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Urinary Tract Infection
A urinary tract infection, or UTI, can occur at different points in the urinary tract, including:
Bladder -- An infection in the bladder is also called cystitis or a bladder infection.
Kidneys -- An infection of one or both kidneys is called pyelonephritis or a kidney infection.
Ureters -- The tubes that take urine from each kidney to the bladder are rarely the only site of infection.
Urethra -- An infection of the tube that empties urine from the bladder to the outside is called urethritis.
Causes
Most UTIs are caused by bacteria that enter the urethra and then the bladder. The infection most commonly develops in the bladder, but can spread to the kidneys. Most of the time, your body can get rid of these bacteria. However, certain conditions increase the risk for having UTIs.
Women tend to get them more often because their urethra is shorter and closer to the anus than in men. Because of this, women are more likely to get an infection after sexual activity or when using a diaphragm for birth control. Menopause also increases the risk for a UTI.
The following also increase your chances of developing a UTI:
Diabetes
Advanced age and conditions that affect personal care habits (such as Alzheimer disease and delirium)
Problems emptying the bladder completely
Enlarged prostate, narrowed urethra, or anything that blocks the flow of urine
Kidney stones
Staying still (immobile) for a long period of time (for example, while you are recovering from a hip fracture)
Pregnancy
Surgery or other procedure involving the urinary tract
Symptoms
The symptoms of a bladder infection include:
Cloudy or bloody urine, which may have a foul or strong odor
Low grade fever in some people
Pain or burning with urination
Pressure or cramping in the lower abdomen or back
Strong need to urinate often, even right after the bladder has been emptied
If the infection spreads to your kidneys, symptoms may include:
Fever above 101°F (38.3°C)
Pain in the side, back, or groin
Chills and shaking or night sweats
Fatigue and a general ill feeling
Flushed, warm, or reddened skin
Nausea and vomiting
Very bad abdominal pain (sometimes)
Exams and Tests
Most of the time, you will need to provide a urine sample for the following tests:
Urinalysis -- This test is done to look for white blood cells, red blood cells, bacteria, and to test chemicals such as nitrites in the urine. This test can diagnose an infection most of the time.
Urine culture -- This test may be done to identify the bacteria and determine the best antibiotic for treatment.
Blood tests such as complete blood count (CBC) and a blood culture & KFT may be done as well.
You may also need the following tests to help rule out other problems in your urinary system:
Ultrasound Of KUBP Region
Treatment
Your health care provider must first decide if the infection is just in the bladder, or if it has spread to the kidneys and how severe it is.
MILD BLADDER AND KIDNEY INFECTIONS
Most of the time, you will need to take an antibiotic to prevent the infection from spreading to the kidneys.
For a simple bladder infection, you will take antibiotics for 3 days (women) or 7 to 14 days (men).
If you are pregnant or have diabetes, or have a mild kidney infection, you will most often take antibiotics for 7 to 14 days.
Finish all of the antibiotics, even if you feel better. If you do not finish the whole dose of medicine, the infection may return and be harder to treat later.
Always drink plenty of water when you have a bladder or kidney infection.
Tell your provider if you might be pregnant before taking these drugs.
MORE SEVERE KIDNEY INFECTIONS
You may need to go into the hospital if you are very sick and cannot take medicines by mouth or drink enough fluids. You may also be admitted to the hospital if you:
Are an older adult
Have kidney stones or changes in the anatomy of your urinary tract
Have recently had urinary tract surgery
Have cancer, diabetes, multiple sclerosis, spinal cord injury, or other medical problems
Are pregnant and have a fever or are otherwise ill
At the hospital, you will receive fluids and antibiotics through a vein.
Some people have UTIs that do not go away with treatment or keep coming back. These are called chronic UTIs. If you have a chronic UTI, you may need stronger antibiotics or to take medicine for a longer time.
You may need surgery if the infection is caused by a problem with the structure of the urinary tract.
Outlook (Prognosis)
Most UTIs can be cured. Bladder infection symptoms most often go away within 24 to 48 hours after treatment begins. If you have a kidney infection, it may take 1 week or longer for symptoms to go away.
Possible Complications
Life-threatening blood infection (sepsis) -- The risk is greater among the young, very old adults, and people whose bodies cannot fight infections (for example, due to HIV or cancer chemotherapy).
Kidney damage or scarring.
Kidney infection.
Recurrent or Persistent UTI: Some people, esp women may get UTI's again and again, even several times a year. This may need detailed investigations and longer term treatment.
DO NOT NEGLECT UTI
DO NOT SELF MEDICATE
Blood in the Urine
(Hematuria )
What is hematuria?
Hematuria is the presence of blood in a person’s urine. It is one of the most worrying thing to happen to anyone.
What causes hematuria?
Common reasons why people may have blood in the urine are;
· UTI or infection in the bladder, kidney, or prostate. UTI is more common in women
· Kidney stones
· Enlarged prostate (BPH) in men.
· Injury, most commonly to the urethra in males.
· vigorous exercise
· sexual activity
· menstruation, when blood may get mixed with urine.
More serious reasons people may have hematuria include;
· bladder, kidney or prostate cancer
· patients who are on blood thinners
· blood-clotting disorders, such as hemophilia
· polycystic kidney disease—a genetic disorder in which many cysts grow on a person’s kidneys
What are the symptoms of hematuria?
People with hematuria have urine that is pink, red, or brown. Even a small amount of blood in the urine can cause urine to change colour. People with hematuria that includes blood clots in the urine may have bladder pain or pain in the back.
Normal Urine Blood in Urine
Sometimes blood in urine may appear brown or " COLA COLORED". This may mean slow bleeding from kidneys or old collected blood in bladder.
How is hematuria diagnosed?
A Urologist diagnoses the cause of the hematuria with
a medical history
a physical exam
urinalysis
additional testing
Medical History
Hematuria may be associated with;
Fever, burning sensation in urine & increased frequency of urination in UTI.
Some may have pain in the back which may be severe. This is seen commonly with kidney stones.
Painless hematuria, esp in elderly may be a sign of cancer.
Physical Examination
During a physical exam the urologist most often taps on the abdomen and back, checking for pain or tenderness in the bladder and kidney area.
He may perform a digital rectal exam on a man to look for any prostate problems.
He may perform a pelvic exam on a woman to look for the source of possible red blood cells in the urine.
TESTS :
Urinalysis
Routine Examination (RE) will confirm blood in urine and may show additional findings like pus cells, bacteria etc
Urine Culture test to see if there is any infection (UTI)
Additional Testing
KFT
Ultrasound of the KUB & Prostate region.
Computed tomography (CT) scan. It can help a doctordiagnose stones in the urinary tract, obstructions, infections, cysts, tumors, and traumatic injuries, when ultrasound is inconclusive OR when more information is needed before starting treatment.
Cystoscopy. Cystoscopy is a procedure that a urologist performs to see inside the patient’s bladder and urethra using a cystoscope, a tubelike instrument. A cystoscopy can detect cancer in a patient’s bladder.
Sometimes an MRI or PET scan may be needed to get more clarity esp in case cancer is the cause of blood in urine.
How is hematuria treated?
Urologists treat hematuria by treating its underlying cause, for example ; antibiotics for UTI depending on urine culture report, or removal of Kidney stones etc.
SUMMARY OF COMMON CAUSES OF BLOOD IN URINE BY AGE:
0-20 YEARS: UTI, Birth Defects causing obstruction
20-40 Years: UTI, Kidney stones, Bladder Tumor
40-60 Years: Bladder Tumor, Stone, UTI
> 60 Years (Male): BPH, Bladder Tumor, UTI
> 60 Years (Female): Bladder Tumor, UTI
Prostate Enlargement - ( BPH) :
Prostate gland is a sex accessory tissue.
The main function of the prostate gland is to secrete an alkaline fluid that comprises approximately 70% of the seminal volume.
The secretions produce lubrication and nutrition for the sperm. The alkaline fluid in the ejaculate results in liquefaction of the seminal plug and helps to neutralize the acidic vaginal environment.
The prostate is located below the bladder neck and surrounds that part of the urethra which starts from the bladder situated behind the pubic bone, ( as shown in picture above).
Normal prostate is around 20-25gm in weight and is approximately the size of a walnut ( ‘ Akhrot’ ).
As age advances, the prostate may also grow in size in some men. As the size increases the prostate presses upon the urethra which is passing through it and also the bladder neck ( shown in the picture above). This leads to difficulty in passing urine which may gradually increase in severity if left untreated.
Symptoms of Enlarged Prostate:
1. Increased frequency of urination.
2. There may be difficulty in starting urination.
3. Flow of urine becomes weak and it falls close to the feet.
4. The stream may get interrupted and stop in between.
5. One may have to strain to empty the bladder
6. There may be dribbling at the end.
7. You may take a long time to pass urine
8. You may have a feeling that the bladder is still not empty,
9. You may have to rush to pass urine.
10. At times some urine may leak before you reach the washroom.
11. Inability to pass urine OR passing only a few drops - Also called Retention of Urine.
This is an emergency situation and demands urgent treatment by way of putting a tube called 'catheter' in the bladder through the penis.
If you have any of the above symptoms you need to get yourself checked.
Enlarged Prostate is diagnosed:
1. From your symptoms as elaborated above.
2. Examination by urologist.
a) He will examine your abdomen to see if your urinary bladder is distended.
b) He may do a finger examination through your rectum to feel the prostate. This will give him an idea of its;
size
texture ( hard prostate may be due to cancer) and if it is
painful ( usually due to infection).
3. TESTS
a) Ultrasound of the KUBP with full bladder
b) Uroflometry with full bladder
c) Urine test
d) Kidney function tests (KFT), if required.
Treatment
This is of two types depending on severity of symptoms and test results.
Medical treatment with medicines.
There are two types of medicines,
a) One type ‘eases’ the flow of urine by relaxing the urine passage.
b) Another type reduces the size of prostate gradually over months.
c) Medicines may not ‘suit’ everyone due to side effects OR may not be fully effective due to various reasons ( large size of prostate).
2. Surgical Treatment
This is indicated when:
a) There is failure of medicines to improve symptoms.
b) When the enlarged prostate has affected kidney function.
c) When enlarged prostate is associated with UTI again & again.
d) When there is stone(s) in the bladder along with enlarged prostate.
Types of surgical Treatment: Common Treatment methods are;
1.TURP ( see photo on right)This is the most common method of treatment in more than 90% cases. Here an endoscope is used to remove prostate through the urinary passage. There is no cut on the body.
2.LASER TREATMENT ( HOLEP) ( see photo on right)This is usually done for very large prostates and for enlarged prostates in people who are on blood thinners. It requires special equipment & training. It is also much costlier than TURP.
There is no significant advantage of LASER procedure in routine enlarged prostate treatment.
catheter
TURP
Before & After TURP: Obstructing Prostate removed with 'opened-up' urinary passage.
LASER : HoLEP
Kidney Stone :
Causes, Symptoms, Treatment and Prevention
Kidneys remove excess chemicals and fluid from the blood to make urine. Sometimes, when too much of certain chemicals are excreted by the kidneys, they may precipitate and form stones.
What are the causes and risk factors of kidney stones?
Anyone can get a kidney stone, but some people are more likely than others to have them.
Men get kidney stones more commonly than women.
The chance of getting a stone is higher if a person ;
had had kidney stones before.
Dose not drink enough water.
Takes a diet high in protein, sodium and/or sugar.
Has structural abnormalities of kidney preventing complete emptying of urine from kidneys
has a certain condition that causes his urine to contain high levels of cystine, oxalate, uric acid or calcium.
Has a family who has had kidney stones.
Symptoms of kidney stones
If you have a very small kidney stone that moves easily through your urinary tract, you may not have any symptoms, and may never know that you had a kidney stone.
If you have a larger kidney stone, you may notice any of the following symptoms:
Pain while passing urine
Nausea and vomiting
Site of Kidney pain
Treatment for kidney stones
The treatment for a kidney stone depends on
a) size of the stone
b) its location ( See Figure)
c) what it is made of
d) whether it is causing pain and
e) whether it is blocking the urinary tract.
Location of stones
For this certain tests are required.
a) Ultrasound / X-ray and/or CT scan.
b) Urine tests
c) Blood tests
Common Treatment for Stones
a) Medical Treatment: If the test results show that the kidney stone is small, it may be treated with antibiotics, pain medicine, plenty of oral fluids to allow the stone to pass out on its own. During this period you will be kept under close observation and may require repeat ultrasound/X-Ray to see progress of the stone.
b) If the stone is large, or if it is blocking the urinary tract, Endoscopic surgical treatment may be necessary like;
i) URS with Laser for breaking stone into small dust-like pieces which pass in urine. This is done for stones in ureter.
ii) RIRS: where special equipment is used to break/remove small stones from kidney with use of Laser.
Iii) PCNL: In this large stones are removed from kidney by making a small (approx.1cm) direct puncture into kidney from your back.
d) ESWL: This treatment uses shock waves to break up the kidney stones into small pieces. After the treatment, the small pieces of the kidney stone will pass through your urinary tract and out of your body with your urine. This treatment usually takes 45 minutes to one hour.
In all these procedures there is NO CUT on the body.
How to prevent kidney stones
a)The best way to prevent most kidney stones is to drink at least 10 to 12 glasses of water per day.
b) Reduce intake of salt and animal protein (meat, eggs).
c) Reduce intake of green leafy vegetables, tomatoes, soft drinks, junk food, dry fruits etc. This reduces intake of Oxalates
d) Orange juice is good and may help prevent stones.
e) If your doctor can find out what your kidney stone is made of, he or she may be able to give you specific diet to help prevent future kidney stones. For this Stone Analysis is done once stone is removed.
Do not start or stop any treatment or diet without talking to your doctor first !
Avoid:
Palak Methi Gobhi Tomatar Pyaz
chiku Dry fruits
Common types of kidney stones
a) Calcium stones are the
most common type of kidney stones (70-80% of all stones). They are usually made of calcium and oxalate (a natural chemical found in most foods), but are sometimes made
of calcium and phosphate).
b) Uric acid stones form when the urine is often too acidic. Uric acid can form stones by itself or with calcium.
c) Struvite stones can happen when you have certain types of urinary tract infections in which bacteria make ammonia that builds up in your urine.
Struvite stones are made of magnesium, ammonium and phosphate
Kidney stone percentages according to type of stone
Highest percentage is Calcium Oxalate (CAOX)
BLADDER TUMOR
Causes
1.Up to 80% of bladder cancer cases are associated with environmental exposure. Tobacco use is by far the most common cause of bladder cancer. Smoking duration and intensity are directly related to increased risk.
The risk of developing bladder carcinoma is 2-6 times greater in smokers than in nonsmokers.
2,Numerous occupations associated with diesel exhaust, petroleum products, and solvents (eg, auto work, truck driving, plumbing, leather and apparel work, rubber and metal work) have also been associated with an increased risk of bladder cancer.
In addition, increased bladder carcinoma risk has been reported in persons, including the following, who work with organic chemicals and dyes:
· Beauticians
· Dry cleaners
· Painters
· Paper production workers
· Rope-and-twine industry workers
· Dental workers
· Physicians
· Barbers
Signs and symptoms
Clinical manifestations of bladder cancer are as follows:
· 1.Blood in urine, without pain - Approximately 80-90% of patient·
2.Irritative bladder symptoms eg, burning in urine, urgency, frequency of urination in 20 to 30% patients.
Common ways to diagnose:
Ultrasound of the abdomen including the Bladder/Kidney region ( commonly called the USG KUBP). This may show the cancer growth in bladder.
Urine test for cancer cells and presence of blood.
other tests for confirmation and extent/spread of growth are CT Scan with contrast. Occasionally MRI may be needed.
This will help in diagnosis and staging of the disease
Treatment: Depends on extent of the disease and its stage which is arrived at after basic and detailed tests.
Treatment Methods:
Endoscopic Removal of tumor: If confined only to the innermost lining (Mucosa) of the urinary bladder.
Surgical Removal of whole bladder if tumor has spread to urinary bladder muscle ( beyond the mucosa)
Radiotherapy +/- Chemotherapy if the tumor has spread beyond the urinary bladder.
Bladder Tumor Like a cauliflower (Gobhi ka phool ) OR 'Water Lily'
MALE INFERTILITY
What is infertility:
You may have male infertility if your wife/female partner has not become pregnant after you have regular sex for 1 year without any birth control/ use of condom.
Doctor will test both you and your wife/partner to find the cause of infertility.
Causes of Male Infertility:
1. Problems in penis erection leading to failure to have intercourse also called ERECTILE DYSFUNCTION
2. Lack of sexual desire or Libido.
3. SPERM DISORDERS. This could be due to;
a) Low sperm counts b) Sperm disorders c) structural disorders
Sperm disorders
Sperm disorders
Problems with making healthy sperm are the most common causes of male infertility. Sperm may be immature, abnormally shaped, or unable to swim. In some cases, you may not have enough sperm. Or you may not make any sperm. This problem may be caused by many different conditions, including:
Infections or inflammatory conditions. One example is infection with the mumps virus after puberty.
Hormone or pituitary gland problems
Immune problems in which you make antibodies against your own sperm
Environmental and lifestyle factors. These include smoking and alcohol use..
Genetic diseases.
Structural problems
Anything that blocks the genital tract can stop the flow of semen. This could be;
1. A genetic or birth defect.
2. Infection or inflammation from a sexually transmitted disease can also block semen.
3. Scar tissue from surgery or
4. Twisted, swollen veins in the scrotum.
Who is at risk for male infertility?
You may be more likely to have male infertility if you have had:
Past inflammation of the prostate or past genital infections
Injury to or twisting (torsion) of the testicles
Early or late puberty
Exposure of the genitals to high temperatures
Hernia repair
Undescended testicles
Varicocele
You may also be at risk if you take certain prescription medicines. These include medicines for ulcers, psoriasis, depression, and high blood pressure.
How is Male infertility treated?
Treatment depends on what is causing your infertility.
A) Medically treatable Causes:
1. Erectile Dysfunction.
2. Lack of Libido and / or Desire
B) Surgically correctible causes of Male infertility are;
1. Varicocele ( Enlarged veins in the male scrotum )
2. Blockage of tubes carrying the sperm ( Vaso-Epidydimal Anastomosis)
3. Reversal of Vasectomy done earlier for birth control.
OTHER TRETMENT FOR INFERTILITY when CAUSES ARE IN FEMALE OR UNIDENTIFIABLE
Artificial insemination. This method puts many healthy sperm at the entrance of the cervix or right into the partner's uterus. The sperm can then make their way to the fallopian tubes.
IVF, GIFT, and other techniques. In vitro fertilization (IVF) and gamete intra-fallopian transfer (GIFT) work like artificial insemination. The doctor collects your sperm. Then he or she mixes your partner’s eggs with a lot of high-quality sperm. He or she may mix the eggs and sperm in the lab or in your partner’s fallopian tube.
Intracytoplasmic sperm injection (ICSI). The doctorr injects a single sperm into an egg. Fertilization then takes place under a microscope. She/he then puts the fertilized egg in your partner’s uterus
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