey,
comparedwith what one would expect in Western
countries.
Glomerular disease may be associated with
schistosomal infection, as could occur in Egypt

Nefrotic Syndrome
Morbidity/ Mortality
In the pre-antibiotic era, infection was a
major factor in the mortality rate among
patients with nephrotic syndrome
In secondary nephrotic syndromes,
morbidity and mortality arerelated to the
primary disease process, such as diabetes
or lupus,

Nefrotic Syndrome
Race
Because diabetes is major cause of
nephrotic syndrome, American Indians,
Hispanics, and African Americans have
ahigher incidence of nephrotic
syndromethan dowhite persons.

Acute Kidney Injury

Acute renal failure (ARF) or
acute kidney injury (AKI), as it
is now referred to in the
literature, is defined as an
abrupt or rapid decline in renal
filtration function.
This condition is usually marked
by a rise in serum creatinine
concentration or azotemia (a
rise in blood urea nitrogen
[BUN] concentration).

Acute Kidney Injury

Frequency
US Approximately 1% of patients admitted to
hospitals have AKI at the time of admission, and
the estimated incidence rate of AKI is 2-5% during
hospitalization.
AKI develops within 30 days postoperatively in
approximately 1% of general surgery cases ; it
develops in up to 67% of intensive care unit
patients.

Acute Kidney Injury

Mortality/Morbidity
The mortality rate estimates for AKI vary from 2590%. The in-hospital mortality rate is 40-50%; in
intensive care settings, the rate is 70-80%.
On long-term follow-up (1-10 years),
approximately 12.5% of AKI survivors are dialysisdependent (rates range widely, from 1-64% and 1931% of them have chronic kidney disease.4

Chronic Kidney Disease

Chronic kidney disease
occurs when one suffers
from gradual and usually
permanent loss of kidney
function over time. This
happens gradually, usually
months to years.

Chronic Kidney Disease

Epidemiology
US A report by CDC determined that 16.8% of all
adults above the age of 20 years have chronic kidney
disease.
By disease stage, the prevalence is as follows: stage
1, 3.1%; stage 2, 4.1%; stage 3, 7.6%; stage 4; and
stage 5, 0.5%.

Chronic Kidney Disease

The prevalence of CDK has increased by 16% from the
previous decade increasing incidence of DM,
hypertension, obesity and an aging population
Chronic kidney disease is more prevalent among
individuals above 60 years of age (39.4%).
Kidney disease is more common among Hispanic,
African American, Asian or Pacific Islander, and Native
American people.

Chronic Kidney Disease

Prevention
Screening test routinely diabetes, high blood
pressure, or high cholesterol
Avoid exposure to drugs especially NSAIDs (nonsteroidal anti-inflammatory drugs), chemicals,
and other toxic substances as much as possible.