Cancer, Bladder
1. What is Bladder Cancer?
Bladder cancer is the sixth most common cancer in the United States.
It is cancer of the bladder. The cancer may be only in the lining of the
bladder, or more extensive would be in the muscular wall of the bladder.
The most aggressive type of bladder cancer may grow through the bladder
wall and spread to nearby organs. Bladder cancer is more common among whites
and men and usually occurs among people in their 60's.
There
are a number of risk factors that are attributed to bladder cancer. Here
are the most common risk factors:
- Smoking
- Industrial chemicals
- Chronic bladder inflammation
2. What are the signs and symptoms of Bladder Cancer?
Bladder cancer often doesn't produce signs or symptoms in its early stages.
The first warning sign is usually blood in the urine. However,
signs and symptoms of bladder cancer may be:
- Blood in urine
- Pelvic Pain
- Frequent urination
- Sensation for the need to urinate without results
- Slowing of the urinary stream
These signs and symptoms are the same as other diseases, so you should
see your physician.
3. How is Bladder Cancer diagnosed?
The physician will ask for a medical history and perform a physical exam.
In addition, a urine sample will be examined, and possibly sent on to a
laboratory for the testing of blood cells and cancer cells. An intravenous
pyelography (IVP) will be ordered, and a cystoscopic procedure will be
performed. The cystoscopy will enable the urologist to look inside the bladder
and perform a biopsy.
4. How is Bladder Cancer treated?
Treatment for bladder cancer is dependent upon the degree of the cancer.
For very superficial cancer, i.e. just the lining of the bladder, biological
therapy would be used.
- Biological Therapy- is a form of treatment that uses the body's natural
ability to fight cancer. Biological therapy may be used alone or after surgery
to help prevent the cancer from recurring. This treatment consists of placing
a solution into the bladder. The bladder is stimulates the immune system.
The medicine stays in the bladder for about 2 hours before the patient is
allowed to empty their bladder. The treatment is continued for approximately
6 weeks, once a week.
- Surgery- There are basically two types of surgery for bladder cancer.
The less extensive, is where the physician will burn away the cancer cells.
The patient will be done on an outpatient bases for the most part, with
anesthesia.
There is also the surgery to remove the bladder called a
Cystectomy. This surgery may be done when the bladder cancer invades the
muscle wall.
- Chemotherapy
- Radiation Therapy
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Cancer, Kidney
1. What is Kidney Cancer?
The majority of kidney cancers are of the type known as renal cell
carcinoma, which are the "meat" of the kidney, rather than the drainage
system of the kidney. A number of the kidney cancers have a heredity
influence associated with diseases such as von Hippel-Lindau, adult
polycystic kidney disease, tuberous sclerosis and a few others. Men
are twice as likely to have kidney cancer than women.
2. What are the symptoms?
- Blood in urine
- Pain
- Mass
- Fever
- Weight loss
- Hypertension
- Varicocele ( Abnormal dilation of the veins of the spermatic cord)
3. How is Kidney Cancer diagnosed?
The most common way to diagnose kidney cancer is with contrast studies
such as intravenous pyelogram (IVP) and CT scans. The diagnosis can also
be made with a renal ultrasound. The MRI is a useful diagnostic test
that may also be used.
4. What are the treatments for Kidney Cancer?
Treatment options are almost exclusively surgical, the removal of
the entire or partially affected kidney.
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Kidney Stone
1. What are Kidney Stones?
Kidney stones are abnormal collections of mineral salts which form
in the kidney and then can move down the ureter (tube connecting the
kidneys and the bladder) and into the bladder. The movement of the
stone can cause the following symptoms:
- Severe pain in the mid to lower back
- Nausea & vomiting
- Bloody urine.
- Fever
2. What can cause Kidney Stones?
The causes of kidney stones vary, men develop them twice as often
as women. If someone else in your family has or has had kidney stones,
then the likelihood to form stones is increased. Once a person has
their first kidney stone they have approximately a 50% chance of
developing another stone sometime later in life. A change in diet
may decrease the chance of forming stones, if diet was a contributor
to the formation of the stone originally.
3. How can Kidney Stones be prevented?
The primary way to prevent kidney stones is to drink plenty of
fluids, ideally water. Some types of foods may be eaten in
moderation and may decrease the chance of forming another stone,
i.e. foods high in calcium. (Totally avoiding calcium, even if the
stones are composed of calcium may do harm, since calcium is important
in the body's function.) There are medications that help prevent the
development of certain kidney stones. Catching the stone so it may be
analyzed for its composition is very helpful in knowing how and what
to do to prevent further stones.
4. How are Kidney Stones evaluated?
When the symptoms are suspicious for a kidney stone, tests are
done to determine if a stone is present. A urinalysis will be taken
to look for blood, crystals or infection. An intravenous pyelogram
(IVP) or CT Scan will be ordered to confirm the diagnosis of a kidney
stone, and also to check the location of the stone. If an individual
is allergic to iodine, an ultrasound of the kidney will be ordered.
5. How are Kidney Stones treated?
The good news is that the majority of stones do not require surgical
intervention. The most common way to treat stones that will not pass
on their own is Extracorporeal Shock Wave Lithotripsy (ESWL). ESWL is
an outpatient procedure performed under intravenous (IV) sedation,
using a high energy machine that delivers shock waves directed by live
X-ray to the stone, resulting in the stone breaking into smaller pieces.
These smaller pieces of the stone will pass into the bladder, and the
patient will pass the fragments when urinating.
About 20% of the stones will not break into smaller pieces or will fail
to pass out of the patient, then surgery will be needed. The two most
common surgical interventions are:
- Ureteroscopy- This procedure may be performed if the stone is
located in the ureter. An instrument, like a small telescope, is
passed through the urethra and bladder up to the stone. Then the
urologist can use a laser to break up the stone, a small wire "basket"
to grab and remove it, or other methods may be better suited for the
location and size of the stone. These procedures do require anesthesia,
and the patient is usually an outpatient at a hospital.
- Percutaneous nephrolithotripsy- A surgical approach less commonly
done, a stone breaking laser instrument is passed directly into the
kidney through an incision and tube placed in the patient's back. This
is usually done for very large stones that can not be treated in any
other fashion. The patient is usually admitted into the hospital and will
stay 1-2 days depending on recovery.
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Urethral Stricture
1. What is a Urethral Stricture?
A urethral stricture is a narrowing of the urethra. Urethral strictures
are more common in men. Some possible causes are: trauma in the pelvic area,
sexually transmitted diseases, tumors in the area, swelling or scar tissue.
2. What are the signs and symptoms?
- Slow stream of urine
- Painful urination
- Difficulty urinating
- Blood in urine
- Abdominal pain
- Discharge
3. How are Urethral Strictures treated?
Once the urologist has diagnosed a urethral stricture, the stricture
may need to be dilated. This is accomplished by passing a urethral dilator
or possibly incising the stricture with a small blade using a cystoscope.
More severe cases my require open surgery. A dilation may have to be
repeated if the stricture re-occurs.
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Urinary Incontinence
1. What is Urinary Incontinence?
Urinary incontinence is the inability to stop the loss of urine.
This is not "normal" at any age beyond the toilet training stage.
Loss of bladder control is a common problem, shared by millions of Americans.
2. What are the different types of Incontinence?
Urge Incontinence: The inability to hold urine long enough to reach
a toilet. There is a strong and sudden urge to urinate followed by an
involuntary loss of urine. People who suffer from urge incontinence say
the need to void comes with little warning and may be present both day
and night.
Stress Incontinence: The involuntary loss of urine during coughing,
sneezing, laughing or other physical activities. The amount of urine
lost may vary from dribbling to gushes of urine.
Factors associated with stress incontinence include weak pelvic muscles due to:
- Lack of exercise
- Overweight
- Strain of continuous coughing
- Injury to the pelvic muscles
- Complications of surgery involving the pelvic muscles or urethra
Overflow Incontinence: The bladder is unable to empty completely.
A relatively large amount of urine is left in the bladder after urinating
and may "overflow" causing leakage.
3. How is Urinary Incontinence diagnosed?
A thorough medical history and a complete physical exam will be
conducted by your doctor. The doctor will need a detailed account from
you to accurately diagnosis your problem. The physician will order
laboratory and imaging tests. Further diagnostic testing may be done
with Urodynamics testing.
4. How is Urinary Incontinence treated?
Treatment of incontinence, non-invasive or surgical is dependent
upon what type of incontinence a patient has.
Non-invasive
Healthy bladder habits: The following are steps that can be taken
to add in proper bladder function:
- Practice healthy toilet habits. Try not to go to the toilet "just
in case." This may result in perpetuating the need to go to the bathroom
more frequently. Avoid straining when you are passing your urine.
Maintain healthy bowel habits. Constipation can adversely affect your bladder.
- Maintain an adequate fluid intake. Try to drink 6 - 8 glasses of fluid
per day. Do not drink large quantities of caffeine and alcohol.
- Try to maintain an ideal body weight.
Bladder Training Program: Bladder training can help individuals with the
symptoms of urgency and frequency. The idea behind a bladder-training program
is to gain control over your bladder. It involves a variety of components,
including maintaining a voiding diary to assess baseline bladder habits and
capacity. One technique applies delaying exercises over a period of time.
This is a program that works best with regular meetings with a healthcare
professional for guidance and education.
Biofeedback & Electrical Stimulation: This involves using a small vaginal
or anal probe that allows the patient to see that activity of their pelvic
muscles on a computer screen. The patient is then taught to physically
identify the pelvic muscles and methods to strengthen and prolong their
contractions. Low-grade electrical stimulation, utilizing the same type of probe,
may also be utilized to help re-train the bladder.
Oral Medications: Due to the different types of incontinence there are many
medications that can be prescribed to the patient. Medications can be used in
conjunction with other treatment options or by themselves. These are often
prescribed for urge incontinence.
Surgical
Surgical Procedures: Varied types of procedures will be dependent upon the
need of the individual with incontinence. Some of the procedures restore
the bladder function by lifting the bladder neck and urethra into its normal
position. While other procedures create a seal that stops the leaking of
urine by injecting material into the urethra. The urologist will determine
the appropriate surgical procedure. The following are some of the surgical procedures:
- Bladder Neck Suspension
- Sling Procedure
- Retropubic Suspensions
- Contigen Treatments
- Carbon Treatments
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Urinary Tract Infections (UTI)
1. What are the causes of a UTI?
An infection occurs when bacteria invades the urethra and start multiplying.
If the infection remains localized to the urethra, it is called urethritis;
if the bacteria enters and invades the bladder, the ensuing infection is called
cystitis. Finally, the infection can travel up the ureters to involve one or
both of the kidneys and is called pyelonephritis.
In addition to bacteria, other microorganisms can cause infections of the urinary
tract. The most frequently encountered are Myocoplasma and Chlamydia that usually
cause an infection of the urethra and/or the prostate in men and/or the pelvic
organs in women. They are usually sexually transmitted and require treatment
of both partners.
Normally, the act of urination will wash invading bacteria out of the urethra
to help prevent infections
2. What are the symptoms of a UTI?
- Frequent urination
- Urgency of urination
- Burning during urination
- Pain in the lower abdomen
- Pain in back or side
- Frequent urination at night
- Pelvic discomfort
The urine may appear:
- Discolored
- Cloudy
- Brownish or reddish
If the kidneys are involved:
- High fever
- Overall bad feeling
- Nausea
- Vomiting
3. How is a UTI diagnosed?
A "Clean Catch" or catheterized urine sample
4. How is a UTI treated?
Urinary tract infections usually require treatment with antibiotics
that are often selected according to the sensitivity test done in the
office. Most UTI's are treated with short courses of antibiotics usually
only one to three days. However, some infections require treatment for
one to two weeks.
Treatment of urinary tract infections involve not only an antibiotic but
also measures to alleviate the discomfort that may be caused by a UTI.
Warm tub baths or sitz baths can often be beneficial as can heating pads.
Avoidance of urinary tract irritants such as caffeine, alcohol and spicy
foods can also help alleviate some of the symptoms.
5. Infections in Pregnancy
Urinary tract infections in pregnant women require prompt treatment as
the infection can be serious - either for Mom or the baby. There are antibiotics
that can be used that are safe for both Mom and baby
6. Recurrent Urinary Tract Infections in Women
Women are at risk for developing recurrent urinary tract infections
primarily because of the short length of the urethra and the proximity
to the anus and vaginal areas. It is estimated that four out of five who
develop a urinary tract infections - usually cystitis - will have another
episode of urinary tract infections even more often. Three or more infections
per year usually require evaluation by a urologist.
Women who have recurrent urinary tract infections can take steps on their
own to avoid infection which include drinking plenty of water every day and
some medical professionals feel that drinking large quantities of cranberry
juice may be beneficial since it contains a substance which inhibits the
growth of bacteria. Also, the bladder should be emptied when the need to
urinate arises since holding the urine may be harmful. Wiping with toilet
tissue should be done from front to back to keep bacteria away from the
urethral area. Showers should be taken instead of tub baths and cleansing
the genital area or taking a shower prior to sexual activity can be helpful
as well as emptying the bladder shortly before and after sexual activity.
Finally, douches and feminine hygiene sprays as well as other related products
should be avoided since they can irritate the tissues of the genital area.
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