General Urology

What are kidney stones?

Kidney stones or calculi are solid collections of normal urinary components which have precipitated out of the urine to form crystals. The majority of stones are calcium-based but there are several other types of stones which can also occur. Kidney stone formation is often influenced by diet, fluid intake, heredity, and occasionally other medical problems. Stones are more common in men and are believed to affect roughly 5-10% of the population.

What are the symptoms of kidney stones?

Kidney stones can be asymptomatic if they are in the kidney and not causing any obstruction. As stones move around in the kidney, they may intermittently cause pain, also known as renal colic. When stones move out of the kidney and into the ureter and begin moving down toward the bladder, they may get stuck along the way and cause obstruction of the kidney. This causes the kidney and ureter to stretch which can cause severe pain, nausea, and vomiting. Stones can also lead to urinary tract infections, blood in the urine, and stones that are in the lower part of the ureter near the bladder can cause urinary frequency and urgency.

The Primary Symptoms

Overactive bladder (OAB) is a very common problem for both women and men. The primary symptoms of OAB include urinalysis frequency (having to go often), urinary urgency (having to go urgently), getting up multiple times at night to urinate (nocturia), and urinary leakage (urge incontinence) when the urge to go is so strong that patients cannot make it to the bathroom in time. Overactive bladder is extremely common but underreported as some patients feel that it is just part of aging and nothing can be done.

The Diagnosis

The diagnosis of overactive bladder is primarily done by a thorough medical history. A voiding diary may also be given to patients to help understand symptoms better and also how much fluid a patient is consuming. Urodynamics also may be used to understand the nature and severity of a patients bladder dysfunction. In this test, a nurse places a small catheter in the bladder with a pressure monitor on end of it and the bladder is then filled. During filling, the patient is asked about their urge to urinate and the catheter will measure bladder pressure. A normal bladder will not have any significant contractions until the bladder is near capacity and then the pressure increases when a patient tries to urinate. Involuntary bladder contractions or bladder spasms are the hallmark of overactive bladder. The pressure and flow rate are then measured once the bladder is full as well as how much residual is left. All of this information is used to make an accurate diagnosis and to help develop a treatment plan.

Treatment

There are multiple treatment options for overactive bladder. It is not something that patient’s need to just live with. Initial treatment often will include an assessment of diet and fluid intake to see if any behavior modifications can help prevent bladder irritation. If this does not solve the problem, a once daily medication is typically the next option. For more challenging cases that do not respond to medication, we offer bladder injections of Botox®, nerve stimulation procedures in the office, or the Interstim® device which is a outpatient surgical option for the management of overactive bladder.

What is a Urinary Tract Infection (UTI)?

A urinary tract infection (UTI) is an infection in any part of your urinary system. That can include your kidneys, ureters, bladder and/or your urethra. Most infections involve the lower urinary tract — the bladder and the urethra.

What causes a Urinary Tract Infection (UTI)?

There are many different causes of urinary tract infection and they happen in both men and women. In general however, they are more common in women and many women experience more than one infection during their lifetimes. Most infections result from the bacteria around the urethra ascending into the bladder.

• Infection of the bladder (cystitis). This type of UTI is usually caused by Escherichia coli (E. coli), a type of bacteria commonly found in the gastrointestinal (GI) tract. However, sometimes other bacteria are responsible. Sexual intercourse may lead to cystitis, but you don’t have to be sexually active to develop it. All women are at risk of cystitis because of their anatomy — specifically, the short distance from the urethra to the anus and the urethral opening to the bladder.
• Infection of the urethra (urethritis). This type of UTI can occur when GI bacteria spread from the anus to the urethra. Also, because the female urethra is close to the vagina, sexually transmitted infections, such as herpes, gonorrhea, chlamydia and mycoplasma, can cause urethritis.

Infections limited to your bladder can be painful and annoying. However, serious consequences can occur if a UTI spreads to your kidneys, so it is important to diagnose and treat a urinary tract infection correctly. Infections can also be the result of stones, foreign bodies, hormonal changes, and poor bladder emptying.

Urinary Tract Infection (UTI)

• Symptoms – Strong urge to urinate, painful urination, blood in urine, pelvic pain (women) or rectal pain (men).
• DX – Usually from a urine sample, other tests may be needed.
• TX –Usually antibiotics.

Urinary Incontinence

• Symptoms – Leaking urine; may get worse.
• DX – Tests to measure bladder capacity, bladder pressure and sphincter strength.
• TX – Depends on the degree of incontinence.Behavioral/muscle training, medication, minimal intervention/devices, surgery.
• WOMEN – Sling; pelvic floor reconstruction.
• MEN – Artificial urinary sphincter; surgical BPH intervention; urethral bulking.

Hematuria (blood in urine)

• Symptoms – Pink or red color in urine.
• DX – Check for infection, kidney problem/injury, prostate enlargement in men, other sources of irritation.
• TX – Depends on the source of the problem.

Kidney infection (can cause permanent damage if left untreated)

• Symptoms – Fever, back pain, painful or unusual urination, blood or pus in urine.
• DX – Lab tests, scan
• TX – Antibiotics.

Kidney stones

• Symptoms – Severe pain in back, groin, abdomen, blood in urine or other urinary problems.
• DX – Lab tests, imaging.
• TX – Depends on size and severity, may range from flushing out stones to hospital procedures.

Ureteropelvic Junction Obstruction

A ureteropelvic junction or UPJ obstruction is a narrowing of blockage at the point where the kidney meets the ureter. This condition can be congenital or can be caused by stones or prior surgery. If it is congenital, it may be that a segment of the ureter is narrow or the muscle does not form correctly so urine does not flow, or it may be caused by a blood vessel crossing over the UPJ. UPJ obstruction may cause abdominal or flank pain, especially after drinking a large volume of fluids as this causes stretching and dilation of the kidney. It may also lead to the development of kidney stones, infections, or even kidney failure from chronic obstruction. UPJ obstruction can be treated by the placement of a ureteral stent, by a ureteroscopic procedure called an endopyelotomy, or by performing a pyeloplasty. During a pyeloplasty, which is often performed laparoscopically or robotically, the narrowed segment of ureter is resected and the healthy edges are sutured back together to relieve the obstruction.