Nearly 50% of post-menopausal women
suffer from stress urinary incontinence.
Fortunately, there are treatment options.

If you have stress incontinence, you may leak urine
when you cough, laugh, exercise, or do similar things.
Fortunately, there are treatment options.

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MEDICAL UROLOGY

We are dedicated to providing quality, patient-centered care and offer tailored treatment options for a range of urological problems and conditions.

LEAKY BLADDER (URINARY INCONTINENCE)

What is continence? Continence means control, specifically control over your urination or defecation. If you are continent of urine, it means that you can hold your urine until you make it to the toilet. If you are incontinent of urine, you cannot hold your urine and either experience leakage or full-blown wetting accidents. There are four types of Urinary Incontinence: Stress Urinary Incontinence, Urgency Urinary Incontinence, Mixed Urinary Incontinence and Overflow Urinary Incontinence.

What is Stress Urinary Incontinence (SUI)?

Stress Urinary Incontinence (SUI) is loss of urine from the bladder with activities such as coughing, sneezing, laughing, or jumping etc. Stress refers to pressure on your bladder, not mental stress.

What causes SUI?

There are multiple risk factors for the development of SUI, and usually several are possible in any woman who suffers from this type of leakage. Some of these risks women have no control over such as: gender, race, and genetic factors. Other risks are related to lifestyle and may be in a woman’s ability to change such as: smoking, chronic cough, chronic constipation, and obesity.

 

In a woman’s life, some things happen to her pelvis that can incite SUI such as: childbirth, hysterectomy, vaginal surgery, radical pelvic surgery, radiation and pelvic injuries. Although urinary incontinence is not a normal part of aging, as we age problems such as dementia, debility, disease, and medications may lead to decompensation of the brain and/or bladder which in turn can cause urinary incontinence.

How does SUI happen?

SUI happens due to problems in the things that are supposed to keep the urethra (the tube that connects the bladder to the outside of our body) closed during activities. The urethra is supported by a “hammock” of tough tissue. This hammock is also dependent on ligaments that attach the urethra to our part of the pelvic bone and a muscle of the pelvic floor called the pubococcygeus. The urethra itself is composed of several layers of muscle, blood vessels, and other tissue that is also important for maintaining control of leakage. When there are activities that cause an increase in the pressure in the abdomen (what is meant by “stress”) the urethra gets closed by the hammock. However, if the strength of any of these components (hammock, ligaments, pubococcygeus, urethra itself) is poor, urine leakage may occur during certain activities.

How is SUI Treated?

A number of treatment options exist for SUI and range from conservative nonsurgical treatments to surgical treatments.

 

Behavioral therapy is the least invasive therapy. It includes education about healthy bladder habits and urinary incontinence, keeping fluid intake and urinary output diaries (bladder diaries), performance of bladder training regimens, pelvic floor muscle exercises (also called Kegel exercises), and possible pelvic floor physical therapy.

 

Medications are not used commonly for SUI because there are no effective medications available specifically for SUI.

 

Incontinence pessaries are plastic devices that are worn in the vagina to compress the urethra to prevent leakage during activities. They are a barrier method that does not correct leakage but helps to control it. Pessaries must be removed and cleaned regularly.

 

Urethral patches and inserts are also barrier devices that are for temporary or occasional use. Urethral inserts are more occlusive than patches but are associated with a higher rate of urethral irritation and infection.

 

Urethral Bulking Agents are a minimally invasive option for SUI. They are materials that are injected with a cystoscope (bladder scope) beneath the lining of the urethra. Once injected, the bulking agent works by increasing the resistance within the urethra. In some cases, the injections are performed in the doctor’s office with the use of local anesthesia, meaning just a shot of lidocaine similar to getting a shot before a dental procedure. Often a series of injections delivered over time is necessary to get the best results. The injections are usually well tolerated and while there may be some decreased urinary flow for 24 hours, there is no risk of permanent inability to urinate. Success rates with bulking agents vary and seeing improvement in leakage is a more likely outcome than getting completely dry. Studies suggest 25% of women will get dry, and 50% will be improved. The remaining 25% fail to get any response to bulking agents. Unfortunately, it is not possible to determine how a woman will respond to bulking agents before using them. Bulking agents are temporary. They will lose their effect over time and require retreatment. Bulking agents fill an important need for the woman who cannot have a larger surgery or who cannot afford the recovery time associated with any surgery.

 

Surgery is the most invasive treatment option for stress urinary incontinence, but it is also the most effective. It is the most likely to make a woman dry. However, it is associated with greater risk than the nonsurgical options. The most common surgery performed today is a synthetic sling procedure. Slings are strips of tissue or material that are placed beneath the urethra to act as a support for the urethra. Not all slings are the same. Some may be made of synthetic or man-made material while others may be made out of biologic tissue such as the patient’s own tissue known as an “autologous fascial sling” or tissue from a pig (porcine dermis) or a cadaver.

 

Midurethral synthetic slings: Even among synthetic slings, there are several types available: retropubic, transobturator, or “mini- sling.” Retropubic slings have a good rate of cure in the short term, with about 94% of women being dry at 1 year. The rates of dry drop in the longer term to about 85% of women being dry beyond 10 years; however, this is still a better dry rate than can be achieved with other treatments. Transobturator slings have not been used quite as long as the retropubic ones, but published studies suggest that they are as good as the retropubic type. Mini-slings are the newest, and data on them is looking promising, but we have not been using them long enough to compare to the others. ‘The type of sling may not matter, but it is important that the synthetic sling be made of Type I mesh. Midurethral synthetic slings have become popular because of their good results, short operative time, and easier recovery than more invasive procedures. Patients will go home after a midurethral sling surgery most of the time.

 

Autologous fascial slings: These procedures have been the traditional gold standard surgery for stress urinary incontinence but are associated with a longer recovery time and slightly increased postoperative pain. Most patients stay at the hospital overnight and are discharged the next day. The same potential risks exist for this sling as for the synthetic ones. Additionally, the harvest site has its own set of risks such as hematoma, seroma, pain, hernia. A delay in the time to onset of normal voiding is greater with an autologous sling than the synthetic ones, but the rates of urinary retention requiring intervention are the same. In most cases, an autologous sling will be chosen for the patient who has a very fixed urethra or very poor/thin vaginal tissues, multiple failed procedures, or a complication from mesh in the past.

 

Retropubic bladder suspension: This procedure, also known as a “Burch procedure” is another operation with good cure rates. It is performed less frequently because it is more invasive than current synthetic slings and has a longer recovery time. It remains a good procedure and may most commonly be chosen if an abdominal hysterectomy is being done.

 

Whether a sling or a retropubic bladder suspension is chosen, the risks of surgery are very much the same. The risks include: infection, bleeding, damage to adjacent organs such as bowel, bladder, urethra or blood vessels, failure to control the stress leak, the development of bladder overactivity, or urinary retention, need for other surgery due to complications, pain, pain with intercourse, extrusion of the sling in the vagina, or erosion of the sling into the urinary tract. The rates of these risks are low.

What is Urgency Urinary Incontinence (UUI)?

Urgency Urinary Incontinence (SUI) is loss of urine with a sudden uncontrollable desire to urinate. Women describe having to rush to the bathroom but not quite making it there, or putting the keys in the door, turning the lock and losing their bladder control right there on the doorstep.

What causes UUI?

Urgency incontinence is usually caused by a bladder spasm or involuntary bladder contraction. The uncontrollable spasm causes a sudden urge to urinate that cannot be ignored or suppressed which then leads to a gush of urine leakage. Classically, a woman describes leakage as she “puts the keys in her door at home” or as she is “pulling her pants down at the toilet.” However, urge leakage can occur at any time.

 

Why involuntary bladder contractions occur in the otherwise healthy woman is not known. The mechanism of what causes the spasm to occur is not clear. Prevailing theories target both the bladder muscle and nerves. In cases of men and women with brain or spinal cord disorders such as stroke, multiple sclerosis or spinal cord injury the impaired central nervous system causes the lack of control over the bladder muscle.

What are the treatments for UUI?

Since we do not know exactly what causes urgency incontinence or involuntary bladder spasms, we do not have a cure. Instead, our treatments suppress the symptoms and spasms.

 

Medications are standard first-line treatment for urgency incontinence. They relax the bladder muscle allowing it to hold more before giving the person the sensation of needing to urinate, preventing unwanted bladder contractions that might cause leakage and giving the person more time to get the bathroom. The most common side effects caused by these medications include dry mouth, constipation, and blurry vision. Occasionally the side effects are bothersome enough that a medication will be changed. Rarely, a patient is allergic to these medications. When medications do not control the patient’s urgency incontinence, or the patient cannot tolerate them, other options are available.

 

Pelvic floor muscle exercises are used for urinary urgency, frequency and urgency incontinence as well as for stress urinary incontinence. Although we usually describe these exercises as strengthening the muscles around the urethra that control our urine flow, exercising these muscles also helps to calm the bladder by sending a feedback message to the brain through the nervous system. This feedback message to the brain is, “Keep the bladder quiet!” Exercising the pelvic floor muscles is helpful not only for stress urinary incontinence but urgency incontinence too.

 

Sacral neuromodulation, marketed under the name of Interstim, has been FDA approved since 1997 for urge incontinence and since 1999 for urinary retention and urgency-frequency. It is effective therapy in many patients even some who did not do well with or could not tolerate medications. InterStim therapy is a proven neuromodulation therapy that targets the communication problem between the brain and the nerves that control the bladder. If those nerves are not communicating correctly, the bladder will not function properly. The InterStim system uses an external device during a trial assessment period and an internal device for long-term therapy. In most cases patients will undergo a testing phase. During this testing phase two small wires are placed into the lower back near the tailbone. Patients are very comfortable with just local anesthesia for this testing phase. The wires are connected to an external stimulator that looks similar to a beeper. Over 3 to 5 days, patients record their urinary symptoms with the stimulator turned on. If they experience a positive response during the test, the device is surgically implanted at a later date. Complications with the implant are rare but include infection, pain at the site, failure to fully control symptoms, malfunction or lead migration, and need for revision for other reasons.

 

Bladder Botox Injections: Botox is a neurotoxin, and the same one that causes botulism. In controlled doses it has been used for spastic muscles in the eye and extremity, and its use in the bladder for bladder spasm is well recognized among urologists. It is injected into the bladder muscle through a cystoscope under either local anesthesia or intravenous sedation. A usual dose is between 100- 200 units which can be injected in 10-20 sites on the bladder wall. Injections may take as few as 15 minutes to complete, and the duration of effect is from 6 to 9 months. Potential risks of injection include infection, bleeding, failure to control symptoms, or urinary retention.

What is Mixed Urinary Incontinence (MUI)?

Mixed Urinary Incontinence (MUI) is a combination of both stress and urgency urinary incontinence. It is common for women to have mixed symptoms.

What is Overflow Urinary Incontinence ?

Overflow Urinary Incontinence is urine loss that occurs as a result of the bladder becoming overly full and occurs in women who have problems with emptying their bladders. Overflow incontinence may occur in the diabetic woman a result of diabetic nerve damage. It may also be seen in the woman who has loss of bladder stretch as a result of pelvic radiation. It may also occur due to obstruction after surgery to correct stress urinary incontinence.

DIFFICULTY EMPTYING BLADDER (URINARY RETENTION, UNDERACTIVE BLADDER)

Urinary retention is a neurogenic bladder condition in which you aren’t able to empty your bladder completely – or at all. You may hesitate before urine flows, or you may have to push urine out. Your urine may only come out in dribbles.

What are causes of Urinary Retention?

Several muscles and nerves must work together for your bladder to hold urine until you are ready to empty it. Nerve messages go back and forth between the brain and the muscles that control bladder emptying. If these nerves are damaged by illness or injury, the muscles may not be able to tighten or relax at the right time.

 

In people with urinary retention, the bladder muscle is underactive. It will not squeeze when it is filled with urine and won’t empty fully or at all. The sphincter muscles around the urethra also may not work the right way. They may remain tight when you are trying to empty your bladder.

How is Urinary Retention diagnosed?

Urinary retention involves the nervous system and the bladder. Your health care provider will conduct different tests to determine the health of both.

 

Medical History. Your health care provider will ask you a number of questions to understand your medical history. This should include information about the symptoms you are having, how long you have had them, and how they are changing your life. A medical history will also include information about your past and current health problems. You should have a list of the over-the-counter and prescription drugs you usually take. Your health care provider should also ask you about your diet, and about how much and what kinds of liquids you drink during the day.

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Physical Exam. Your health care provider will examine you to look for something that may be causing your symptoms. In women, the physical exam will likely include your abdomen, the organs in your pelvis and your rectum. In men, the physical exam will include your abdomen, prostate and rectum.

 

Bladder Diary. You may be asked to keep a bladder diary, where you will note how often you go to the bathroom and any time you leak urine. This will help your health care provider learn more about your day-to-day symptoms.

 

Other Tests:

  • Urine culture. Your health care provider may ask you to leave a sample of your urine to test for infection or blood.
  • Bladder scan. This type of ultrasound shows how much urine is still in the bladder after you go to the bathroom.
  • Cystoscopy. During this test, the doctor inserts a narrow tube with a tiny lens into the bladder. This allows them to rule out other causes of your symptoms.
  • Urodynamic testing. These tests check how well your lower urinary tract stores and releases urine. There are several urodynamic tests you may be asked to take. You may be asked to urinate into a special funnel to see how much urine you produce and how long it takes. You may have a catheter inserted in your bladder to drain your bladder or to add water to it and check the resulting pressure.
  • Imaging. Your health care provider may need to do additional imaging tests such as x-rays and CT scans to diagnose your condition. You may also be referred to a specialist for an exam that may include imaging of the spine and brain.

How is Urinary Retention treated?

Underactive bladder is a serious condition, but when it is watched closely and treated the best way, patients can see large improvements in their quality of life.

 

Specific treatment will be decided by your health care provider based on:

  • your age, overall health and medical history
  • the cause of the retention
  • the type of symptoms
  • the severity of symptoms
  • your tolerance for certain drugs, procedures or therapies
  • their expectations for the course of the condition

Treatment may include:

    • Lifestyle
      • Scheduled voiding
      • Double voiding
      • Bladder diary
      • Dietary changes
    • Medication
    • Catheters:
      • Clean intermittent
      • Continuous
    • Surgery
      • Artificial sphincter
      • Urinary diversion
      • Bladder augmentation
      • Sphincter resection/sphincterotomy

What can I do?

Talk to your health care provider about any symptoms you have. Find out what can be done to manage your symptoms. When given treatment choices, think about what will work best for you and your lifestyle.

OVERACTIVE BLADDER (URINARY URGENCY, URINARY FREQUENCY)

Overactive Bladder (OAB) is a complex condition affecting about 15 percent of women across all ages. It can be costly, embarrassing and result in avoiding social activities for fear of leakage. Age increases the risk for OAB as do some bladder conditions (infection, bladder stones, or abnormal growths). For some women, the cause is unknown.

How do I know if I have OAB?

Women with OAB feel a sudden urge to urinate, sometimes followed by leaking. Some women leak on the way to the bathroom, or while they are pulling down their clothes. It is common to feel the frequent urge to go even though your bladder isn’t full.

 

Made of muscle, the bladder walls hold urine. As urine flows into the bladder, the walls expand to make room for more fluid, like a water balloon. The muscles that surround the urethra, the tube you urinate from, tighten to hold in urine while the bladder muscle relaxes.

 

When you urinate, your brain signals the urethra and pelvic floor muscles to relax. The bladder muscle squeezes, pushing the urine out of the body. Typically, women urinate four to seven times per day and one time at night.

 

In women with OAB, the bladder muscle is overactive and squeezes too often. These bladder spasms make it feel like you need to urinate often and quickly, even if there isn’t much urine in your bladder.

How is OAB diagnosed?

It can feel embarrassing to have these bladder issues. You are not alone. As a first step to taking. Back your life, talk to your medical provider or bladder specialist like a urogynecologist or urologist. Discuss when and how often you leak urine. A physical exam helps identify other conditions that influence the bladder, such as prolapse.

 

Additional tests might include:

  • Urine analysis to check for a urinary tract infection and blood in your urine.
  • Ultrasound to assess how much urine remains in your bladder after urinating.
  • Urodynamics to provide information on your bladder and urethra.

 

You may also be asked to complete a bladder diary. This requires you to record what, how much, and how often you drink. You also measure the amount you urinate. This will help your provider learn more about your bladder symptoms.

How is OAB treated?

Ask about the best treatment or combination of therapies for you. OAB can be controlled, and you can get your life back.

 

•Dietary Changes. Certain types of drinks can provoke bladder spasms. For example, coffee, tea, sodas and other beverages with caffeine worsen symptoms. Artificial sweeteners, fruit juices and alcohol can also bother your bladder. Completing a bladder diary can help you look for a connection between your diet and bladder symptoms.

 

•Pads and Skin Care. Hopefully OAB treatment will reduce leakage. In the meantime, use only all-cotton or incontinence pads (not menstrual pads), which are gentle on the skin. Try to let the skin air out and dry when possible. Some women need to use a barrier cream that protects the skin near the vagina.

 

•Bladder Training. Women with OAB tend to go to the bathroom often. However, this can make symptoms worse. Your bladder learns to hold less urine, leading to even more frequent bathroom trips. Bladder re-training involves using your pelvic floor muscles and “mind over bladder” techniques to gradually increase time between bathroom visits. As you do this more and more, your bladder muscle readjusts.

 

This allows you to make fewer bathroom trips. This retraining can be hard to do – ask your doctor for a referral to a pelvic floor physical therapist to learn how to do it.

 

•Medicines. OAB medicines help your bladder hold more urine for longer periods of time. They also reduce urine leakage. Potential side effects include dry mouth and constipation. There are many different medicines available. Let your doctor know how the drugs work with you. It may take trying different medicines before you find the one that works best for you.

 

•Pelvic Floor Physical Therapy. Most women find that pelvic floor muscle exercises help improve the symptoms. For the best effect, work with a specialized PT to learn the techniques. Ask your provider for a referral. Then, use the exercises every time you feel urgency. It may take 3 to 6 months of regular pelvic floor muscle exercise to see results.

 

•Botulinum Toxin (Botox). Botox relaxes the bladder muscle. This allows more urine to be held in the bladder before you have to go to the bathroom. Under a local anesthetic or sedation, your provider uses a small camera and needle to inject Botox into the bladder wall.

 

Typically, the injection needs to be repeated 1 to 2 times a year. A small number of women experience side effects, such as difficulty emptying their bladder or urinary tract infection. Ask your provider if Botox is right for you.

•Nerve Stimulation. There are many nerves involved in bladder function. Nerve stimulators help control these nerves, reducing the need to urinate often.

 

Tibial nerve stimulation is similar to acupuncture. A small needle is inserted near a nerve in the ankle and connected to an external device that delivers small pulses to the nerve. This changes the messaging to the bladder. This is done during a series of office visits.

 

Sacral nerve stimulation is a device surgically implanted near the spine. It modulates the bladder nerves.

RECURRENT URINARY TRACT INFECTIONS (BACTERIAL CYSTITIS, PYELONEPHRITIS)

Urinary tract infections (UTIs) are very common in women. About 40 percent of women will experience a UTI at least once in their lifetime. UTIs are uncomfortable but are rarely dangerous or life-threatening.

What is the Urinary System?

The role of the urinary system is to remove waste from your body. It is made up of the kidneys, ureters, bladder and urethra.

  • The kidneys filter waste from your blood and make urine.
  • The ureters are long, thin tubes that carry the urine from the kidneys to the bladder.
  • The bladder is a muscular pouch that expands to store the urine.
  • The urethra is the tube that carries the urine from the bladder to the outside of the body.

What are UTIs?

A UTI is the abnormal growth of bacteria anywhere along the urinary tract combined with symptoms. The most common site for these to occur is the bladder. UTIs can go by several names, including:

  • Cystitis is an infection of the bladder.
  • Urethritis is an infection in the urethra.
  • Pyelonephritis is an infection of the kidneys.

 

Women are at higher risk for UTIs because the urethral opening is located near the anus. The female urethra is about two inches long, so bacteria from the colon and vagina are sometimes able to enter the urinary tract. The good news is that UTIs are rarely serious in healthy women and can easily be treated.

Who is at higher risk for UTIs?

•Sexually active women

•Pregnant women

•Menopausal women – After menopause the level of estrogen drops in a woman’s body. This results in changes to the vaginal pH. This can change the types of bacteria that live in the vagina to those more likely to cause UTIs.

•Women with diabetes or other health conditions that decrease their body’s ability to fight infection

 

Surgeries performed on or near your urinary tract increase your risk for developing a UTI. If you have a catheter placed during surgery or if you need to use a catheter after surgery to help you empty the bladder, you are at increased risk for getting a UTI.

How are UTIs diagnosed?

Your health care provider will first ask about your symptoms. Then, to confirm the diagnosis, a urine test is usually done. Your urine is tested for components like blood, bacterial byproducts and cells that indicate infection. This test can be done quickly in the office, and then a urine culture may be performed to determine the type of bacteria present as well as the best antibiotic to use.

How are UTIs treated?

An uncomplicated UTI is usually treated with oral antibiotic pills. The specific antibiotic and length of treatment will depend on the type of bacteria found to be causing the infections, as well as your medical history. Women usually feel better within 24 hours of starting the antibiotic. However, it is important for you to finish taking all of the medicine. If you stop taking the antibiotics, the infection may return. If you are pregnant, diabetic, recently had surgery, or have a kidney infection, you may need to take an antibiotic for seven to 14 days.

 

At your pharmacy, look for a medication called phenoazopyridine. It is available over the counter to soothe the burning and pain symptoms that can come with a UTI.

 

Urine culture results are usually available in 2 to 3 days. If those results show that the antibiotic you have been taking is ineffective against your infection, your provider may change the antibiotic. Sometimes, the antibiotics alone may not be enough or the infection may have spread since your urine test was done. Call your health care provider if your symptoms do not get better, if you have a fever or chills, or if you experience increasing pain in your back and pelvic area.

What are Recurrent UTIs?

If you have three or more UTIs in a year, that is called having “recurrent UTIs”. This can be very frustrating. Recurrent UTIs appear to run in families. Other risks include being sexually active and using a diaphragm or spermicide. Women who have recently had pelvic surgery or used a catheter are also at risk.

 

After a thorough pelvic exam to look for anatomic causes or UTIs, your provider may recommend additional evaluation with a urogynecologist or urologist. You may need a cystoscopy, which is a procedure performed in the office that allows your doctor to view the inside of your bladder using a special camera. You may also need an ultrasound or CT scan to examine your kidneys.

 

There are steps you can take to help prevent recurrent UTIs. Speak with your doctor about:

  • Using vaginal low-dose estrogen
  • Consuming probiotics, cranberry juice or cranberry tablets
  • Using urine sterilizing pills or taking a low dose of an antibiotic after sex or daily for several months

UNEXPLAINED BLOOD IN THE URINE (HEMATURIA)

Hematuria is the diagnosis of blood in urine. Sometimes it can simply be seen as pinkish urine, but other times it can only be seen with a microscope. With hematuria, you may not have other symptoms, or you may feel pain. But, it is not normal to find blood in your urine, so it’s important to find the cause.

What are the types of Hematuria?

There are two types of Hematuria:

  • Gross Hematuria: Red blood cells (RBCs) give urine a pinkish, red or cola coloring. Even a small amount of blood can cause urine to change color. Gross hematuria is often from problems in the lower part of the urinary tract, such as the bladder or prostate, but can also come from the kidney. Causes can be from an injury, infection or normal menstruation (a woman’s menstrual “period”).
  • Microscopic Hematuria: RBCs may not be seen at all, only under a high-powered microscope. There may be no other signs. Microscopic hematuria could come from anywhere in the urinary tract, from the kidney to the urethra.

What causes Hematuria?

It’s important to find the cause of hematuria. Most causes are not serious, but some could be, like cancer.

 

Hematuria can be from a non-serious (benign) cause:

  • Menstruation
  • Vigorous exercise
  • Sexual activity
  • Viral illness
  • Kidney stones
  • Trauma
  • Infection (like a bladder infection or urinary tract infection [UTI])

 

Or from a more serious cause:

  • Inflammation of the kidney, urethra, bladder or prostate
  • Polycystic kidney disease
  • Blood clots or bleeding disorders, such as hemophilia
  • Sickle cell disease
  • Cancer of the kidney or bladder

What are risk factors for Hematuria?

There are many reasons why you may have blood in your urine, they can include:

 

  • Cigarette smoking (past or current)
  • Exposure to chemicals in the workplace
  • Radiation for cancer in the pelvic area
  • Ongoing pain, infection or past pelvic disease
  • Urinary tract infections that don’t go away

How is Hematuria diagnosed?

Health care providers will first ask about your health history. They want to learn about your physical health, symptoms and risks. They’ll want to know about infections, menstruation (period), kidney stones, drugs, smoking or a recent injury. Urine tests will be ordered, maybe over a period of time, to see signs of blood in the urine.

 

A dipstick test will find RBCs. Then the urine must be looked at under a high-powered microscope to diagnose microscopic hematuria.

 

The next step is to diagnose the cause:

  • Urinalysis. The urine can be tested to find cancer cells, infection or kidney (renal) disease. For example, this test can find white blood cells to signal a UTI; or odd, clumped RBCs or certain proteins to signal kidney disease.
  • Blood test. A blood test can show kidney health. For example, high levels of the protein creatinine, shows kidney disease.
  • Cystoscopy. Cystoscopy looks inside the urethra and bladder to confirm cancer cells or other issues in the bladder. This test should be done with patients who have risk factors for kidney and urinary tract problems.
  • Kidney imaging tests. Imaging tests with or without contrast dyes. They can show a tumor, a kidney or bladder stone, an enlarged prostate or other urine flow blockage. These tests include ultrasound, multi-phasic computed tomography (CT) urography, retrograde pyelograms (RPGs) and/or magnetic resonance imaging (MRI).

 

Sometimes it is not clear why microscopic blood is found. In this case, your doctor may test your urine each year. If blood is still seen, tests may be repeated until the cause is found. If no more blood is seen, then testing may only be repeated 4-5 years later.

How is Hematuria treated?

If you have microscopic hematuria, most causes are not life threatening. It helps to work closely with your health care provider to learn the cause to treat the problem.

 

Hematuria is managed by treating its underlying cause:

  • If no serious condition is causing hematuria, then no treatment is needed.
  • Hematuria caused by a UTI is treated with antibiotics. A follow-up urinalysis should be done after treatment. It’s important to confirm that the infection is gone.
  • If hematuria is caused by kidney disease, kidney stones, or blood disorders, then your treatment plan should be followed carefully. It may take time to manage your health.
  • If hematuria is caused by cancer, then more serious treatment will be needed. A second opinion with an oncologist or oncology surgeon may help. If a kidney or bladder tumor is found early, the cancer can often be cured.

KIDNEY STONES (UROLITHIASIS)

Urine contains many dissolved minerals and salts. When the urine has high levels of minerals and salts, hard stones can form. These stones can be “silent” or very painful. More than 1 million Americans will get a kidney stone this year.

What are the different types of Kidney Stones?

Kidney stones come in many different types and colors. There are four main types of stones:

  • Calcium Stones. Calcium stones are the most common type of kidney stone. There are two types of calcium stones: calcium oxalate and calcium phosphate.
  • Uric Acid Stones. Having acidic urine increases your risk for uric acid stones. Acidic urine may come from being overweight, chronic diarrhea, type 2 diabetes, gout, and a diet that is high in animal protein and low in fruits and vegetables. This is not a common type of stone.
  • Struvite/Infection Stones. These stones are related to chronic urinary tract infections (UTIs). Struvite stones are not common.
  • Cystine Stones. Cystine is an amino acid that is in certain foods; it is one of the building blocks of protein. When high amounts of cystine are in the urine, it causes cystine stones to form. Cystine stones often start to form in childhood. These are a rare type of stone.

What are symptoms of Kidney Stones?

Stones in the kidney may not cause any symptoms and can go undiagnosed. However, if a stone blocks the flow of urine out of the kidney, it can cause a lot of pain. Other symptoms of stones include:

  • A sharp, cramping pain in the back and side, often moving to the lower abdomen or groin. For men, you may feel pain at the tip of the penis.
  • An intense need to urinate or urinating more often.
  • A burning feeling during urination.
  • Urine that is dark or red due to blood.
  • Nausea and vomiting.

How are Kidney Stones treated?

Treatment depends on the type of stone you have, it’s size, location, and how long you’ve had symptoms. There are different treatments to choose from. It helps to talk with your health care provider about which option is best for you.

  • Wait for the stone to pass by itself. Often you can simply drink more water and wait for the stone to pass. Smaller stones are more likely than larger stones to pass on their own.
  • Medication. Certain medications have been shown to improve the chance that a stone will pass.
  • Surgery. Surgery may be needed to remove a stone from the ureter or kidney if:
    • The stone fails to pass on its own.
    • The pain is too great to wait for the stone to pass.
    • The stone is affecting kidney function.

How are Kidney Stones prevented?

Once your health care provider finds out why you are forming stones, he or she will give you tips on how to prevent them in the future. There is no “one-size-fits-all” remedy for preventing kidney stones. Everyone is different. You may have to change your diet or take medications. Below are some tips to help prevent stones.

  • Drink enough fluids each day (about 3 liters or ten, 10-ounces glasses).
  • Reduce the amount of salt in your diet.
  • Eat the recommended amount of calcium.
  • Eat plenty of fruits and vegetables.
  • Eat foods with low oxalate levels.
  • Eat less meat.

VAGINAL/BLADDER PROLAPSE (CYSTOCELE, RECTOCELE. UTEROVAGINAL PROLAPSE)

Under normal conditions in women, the bladder is held in place by a “hammock” of supportive pelvic floor muscles and tissue. When these tissues are stretched and/or become weak, the bladder can drop and bulge through this layer and into the vagina. This results in bladder prolapse, also called cystocele. In severe cases, the prolapsed bladder can appear at the opening of the vagina. Sometimes it can even protrude (drop) through the vaginal opening. Bladder prolapse is common in women. The symptoms of bladder prolapse can be bothersome, but it can be treated.

What are the symptoms of Bladder Prolapse?

The most common symptom is the feeling of a vaginal bulge. A bulge in the vagina is something you can see or feel.

 

Other signs and symptoms that may be related to prolapse are:

  • frequent voiding or the urge to pass urine
  • urinary incontinence (unwanted loss of urine)
  • not feeling relief right after voiding
  • frequent urinary tract infections
  • pain in the vagina, pelvis, lower abdomen, groin or lower back
  • heaviness or pressure in the vaginal area
  • sex that is painful
  • tissue sticking out of the vagina that may be tender and/or bleeding

 

Some cases of prolapse may not cause any symptoms.

What causes Bladder Prolapse?

Prolapse can develop for many reasons. The major cause is stress on this supportive “hammock” when giving birth. Women who have many pregnancies, deliver vaginally, or have long or difficult childbirth are at higher risk.

 

Other factors that can lead to prolapse are:

  • heavy lifting
  • chronic coughing (or other lung problems)
  • constipation
  • frequent straining to pass stool
  • obesity
  • menopause (when estrogen levels start to drop)/li>
  • prior pelvic surgery
  • aging

How is Bladder Prolapse diagnosed?

Prolapse can be found with a clinical history and a pelvic exam. The exam may be done while you are lying down, straining or pushing, or standing. Your health care provider may measure how serious the prolapse is and what parts of the vagina are falling.

 

Other tests and imaging studies may also be done to check the pelvic floor, such as:

  • cystoscopy
  • urodynamics
  • x-rays
  • ultrasound
  • MRI

How is Bladder Prolapse treated?

Bladder treatment options can be divided into two categories: Conservative Management and Surgery.

 

Conservative Management. Conservative measures involve:

 

  • No treatment. Some women have bladder prolapse and do not have bothersome symptoms. You do not need to treat your prolapse if it is not causing you problems or blocking your urine flow.
  • Behavior therapy. This can include kegel exercises (which help strengthen pelvic floor muscles), pelvic floor physical therapy, or a pessary (a vaginal support device).
  • Drug therapy. This includes estrogen replacement therapy .

 

Surgery. The goal of surgery is to repair your body and improve symptoms. Surgery can be performed through the vagina or the abdomen. There are several ways the surgery can be done, they include:

 

  • Open surgery. When an incision (cut) is made through the abdomen.
  • Minimally invasive surgery. Uses small incisions (cuts) in the abdomen.
  • Laparoscopic. The doctor places surgical instruments through the abdominal wall.
  • Robot-assisted laparoscopic. Robotic instruments are placed through the abdominal wall. They are attached to robotic arms and controlled by the surgeon.

 

Surgery also involves options of:

  • native tissue repair (using one’s own tissue and sutures)
  • augmentation with surgical material
    • polypropylene mesh
    • biological graft

 

Before having surgery you should have an in-depth talk with your surgeon. You should learn about the risks, benefits, and other choices for repairing cystocele with surgery. It is important that you give informed consent. This can only be done after your doctor has answered all of your questions.

 

If prolapse is left untreated, over time it may stay the same or slowly get worse. In rare cases, severe prolapse can cause obstruction of the kidneys or urinary retention (inability to pass urine). This may lead to kidney damage or infection.