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Urinary Incontinence
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Urinary Incontinence

1.Oncology  2. Stone disease 3. Reconstruction 

1.Incontinence 2.Voiding Dysfunction 3.Urinary Tract Infection (UTI) 4.Urethral Syndrome 5.Interstitial Cystitis (IC)

 

Introduction:

Urological surgery was one of the last surgical disciplines to become recognised as a separate specialty from general surgery in terms of training and practice. Urological disorders account for about one third of all surgical admissions to hospital. Such disorders are common in the community, and though few are life threatening, many may have a profound effect on the quality of life.

Philosophy of urology

There is an ever increasing preference for both diagnosis and treatment to be minimally invasive. Investigations are becoming more sophisticated, and the equivalent of a diagnostic laparotomy is needed very rarely, if at all. Ultrasonography and computed tomography have replaced many of the more invasive investigations, such as intravenous urography, angiography, and lymphography.

Urodynamic disorders

Problems of bladder outflow obstruction secondary to benign prostatic hypertrophy constitute about a third of urological practice. Other urodynamic disorders occur in patients with neurological disorders of many kinds. The management of patients with urinary incontinence is also included under this heading.

Oncology

Bladder tumours and prostate cancer are the two commonest malignant diseases presenting to urologists. Most urology departments run a haematuria service as many studies confirm the importance of investigating haematuria urgently. Prostate cancer is now being diagnosed at an earlier stage and more often since the advent of prostatic specific antigen and transrectal, ultrasound guided biopsies of the prostate. All urologists can treat patients with a bladder tumour or prostate cancer, but more complex and advanced disease requiring major surgery is best dealt with by a cancer centre.

Stone disease

The prevalence of stone disease in the United Kingdom (3%) is much lower than in many other developed and developing countries. The need for expensive, high technology equipment dictates that patients who need intervention for their stones are best treated in stone centres, of which there should be one or two per health region.

Reconstruction

Reconstructive urological procedures include surgery for congenital malformations, though many of these are best treated by paediatric rather than adult urologists. Complex urethral strictures need special expertise. There is an increasing tendency to avoid urinary diversion in favour of a reconstructive procedure--to provide a continent neobladder--in patients who have had a cystectomy or who have intractable incontinence secondary to bladder neuropathy or congenital malformation. Such procedures are usually carried out by those who specialise in reconstructive urology.

Urinary Incontinence:

Incontinence is any involuntary loss of urine. It affects approximately two million Americans and accounts for billions of health care dollars spent annually. Incontinence affects both men and women. It is not a normal part of aging. It is a sign of an underlying condition.

Causes of Urinary Incontinence

Incontinence has many causes. It can be the result of trauma, surgery, childbirth or hormonal loss post-menopause. It can be related to diseases such as diabetes, stroke, multiple sclerosis or spinal cord injury. 

Types of Incontinence

The two most common types of incontinence are called stress and urge. Stress incontinence is loss of urine when a person coughs, laughs or sneezes or with activity such as walking, running or lifting. Urge incontinence is when urine starts to flow before the person has time to get to a restroom. A person can have both stress and urge incontinence. This is referred to as mixed incontinence.

Other types of incontinence include overflow incontinence. This is when the bladder never empties properly and continuously drips urine. Functional incontinence is when a person can not reach a restroom in time due to physical limitations.   

Diagnoses of Urinary Incontinence  

Your doctor or health care provider will want to take a complete history and perform a physical examination. Sometimes, additional tests are needed to determine the type of incontinence. These include blood and urine tests as well as X-Ray studies of the urinary tract. The urologist may wish to look inside the bladder using a cystoscope. A special test called urodynamics can evaluate the function of the bladder.

Treatments There are many treatment options available to help people with urinary incontinence. Management options include pads, diapers, external or internal catheters and clamps. Behavioral treatment options include dietary modifications, timed voiding and pelvic floor retraining. Pelvic floor exercises (also known as Kegel exercises) can help to strengthen the muscles that support the bladder and prevent urine leakage.

Drug therapy is most effective for urge incontinence. A variety of agents are available to help relax the bladder and prevent the involuntary contractions that cause urine leakage. Some people may benefit from electrical stimulation therapy combined with Kegel Exercises. With electrical stimulation therapy, a small current is passed along the muscle paths leading to the bladder to help reset the nerve pathways to function properly.

There are also many surgical options for treating incontinence. Collagen injections can be placed at the opening of the bladder to help tighten the closure of the bladder. For women, urethral slings or supports can be placed. Bladder suspension surgery can benefit women who also have bladder prolapse (dropped bladder). Men with incontinence can also have urethral slings. The artificial urinary sphincter involves surgical placement of a cuff around the urethra that can be inflated or deflated by the person based on their urge to urinate.

Female UrologyThe subspecialty of female urology is concerned with the diagnosis and treatment of those urinary tract disorders most prevalent in females. These include urinary incontinence and pelvic floor prolapse, voiding dysfunction, recurrent urinary tract infection, urethral syndrome and interstitial cystitis. Expert evaluation of these conditions includes a complete history and physical exam. Urodynamics (bladder function test) and imaging studies may be required to fully evaluate the urinary tracts. Additional bladder studies such as cystoscopy may be necessary. The Department of Urology at Stony Brook offers a comprehensive evaluation and treatment plan for these female urologic disorders.

IncontinenceIncontinence is an involuntary loss of urine. It is further defined by type as either stress (leakage with straining, coughing, sneezing), urge, mixed, overflow, functional or reflex incontinence. Treatment is dependent on the type of incontinence. Current therapies include dietary changes, scheduled voiding, bladder retraining, pelvic muscle exercises, biofeedback, electrical stimulation therapy, medication, collagen implants and minimally invasive surgery.

Voiding Dysfunction  Voiding dysfunction can take many forms. The main symptoms are urinary frequency, urgency, painful urination and/or incomplete bladder emptying. Treatment is aimed at decreasing or eliminating symptoms. Treatment may involve medications or pelvic floor relaxation exercises.

Urinary Tract Infection (UTI)A recurrent urinary tract infection (UTI) may be generally defined as three or more infections within one year. This may be idiopathic (no obvious cause or related to a urologic disorder such as stones, tumor, reflux (urine flows backwards toward the kidney) or ineffective bladder emptying. Treatment is aimed at identifying the cause and/or proper antibiotic therapy to break the cycle of recurrent infection.

Urethral SyndromeUrethral syndrome is a condition involving pain at the urethra that can occur during urination or without regard to urination. Treatment may consist of oral medication or local estrogen replacement therapy. Urethral syndrome may exist as a component of interstitial cystitis.

Interstitial Cystitis (IC)Interstitial cystitis (IC) is a urologic syndrome characterized by excessive urinary urgency, frequency, nocturia (nighttime urination) and pain in the lower abdomen and/or perineum. It can occur at any age, however, the median age at diagnosis is between 42 and 46 years. The cause of IC is unclear. It is believed to be related to irregularities in the bladder lining and/or an allergic/immune response. IC can severely affect an individual's quality of life. Promising developments in the treatment of IC include medications, such as Elmiron, which works to restore the normal function of the bladder lining. Other drugs with calming effects on the bladder may also be helpful. Bladder instillations with dimethyl sulfoxide (DMSO) have achieved variable success. Hydrodistention of the bladder under anesthesia is a common therapeutic and diagnostic procedure. In the most severe cases, surgery including denervation, urinary diversion and augmentation cytoplasty may be performed. All of these evaluation and treatment options are available at the Urology Department of Stony Brook.   

References: http://bmj.bmjjournals.com http://www.hsc.stonybrook.edu

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