Renal and Genitourinary ConcernsDisusun oleh :

Introduction15-20% Patient in US Hospitals are discharged with the diagnoses of Genitourinary disorders (adult Pop)Spaceflight stress in AstronautGU tract disorderRigorous exercise, microgravity, dietary changes,

MicrogravityweightlessnessMetabolic & Physiological changesFluid Volume changesElectrolytes Level changesBone & Muscle undergo changes

the Genitourinary System

Body Fluid BalanceMicrogravity as a dominant factorPhysiological changes (Weightlessness)

Loss of Gravity on earthredistribution of body fluids towards the head & Central circulation

Microgravityspace motion sicknessintake fluid

The Combination of fluid redistribution & decreased fluid intake1. Diminished Plasma Volume ( 12% due to >>solute concentration & osmolality2. Reduced Urine Output ( 72 H on weightlessness )

Bone Mineral LossBed restquadriplegic (micro gravity)gravity-resistant muscular action put to restloss bone mineral density200-300 mg/day calcium lost by Astronauts (urinary & fecal excretion)222-400 mg/day posphorous loss mainly urinaryThe greater trochanter, femoral neck, lumbar spine, and calcaneus1,3-1,5 % monthly loss in bone mineral density

Voiding ChallengesMission schedulleintense operational timelinedelayed basic needs (eat, drink and voiding)Inadequate fluid intake + subsequent relative dehydration

Increase urine solute concentrationIncrease forming renal stones

Retention due to urinary stasis (lower tract)>>bladder calculi & Infection

Waste Management SystemUrine Collection bagApollo bags only for mancondom like applianceconnect to funnel

Waste collecting system (WCS)Negative Pressure on TankAspirating urine & Faeces to the phase separatorWaste water tank can be dumped overboard

ActivatedUrine Collecting devicesPolythilene bag >>volume

In Space Flight

NephrolithiasisClassification of renal stone :Calcium (80% Urinary Calculi 65-75% Calcium Oxalate or

Factors in stone formationNormalycrystal form urinesupersaturated with mineralsstone forming salt increase the solubilitywith the normal urin flow + normal intake fluid + statis condition stone forming, infectionReccurent infectionstone formingGenetics predisposition, dietary factors, anatomical abnormality

Inhibitory FactorsIons (Citrate, magnesium and phospate)bond with calcium and oxalate on soluble form

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)

OrganicNon Organic

Flight OperationsAstronauts 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 formationPain in the lower backbelow the ribsspreading in to the front of the abdomenassociated with the calculus position.Calculus in the calixdiscomfort from min-moderateCalculus pass in to the uretersevere-incapacitating painpartial obstruction/acute distension of the collecting system

The most comm sites :

1.the ureterovesical junctiongroin pain, produce cystitis, urgency, frekuency, and dissuria2.the ureteropelvic junctionPain radiating to the the flank3.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 significanceNot only affect the individual (Astronauts) also jeoperdise succes of the mission.

Problems are :Potential forniceal ruptureInfectionurosepsisInability to maintain oral hydration due to the ileus

History of urinary evaluation and calculi in space flightU.S space program identified14 renal calculus events in 12 AstronautsRussianthree cosmonautspost flight urinary calculi.

The decrease of urinary output and also lower fluid intake + increase of workload scheduleMicro gravitybone to loss calciumexcess calcium to excrete as urinary waste

CALCULUS FORMATION >>

Countermeasures and risk assesmentDiets low oxalate ( reduced animal protein)Potassium citrateminimize development & growth of renal stonesExercise+Biophosphonatesprevent bone loss & inhibit bone resorption due to microgravity

Renal risk assesmentRenal stone risk index assement :Matrix componentsUroproteinsUromucoidGlycosaminoglicansBlood urea nitrogenElectrolytesCreatinineCalciumUric acidphosphorus

The person who had increase of these multiple abnormality results, should be considered not to go on board, or prevent wit pharmacological preflight

Management of renal stones in AstronautsAfter diagnosedTreatment3month followup using X-ray examination of kidney, blader and ureterIncrease fluid intake and reduce animal proteinmineral water with bicarbonate, lemonade, and citrus fruit juiceIf still persistent renal stoneswaiver considerationtreatment from flight surgeon

Inflight prevention an managementTaking oral fluids in amounts sufficient to maintain adequate hydrationSpace motion sickeness IV line Pottasium citrate and magnesium citrate to countermeasures renal stones formingUSG is available on the space shipHydronephrosis and obstructionESWLLargestones in calix renal or pelvicpercutaneous nephrolithotripsy

Inflight management of Genitourinary ProblemsUrethritis/Cystitid InfectionsPyelonephritisProstatitisBartholins glan infectionEpididymitisUrinary Obstruction : Lower tract Infection, BPH, uretheral stricture, divertikula, calculi and trauma

ConclusionsGenitourinary issues remain important considerations for human space missionsGU issues mostly caused by prolonged microgravity on the human bodyPrevent precipitation will be the key to countermeasures renal stone formingImaging and minimaly invasive capability to treat the stones important to develop for the future flight

ATTENTION