Renal and Genitourinary

Concerns
Disusun oleh :

Introduction
15-20% Patient in US Hospitals are discharged
with the diagnoses of Genitourinary disorders
(adult Pop)
Spaceflight stress in AstronautGU tract
disorder
Rigorous exercise, microgravity, dietary changes,
<<drinking water, thermal stress

Microgravityweightlessness

Metabolic & Physiological

changes

Fluid Volume changes

Electrolytes Level changes

Bone & Muscle undergo

changes

the Genitourinary System

Body Fluid Balance

Microgravity as a dominant
factorPhysiological changes (Weightlessness)
Loss of Gravity on earthredistribution of body
fluids towards the head & Central circulation
Microgravityspace motion sicknessintake
fluid << (nausea/vomitus)

The Combination of fluid redistribution

& decreased fluid intake

2. Reduced Urine
Output ( 72 H on
weightlessness )

1. Diminished Plasma
Volume ( 12%<<)
3. Risk urinary
calculus >> due to
>>solute
concentration &
osmolality

Bone Mineral Loss

Bed restquadriplegic (micro gravity)gravityresistant muscular action put to restloss bone
mineral density
200-300 mg/day calcium lost by Astronauts
(urinary & fecal excretion)
222-400 mg/day posphorous loss mainly
urinary
The greater trochanter, femoral neck, lumbar
spine, and calcaneus1,3-1,5 % monthly loss in
bone mineral density

Voiding Challenges
Mission schedulleintense operational
timelinedelayed basic needs (eat, drink and
voiding)
Inadequate fluid intake + subsequent relative
dehydration
Increase urine solute
concentration
Retention due to urinary
stasis (lower tract)

Increase forming renal

stones
>>bladder calculi &
Infection

Waste Management System

Urine Collection bagApollo bags only for
mancondom like applianceconnect to funnel
Waste collecting
system (WCS)

Activated

Negative Pressure on
Tank
Aspirating urine &
Faeces to the phase
separator

Waste water
tank can be
dumped
overboard

Urine Collecting
devicesPolythil
ene bag
>>volume

In Space Flight

Nephrolithiasis
Classification of renal stone :
Calcium (80% Urinary Calculi 65-75% Calcium
Oxalate or <5% Calcium Phospate)
Uric Acid (6%)
Struvite (Infection)/Magnesium ammonium
phospate
Cystine (1%)
Miscellaneous Stone

Factors in stone formation

Normalycrystal form urinesupersaturated
with mineralsstone forming salt increase the
solubilitywith the normal urin flow + normal
intake fluid<<precipitation decrease
Decrease urine flow & low intake fluid(long term
dehydration)precipitation/osmolality >> +
statis condition stone forming, infection
Reccurent infectionstone forming
Genetics predisposition, dietary factors,
anatomical abnormality

Inhibitory Factors
Ions (Citrate, magnesium and phospate)bond
with calcium and oxalate on soluble form
Organic

Non Organic

Tamm-Horsfall protein, nephrocalcin,

chondroitin-4-sulfate, heparin dan
glycoaminoglycansprevent/slowing growth of
crystal & allowing small crystals to be removed
from the body (urine void)

Flight Operations
Astronauts training & spaceflight
preparationlong periods in environment make
it difficult to void or intake fluid.

Increase the risk of stone formation

Classic Symptoms & Signs of stone

formation
Pain in the lower backbelow the
ribsspreading in to the front of the
abdomenassociated with the calculus position.
Calculus in the calixdiscomfort from minmoderate
Calculus pass in to the uretersevereincapacitating painpartial obstruction/acute
distension of the collecting system

 The most comm sites :

1. the ureterovesical junctiongroin pain,
produce cystitis, urgency, frekuency, and
dissuria
2. the ureteropelvic junctionPain
radiating to the the flank
3. the mid-ureter that crosses the iliac vessels
at the pelvic inlet, flank radiating to the lower
quadrant of abdomendd/app and sigmoid
diverticular

Aeromedical significance
Not only affect the individual (Astronauts) also
jeoperdise succes of the mission.
Problems are :
1.Potential forniceal rupture
2.Infectionurosepsis
3.Inability to maintain oral hydration due to the
ileus

History of urinary evaluation and

calculi in space flight
U.S space program identified14 renal calculus
events in 12 Astronauts
Russianthree cosmonautspost flight urinary
calculi.
Micro gravitybone
to loss
calciumexcess
calcium to excrete as
urinary waste

The decrease of
urinary output and
also lower fluid
intake + increase of
workload schedule
CALCULUS
FORMATION >>

Countermeasures and risk assesment

Diets low oxalate ( reduced animal protein)
Potassium citrateminimize development &
growth of renal stones
Exercise+Biophosphonatesprevent bone loss
& inhibit bone resorption due to microgravity

Renal risk assesment

Renal stone risk index assement :

Matrix components
Uroproteins
Uromucoid
Glycosaminoglicans
Blood urea nitrogen
Electrolytes
Creatinine
Calcium
Uric acid
phosphorus

The person who

had increase of
these multiple
abnormality
results, should
be considered
not to go on
board, or
prevent wit
pharmacologica
l preflight

Management of renal stones in

Astronauts

After diagnosedTreatment3month followup

using X-ray examination of kidney, blader and
ureter
Increase fluid intake and reduce animal
proteinmineral water with bicarbonate,
lemonade, and citrus fruit juice
If still persistent renal stoneswaiver
considerationtreatment from flight surgeon

Inflight prevention an management

Taking oral fluids in amounts sufficient to
maintain adequate hydration
Space motion sickeness IV line
Pottasium citrate and magnesium citrate to
countermeasures renal stones forming
USG is available on the space ship
Hydronephrosis and obstructionESWL
Largestones in calix renal or
pelvicpercutaneous nephrolithotripsy

Inflight management of
Genitourinary Problems

Urethritis/Cystitid Infections
Pyelonephritis
Prostatitis
Bartholins glan infection
Epididymitis
Urinary Obstruction : Lower tract Infection,
BPH, uretheral stricture, divertikula, calculi and
trauma

Conclusions
Genitourinary issues remain important
considerations for human space missions
GU issues mostly caused by prolonged
microgravity on the human body
Prevent precipitation will be the key to
countermeasures renal stone forming
Imaging and minimaly invasive capability to
treat the stones important to develop for the
future flight

ATTENTION