Manual Single National Disability Rating to Colombia - Decree 917 of 1999 (Part I of II) - Chapter VI - 6. Genital and urinary systems 6.1 General - 6.2.1. Evaluation criteria for the deficiency of upper urinary tract

MANUAL SINGLE NATIONAL DISABILITY
(PART I OF II)

CHAPTER VI
6. Genital and urinary systems
6.1 General

This chapter defines the criteria for assessing the deficiencies in the body of persons on the permanent damage caused by diseases of the genital system, urinary, or both. The analysis of this system includes the upper urinary tract, bladder, urethra, male genitalia and female genitalia. It requires an observation period of at least one year after the transplant to reasonably determine whether the patient has reached the desired point and steady improvement.

6.2.1. Evaluation criteria for the deficiency of upper urinary tract.TABLE No. 6.1: CRITERIA FOR THE ASSESSMENT OF GLOBAL GAP FOR UPPER URINARY TRACT PATHOLOGY

Class Description of criteria Global Deficit (%)

I · There is a decrease of the upper urinary tract function defined by a creatinine clearance 75 to 90 litros/24 hours (between 52-62.5 ml / min.) And has a Fenolsulfonoftaleína excretion (PSP) from 15 to 20% in 15 minutes. • There are signs and symptoms of intermittent upper urinary tract dysfunction do not require continuous treatment or surveillance. 1.0-4.9

II · There is a decrease of the upper urinary tract function defined by a creatinine clearance 60 to 75 litros/24 hours (between 42-52 ml / min.) And has a PSP excretion of 10 to 15% in 15 minutes . • Although creatinine clearance is greater than 75 litros/24 hours (52 ml / min.) PSP and excretion of more than 15% in 15 minutes, the signs and symptoms of illness or upper urinary tract dysfunction requiring constant vigilance and frequent treatment. 5.0-14.9

III · displayed a decrease in the upper urinary tract function determined by creatinine clearance 40 - 60 litros/24 hours (28 to 42 ml / min.) And PSP excretion of 5 to 10% in 15 minutes. • Although creatinine clearance is from 60 to 75 litros/24 hours (42 to 52 ml / min.) and PSP excretion of 10 to 15% in 15 minutes, the symptoms and signs of disease

or upper urinary tract dysfunction are incompletely controlled in surgical or medical treatment continued. 15.0-29.9

 IV · There is a decrease of the upper urinary tract function determined by creatinine clearance less than 40 litros/24 hours (28 ml / min.) PSP and excretion of less than 5% in 15 minutes. • Although the creatinine clearance is 40 to 60 litros/24 hours (28 - 42 ml / min.) and the secretion of PSP is 5 - 10% in 15 minutes, the symptoms and signs of disease or upper urinary tract dysfunction persist despite surgery or constant medical. 30.0-45.0

NOTE: A person with a single kidney from any cause must be assigned 5.0% of global impairment, and has had a structural loss of an essential organ. This value must be combined with any permanent impairment (including in the remaining kidney failure) that is relevant in the present case. For damage of renal function impairment that generate a Class IV "due to chronic renal disease such as hypertensive vascular disease of renal origin, chronic nephritis, nephrolithiasis, polycystic disease, chronic hydronephrosis, etc., Associated with the following alterations :

a. Peritoneal dialysis or hemodialysis indispensable for survival, due to irreversible renal failure, or renal transplantation evaluated one year after made, which remains a serious kidney failure or complications arising therefrom.

b. Creatinemia persistent elevation in the course of 4 months or more, or reduction of creatinine clearance of 20 ml / min. (29 L/24 hours) or less for 6 months with one of the following problems:

a) Renal osteodystrophy manifested by severe disorders ostealgias of radiological osteitis

fibrous, severe osteoporosis and pathologic fractures, or

b) persistent sensory or motor neuropathies;

c) intractable prurigo, or

d) fluid overload syndrome, resulting in diastolic blood pressure less than

110 mm Hg or pulmonary vascular congestion, or

e) strong and persistent anorexia, weight loss, according to the values ​​in Table 1

Chapter Gastroenterology.

f) persistent anemia with hematocrit of 30% or less.

c. Nephrotic syndrome with anasarca important that persists, at least 6 months despite the

described therapy, albumin of 3.0 g/100 cc or less and proteinuria of 3.5 g/24 hours or more, or

proteinuria of 10.0 g/24 hours or more.

6.2.2. Criteria for evaluating permanent impairment of urinary lead Superior.

The following values ​​of the deficiency for permanent referrals should be combined with those identified under the criteria given in the preceding paragraph, regardless of how they work in the preservation of renal integrity and the elimination of urine.

TABLE No. 6.2: CRITERIA FOR THE EVALUATION OF PERMANENT IMPAIRMENT LEADS GLOBAL FOR UPPER URINARY TRACT DEFICIENCY LEADS GLOBAL (%)

Uretero-intestinal Referrals 5.0 - 10

Cutaneous ureterostomy without intubation 5.0 - 10

Nephrostomy or ureterostomy intubated 7.5 - 15

6.3 BLADDER

Symptoms and signs of abnormal changes in the bladder include urinary frequency (polyuria, urinary frequency, oliguria or nocturia), dysuria or burning pain, urinary urgency, incontinence, involuntary retention, hematuria, pyuria, crystalluria, excretion of urinary calculi and suprapubic masses, among others.

TABLE No. 6.3: CRITERIA FOR ASSESSING DEFICIENCY BY GLOBAL PATHOLOGY OF BLADDER

Class Description of criteria Global Deficit (%)

I • There are symptoms and signs of bladder disorders that require treatment, but there is a malfunction of it. 1.0-4.9

II • There are symptoms and signs of bladder disorders, which require constant treatment. · There is good bladder reflex activity, but no voluntary control. 5.0-9.9

III • The bladder has a poor reflex activity (drip flashing) and no voluntary control. 10.0-17.5

IV • There is no reflection control, or voluntary bladder and presents constant drip. • The removal of the bladder for any reason, resulting in urinary diversion must be assigned a similar type of deficiency. 17.6-30.0

6.4 URETHRA

The symptoms and signs of abnormal urethra include dysuria, decreased urinary stream and the size, retention, incontinence, epi or hypospadias and urethral strictures periurethral masses, among others.

TABLE No. 6.4: CRITERIA FOR ASSESSING DEFICIENCY BY GLOBAL urethral diseasesClass Description of criteria Global Deficit (%)

I There are symptoms and signs of urethral pathology, which require intermittent therapy for his control. 1.0-4.9

II There are symptoms and signs of urethral pathology that can not be effectively controlled by treatment. 5.0-10.0

MALE GENITALIA 6.5

The male genitalia comprise the penis, scrotum, testis, epididymis, spermatic cord, prostate and seminal vesicles.

Penis 6.5.1 Symptoms and signs of abnormal penile erection include abnormalities of sensation and partial or complete loss of the penis. When evaluating the role of the penis is necessary to address both sexual function deficiency as a deficiency of the urethra, which must be combined for the final grade.

TABLE No. 6.5: CRITERIA FOR ASSESSING DEFICIENCY BY GLOBAL PATHOLOGIES PENIS

Class Description of criteria Global Deficit (%)

I can be sexual function, but with varying degrees of difficulty with erection, ejaculation, awareness of it, or both. 2.5-4.9

II sexual function is possible with sufficient erection but not ejaculation, or aware of it. 5.0-7.4

III can not be sexual function. 7.5-10.0

6.5.2 Scrotum

Symptoms and signs of changes in the scrotum include pain, enlargement, loss of mobility and inappropriate placement of the testis.

TABLE No. 6.6: CRITERIA FOR ASSESSING DEFICIENCY BY GLOBAL LATERA OF SCROTUM

Class Description of criteria Global Deficit (%)

I • There are symptoms and signs of loss or disease of the scrotum and no evidence of poor testicular function, although there may be bad position of the testes. 1-2.4

II • There are symptoms and signs of structural abnormality or disease of the scrotum, testicles that require relocation to another position different from the scrotum to preserve its function and no pain or discomfort with activity, or · There is total loss of the scrotum, which generally for diabetic scrotal abscess and should be weighed against the damage for Diabetes Mellitus. 2.5-7.5

6.5.3. Testis, epididymis and spermatic cords.

Symptoms and signs of alterations of the testicles, epididymis and spermatic cords are referred pain, abnormal secondary sexual characteristics, changes in the size, shape, position and texture of these structures and abnormalities of semen and testicular hormones, among others.

TABLE No. 6.7: CRITERIA FOR ASSESSING DEFICIENCY BY GLOBAL Pathology of the testis, epididymis and spermatic cord

Class Description of criteria Global Deficit (%)

I · Symptoms and signs of disease of the testes, epididymis, spermatic cords, or all, registering anatomical changes. Do not require constant treatment. Do not exist seminal function abnormalities, or there is only one testicle. 1.0-2.4

II • There are symptoms and signs of disease of the testes, epididymis, spermatic cord or all, and there is an anatomical abnormality. · Requires frequent or constant treatment. • There are seminal and hormonal abnormalities detectable. 2.5-7.4

III • The trauma or disease causes bilateral anatomical loss or no detectable hormonal seminal role of the testis, epididymis, spermatic cords or all. 7.5-10.0

6.5.4. Prostate and seminal vesicles. Symptoms and signs of changes in the prostate and seminal vesicles can include local or referred pain, changes in consistency, size and texture detectable by the examiner, disturbances of the function of the spermatic cords, epididymis and testicles, oligospermia, hemospermia and urinary symptoms, among others.

TABLE No. 6.8: CRITERIA FOR ASSESSING DEFICIENCY BY GLOBAL PATHOLOGY prostate and seminal vesicles

Class Description of criteria Global Deficit (%)

I • There are symptoms and signs of dysfunction or prostate disease, seminal vesicle, or both. · There anatomical changes. Do not require constant treatment. 1.0-2.4

II • There are frequent signs and symptoms of prostate disease or dysfunction, seminal vesicle, or both. · There anatomical changes. · Requires constant treatment. 2.5-7.4

III • There are ablation of the prostate, seminal vesicles or both. 7.5-10.0

FEMALE GENITALIA 6.6

Female genital organs are the vulva, vagina, uterus, fallopian tubes and ovaries. To determine the deficiency is recognized that age influences while the woman is of childbearing age.

6.6.1 Vulva and Vagina. The signs and symptoms of vulvar and vaginal disorders include loss or alteration of

sensitivity or sexual sensations, partial or complete agenesis, signs of inflammation, leukorrhea, erythema, dyspareunia, scars and ulcers, among others.

TABLE No. 6.9: CRITERIA FOR ASSESSING DEFICIENCY BY GLOBAL PATHOLOGY OF THE VULVA AND VAGINA

Class Description of criteria Global Deficit (%)

I • There are symptoms and signs of disease or deformity of the vulva, vagina, or both, which do not require constant treatment. • It is possible intercourse. • The vagina is ready for vaginal delivery during the premenopausal years. 1.0-4.9

II • There are symptoms and signs of disease or deformity of the vulva, vagina, or both, that require constant treatment. • The sex is possible, though with different degrees of difficulty. • During the premenopausal years is limited suitability for vaginal delivery. 5-12.4

III • There are symptoms and signs of disease or deformity of the vulva, vagina, or both, which are not controlled with treatment. • It is not possible intercourse. • During the premenopausal years is not possible vaginal delivery. 12.5-20.0

6.6.2 Neck and Uterus: Symptoms and signs of cervical and uterine abnormalities include menstrual disorders, fertility, pregnancy or labor, stenosis or atresia of the cervical canal, cervical incompetence, bleeding genitals, mass displacement and uterus, among others.

TABLE No. 6.10: CRITERIA FOR ASSESSING DEFICIENCY BY GLOBAL AND NECK PATHOLOGY OF UTERUS

Class Description of criteria Global Deficit (%)

I • There are symptoms and signs of disease or deformity of the neck of the uterus or both, which do not require lifelong treatment. • If there is cervical stenosis, did not require treatment.

· There anatomical loss of cervical, uterine or both in postmenopausal years. 1.0-4.9

II • There are symptoms and signs of disease or deformity of the neck of the uterus or both, requiring continuous treatment; · There cervical stenosis, which requires ongoing treatment. 5-12.4

III • There are symptoms or signs of disease or deformity of the neck, uterus, or both, that are not controlled with treatment; • The complete cervical stenosis; • In the premenopausal years is rather comprehensive loss functional, anatomical, or both, the neck of the uterus or both. 12.5-17.5

6.6.3 fallopian tubes and ovaries: Symptoms and signs of abnormalities of the fallopian tubes and ovaries incluyensangrado vaginal morphology changes, fever, fertility disorders, dysmenorrhea, hormonal dysfunction, hirsutism, menstrual dysfunction and pelvic masses, among others. To assess changes in hormonal type should be taken into account the evaluation criteria and combine the endocrine system.

TABLE No. 6.11: CRITERIA FOR ASSESSING DEFICIENCY BY GLOBAL HORN PATHOLOGIES tubes and ovaries
Class Description of criteria Global Deficit (%)

I • There are symptoms or signs of disease or deformity of the fallopian tubes, ovaries or both, which do not require treatment; • Only one fallopian tube, ovary or both, is working in the premenopausal years · There bilateral loss of function of the fallopian tubes, ovaries or both in postmenopausal years. 1.0-4.9

II • There are symptoms and signs of disease or deformity of the fallopian tubes, ovaries or both, that require constant treatment, but there remains the permeability of the tubes and possible ovulation and fertilization. 5-14.9

III • There are symptoms and signs of disease or deformity of the fallopian tubes, ovaries or both. • There are a total loss of permeable tubes or total failure to produce eggs in the premenopausal years or oophorectomy. 15.0-17.5