Urinary Tract Conditions

Overview

Your urinary system works with other organs to get rid of wastes and keep chemicals and water in the body balanced. As an adult woman, you eliminate about a quart and a half of urine each day, but the amount can vary depending on the amount of fluid and food you’ve consumed and how much you lose through sweating and breathing. Some medications can affect the quantity of urine your body eliminates.

When your body uses proteins derived from the foods you eat, it creates a waste product called urea that is carried in the bloodstream to the kidneys, two bean-shaped organs approximately the size of fists. They are located just below the rib cage near the middle of the back. Each kidney has about a million tiny filtering units called nephrons, which remove urea from the blood.

A ball of small blood capillaries (a glomerulus) and a small tube called a renal tubule comprise a nephron. The kidneys remove or return chemicals such as phosphorus,potassium and sodium in quantities needed to maintain optimal blood levels of these substances. Urea, water and other waste products create urine as the substances move through the nephrons and down the kidney’s renal tubules.

The kidney also releases three vital hormones: erythropoietin which stimulates production of red blood cells in bones; renin, a blood-pressure regulator; and the active form of vitamin D, which maintains calcium levels in bone.

Urine exits the kidneys through two thin tubes about eight to 10 inches long called ureters, which carry the fluid to the bladder, a hollow muscular organ that stores urine. Ureter muscles tighten and relax to pump urine downward and away from the kidneys. The process is more or less continuous, with minute quantities of urine emptying into the bladder about every 10 to 15 seconds. If the urine gets stuck in the ureters or backs up, a kidney infection can result.

Shaped like a balloon, the bladder sits in the pelvis and stores urine until you are ready to urinate. As it becomes fuller, it swells into a round shape and then shrinks when it is emptied. A healthy urinary system can hold up to 16 ounces of urine for two to five hours. Bladder nerves send signals to let you know when to urinate; the signals grow steadily more urgent as the bladder fills.

To keep urine from leaking, circular muscles called sphincters close tightly around the opening of the bladder. When you decide to urinate, bladder muscles tighten and sphincter muscles relax, and the urine is pushed down the urethra.

As you age, the structure of your kidneys can change, reducing their ability to remove wastes. Illness and injury can also affect the filtering ability of the kidneys or block urine’s passage. Urinary system muscles also tend to weaken as you grow older, leading to increased incidence of urinary tract infections and incontinence.

Urinary system disorders are widespread. According to the National Kidney Foundation, approximately 26 million Americans have chronic kidney disease, and most do not know it. Millions more are at risk. Incontinence and overactive bladder are two of the most common health problems among women. And 85,790 Americans died of end-stage renal disease in 2005.

Major Urinary System Disorders

Health care professionals often use the term “renal function” when talking about the kidneys; if both kidneys are healthy, you have 100 percent renal function. If one becomes nonfunctional or is donated for a transplant operation, you will still be healthy, even with only 50 percent of renal function. However, if function slips below 20 percent, serious health problems arise because the kidneys can no longer perform their function of regulating water and chemicals and removing waste. Levels below 10 to 15 percent necessitate dialysis or transplantation.

Renal function levels below 10 to 15 percent necessitate dialysis or transplantation. Unfortunately, symptoms of chronic renal failure (a gradual loss of function) may go undetected for several years and often do not become noticeable before kidney function falls to 25 percent or less.

Acute renal failure denotes a sudden onset of renal failure, such as that caused by an accident, certain drugs or poison. The kidneys may recover or the damage may be permanent. If the kidneys stop working entirely, the result is a condition called uremia, in which the body fills with extra water and waste products, leading to swelling in the hands or feet, fatigue and weakness. End-stage renal disease (ESRD) refers to when the kidneys have lost all or nearly all function.

Specific kidney conditions include:

Analgesic Nephropathy

Improper use of over-the-counter painkillers, or analgesics, can lead to kidney failure. These products include aspirin, acetaminophen, ibuprofen and naproxen sodium, all of which are safe for most people when taken at the recommended dosages. However, combining these drugs or taking them when you have certain conditions boosts your risk of kidney disease. You should avoid these medications if you have anautoimmune disease such as lupus, advanced age, chronic kidney conditions or have recently binged on alcohol.

If you have any of these conditions, make sure your health care professional and pharmacist are consulted before you risk taking an analgesic, since short-term use can cause acute (temporary) kidney failure.

Taking one or more of these products daily for several years can cause analgesic nephropathy, chronic kidney disease leading gradually to end-stage renal disease (ESRD). Combination painkillers (such as aspirin and acetaminophen) are especially dangerous. If you find you need painkillers often, talk to a health care professional about the best options for protecting your kidneys.

Cystocele

A cystocele, occurs when the pelvic floor muscles, which form the wall between the bladder and vagina, weaken, allowing the bladder to drop into the vagina. The consequences are discomfort and voiding difficulties, such as urine leakage or incomplete bladder emptying.

There are three grades of cystocele:

• Grade 1: the bladder drops a short way into the vagina
• Grade 2: the bladder sinks to the opening of the vagina
• Grade 3: the bladder bulges through the vaginal opening

Interstitial Cystitis (IC)

Interstitial cystitis (IC) may also be called painful bladder syndrome, urethral syndrome and frequency-urgency syndrome. It is an inflammatory condition of the lining of the bladder.

The inflammation associated with this chronic bladder disorder can cause diminished bladder capacity or size, glomerulations (pinpoint bleeding) and (rarely) ulcers in the bladder lining. Rarely, in severe cases, scarring and stiffening of the bladder can occur. Although the cause of this disorder is unknown, research shows that it may be associated with other diseases such as vulvodynia (vulvar or vaginal pain),fibromyalgia, irritable bowel syndrome (IBS) and endometriosis. Interstitial cystitis affects an estimated 1.3 million Americans, more than 1 million of whom are women.

Typical IC-associated sensations include discomfort, pressure, tenderness or intense pain in the bladder and surrounding pelvic area. The intensity of pain may shift as the bladder fills or empties. Other symptoms include pain associated with intercourse and frequent and/or urgent need to urinate (women with severe IC may urinate as many as 60 times a day). Symptoms often get worse before or during menstruation and after sexual activity.

No one knows for sure what causes IC; theories point to an autoimmune disease, abnormality in the urine, hereditary condition, infection or allergic condition.

Glomerular diseases

Diseases that damage the glomeruli—the kidney’s filtering units—can lead to kidney failure. Two major categories of glomerular diseases are:

• glomerulonephritis, inflammation of the membrane tissue in the kidney that filters wastes and extra fluid from the blood
• glomerulosclerosis, scarring or hardening of tiny blood vessels in the kidney

When the glomeruli are damaged, protein and blood can seep into the urine, and waste products can accumulate in the blood. If too much of the protein albumin is lost, the blood is less able to absorb extra fluid.

Glomerular diseases are indicated by:

• proteinuria
• hematuria
• reduced glomerular filtration rate (inefficient waste filtering)
• hypoproteinemia (low levels of protein in the blood)
• swelling, or edema

The diseases have many causes, including:

• Autoimmune diseases, such as lupus. Autoimmune diseases are conditions that develop as a result of the immune system attacking healthy tissue instead of combating invading bacteria or viruses.
• Hereditary nephritis, also called Alport syndrome. A family history of chronic glomerular disease or impaired vision may stem from this syndrome, and men are more likely to progress to chronic renal failure and/or vision loss.
• Infection-related glomerular disease, such as strep throat, heart infection (bacterial endocarditis), HIV or skin infection (impetigo). The kidneys usually recover from infection-related damage, but sometimes damage is permanent and ESRD results.

Hematuria

Hematuria is a term used for the presence of red blood cells in the urine. Sometimes hematuria is visible, but in many cases the urine appears normal. Hematuria is not a disease in itself, but a sign of some other condition.

The cause may be a serious one, such as bladder or kidney cancer, but more often the cause is relatively benign. Exercise can cause episodic hematuria, for example. Obvious blood in the urine is often associated with bladder infections or kidney stones. Still, you should check with a health care professional any time you see blood in your urine or follow up if a urinalysis shows red blood cells in your urine.

To identify the cause of hematuria, your doctor may order various tests, such as urinalysis, blood tests, ultrasound, intravenous pyelogram or CT urogram, or may examine your bladder with a cystoscope. If white blood cells are present in the urine, a urinary tract infection or kidney disease may be the cause.

Treatment is tailored to the cause of the hematuria. If it is not caused by a serious condition, no treatment is necessary.

End-Stage Renal Disease (ESDR) and Kidney Failure

The early stages of kidney disease may not cause noticeable symptoms. However, symptoms may include frequent headaches, fatigue or an all-over itch. Worsening disease can cause urination patterns to change (becoming more or less frequent), appetite loss, nausea and vomiting, swelling or numbness in the hands or feet, drowsiness, difficulty concentrating, skin darkening and muscle cramps. Treatment generally requires dialysis or transplant, described in the treatment section.

Diabetes is the leading cause of ESRD.

When diabetes is undiagnosed or poorly controlled, excess sugar circulates in the blood, leading to higher blood flow into the kidney and glomerular scarring. Diabetic nephropathy is the term used for such damage, which can be delayed or prevented by maintaining healthy blood sugar levels. If you have diabetes, high blood pressure or a genetic condition called polycystic kidney disease, your health care team will monitor your condition to prevent or limit the damage to the kidneys. Such damage may lead to renal failure and ESRD.

Bladder Cancer and Kidney Cancer

Signs and symptoms of bladder cancer include blood in the urine (which may be bright red or rusty in appearance or only seen under the microscope), painful or frequent urination or feeling the urge to urinate even though the bladder is empty.

Renal cell cancer is the most common form of kidney cancer. As the cancer grows, it may spread to nearby organs, such as the liver, colon or pancreas, or may disperse (metastasize) to other parts of the body. Cancer cells often spread to lymph nodes, bean-shaped organs that produce infection-fighting cells. Signs and symptoms of renal cell cancer include blood in the urine, back or abdominal pain, or a mass on the kidney. Many kidney cancers are diagnosed by ultrasound or CT examination performed for other medical reasons.

Kidney or Ureter Stones

Stones, or calculi, are usually formed in the kidneys but may be found anywhere in the urinary system. Stones are among the most painful and most common urinary tract disorders—an estimated five to 10 percent of Americans will have a kidney stone at some point in their lives. Men are afflicted with kidney stones more often than women, and Caucasians are more susceptible than African Americans. Stones are most likely to occur between the ages of 20 and 50 in women (later in men) and are more likely to occur in people who have previously had stones.

Kidney stones vary widely in size and in the amount of pain they cause. Most are passed from the body without assistance, but there are a variety of strategies to treat stones that linger.

A kidney stone forms from crystals that separate from urine and accumulate on the kidney’s inner surfaces. Urine contains chemicals that prevent crystal formation, but in some people the process doesn’t work well and they develop stones. If the stones are small enough, they travel through the urinary tract and leave the body without causing symptoms.

Most stones contain calcium and either oxalate or phosphate—all three are part of a healthy diet. Less common are struvite or infection stones, caused by urinary tract infections. Terms used to describe stones include nephrolithiasis (kidney stones),urolithiasis (urinary tract stones) and ureterolithiasis (ureter stones).

Risk for kidney stones is higher in those with family histories of stones; those who have urinary tract infections, kidney disorders and metabolic disorders such as hyperparathyroidism, cystinuria (too much of an amino acid called cystine) orhyperoxaluria (excess production of oxalate salt); and those with a disease called renal tubular acidosis. High levels of urinary calcium lead to crystals of calcium oxalate or calcium phosphate, which can grow into painful stones.

Other risk factors include:

• hyperuricosuria—a disorder of uric acid metabolism
• gout
• excess intake of vitamin D
• blockage of the urinary tract
• use of diuretics or calcium-based antacids
• chronic bowel inflammation, intestinal bypass surgery or ostomy surgery

The initial symptom is usually sudden, intense pain, provoked by the movement of a stone in the urinary tract. The feeling is usually a sharp, very severe, cramping pain in the back and side in the kidney or lower abdominal region. Nausea and vomiting may occur, and the pain may spread to the groin. A stone too large to pass easily causes continuing pain in the muscles in the ureter as they try to squeeze the stone into the bladder. As the stone approaches the bladder, you may feel compelled to urinate more frequently or feel a burning pain when you urinate.

Note: Fever and chills suggest an infection that warrants a health care professional’s immediate attention.

Kidney stones are usually diagnosed via x-ray or sonogram. Urinalysis often shows blood cells. A health care professional may order blood and urine tests to detect abnormal substances that may be stimulating stone production. A type of x-ray called an intravenous pyelogram (IVP) or spiral CT scan may be used to scan the urinary system as well. In addition, to help determine what’s causing your kidney stones and, therefore, to plan appropriate prevention measures, your health care professional may ask you to urinate through a strainer designed to catch any stones you pass so the stones can be analyzed for their makeup.

Neurogenic Bladder

The smooth functioning of the urinary system depends on muscles and nerves working properly to store urine in the bladder and release it at the appropriate time. Nerves running between the bladder and the brain tell the brain when the bladder is full and tell the bladder when it’s OK to relax and release the urine. When the nerves that carry these messages malfunction, a condition called neurogenic bladder results.

Some possible causes of neurogenic bladder include:

• diabetes
• accidents that cause trauma to the brain or spinal cord
• nerve problems such as multiple sclerosis, strokes, or Parkinsonism
• congenital nerve problems such as spina bifida

Primary effects of neurogenic bladder are:

• urine leakage, when muscles holding the urine do not get the message to stay tight to retain the urine
• urine retention, when the muscles holding in the urine do not get the message that they should let go
• damage to the tiny blood vessels in the kidneys that results when the bladder gets too full. This prevents good drainage, causing back pressure.
• bladder infection or infection of the kidneys

Polycystic Kidney Disease (PKD)

This genetic disorder causes multiple cysts to grow in the kidneys and gradually displace functioning parts of the kidney. PKD symptoms sometimes show up in childhood, including frequent headaches and back or side pain. Other symptoms include high blood pressure, urinary tract infections and kidney stones, as well as blood or protein in urine. The disease, however, may exhibit no symptoms for years. There are two forms of PKD :

• Autosomal Dominant Polycystic Kidney Disease (ADPKD) is the most common, affecting one in 400 to one in 1,000 adults. Symptoms include high blood pressure, and the condition can lead to renal failure.
• Autosomal Recessive Polycystic Kidney Disease (ARPKD), also known as infantile PKD , is far less common, affecting only one in 10,000 to one in 20,000 at a far younger age, including newborns, infants and children. It can be detected during pregnancy through amniocentesis or chorionic villus sampling.

Proteinuria

Proteinuria denotes high levels of macromolecule within the excretion. When kidneys area unit healthy, filtering units referred to as glomeruli take away waste merchandise however leave behind nutrients the body wants, like proteins, that area unit sometimes overlarge to withstand kidney filters unless the kidneys are damaged. When simple protein, alittle macromolecule, seeps into the urine, blood vessels lose their capacity to reabsorb fluid from the tissues. The fluid then builds up in hands, feet or ankles, causing swelling.

Symptoms of symptom embody foamy-appearing excretion and swelling within the hands, feet, abdomen or face. But the condition can even be invisible, manufacturing no symptoms. Laboratory testing is that the solely thanks to live symptom.

One basic check uses a with chemicals treated strip of paper to find macromolecule levels. The paper changes color if swayback in excretion with high levels of macromolecule. A additional sensitive check, which might find microalbuminuria, requires urine collection over 24 hours. You may even have to produce a blood sample for creatinine and organic compound chemical element testing (see nephropathy and nephritic failure). If blood levels of those 2 substances area unit high, urinary organ operate is impaired.

Proteinuria could be a sign of Bright’s disease, additionally referred to as nephropathy (inflammation of the kidney). Diabetes, high blood pressure and numerous urinary organ diseases will cause the inflammation, which might cause kidney failure and, ultimately, end-stage renal disease (ESRD).

The severity of harm correlates with the amount of symptom and whether or not the macromolecule content is entirely simple protein or includes different proteins (the additional styles of proteins, the larger the damage).

If you have got polygenic disorder, you ought to be often checked for symptom. The National urinary organ Foundation additionally recommends that each one routine checkups embody symptom testing, especially for those at high risk.

Small amounts of simple protein within the urine—microalbuminuria—is the primary sign of declining urinary organ operate in folks with polygenic disorder (the leading reason behind ESRD). As operate continues to slip, the level of albumin rises and the condition becomes proteinuria.

The second most typical reason behind ESRD is high pressure level. Proteinuria and high pressure level along indicate deteriorating urinary organ operate. Medication for high blood pressure should be started, or renal failure will result. African Americans area unit at higher risk for top pressure level and therefore the ensuing urinary organ issues than Caucasians.

Proteinuria additionally strikes additional oftentimes in Native Americans, Hispanic Americans, Pacific Islanders, older people and overweight people. If you have got a case history of nephropathy, you ought to have your excretion tested often.

Urinary Incontinence

Many factors will cause incontinence, or a loss of bladder management leading to the involuntary unleash of excretion. Incontinence could be a downside for uncountable yank ladies, particularly those aged 65 and older. It is particularly common in ladies United Nations agency area unit pregnant or have recently delivered a baby and in older ladies. Incontinence can also affect men.

Bladder control, or continence, is the result of a system of nerves and muscles working together correctly. If the muscles at the bladder neck or within the girdle floor area unit weak, laughter, unconditioned reflex or work will cause discharge.

A condition referred to as urinary incontinence arises once the bladder muscle is active and contracts involuntarily. Since the prevalence of urinary incontinence is unpredictable, it is more devastating to one’s quality of life. Overactive bladder (OAB) happens once you void over eight times within the day and doubly in the dead of night, have a strong urge to void, and/or urge incontinence. It affects millions of Americans, both men and women.

Overflow incontinence happens once your bladder is to a fault full and leaks excretion. You may feel as though you need to empty your bladder but cannot.

Urinary Tract Infection (UTI)

Urinary tract infections area unit sometimes caused by microorganism from the viscus that go on the skin close to the body part or close to the duct. Because the openings of the bowel, vagina and urethra are close together, it’s easy for the bacteria to spread from the bowel to the urethra and travel up the urinary tract into the bladder, generally into the kidneys.

Normal excretion is sterile, containing fluid, salts and waste merchandise, but not bacteria. Infections will return from a range of microorganism that ordinarily sleep in the gastrointestinal system, but infections can also be caused by sexually transmitted microorganisms such as chlamydia and mycoplasma.

Infection will occur once the microorganism take hold the gap of the canal and multiply, manufacturing AN infection of the canal, referred to as urinary tract infection. Infection can even occur once the microorganism get into the bladder, inflicting urinary tract infection, or a bladder infection. If the matter isn’t treated, the infection will continue spreading up the tract, inflicting infection within the kidneys, called pyelonephritis. A urinary organ infection that’s not treated may end up within the kidneys being unable to empty excretion, permitting the bacteria to enter the bloodstream, which can cause a life-threatening infection.

The first sign of a UTI is typically a robust urge to urinate. As you unleash excretion, you are feeling a painful burning sensation, and tiny excretion is eliminated. The urge to urinate returns quickly, and urination may be hard to control. You may have urine leakage during sleep. You may even have soreness in your lower abdomen, in your back, or in the sides of your body. Your excretion might look cloudy or have a ruddy tinge from blood. It may smell foul or strong. You also might feel tired, shaky and washed out. If the infection has unfold to the kidneys, you’ll have fever, chills, nausea, expulsion and back pain, additionally to the frequent urge to urinate and painful excretion.

Vesicoureteral Reflux (VUR)

When water flows backward from the bladder into the ureters, the condition is named reflux (VUR). It is most often diagnosed in childhood. If your kid develops a tract infection, he or she ought to be evaluated for VUR as a result of the condition is found in concerning simple fraction of youngsters with a UTI .

Primary VUR arises when a child is born with an impaired valve where the ureter joins the bladder. The valve fails to shut absolutely, causing urine to back up from the bladder into the ureters and kidneys. The condition could improve over time because the duct grows and valve operate improves.

Secondary VUR arises thanks to a blockage within the tract, often the result of an infection that causes the ureter to swell. Again, the result’s a flowing of water into the kidneys.

The leading symptom of VUR is infection. Other symptoms could arise as a baby gets older, including high blood pressure, proteinuria and kidney failure.

Diagnosing VUR could involve a expelling cystourethrogram, a test that provides an image of the urinary system to determine if a defect in the urinary tract is causing VUR and infection. Other tests may include a kidney and bladder ultrasound; an intravenous pyelogram (IVP), which involves injecting a liquid that can be seen on x-rays to highlight any obstructions in the excretory organ or bladder; or nuclear scans, tests that use radioactive material injected into a vein to reveal how well the kidneys and bladder are functioning.

The goal of VUR treatment is to forestall excretory organ harm. An infection ought to be treated now with antibiotics to forestall it from stepping into the kidneys. Antibiotics can even facilitate correct reflux caused by AN infection. Sometimes surgery is critical to repair a physical defect that causes VUR.

Urinary Retention

Sometimes the bladder fails to empty absolutely, leading to retained urine. Acute retentiveness ends up in a explosive inability to urinate, accompanied by pain and discomfort. The condition may be caused by a urinary tract obstruction from the prostate gland in men or from pelvic masses in women (fibroid tumors are the most common); stress orneurological factors; infection; and certain medications. Relaxation of the girdle floor structures leading to an outsized bulging colpocystocele may additionally lead to kinking of the epithelial duct and retentiveness. The cause determines the treatment.

Urinary retention could be a comparatively common downside when surgery. It happens as a results of the anesthetic, medication used for pain management or the kind of surgery performed. Chronic urinary retention, by contrast, refers to a persistent condition of urine remaining in the bladder and incomplete emptying. Chronic retentiveness will result in tract infections.

Evaluation for retentiveness includes a anamnesis and physical examination (including a prostate examination in men) to seek out the supply of the matter. If AN acute nerve downside is suspected, your doctor may order a CT scan or MRI . A urogynecologist or medical specialist could perform advanced urodynamic testing to assist confirm the explanation for the expelling disfunction. He or she may additionally perform a cystoscopic examination.

Diagnosis

If you are having urinary system symptoms, you may be asked to undergo various tests. Some of the most common are:

Blood tests. Tests for kidney disease include:

• Serum creatinine. Measures blood levels of a substance called creatinine that is generated when the body breaks down protein and uses it.
• Creatinine clearance. Measures how effectively your kidneys remove creatinine.
• Blood urea nitrogen (BUN). A nitrogen-containing substance called urea is a normal byproduct resulting when the body breaks down protein and uses it. Healthy kidneys remove urea from the blood for excretion in urine. Excess urea in the blood is a sign the kidneys are not functioning well. BUN can also be transiently elevated with dehydration.

Dipstick test for proteinuria. When the kidneys are not functioning well, protein may be present in urine. Foamy urine is a strong sign of protein, but usually there are no visible symptoms. The test for proteinuria uses a dipstick that changes color in the presence of protein.

Renal biopsy. In this procedure a health care professional obtains a sample of kidney tissue to examine under a microscope. A needle is inserted through the skin into the back of the kidney to retrieve a tissue sample.

Renal imaging. If blood and urine testing suggests impaired kidney function, your health care professional may recommend renal imaging, a procedure that captures an image of the kidneys using ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI).

Urinalysis. For this test, you urinate into a special container and leave the sample with a nurse or lab technician. The urine is then analyzed for signs of infection, blood cells and abnormal substances such as proteins, glucose or white blood cells and bacteria.

Urine culture. A urine culture is a laboratory test that tests for infection in your urine by allowing any bacteria in the urine sample to grow and multiply. The bacteria are then identified and tested to see which antibiotic will work best to kill the bacteria. Your urine is sent for a culture if infection is suspected on urinalysis.

Urine cytology. A urine cytology involves a check of your urine for cancer cells.

Ultrasound. Lubricating jelly is rubbed on your abdomen and pelvis, and a wand passes over your kidneys and bladder to check for abnormalities in your urinary tract or genitals, as well as residual or leftover urine in your bladder.

Intravenous pyelogram (IVP). This test x-rays the urinary tract to identify a malformation, tumor, kidney or bladder stone or other blockage preventing normal urine flow. A dye containing iodine is administered via a needle into a vein; the dye is then incorporated into the urine, making the urinary tract easier to see on x-rays.

Cystoscopic examination. During this test, a health care professional inserts an instrument called a cystoscope through the urethra and into the bladder. The cystoscope is pencil thin and has a light at the tip to allow a look inside the tract. A cystoscope may have an additional instrument attached to perform a treatment procedure, such as a biopsy. Cystoscopy may be recommended in a variety of circumstances, including frequent urinary tract infections, blood in the urine, incontinence or overactive bladder, presence of unusual cells in the bladder, need for a catheter, chronic pain or interstitial cystitis, urinary tract blockage, kidney stone or an unusual growth. A ureteroscope, which is an even smaller tube, can be inserted into a ureter.

Urodynamic test. This is a series of tests of bladder function. Bladder pressure is measured because the bladder fills, stores and empties urine—in different words, in each phase of bladder activity. For this take a look at, a small tube called a catheter is inserted through the urethra into your bladder. The bladder is then crammed with either water or associate degree x-ray dye. Another tiny tube is inserted into the duct or body part to live abdominal pressure once you strain or cough; if a dye is employed, an x-ray is taken. Your doctor may suggest this series of tests if your symptoms suggest muscle or nerve problems in the lower urinary system bladder, urethra and sphincter muscles.

Treatment

A primary care health care skilled will treat several urinary disorders, but some conditions may require consultation with a urologist, a surgeon who specializes in the treatment of urinary system disorders and conditions affecting the reproductive system. A urogynecologist could be a gynecologist World Health Organization is trained to treat bladder and girdle floor disorders in ladies. For excretory organ disorders, particularly kidney failure, a nephrologist (a medical specialist in kidney diseases) may be needed.

Treatment for cystocele

A grade one or a pair of colpocystocele might need no treatment, except avoidance of heavy lifting or straining. For moderately bothersome cystoceles, a pessary (a plastic or rubber device that fits into your vagina to help support your uterus, vagina, bladder or rectum) may be fitted to the vagina to hold the bladder in place. A contraceptive should be removed and cleansed often to stop infection and ulcers.

A large colpocystocele might need surgery to reposition the bladder. The surgery needs a hospital keep of 1 to many days and 4 to 6 weeks for a full recovery.

Treatment for kidney stones

Surgery typically not necessary to get rid of excretory organ stones. Drinking lots of water—two to a few quarts per day––and stoning up {which can|which might|which might} relax the channel may yield the stone to pass down the tract. A health care professional may recommend that you stay home, drink plenty of fluids and take pain medicine as needed. You may be asked to avoid wasting the passed stone for tests.

Shockwave lithotripsy. The most common method for removing stones is shockwave lithotripsy (SWL), in which shockwaves initiated outside the body travel through skin and body tissues until they hit the stones. The stones disintegrate into sand-like particles and area unit more matured the tract. The procedure could also be worn out a hospital or on associate degree patient basis; you sometimes resume your traditional activities at intervals a couple of days, but it may take months for you to pass all the pieces.

Complications might embrace blood within the water for a couple of days, bruising and discomfort of the back or abdomen. To minimize risk of issues when the treatment, you must avoid medications that cut back curdling (such as aspirin) for one to 2 weeks before treatment.

The stone particles may cause pain as they pass through the urinary tract. Your health care professional may insert a small tube called a stent through the bladder into the ureter to help the fragments pass. Some people may need two or more SWL treatments.

Surgery is generally an option when the stone:

• does not pass after a reasonable time and causes constant pain
• is too large to pass on its own or is caught in a difficult place
• blocks urine flow
• causes continuing urinary tract infection
• harms kidney tissue or provokes incessant bleeding
• is growing (as shown on x-rays)

The two most common surgical techniques for removing stones are:

• Urethroscopic stone removal. This procedure is used for stones lodged in the ureter or for kidney stones. A small fiber-optic instrument called a ureteroscope is passed through the urethra and bladder and into the ureter or kidney. When the stone is found, the surgeon either removes it or shatters it with an instrument that breaks the stone.
• Percutaneous nephrolithotomy. This surgical treatment typically needs a hospital keep and is employed for big stones or stones in locations not causative to SWL. The Dr. makes atiny low incision within the back, creates a tunnel to the excretory organ and uses a nephroscope to seek out and take away the stone. A nephrostomy tube might keep within the excretory organ throughout the healing method. Large stones may require use of an ultrasound, electrohydraulic energy probe or laser to break up the stone. One advantage over SWL is that transcutaneous nephrolithotomy removes the stone particles instead of feat them to suffer the excretory organ and out the ureters.
• Parathyroid gland surgery. In some cases, calcium stones are caused by a small benign tumor in one of the parathyroid glands, four glands located just below your Adam’s apple. If this is the case, you may have surgery to remove the tumor or one or more of the parathyroid glands.

Treatment for bladder cancer

Treatment for bladder cancer depends on the dimensions and staging of the tumour. For early-stage tumors, the usual treatment is transurethral resection of the bladder tumor, a procedure during which a lighted tube is inserted through the urethra and into the bladder to remove the cancer for diagnostic assay and to chop or burn away any remaining cancer cells. Chemotherapy and immunotherapy may also be used to prevent cancer recurrence. In extreme cases, a cystectomy, or removal of the bladder, may be performed.

Treatment for interstitial cystitis (IC)

Behavioral therapy. Make sure you get enough water, ideally about two quarts a day. Although no scientific evidence points to dietary factors as the cause of IC, avoiding potential bladder irritants, including coffee, chocolate, carbonated beverages, acidic foods or drinks, may help ease symptoms. Controlling stress can also help.

Medications.  Medications are the primary treatment for IC. The only drug specifically approved for IC is pentosan (Elmiron). Pentosan helps restore the conventional bladder lining however might take up to 6 months to figure. Several other medications not specifically indicated for IC may also help reduce symptoms, including nonsteroidal anti-inflammatory drugs (NSAIDs), antihistamines and antidepressants, particularly amitriptyline (Elavil) or imipramine (Tofranil). You may require more than one medication.

Bladder instillation. Also called a bladder wash or bath, the bladder is filled with a drug cocktail containing one of several substances including heparin, pentosan, or dimethyl sulfoxide (DMSO, RIMSO-50), which must be command for a such as amount of time—usually ten to twenty minutes––before urinating. This treatment is performed each week or 2 for 6 to eight weeks and perennial PRN.

Because DMSO passes into the bladder wall, it reaches tissue more effectively to reduce inflammation and pain. It conjointly seems to stop the muscle spasms that cause pain and urgent/frequent got to urinate.

Side effects of DMSO embody a garlic style and odor that will last up to a few days following treatment. Bladder symptoms may get temporarily worse for a day or so after initial treatments. Blood tests, including a complete blood count and kidney and liver function tests, should be conducted twice a year. Other medications is also additional, such as a local anesthetic, to make a DMSO “cocktail.”

In addition, a newer approach to bladder instillation involves using a mixture of heparin, lidocaine and sodium bicarbonate. When instilled directly into the bladder, this combination of drugs significantly relieved urinary pain and urgency in the majority of people participating in a clinical trial.

Bladder distention. This treatment arose from the observation that some patients felt higher once undergoing cystoscopy, during which the bladder is filled to capacity with liquid. Symptoms typically intensify every day or 2 once distension however come back to pre-procedure levels or improve once 2 to four weeks. No one is aware of specifically why this treatment is effective, however one theory is that distension will increase bladder capability by busy with the bladder’s transmission of pain signals. This is not an ideal treatment, however. It only helps small numbers of patients and requires anesthesia.

Bladder distention. This treatment arose from the observation that some patients felt higher once undergoing cystoscopy, during which the bladder is filled to capacity with liquid. Symptoms typically intensify every day or 2 once distension however come back to pre-procedure levels or improve once 2 to four weeks. No one is aware of specifically why this treatment is effective, however one theory is that distension will increase bladder capability by busy with the bladder’s transmission of pain signals. This is not an ideal treatment, however. It only helps small numbers of patients and requires anesthesia.

Surgery. All surgical treatments for IC have unpredictable results and most health care professionals turn to surgery only as a last resort. Surgical procedures include:

• Fulguration, a process in which a cystoscope is inserted through the urethra, and Hunner’s ulcers (star-shaped lesions found on the bladder walls of some people with IC) are coagulated with electricity or a laser.
• Neuromodulation or sacral nerve root stimulation is a newer treatment option that involves stimulating the sacral nerve to help alleviate frequency, urgency and pain. A small electrode is placed under the skin next to the third sacral nerve root in the back. If a test stimulation is effective, a permanent battery is placed under the skin for regular stimulations. Although this can be very helpful in some patients, the results are not always sustained.
• Augmentation is a surgical procedure that enlarges the bladder by removing damaged and inflamed sections of the bladder and rebuilding it with bowel (small or large intestine) tissue. The effect on pain varies, and IC may recur on the bowel tissue used to enlarge the bladder.

The bladder can also be removed entirely in a procedure called cystectomy. The ureters are then attached to a segment of bowel that opens onto the skin of the abdomen. Urine empties through the opening, called a stoma, into a bag outside the body.

Bear in mind that even a cystectomy does not guarantee the end of IC symptoms; some women experience phantom pain. So make sure you explore other options first.

Treatment for urinary tract infections

Luckily, most infections don’t seem to be serious and may be simply treated with antibiotic medications. However, a tract infection will be stubborn and typically recurs many weeks once the treatment.

Nearly twenty p.c of ladies WHO have a tract infection can have another, and 30 percent of those who have had two will have a third. About eighty p.c of these WHO have had 3 can have a fourth. If left untreated, urinary tract infections can lead to other more complicated health problems so they should not be ignored. Prevention includes drinking many liquids, frequent urination and taking vitamin C. Cranberry prevents the bacterium from adhering to the bladder wall and should be a good deterrent to bladder infections. Women WHO expertise repeated bladder infections typically have the bacterium introduced throughout sexuality. Treatment prophylactically with one antibiotic pill taken simply once sex will stop extra bladder infections.

Treatment for urinary retention

Treatment for retentiveness could embody the insertion of a Foley tube through the duct into the bladder to alleviate retentiveness. Various canal dilators is also wont to open the channel wide enough to pass a tube through. If a catheter cannot reach your bladder because of an obstruction in the urethra, a suprapubic tube may be placed through the skin, over the pubic bone and through the lower abdominal wall directly into the bladder. The tube provides temporary drainage until the situation can be managed via a cytoscopic procedure.

Treatment for proteinuria

Treatment for albuminuria starts with dominant high blood pressure and/or polygenic disorder. Those with polygenic disorder ought to live glucose levels oft, eat a balanced diet to appropriately manage diabetes, exercise and take prescribed medicines. Those with high area unita} are sometimes prescribed ACE (angiotensin-converting enzyme) inhibitors or the same category of medication known as vasoconstrictive receptor blockers (ARBs) to manage the condition. These medication defend the kidneys quite different vital sign medicines. People with reduced excretory organ operate and high vital sign ought to attempt to keep their vital sign below 130/80 torr.

The National excretory organ Foundation conjointly recommends limiting salt and supermolecule intake. A consultation with a dietician could assist you develop a kidney-healthy dietary set up.

Treatments for incontinence

A variety of treatments are available to treat incontinence, including:

• Exercises: Pelvic floor exercises known as Kegel exercises can strengthen the muscles you use to stop urinating so you can hold urine in your bladder longer. To do Kegels, squeeze the muscles you use to stop urinating for a few seconds and then relax. Your health care professional can tell you specifically how often and for how long you should do Kegels.
• Medications: A variety of drugs can be used to help control incontinence. Some of them relax bladder muscles, helping your bladder to empty more completely, some help prevent bladder contractions and others tighten the muscles in the bladder and urethra to reduce leakage.
• Biofeedback techniques: These techniques can help you become more aware of signals from your body so you can gain more control over the muscles in your bladder and urethra.
• Pessary: A vaginal insert that holds up the bladder neck. It may also pinch the urethra closed to help retain urine in the bladder. It is usually not necessary to remove the pessary to urinate. Normal bladder contractions can usually force urine out through the pinched-off urethra.
• Surgery: Surgery can improve incontinence if the condition is caused by a physical problem such as a change in the bladder position. Common surgery for incontinence involves placing a sling beneath the urethra to help close it during episodes of increased pressure or reducing a bulging bladder or urethra and securing it. Surgery is usually not recommended until you are finished having children because both pregnancy and childbirth can cause damage.

Other Treatments for Kidney Conditions

Hemodialysis is the most common treatment for advanced or permanent kidney failure. In this procedure your blood is circulated out of your body, the wastes filtered out in a machine and the clean blood returned to the body. Removing harmful wastes and extra salt and fluids helps control your blood pressure and maintain proper chemical balance in the body. Treatments are given in a clinic, often called a dialysis center, usually three times a week for three to five hours per visit. The annual survival rate for people on dialysis is about 80 percent.

Peritoneal dialysis allows you to give yourself treatments at home for advanced and permanent kidney failure, but it is important that you work closely with your health team. As with hemodialysis, the treatment filters your blood and returns it to circulate in your body. For this procedure, a soft tube (catheter) is surgically placed in your abdomen and then is used to fill your abdomen with a cleansing liquid. Your body’s waste products and extra fluid transfer from your blood into the dialysis solution and then are drained out of the body. The process of actually putting the solution in and out of your abdomen takes about 30 to 40 minutes, but the solution stays in your abdomen for four to six hours. This process is typically done four times a day. There are two forms of peritoneal dialysis: Continuous ambulatory peritoneal dialysis (CAPD) doesn’t require a machine and you can walk around with the solution in your abdomen. Continuous cycler-assisted peritoneal dialysis (CCPD), also called automated peritoneal dialysis, uses a machine to fill and drain your abdomen, usually while you sleep.

Infection is the most common problem with peritoneal dialysis. You must understand and follow all instructions from your health team. Keep a close watch for any signs of infection and report them immediately. These include:

• Fever
• Nausea or vomiting
• Redness or pain near the catheter
• Unusual color or cloudiness in your used dialysis solution
• A catheter cuff that is out of place

Transplants. For some with kidney failure, transplantation is an option. If the donated kidney is not a close match for your body, your immune system will react against it as if it were a virus or bacteria. Drugs that suppress the immune system are used to help the body accept the transplant. Transplant is more effective than dialysis, with a one-year survival rate of 95 percent and 80 percent at five years for people receiving living-donor kidneys. (Survival rates are slightly lower for people receiving deceased-donor kidneys.

Prevention

1. Approximately 26 million Americans have kidney disease and millions more are at risk, according to the National Kidney Foundation.
2. Incontinence and overactive bladder are among the most common health problems in women.
3. Drinking plenty of water is key to urinary system health. A good rule of thumb is to drink enough water and other fluids (at least eight glasses a day) to keep the urine clear or straw colored.
4. Combining over-the-counter painkillers such as aspirin, acetaminophen, naproxen sodium and ibuprofen can be toxic to your kidneys. Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can also damage the kidneys.
5. Kidney stones are among the most painful and most common urinary tract disorders—about 5 to 10 percent of Americans will have a kidney stone at some point in their lives. Stones are most likely to occur between the ages of 20 and 50 in women and are more likely to occur in people who have previously had stones.
6. Diabetes accounts for most cases of end-stage renal disease (ESRD). Diabetes-related ESRD can be delayed or prevented by keeping blood sugar levels down.
7. African Americans are at greater risk than Caucasians for high blood pressure and the resulting kidney problems. African Americans age 25 to 44 are more likely than Caucasians to develop kidney failure related to hypertension.
8. “Renal function” refers to how well your kidneys are functioning. If both kidneys are healthy, you have 100 percent renal function. If one becomes non-functional or is donated for a transplant, you will still be healthy, even with only 50 percent of renal function. However, if function slips below 20 percent, serious health problems arise, and below 10 to 15 percent dialysis or a transplant may be required.
9. End-stage renal disease (ESRD) refers to permanent total or nearly total kidney failure, requiring dialysis or transplantation. If untreated, ESRD can cause seizures, coma and death. In the United States , 85,790 died of ESRD in 2005.
10. The annual survival rate for people on kidney dialysis is about 80 percent. Transplant is more effective than dialysis, with a one-year survival rate of 95 percent and 80 percent at five years for people receiving living-donor kidneys.

Key Q&A

1. What could cause blood in my urine?The cause may be a serious one, such as bladder or kidney cancer, but more often the cause is relatively benign. For example, urinary tract infections or exercise can cause episodes of hematuria—the medical term for blood in the urine. Still, you should check with a health care professional any time you see blood in your urine.
2. Why am I having repeated incidences of kidney stones?A variety of factors can make a person susceptible to stones in the urinary tract. Risk for stones is higher in those with family histories of stones; those who have urinary tract infections, kidney disorders and metabolic disorders such as hyperparathyroidism, cystinuria (too much of an amino acid called cystine) and hyperoxaluria (excess production an oxalate salt); and those with a disease called renal tubular acidosis. Another risk factor is absorptive hypercalciuria, in which the body absorbs too much calcium from food and dumps the excess into the urine. High levels of urinary calcium lead to crystals of calcium oxalate or calcium phosphate, which can grow into painful stones.Various laboratory tests and a family history should allow your health care professional to determine a likely cause. You can then make dietary changes to prevent future stones.
3. My health care professional is concerned because I have protein in my urine, but I feel fine. Should I worry?Yes. Proteinuria is a sign of glomerulonephritis (inflammation of the glomeruli; see below), also called nephritis (inflammation of the kidney). Diabetes, hypertension and various kidney diseases can cause the inflammation, which can lead to renal failure and, ultimately, end-stage renal disease (ESRD).
4. What is the connection between diabetes and kidney disease?Diabetes is the number one cause of end-stage renal disease. If diabetes is undiagnosed or poorly controlled, excess sugar will circulate in the blood, leading to higher blood flow into the kidney and glomerular scarring. Diabetic nephropathy is the term used for such damage, which can be delayed or prevented by keeping blood sugar levels down.
5. What is the connection between high blood pressure and kidney disease?The number two cause of ESRD is high blood pressure. Long-term control of blood pressure is critical to preserving kidney function. ACE (angiotensin-converting enzyme) inhibitors and a similar class of drugs called angiotensin receptor blockers (ARBs) are the best medications for controlling the condition and preventing kidney damage. These drugs protect the kidneys more than other blood pressure medicines. People with reduced kidney function and high blood pressure should try to keep their blood pressure below 130/80 mm Hg.
6. How can I protect my kidneys if I have diabetes?
   • Have your glycohemoglobin (hbA1c) checked regularly; the test measures your average blood sugar for the previous two to three months.
   • Adhere to your diabetes control regimen, including insulin injections and other medications, diet, exercise and blood sugar monitoring.
   • Have your blood pressure checked several times a year (at every visit to your health care professional) and follow any recommendations for reducing it. Ask your health care professional about ACE inhibitors and ARBs.
   • Have your urine checked yearly for protein and microalbumin (a protein component).
   • Ask your health care professional whether you need to lower your protein intake.
7. How can I prevent recurrence of a cystocele?Avoidance of straining from chronic constipation, avoidance of heavy lifting and learning to contract the pelvic floor muscles to “splint” the pelvic floor during coughing, sneezing and lifting will help to prevent recurrent cystocele. In addition, weight loss in obese women may be helpful. Seeking medical attention to prevent chronic cough is also beneficial.
8. Is surgery the best option for a painful case of interstitial cystitis (IC)?No, the results of the various types of IC surgeries are unpredictable—new ulcers may form after old ones are removed, and IC may afflict bowel tissue used to augment or rebuild the bladder. Even a cystectomy—removal of the bladder—does not guarantee the end of IC symptoms; some patients experience phantom pain. Be sure to explore other options first. Health care professionals should only turn to surgery as a last resort.
9. What other treatment options are available for IC?Sometimes eliminating irritating food and beverages from the diet—such as tomatoes, coffee, spices and acidic foods—reduces symptoms of IC. Nonmedicinal approaches to relief include gentle stretching exercises and bladder training. Bladder training involves working with a health care professional to plan specific times at which to urinate and then using relaxation techniques and distractions to stick to the schedule. Patients keep a diary and over time try to extend the time between scheduled urinations.Transcutaneous electrical nerve stimulation (TENS) is a relatively inexpensive treatment that uses mild electrical pulses to relieve pain and reduce frequency of urination. The pulses are administered through wires on the lower back or above the pubic area, although some devices are inserted into the vagina or rectum (in men). Scientists believe TENS works to relieve IC by increasing blood flow to the bladder and triggering pain-relieving substances.
10. What tests can I expect if I am having urinary system symptoms?Urinalysis and blood testing are standard. Depending on your particular symptoms and history, your health care professional may perform a cystoscopy, in which a tiny telescope is inserted through the urethra into the bladder; a biopsy, in which tissue is removed for evaluation; an intravenous pyelogram or a CT urogram, in which an x-ray is taken of the urinary tract enhanced with a radioactive dye; a urodynamic test, in which the bladder is filled with liquid and then emptied to measure function; or imaging using magnetic resonance imaging or computed tomography techniques.