FAQs: Women's Health
Cancer, Bladder Urethral Stricture
Cancer, Kidney Urinary Incontinence
Kidney Stones Urinary Tract Infections (UTI)
   


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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