Division 1 - Chapter 10
Chapter 10 - The Urinary System
10.0 Introduction
In conducting an assessment, the assessor must have regard to the Principles of Assessment and the definitions contained in the Glossary.
Impairments assessed under Chapter 10 include those caused by secondary conditions accompanying an endocrine system condition. An impairment assessed under Chapter 3 - The Endocrine System should be combined with those resulting from the secondary conditions assessed under Chapter 10.
10.1 The Upper Urinary Tract
The upper urinary tract comprises the kidney and ureters.
Upper urinary tract dysfunction may be indicated by symptoms and signs including:
- changes in urination;
- oedema;
- decreased physical stamina;
- appetite and weight loss;
- anaemia;
- uraemia;
- loin, abdominal or costovertebral angle pain;
- haematuria;
- chills and fever;
- hypertension or its complications;
- abnormalities in the appearance of the urine or its sediment; and
- biochemical blood changes.
Especially in its early stages, renal disease may only become evident with laboratory findings.
Continuous medical treatment includes drug or dietary therapy.
Renal replacement therapy includes peritoneal or haemodialysis and renal transplantation.
Table 10.1: The Upper Urinary Tract
|
Criteria (criteria in BOTH Category A and Category B must be satisfied if present) |
||
|
Category A |
Category B |
|
|
% WPI |
Creatinine Clearance |
Other Symptom(s) |
|
0 |
>62 ml/min |
AND intermittent symptoms and signs of upper urinary tract dysfunction are present but do not require continuous treatment or surveillance. |
|
5 |
52-62 ml/min |
AND intermittent symptoms and signs of upper urinary tract dysfunction are present but do not require continuous treatment or surveillance. |
|
10 |
not applicable |
Loss of one kidney or one kidney not functioning. |
|
15 |
>62 ml/min |
AND intermittent symptoms and signs of upper urinary tract dysfunction are present and require continuous surveillance and frequent treatment. |
|
20 |
52-62 ml/min |
AND symptoms and signs of upper urinary tract dysfunction are present and require continuous surveillance and frequent treatment. |
|
25 |
not applicable |
Successful renal transplantation results in marked renal function improvement (irrespective of creatinine clearance level). |
|
30 |
43-52 ml/min |
AND symptoms and signs of upper urinary tract dysfunction are present and require continuous surveillance and frequent treatment. |
|
40 |
28-42 ml/min |
not applicable |
|
50 |
43-52 ml/min |
AND symptoms and signs of upper urinary tract dysfunction are present and are not completely controlled by surgical or continuous medical treatment. |
|
60 |
<28 ml/min |
not applicable |
|
70 |
28-42 ml/min |
AND symptoms and signs of upper urinary tract dysfunction are present and are not controlled by surgical or continuous treatment. |
|
80 |
<28 ml/min |
AND symptoms and signs of upper urinary tract dysfunction are present and are not controlled by surgical or continuous treatment. |
|
90 |
<14 ml/min |
AND renal replacement therapy. |
|
95 |
<14 ml/min |
AND metabolic coma from renal failure. |
10.2 Urinary Diversion
Using the Combined Values Chart (Appendix 1), WPI ratings derived from Table 10.2 below may be combined with WPI ratings derived from Table 10.1.
Table 10.2: Urinary Diversion
|
% WPI |
Type of Diversion |
|
10 |
Ureterointestinal. Cutaneous ureterostomy. |
|
15 |
Nephrostomy. |
10.3 Lower urinary tract
The lower urinary tract comprises the bladder and urethra.
Table 10.3: Lower Urinary Tract is on the following page.
Using the Combined Values Chart (see Appendix 1), WPI ratings derived from Table 10.3 may be combined with WPI ratings from Table 10.1: The Upper Urinary Tract, and with WPI ratings from Table 10.2: Urinary Diversion.
Impairment in the lower urinary tract due to neurological causes, as opposed to local lower urinary tract pathology, should be assessed under Table 12.7: Neurological Impairment of the Urinary System (Chapter 12 - The Neurological System).
If:
- several impairments of the urinary system are present; and
- there is an impairment of bladder function due to neurological causes;
then:
- a WPI rating from Table 10.3 (except for bladder function) may be combined with a WPI rating from Chapter 12 - The Neurological System.
Symptoms and signs of bladder disorder include:
- urinary frequency;
- dysuria;
- urinary incontinence;
- urine retention;
- haematuria;
- pyuria;
- passage of urinary calculi; and
- a suprapubic mass.
Signs and symptoms of urethra function impairment include:
- dysuria;
- diminished urinary stream;
- urinary retention;
- incontinence;
- extraneous or ectopic urinary openings;
- periurethral masses; and
- diminished urethral calibre.
Table 10.3: Lower Urinary Tract
|
% WPI |
Criteria |
|
0 |
Symptoms and signs of bladder or urethral disorder occurring 1-3 times a year and requiring intermittent treatment - between episodes lower urinary tract function is normal. |
|
5 |
Symptoms and signs of bladder or urethral disorder occurring 4-6 times a year and requiring intermittent treatment - between episodes lower urinary tract function is normal; or Urethral stricture requiring dilation up to 6 times a year ? between dilations there is normal urethral function. |
|
10 |
Symptoms and signs of bladder disorder occurring 7-12 times a year and requiring intermittent treatment - between episodes bladder function is normal; or Urethral stricture requiring dilation more than 6 times a year - between dilations there are significant periods of normal urethral function. |
|
15 |
Symptoms and signs of bladder disorder occurring more than 12 times a year and requiring intermittent treatment - between episodes bladder function is normal; or Urethral fistula. |
|
20 |
Symptoms and signs of bladder disorder requiring continuous treatment; or Good bladder reflex activity (that is, storage of urine) but no voluntary control over the reflex activity; or Urethral stricture requiring dilation more than 6 times a year - between dilations there are no significant periods of normal urethral function. |
|
30 |
Poor reflex bladder activity (that is, intermittent dribbling incontinence, stress incontinence or urge incontinence) and no voluntary control over the incontinence; or Urethral dysfunction resulting in intermittent urine dribbling and loss of voluntary urinary control. |
|
40 |
No reflex or voluntary control of bladder (that is, continuous dribbling incontinence); or Urinary diversion with cystectomy. |
Acknowledgments | Introduction | Tables and Figures
| Principles of Assessment
Division 1 | 1 - The Cardiovascular System | 2 - The Respiratory System
3 - The Endocrine System | 4 - Disfigurement and Skin Disorders
5 - Psychiatric Conditions | 6 - The Visual System
7 - Ear, Nose and Throat Disorders | 8 - The Digestive System
9 - The Musculoskeletal System | 10 - The Urinary System
11 - The Reproductive System | 12 - The Neurological System
13 - The Haematopoietic System
Division 2 | Division 3 | Appendix