PATIENT "Dr. Robinson saved my life. He found kidney obstruction on both sides and corrected the problem with stents. He also did surgery to correct my urinary incontinence. I was very pleased with the outcome of both of these surgeries. Dr. Robinson and his entire staff answered all my questions and really put me at ease " Bladder Overview Urethral Stricture
|
 GENERAL UROLOGY FAQ
A: Although females experience some of the same problems that men experience such as urinary tract infections, kidney stones, congenital urinary abnormalities, urologic malignancies, and primary kidney diseases, there are some Urology problems unique to females due to the anatomic developmental differences between men and women. Q: What are some common female Urology problems? A: Some common female Urology problems are as follows: 1. Urinary Tract Infections (UTIs) Q: How common are UTIs? A: Urinary Tract Infections account for approximately 7 million visits to physicians' offices, and necessitate or complicate over 1 million hospital admissions in the United States annually. UTIs are more common in women than in men, except in the neonatal period. Q: Why are women more prone to UTIs than men? A: Women are more prone to UTIs than men due to the close proximity of the urethra, vagina, and rectum. Surveys have shown that 1% of school girls age 5-14 years have bacteria in the urine. This figure increases to about 4% by young adulthood. Q: How does bacteria get into the urinary tract? A: Most bacteria enter the urinary tract from the fecal reservoir, entering the urethra into the bladder. Bacteria can also enter through the blood where the kidney is occasionally secondarily infected with Staphylococcus or the fungus Candida. A less common source of bacteria is direct extension from adjacent organs via lymphatics, such as a severe bowel infection or retroperitoneal abscess. Q: What are the most common bacteria found in UTIs? A: As mentioned previously, most UTIs are caused by facultative anaerobes from the bowel flora. Escherichia coli is the most common cause of UTIs, accounting for 85% of community-acquired and 50% of hospital-acquired infections. Other gram-negative Enterobacteriaceae, including Proteus and Klebsiella, and gram-positive Enterococcus faecalis and Staphylococcus saprophyticus, are responsibile for the remainder of most community-acquired infections. Nosocomial infections, or hospital-acquired UTIs, are frequently caused by Enterococcus faecalis as well as Klebsiella, Enterobacter, Citrobacter, Serratia, Pseudomonas Aeruginosa, Providencia, and Staph Epidermidis. Q: Are bladder infections and UTIs the same? A: No. Although it has become commonplace among some physicians to lump all UTIs together, a more specific classification is uncomplicated and complicated or lower tract vs upper tract (cystitis vs pyelonephritis). Cystitis is an uncomplicated UTI confined to the lower urinary tract (bladder and urethra), whereas a complicated UTI involves the upper tract (kidneys) commonly referred to as pyelonephritis. Pyelonephritis is more serious and usually involves fever and flank pain. Lower tract UTIs are characterized by irritative voiding symptoms such as frequency, burning on urination, urgency, and sensation of incomplete voiding. Complicated pyelonephritis can lead to bacteria in the blood stream with fever and vascular collapse (sepsis). If untreated, sepsis can lead to death. Q: How do you diagnose UTIs? A: For patients with urinary symptoms the following should be done:
Q: Are radiological studies necessary for UTIs? A: Radiology studies are unnecessary for evaluation of most patients with UTIs; however, in certain cases they may be useful to determine if further intervention is necessary and to find the cause of the complicated infection. Examples of such cases are: UTI associated with possible urinary traction obstruction; persistent UTI (pyelonephritis) unresponsive to medication after one week, patients with papillary necrosis, diabetes, on dialysis, T.B., proteus or fungal infection; or persistent-recurrent UTIs. Patients with persistent pyelonephritis often have perinephritic or renal abscesses. Q: What are some of the useful radiology tests and how are they different? A: These tests are as follows:
Q: How do you treat UTIs? A: The mainstay of treatment is antibiotics. However, a source should be sought for recurrent, persistent, or complicated UTIs and corrected: e.g., obstruction from urinary stones, congenital urinary tract anomalies, indwelling catheters, diabetes, and spinal cord injury. Q: What antibiotics and do you use and how long do you treat UTIs? A: The treatment is dictated by the category of infection. For uncomplicated lower tract infections such as cystitis, Trimethoprim-sulfamethoxazole and trimethoprim for three days is usually effective in young women. The fluoroquinolones are also highly effective but more expensive. Uncomplicated upper tract infections (pyelonephritis) usually respond to the above antibiotics and should be treated for at least 14 days. Complicated pyelonephritis should be treated for at least 21 days, guided by urine and blood cultures. Q: What are recurrent UTIs and why is it important to distinguish between recurrence and reinfections? A: Recurrent UTIs are usually new infections from bacteria outside the urinary tract (re-infection). Recurrent infections due to the re-emergence of bacteria from a site within the urinary tract (bacterial persistence) are uncommon. The distinction between re-infection and bacterial persistence is important in management because women with re-infection usually do not have an underlying alterable urologic abnormality and usually require long-term medical management. Conversely, patients with bacterial persistence can usually be cured of recurrent infections by identification and surgical removal or correction of the focus of infection. Q: Does menopause cause increased UTIs? A: Post-menopausal women do have frequent re-infections usually due to increased residual urine after voiding, which is often associated with bladder and uterine prolapse. Also, the lack of estrogen causes changes in the vaginal microflora including a loss of lactobacilli and increased colonization by E.Coli. Estrogen replacement will frequently restore the normal vaginal environment and allow recolonization. Estrogen replacement in these cases has decreased the re-infection rate. Q: My friend takes "preventive" antibiotics. Is that OK? A: Yes. Prophylactic therapy is effective in the management of women with recurrent urinary tract infections, with recurrences decreased by 95% when compared to controls. Prophylactic therapy requires only a small dose of antibiotics daily for 6 to 12 months. Q: What is urinary incontinence? A: Urinary incontinence is defined as the uncontrollable loss of urine. It is the most common urologic disorder affecting both men and women in the United States. Women are affected more than men in a 3:1 ratio. Q: Are there different types of incontinence? A: Yes. Urinary incontinence can be divided into seven categories as follows:
Q: What are the causes and symptoms of the different types of incontinence? A: Patients with urge incontinence may wet themselves if they don't get to the bathroom immediately, get up frequently during the night to urinate, go to the bathroom every 1 ½ -2 hours, wet the bed at night, and feel they void out of proportion to what they consume. This is due to bladder overactivity, hyperreflexia, and instability. Stress incontinence is characterized by leak of urine with exertion such as coughing, sneezing, laughing, or physical activity. These patients usually leak upon getting out of bed in the morning or when they get up from a chair. This is usually due to urethral hypermobility, intrinsic sphincter deficiency, or stress hyperreflexia. Overflow incontinence is characterized by night time frequency, prolonged voiding, weak and dribbling stream, voiding in small amounts with a sensation of incomplete emptying, dribbling throughout the day, and feeling the urge to urinate but being unable to. This is usually due to bladder outlet obstruction secondary to urethral scarring, temporary swelling after childbirth, or pelvic surgery. This results in a full bladder with constant pressure on the bladder neck causing urinary leakage. Unaware incontinence occurs from bladder overactivity, sphincter abnormality, or extra-urethral incontinence, such as in ectopic ureter or urinary fistulae. Continuous leakage may be due to sphincter abnormality, abnormal bladder contractility, or extra-urethral incontinence, as mentioned above. Nocturnal enuresis is due to sphincter abnormality or bladder overactivity. Post-void dribble results in the collection of urine beyond the external sphincter from unknown reasons, urethral diverticulum, and vaginal pooling. Extra-urethral incontinence occurs when urine is expelled outside of the urethra such as occurs in vesicouretero, or urethro-vaginal fistula and ectopic ureter. The causes of these conditions are radiation, congenital, trauma, and post-surgical or obstetric injuries. Q: What should I do if I experience some of the above symptoms and am A: Because urinary incontinence is often the source of great social embarrassment, it may be the sign of significant underlying pathology, and in most cases is successfully treatable. You should seek consultation with a Urologist experienced in managing urinary incontinence as soon as possible. Q: What's involved in the diagnostic evaluation of urinary incontinence? A: As with most medical problems, the evaluation begins with a good history and physical exam with special attention to the voiding history which may subsequently include creating a "voiding diary" and "pad test". Specific diagnostic tests may include the following:
Q: How do you treat urinary incontinence? A: Treatment of urinary incontinence depends upon the type, cause, and severity of the problem. Most importantly, the treatment of incontinence should be predicated on a clear understanding of the underlying physiology and pathology. In some cases exercising the pelvic floor muscles (Kegels, biofeedback, or electrical stimulation) or periurethral injection of collagen may suffice in mild cases of stress incontinence. In some cases medications may be effective, e.g., estrogens may be effective when stress incontinence is due to hormonal imbalance. If urge incontinence also exists, combination therapy may be necessary. In severe cases associated with anatomical abnormalities such as intrinsic sphincter deficiency, large cystoceles, urethral diverticulum, vesico-vaginal fistulae or genital prolapse, surgery may be the best option. For the neurogenic bladder, clean, intermittent self-catheterization is an option. Based on the results of your urologic evaluation, your Urologist will recommend the best management option for you. With today's advanced diagnostics and treatment options, the choice of doing nothing, wearing absorbent products, or stuffing one's undergarments with tissue/towels is usually a poor choice and unnecessary? Just say no to incontinence! Q: Is it true that today's surgery for urinary incontinence is simpler than years ago and can be done as outpatient surgery with shorter recovery time and less loss of work/personal time off? A: Yes. With today's increased technology for diagnostics and understanding of the female anatomy and physiology and improved surgical skills, most surgery for urinary incontinence can be done through minimal (key hole) incisions, with the majority of the work done transvaginally in a day surgery environment. As would be expected with minimal incisions, the healing time is quicker and the return to normal activities is shortened. |
|||||
Q: Are female Urology problems different from men? 