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Urinary Tract Infections (UTI)
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
- 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 diagnose 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 can be non-invasive or surgical dependent upon what type of incontinence a patient has.
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 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
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.
2. What can cause Kidney Stones?
The causes of kidney stones vary, and 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 a patient experience symptoms common to kidney stones, 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, this involves a stone breaking laser instrument that 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 cannot be treated in any other fashion. The patient is usually admitted into the hospital and will stay 1-2 days depending on recovery.
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, and swelling or scar tissue.
2. What are the signs and symptoms?
- Slow stream of urine
- Painful urination
- Difficulty urinating
- Blood in urine
- Abdominal pain
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 may require open surgery. A dilation may have to be repeated if the stricture re-occurs.
Urinary Tract Infections (UTI)
1. What are the causes of a UTI?
An infection occurs when bacteria enter the urethra and start multiplying. If the infection stays within the urethra, it is called urethritis. If the infection enters the bladder, the infection is called cystitis. The infection will sometimes involve the prostate, this is called prostatitis. Last, the infection can go into the kidneys, this is called pyelonephritis. Also, other microorganisms can cause infections. Some of these are sexually transmitted and require treatment of both partners.
Normally, the act of urination will wash the 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:
- Brownish or reddish
If the kidneys are involved:
- High fever
- Overall bad feeling
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.