Urogenital
diseases include diseases of the
urinary tract of the excretory systemÑfrom the
kidney to the external opening of the urethraÑand of the tract of the reproductive system. These diseases are commonly grouped for convenience because in males the two tracts share the terminal end and in females the tracts, although separate, are contiguous. Thus in either sex a problem in one tract is likely to affect the other. The medical specialties most directly concerned with urogenital diseases are gynecology and urology; both involve the urinary tract, but the former specializes in female and the latter in male genital-tract disorders. The illnesses studied include a wide range of infectious diseases, tumors, congenital (inborn) disorders, allergy and immunity problems, and diseases of other body systems or of general metabolism that also affect these tracts, such as cardiovascular disease and diabetes.
Urinary-Tract Diseases
Among the more serious kidney diseases are glomerulonephritis, nephrosis, and pyelonephritis. Of the many observed forms of glomerulonephritis, most show evidence of deposits of antibody-antigen complexes in the glomeruli, the kidney's filtering units; thus one common form of the disease occurs two to three weeks after an infection of the throat or skin with streptococci. Most cases are temporary but a few become chronic, leading to kidney failure and uremia. Nephrosis, or nephrotic syndrome, is an outpouring of protein into the urine due to glomeruli damage. It is not itself a disease but a symptom observed at some time in the course of chronic glomerulonephritis, multiple myeloma, lupus erythematosus, or other serious diseases. Pyelonephritis is a serious infection of kidney tissue that can result in permanent damage if not treated promptly. It usually results from bacterial infections of the bladder (see cystitis) or of the ureter, the tube ascending from the bladder to the kidney.
Infections of the urethra, the final portion of the urinary tract, are collectively know as urethritis. Such infections include Chlamydia and gonorrhea (see also sexually transmitted diseases), among others, although in females gonorrhea tends to ascend the
genital passage. The agents responsible for urethritis can also spread into adjacent tissues.
Another urinary-tract affliction is the development of kidney
stones and bladder stones; such stones also commonly arise in conjunction with infections. Stones are caused by the precipitation of insoluble materials from the urine: some persons with gout form uric-acid stones, and some persons with
tumors of the parathyroid glands form calcium stones. Small stones become trapped as they descend from the kidney into the ureter, and the waves of contraction to move them along produce the extremely painful condition known as ureteral colic.
Male Genital-Tract Disease
One site along the male genital tract that is a frequent source of problems in middle and older age is the prostate gland. The gland surrounds the urethra just below the bladder; because of this location, the prostate compresses the posterior urethra when it is enlarged by infections (prostatis) or by benign tumors. The compression obstructs urinary flow and, if severe enough and continued over a long period of time, results in urinary-tract infection, severe renal damage, and uremia. Cancer of the prostate also becomes increasingly common in men over the age of 60; its development is stimulated by male hormones and retardedÑto a variable extentÑby female hormones (see sex hormones).
Female Genital-Tract Diseases
The vagina, uterus, and associated glands of the female genital tract are all common sites of sexually transmitted diseases and of a number of other infections due to other bacteria and yeasts. Bacteria that move upward from the vagina during menstruation are also responsible for major problems of the fallopian tubes; such infections result in abscess of the tubes and in localized peritonitis. Thiserious and painful condition is known as pelvic inflammatory disease (PID). The condition can also lead to scarring of the fallopian tubes, which is a major cause of infertility. A number of bacteriaÑparticularly those which cause gonorrheaÑhave been implicated in PID, as well as some viruses.
A number of benign and malignant cysts and tumors can develop in the female genital tract. In fact, no other organ exhibits as many distinct types of malignant tumors as the ovary. The ovary is also the seat of several types of benign cysts and solid tumors, including endometriosisÑa benign transplant of cells from the uterine lining (endometrium) cast off during menstruation. In the endometrium itself, malignancies occur with increasing frequency among the elderly; malignancies of the uterine muscle, called leiomyosarcomas, are seen more occasionally, but the benign tumors called leiomyomas are also fairly common.
The Pap test is routinely given in the United States to detect cancer of the neck of the uterus, or cervix, another common malignancy. The vagina and associated glands are not common sites for tumors, except for the increased frequency of vaginal carcinomas seen in daughters of women who had been treated with large doses of progestins (sex hormones) while pregnant.
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