Common Urologic Problems

Some common urologic problems treated at Harbin Clinic Urology:

Bladder Cancer

Bladder cancer begins in the cells that line the inside of the bladder and typically affects older adults, though it can occur at any age.  Smoking is the #1 risk factor for the development of bladder cancer. Bladder cancer often causes painless hematuria (blood in the urine). This can present as bright red or cola colored urine but can also appear on a microscopic examination of your urine in the doctor’s office. Frequent urination, painful urination, recurrent urinary tract infections, abdominal pain and back pain can be other presenting signs and symptoms. Diagnosis is based upon inserting a scope into the urethra to see inside the bladder (cystoscopy), sending a sample of urine to be analyzed under a microscope to check for cancer cells (urine cytology), and imaging tests such as a CT scan that allows your doctor to better see the urinary tract and the surrounding tissues.

If an abnormal growth is identified, your doctor may pass a special scope through your urethra and into the bladder to remove the mass. This procedure is called transurethral resection of bladder tumor (TURBT). The specimen is then examined under the microscope to determine the extent of disease and to decide if any further treatment is indicated. The great majority of bladder cancers are diagnosed at an early stage when bladder cancer is highly treatable. However, even early-stage bladder cancer is likely to recur. For this reason, bladder cancer survivors often undergo follow-up screening tests for years after treatment.

Erectile Dysfunction

Erectile dysfunction (ED) is defined as the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. It affects as many as 30 million American men, with more than 50% of men 50 to 70 years. Erectile dysfunction is more often caused by physical (organic) problems than psychological (non-organic) ones. It is important to undergo evaluation for ED as it can be an indicator of underlying heart disease, diabetes or other serious medical conditions. Erectile dysfunction treatments include oral medications, vacuum erection devices, injection therapies and surgical implantation of a penile prosthesis to help restore sexual function.

Hematuria/Blood in Urine

Hematuria is the presence of blood in the urine. It can be visible and present as red or cola-colored urine known as gross hematuria.  The urine may otherwise appear normal to the naked eye but have red blood cells seen under the microscope and is termed microscopic hematuria. Several conditions can cause hematuria and are divided into either painful or painless processes. Painful hematuria can result from kidney, bladder or prostate infection, stone passage or trauma and treatment is generally limited to treating the condition. The cause for painless hematuria can include benign conditions such as medical renal disease, benign prostatic bleeding and strenuous physical exertion but also includes causes such as kidney, ureteral or bladder cancer.

Painless hematuria, whether visible or microscopic, requires a thorough evaluation. The urine is sent for cytology, a microscopic evaluation of the bladder cells looking for malignancy.  The kidneys and ureters are imaged with either a CT scan, intravenous pyelogram (an x-ray test where contrast is injected into the vein, travels to the kidney and is excreted in the urine, outlining the urinary system) or renal ultrasound. The bladder is evaluated with cystoscopy, a procedure where a camera is advanced through the urethra into the bladder and the bladder is visualized directly. In a majority of cases, no specific source of the blood is identified and the cause is termed idiopathic, meaning that no concern for a detrimental medical condition is present.  If a pathologic process is identified, then treatment based upon the cause is discussed.

Incontinence

Incontinence is the involuntary loss of urine.  Known as stress urinary incontinence (SUI),  can maneuvers that increase abdominal pressure such as coughing, bending or exercising are often the cause.  Some may feel a strong, sudden urge to urinate just before losing a large amount of urine. This is known as urge incontinence. Many may experience a combination of each, known as mixed urinary incontinence.

Incontinence occurs because of problems with the muscles and nerves that help to control and release urine appropriately. Treatment options depend upon the cause. Stress incontinence generally requires surgical intervention ranging from periurethral collagen injection to sling procedures that restore the normal support structure to the urinary system. Stress incontinence in men who have undergone prostate surgery can be managed with sling procedures and collagen, but may require placement of an artificial urinary sphincter. Urgency incontinence is managed with behavioral modification as well as medication. Urge incontinence that does not respond to these therapies is considered refractory and may require a special procedure called Interstim or sacral neuromodulation.

Kidney Cancer                

It is estimated that almost 51,000 people in the United States are diagnosed with kidney cancer each year. Many kidney cancers are detected incidentally with imaging techniques such as computerized tomography (CT) or ultrasound during evaluation for other diseases or conditions.  Kidney cancer rarely causes signs or symptoms early on but can present with blood in the urine, persistent pain in the upper back just below the ribs, weight loss, fatigue or intermittent fever. Treatment options include removing either the entire kidney or if possible, removing the tumor from the kidney. This can be accomplished either through an open incision, or laparoscopically. Other options include the utilization of freezing or heating techniques to kill the cancer cells by placing specialized needles into the tumor. Your doctor can explain each operation and discuss which is most suitable. The need for further treatment is based upon evaluating the extent of disease, also known as pathologic staging, after the tumor has been removed.

Kidney Stone

Kidney stones are one of the most painful of the urologic disorders. Stones form in the kidney and sometimes travel from the kidney down the ureter (the tube that carries the urine from the kidney) into the bladder. This can obstruct the flow of urine, thereby putting pressure on the kidney, leading to pain, nausea and vomiting.  Most kidney stones pass out of the body without intervention. Stones that cause lasting symptoms, severe pain and vomiting or other complications may be treated by various techniques.

Treatment options include extracorporeal shock wave lithotripsy (ESWL), a procedure that entails placing a machine on the outside of the body and focusing sound waves on the stone to fragment it, and ureteroscopy, placing a camera through the urethra into the bladder and then up the ureter, breaking the stone and removing it under direct vision.  Some stones may be treated medically, specifically uric acid stones.  For very large stones within the kidney, a more aggressive surgical intervention called a percutaneous nephrolithotomy (PCNL) is performed. This procedure entails developing a tract from the back directly into the kidney, then utilizing a larger camera and larger instruments to fragment and remove the stone through this tract.  Dietary and lifestyle modifications can be made so as to decrease your risk for developing kidney stones.  These include increasing daily water intake, decreasing salt intake and decreasing red meat intake.

Prostatitis

Prostatitis, an infection or inflammation of the prostate, is divided into acute or chronic and bacterial or non-bacterial. When no bacteria are present, it is termed non-bacterial prostatitis, accounting ninety to ninety-five percent of all prostatitis. When it continues to recur, it is termed chronic prostatitis. A physical exam includes checking the abdomen and pelvic area for tenderness and a digital rectal exam to palpate the prostate. Urine and prostate fluid may be collected to look for bacteria and white blood cells. Acute bacterial prostatitis may present with sudden fever, pelvic/perineal/low back pain, burning and frequency of urination, and at times, the inability to urinate.  Pain relievers and several weeks of antibiotics are typically needed for acute prostatitis. A catheter may need to be placed into the bladder if the patient is unable to void.

Chronic bacterial prostatitis develops more slowly than acute prostatitis with less severity of symptoms. Possible treatments include prolonged courses of antibiotics, anti-inflammatories and prostate relaxing medications called alpha blockers.

The signs and symptoms of non-bacterial prostatitis are similar to those of chronic bacterial prostatitis, although generally without a low-grade fever. Treatment of nonbacterial prostatitis is less clear and mainly involves relieving symptoms. Other treatment options include pelvic floor physical therapy, muscle relaxants, and at times, minimally invasive heat therapies.

Prostate Cancer

One out of six men will be diagnosed with prostate cancer in their lifetime. Prostate cancer is the second leading cancer diagnosis in men.  Screening for prostate cancer includes a simple blood test called a PSA test as well as a digital rectal exam (DRE).  PSA (prostate specific antigen) is a protein the prostate makes that is secreted into the bloodstream.  It can be elevated in prostate cancer, but an elevated PSA is not diagnostic. A prostate biopsyis performed in office to check for abnormalities found in the PSA test or on the DRE.  If prostate cancer is detected, treatment options include active surveillance, medical management, surgical removal, radiation therapy, and cryoablation (freezing the prostate). Discussions with your physician will direct the proper treatment choice for your specific situation.

Testicular Cancer

Testicular cancer arises from cells in the testicle that produce either sperm or male sex hormones. While testicular cancer is rare, it is the most common tumor in men aged 15-34 years. Presenting signs and symptoms include a lump or enlargement of the testicle, a feeling of heaviness, dull ache or pain in the scrotum/testicle, a sudden collection of fluid around the testicle and rarely, breast tenderness or enlargement. Evaluation includes a physical exam, a scrotal ultrasound and blood tests to check for specific substances that the tumors may produce in excess (called tumor markers). If a mass is detected, then surgery is performed to remove the testicle. Once the diagnosis is confirmed, evaluation includes a CAT scan of the abdomen and pelvis, a chest x-ray and a repeat of the tumor markers if they were initially elevated. After the exam your physician will determine further therapy. Testicular cancer is fortunately very sensitive to radiation and chemotherapy, and men with disease that has spread still have a high likelihood for cure.

Urinary Tract Infections

An urinary tract infection is localized to the genito-urinary system.  This system is composed of the kidneys, ureters, bladder and urethra. Any part of the system can become infected, but most infections involve the bladder. Women are at greater risk than men. A urinary tract infection limited to the bladder is also known as acute cystitis and presents with burning urination (dysuria), frequency and urgency of urination with small volume voids, pelvic/suprapubic pressure and, occasionally, blood in the urine. The elderly or immune compromised may have confusion or altered mentation. Diagnosis is based on performing a chemical and microscopic analysis in the office. A urine culture confirms the diagnosis while also providing the type of bacteria and a listing of antibiotics to properly treat the infecting organism. A short course of oral antibiotics is the typical treatment. A urinary tract infection involving the kidneys can be quite serious, causing high fevers, chills, and upper back pain. This type of infection may require hospitalization and intravenous (IV) antibiotics to resolve.

Recurring bladder infections are not uncommon and the workup includes radiologic imaging to rule out kidney stones or obstruction, bladder imaging to ensure complete bladder emptying and cystoscopy to exclude abnormal bladder anatomy.