What is the prostate?

The prostate is part of the male reproductive system located below the bladder and surrounding the urethra, the tube-like structure that carries urine from the bladder out through the penis. Normally, it is about the size of a walnut.  The main function of the prostate is to produce ejaculatory fluid.  You urinate directly through your prostate

What is BPH?

Benign prostatic hyperplasia (BPH) is a common urological condition caused by the non-cancerous enlargement of the prostate gland in aging men.  Over 70% of men in their 60s experience symptoms of BPH. Since the prostate surrounds the urethra, its enlargement can result in symptoms that irritate or obstruct the bladder.

Common symptoms include:

  • Frequent need to urinate both day and night
  • Weak or slow urinary stream
  • Sensation that you cannot completely empty your bladder
  • Difficulty starting stream
  • Urgent need to urinate, sometimes with incontinence or leaking urine before you make it to the bathroom
  • Urinary stream that starts and stops

How is BPH diagnosed?

Often, it can be diagnosed by a thorough discussion of symptoms.  The American Urological Association (AUA) BPH Symptom Score Index was developed to help quantify symptoms. This diagnostic system includes a series of questions that helps identify the severity of the BPH — ranging from mild to severe.

Other tests that are sometimes used to diagnose can include digital rectal examination (DRE), PSA test, ultrasound, urine flow study, and cystoscopy.

How is BPH treated?

Watchful Waiting

When symptoms are mild, your doctor may just monitor your condition and ask you to track your symptoms before deciding if any treatment is necessary.

Medications

Medications include alpha blockers which relax the muscles around the neck of your bladder, making it easier to urinate, and alpha reductase inhibitors which act to shrink the prostate. While medications can be very helpful in relieving symptoms for some men, patients must continue taking them long-term to maintain the effects.

Medications are usually first-line therapy.  When medical therapy fails, or men do not tolerate or want to take medications, a procedure is necessary to relieve the obstruction. Surgery is almost always recommended for men who are unable to urinate, have kidney damage, frequent urinary tract infections, significant urethral bleeding or stones in the bladder. There are several different ways that the obstruction can be relieved and

UroLift® System Treatment

The UroLift® System treatment is a minimally invasive approach to treating BPH that can be done in the office.  It lifts or holds the enlarged prostate tissue out of the way so it no longer blocks the urethra. There is no cutting, heating or removal of prostate tissue. Clinical data has shown that the UroLift System treatment is safe and effective in relieving lower urinary tract symptoms due to BPH without any impact to sexual function.

Learn more about how the UroLift System treatment works or visit our FAQ page for more information on the benefits, risks, and recovery.

Surgery

Removal of the prostate can be accomplished in several different ways. The location of the enlargement within the prostate and the patient’s general health will help the urologist determine which of the three following procedures to use.

Transurethral Resection of the Prostate (TURP)

TURP is the most common surgery to treat BPH and approximately 200,000 men have this procedure each year. During this procedure, patients undergo general anesthesia, and prostate tissue is removed. TURP is often considered the “gold standard” for long-term results.

After prostate tissue has been removed, the body needs time to heal. The remaining prostate tissue may actually swell and become inflamed before the desired shrinking effect occurs. Patients may suffer an uncomfortable recovery period that includes short-term problems
such as bleeding, infection, erectile dysfunction, and urinary incontinence. Patients have to
have a catheter that is attached to a urine bag inserted into their bladder for several days after the procedure.

Symptom relief may not occur immediately, but lasts for a long time in many patients once it does occur.

There can be long-term side effects after TURP such as dry orgasm (retrograde ejaculation), erectile dysfunction or incontinence (leaking of urine

Laser resection of prostate

TURP may be performed with a laser in procedures called photoselective vaporization of the prostate (PVP) or holmium laser enucleation (HOLEP). Laser therapy lessens the bleeding risks of traditional TURP. However, since prostate tissue is still removed, there can be tissue swelling and an uncomfortable healing time. Typically, a catheter has to be inserted into the bladder after the procedure.

Transurethral incision of the prostate (TUIP)

Transurethral incision is used for men with smaller prostate glands who suffer from significant obstructive symptoms. Instead of cutting and removing tissue to relieve the obstructed bladder, this procedure widens the urethra by making several small cuts in the bladder neck where the urethra joins the bladder and in the prostate itself. This reduces the pressure of the prostate on the urethra and makes urination easier.  Patients normally stay in the hospital one to three days. A catheter is left in the bladder for one to three days after surgery.

Open prostatectomy:

When a transurethral (endoscopic) procedure cannot be done, open surgery may be required. Open prostatectomy for BPH is also performed for a prostate that is too large to remove through the penis.

An incision is made in the abdominal wall from below the belly button to the pubic bone. The prostate gland can then be removed in its entirety through either an incision in the fibrous capsule surrounding the prostate (retropubic prostatectomy) or through an incision made in the bladder (suprapubic prostatectomy). Postoperative pain is mild to moderate. Patients usually stay in the hospital for 2-3 days and go home with a urinary catheter. In some cases a second, temporary catheter draining the bladder through the lower abdominal wall is also used.

What can be expected after treatment?

Postoperatively, patients typically experience significant improvement in their symptoms (table 1). As with any operative procedure, complications do exist. Some occur in the early postoperative period (table 2) while others may occur many years later (table 3).

Table 1: Overall improvement in patient symptoms

TURP

TUIP

Open

88%

80%

98%

Table 2: Immediate post-operative complications

 

TURP

TUIP

Open

Infection

15%

13%

13%

Bleeding requiring transfusion

5-10%

1%

8%

Impotence

14%

12%

17%

Retrograde ejaculation

73%

25%

77%

Incontinence

1%

<1%

<1%

Table 3: Late post-operative complications

 

TURP

TUIP

Open

Stricture and bladder neck contracture
(scar tissue causing obstruction)

4%

3%

4%

Additional surgery within 5 years

10%

9%

2%

 

Will surgery for BPH affect my ability to enjoy sex?

Most urologists say that even though it takes a while for sexual function to return fully, most men are able to enjoy sex again. Most experts agree that if you were able to maintain an erection shortly before surgery, you will probably be able to do so after surgery. Most men find little or no difference in the sensation of orgasm although they may find themselves suffering from retrograde ejaculation.

 

Is BPH common?

Yes, it is very common. It will affect approximately 50 percent of men between the ages of 51 and 60 and up to 90 percent of men over the age of 80.

Does BPH lead to prostate cancer?

No, BPH is not cancer and cannot lead to cancer, although both conditions can exist together. There are usually no symptoms during the early stages of prostate cancer, so yearly physical examinations and PSA testing are highly recommended.

Surgical Management of Stones

Normally, urine contains chemicals that prevent crystals from forming. But what happens when you start to have pain in your back or side or you are having problems with urination? Could you be one of the thousands of people with kidney stones? The information below should give you a head start about this potentially serious health hazard.

The kidney performs many functions, the most important of which is the filtering of blood to remove toxins. Blood flows into the filtering component of the kidney called the glomerulus. The filtered portion of the blood then progresses through channels within the kidney, called tubules, which perform “fine tuning” of the filtering process. The final product of the filtered blood is urine, which gathers briefly in the renal pelvis and then is transported down the ureter, the muscular tube that carries urine to the bladder.

What happens under normal conditions? What are kidney stones?

Normally, urine contains many dissolved substances. At times, some materials may become concentrated in the urine and form solid crystals. These crystals can lead to the development of stones when materials continue to build up around them, much as a pearl is formed in an oyster.

The incidence of urolithiasis, or stone disease, is about 12 percent by age 70 for males and 5 percent for females in the United States. The debilitating effects of urolithiasis are quite substantial, with patients incurring billions of dollars in treatment costs each year. Stones occur more commonly in men than women, at a ratio of 3-to-1. In general, the peak incidence of stones occurs when a person is in their 30s.

The majority of stones contain calcium, with most being comprised of a material called calcium oxalate. Other types of stones include substances such as calcium phosphate, uric acid, cystine and struvite. 

What are some risk factors for kidney stones? 

A number of risk factors play major roles in stone formation. The first is loss of body fluids (dehydration). When one does not consume enough fluids during the day, the urine often becomes quite concentrated and darker. This increases the chance that crystals can form from materials within the urine, because there is less fluid available to dissolve them.

Diet can also affect the probability of stone formation. A high-protein diet can cause the acid content in the body to increase. This decreases the amount of urinary citrate, a “good” chemical that helps prevent stones. As a result, stones are more likely to form. A high-salt diet is another risk factor, as an increased amount of sodium passing into the urine can also pull calcium along with it. The net result is an increased calcium level in the urine, which increases the probability for stones. Intake of oxalate-rich foods such as leafy green vegetables, tea or chocolate may also worsen the situation.

Finally, a family history of stones, especially in a first-degree relative (parent or sibling), dramatically increases the probability of having stones.

What are the symptoms of kidney stones?

Once stones form in the urinary tract, they often grow with time and may change location within the kidney. Some stones may be washed out of the kidney by urine flow and end up trapped within the ureter. Stones usually begin causing symptoms when they block the outflow of the urine leading to the bladder.

Symptoms of an obstructing stone can vary. Most often, patients will complain of pain centered in their sides (flank), which may also radiate toward the front of the abdomen or to the groin area. At times, the pain may become so severe that the patient becomes unable to find a comfortable position. Blood in the urine (hematuria) may also appear when a stone is present. In some patients, especially those with diabetes, a fever may develop from infected urine that becomes trapped behind a stone. This is a medical emergency, as a bacterial infection that is not drained can cause a critical illness.

How are kidney stones diagnosed?

When a urinary stone is suspected, an immediate evaluation is required. Blood is obtained to check on overall kidney function as well as to exclude signs of infection throughout the body. Urine is sent for a urinalysis and culture. A simple X-ray of the abdomen is sometimes enough to pinpoint a calcification in the area of the kidneys or ureters, thus identifying a likely obstructing stone. If the X-ray film does not provide enough information to make a diagnosis, then an intravenous pyelogram (IVP) may be performed. A kidney blocked by a stone will not be able to excrete the dye from the IVP test as quickly and may appear enlarged. A final diagnostic exam that can be done is an abdominal/pelvic CT scan, which is very sensitive and can detect almost all types of urinary stones.

The abovementioned tests give your urologist information about the size, location and number of stones that are causing the symptoms. This allows the urologist to determine appropriate treatments.

How are kidney stones treated?

Stone size, the number of stones and their location are perhaps the most important factors in deciding the appropriate treatment for a patient with kidney stones. The composition of a stone, if known, can also affect the choice of treatments. Options for surgical treatment of stones include:

Shock Wave Lithotripsy (SWL): This is a completely non-invasive form of treatment in which an energy source generates a shock wave that is directed at a urinary stone within the kidney or ureter. Shock waves are transmitted to the patient either through a water bath, which the patient is placed in, or using a water-filled cushion that is placed against the skin. Ultrasound or fluoroscopy is used to locate the stone and focus the shock waves. The repeated force caused by the shock waves fragments the stone into small pieces.

SWL is most often performed under heavy sedation, although general anesthesia is sometimes used. Once the treatment is completed, the small stone particles then pass down the ureter and are eventually urinated away. In certain cases, a stent may need to be placed up the ureter just prior to SWL to assist in stone fragment passage.

Certain types of stone (cystine, calcium oxalate monohydrate) are resistant to SWL and usually require another treatment. In addition, larger stones (generally greater than 2.5 centimeters) may break into large pieces that can still block the kidney. Stones located in the lower portion of the kidney also have a decreased chance of passage.

Ureteroscopy (URS): This treatment involves the use of a very small, fiber-optic instrument called a ureteroscope, which allows access to stones in the ureter or kidney. The ureteroscope allows your urologist to directly visualize the stone by progressing up the ureter via the bladder. No incisions are necessary but general anesthesia is used.

Once the stone is seen through the ureteroscope, a small, basket-like device can be used to grasp smaller stones and remove them. If a stone is too large to remove, a laser, spark-generating probe or air-driven (pneumatic) probe can be passed through a channel built into the ureteroscope and the stone can be fragmented. 

A straightforward case is complete once the stone has been shattered appropriately. However, if extensive manipulation was required to reach and/or treat the stone, your urologist may choose to place a stent within the ureter to allow the post-operative swelling to subside.

Percutaneous nephrolithotomy (PNL): PNL is the treatment of choice for large stones located within the kidney that will not be effectively treated with either SWL or URS. General anesthesia is required to perform a PNL. The main advantage of this approach compared to traditional open surgery is that only a small incision (about one centimeter) is required in the flank. The urologist then places a guide wire through the incision. The wire is inserted into the kidney under fluoroscopic guidance and directed down the ureter. A passage is then created around the wire using dilators to provide access into the kidney. 

An instrument called a nephroscope is then passed into the kidney to visualize the stone. Fragmentation can then be done using an ultrasonic probe or a laser. Because the tract allows passage of larger instruments, your urologist can suction out or grasp the stone fragments as they are produced. This results in a higher clearance of stone fragments than with SWL or URS.

Once the procedure is complete, a tube is left in the flank to drain the kidney for several days.

Open surgery: A large incision is required in order to expose the kidney or portion of ureter that is involved with the stone.  The portion of kidney overlying the stone or the ureteral wall is then surgically cut and the stone removed.

At present, open surgery is used only for very complicated cases of stone disease.

What can be expected after treatment for kidney stones?

Recovery times vary depending upon treatment, with the less invasive procedures allowing shorter recovery periods and quicker return to activity.

Shock Wave Lithotripsy (SWL): Patients generally go home the same day as the procedure and are able to resume a normal activity level in two to three days. Fluid intake is encouraged, as larger quantities of urine can help stone fragments to pass. Because the fragments need to pass spontaneously down the ureter, some flank pain can be anticipated. It is possible that the stone may not have shattered well enough to pass all of the fragments. If so, a repeat SWL treatment or other option may be required. If a stent was placed prior to SWL, this will need to be removed in your urologist’s office within a few weeks. Stents are usually well tolerated by patients but can occasionally cause some bladder irritation and frequent urination.

Ureteroscopy (URS): Patients normally go home the same day and can resume normal activity in two to three days. As with SWL, if your urologist places a stent, it will need to be removed in approximately one week. 

Percutaneous nephrolithotomy (PNL): After PNL, patients usually spend two to three days in the hospital. Your urologist may choose to have additional X-rays done while you are still in the hospital to determine if any stone fragments are still present. If some remain, your urologist may want to look back into the kidney with a nephroscope to remove them. This secondary procedure usually can be done with sedation and through the existing tract into the kidney. Once the stones have been removed, the stent coming out of the flank is removed and the patient can be discharged. Normal activity can be resumed after approximately one to two weeks.

Open surgery: Because these procedures are the most invasive and painful, patients often spend up to five to seven days in the hospital. Full recovery may take up to six weeks.

Postoperatively, your urologist will encourage a high fluid intake, to keep the daily volume of urine produced greater than two liters a day. In addition, you may need to undergo additional blood and urine tests to determine specific risk factors for stone formation and help minimize the chance for future stones. Although stone recurrence rates differ with each individual, a good estimate to keep in mind is a 50 percent chance of redeveloping a stone within a five-year period.

Frequently Asked Questions:

What are the risks or potential complications of the various treatments?

Each treatment has its own inherent risks. Some risks that can be associated with all surgical procedures are the possibility of bleeding and infection. It is extremely rare for patients undergoing shock wave lithotripsy (SWL) or ureteroscopy (URS) to have any problems with blood loss or infection. The probability is higher with more invasive treatments such as percutaneous nephrolithotomy (PNL) or open surgery. In most cases, patients do not require transfusion unless the procedure is unusually difficult.

With SWL, except in emergencies, patients must avoid aspirin, non-steroidal anti-inflammatory drugs such as ibuprofen or other blood thinners, as these can cause significant bleeding around the kidney. It is important that these medications be stopped at least one week prior to treatment if possible. SWL is generally a very safe treatment. Long-term follow up of patients has shown a slight increase in blood pressure, but no lasting adverse effect on kidney function has been noted.

In URS, there is a small possibility that the ureteral wall could be damaged or torn during the procedure. If this occurs, placement of a stent for two to three weeks is usually sufficient to allow the damaged area to heal. A complete tear of the ureter is very rare and requires open surgery to repair.

When PNL is performed, there is a small chance of air or fluids forming around a lung if the access channel is made toward the upper portion of the kidney. These entities are treated with a chest tube, which allows drainage of the fluid from around the lung. Other rare complications include injury to the bowel and injury to blood vessels within the kidney.

Will I have significant pain after the procedure?

Some discomfort is inevitable after surgical intervention for stones. The degree of discomfort is directly related to the invasiveness of the procedure. If needed, your urologist will prescribe medication to help control the pain during the recovery period.

What are signs of a problem postoperatively?

It is not uncommon for a patient to have a low-grade fever for the first 48 hours after surgery. However, if the fever continues or rises above 101.5° F (38.5° C) it could be a sign of active infection and should be reported to your urologist. Flank discomfort is also common after surgical interventions. However, if the pain becomes increasingly worse or unbearable, despite medication, your urologist should be notified.

How many times will I need to be treated?

The answer to this question depends on the size of stone and the treatment used. The chances for re-treatment are highest after SWL if the stone is large, extremely hard or in the lower portion of the kidney. PNL and open surgery tend to produce the highest stone-free rates.

Hematuria

There are many reasons why a person can have blood in their urine. This condition, known as hematuria, can be an indication of a serious problem or conversely, have no negative connotation. What should you do if you find out that there’s blood in your urine? Read the following to learn more.

What is Hematuria?

Hematuria is defined as the presence of red blood cells in the urine. It can be characterized as either “gross” (visible to the naked eye) or “microscopic” (visible only under the microscope). Microscopic hematuria is an incidental finding often discovered on urine tests as part of a routine medical evaluation, whereas gross hematuria could prompt you to visit the doctor. Hematuria can originate from any site along the urinary tract, including the kidneys, ureters, bladder, prostate and urethra. It is estimated that hematuria occurs in 2.5 to 21 percent of the population. In many patients no specific cause is found; however, hematuria may be a marker for infection, stone disease or urinary tract cancer. Risk factors for significant underlying disease include: smoking, radiation, overuse of some pain medicines and exposure to certain chemicals.

What are the common causes of Hematuria?

Blood in the urine is often not a sign of significant disease. Studies have shown that between nine to 18 percent of normal individuals can have some degree of hematuria. However, hematuria can be a sign of an important medical condition requiring treatment. Below is a list of common causes of hematuria:

  • Bladder Cancer
  • Kidney Cancer
  • Prostate Cancer
  • Ureteral Cancer
  • Urethral Cancer
  • Urinary Stone Disease
  • Urinary Tract Infection
  • Pyelonephritis (Kidney Infection)
  • Benign Prostatic Hypertrophy (Enlarged Prostate)
  • Renal (Kidney) Disease
  • Radiation or Chemical Induced Cystitis (Bladder Irritation)
  • Injury to the Urinary Tract
  • Prostatitis (Prostate Infection)
  • Exercise Hematuria

How is Hematuria diagnosed?

Visible hematuria is often worrisome to the patient and prompts them to seek medical attention; however, microscopic hematuria can be just as severe. It often has no symptoms and is detected on a urine dipstick test. If the dipstick test is positive for blood the amount of blood is often determined by looking at the urine with a microscope. If three or more red blood cells (RBC) are seen per high power field on two of three specimens, further evaluation to determine a cause is recommended.

What additional tests are needed?

Any patient with gross hematuria or significant microscopic hematuria should have further evaluation of the urinary tract. The first step is a careful history and physical examination. Laboratory analysis consists of a urinalysis and examination of urinary sediment under a microscope. The urine should be evaluated for protein (a sign of kidney disease) and evidence of urinary tract infection. The number of red blood cells per high-powered field should be determined. In addition the shape of the blood cells should be evaluated. This can help determine where the bleeding is coming from. In patients with white blood cells in the urine, a urine culture should be performed as well. A urinary cytology is also obtained to look for abnormal cells in the urine. A blood test should also be done to measure serum creatinine (a measure of kidney function). Those patients with significant protein in their urine, abnormally shaped red blood cells, or an elevated creatinine level should undergo general medical evaluation for the presence of kidney disease.

A complete urologic evaluation for hematuria also includes X-rays of the kidneys and ureters to detect kidney masses, tumors of the ureters and the presence of urinary stones. This traditionally consisted of an intravenous pyelogram (IVP). In this study, a radiographic dye is injected into the blood stream and X-rays are taken as the kidneys excrete the dye. This study has trouble detecting small renal masses and is often combined with a renal ultrasound.

Many physicians may opt for other imaging studies such as a computerized tomography (CT) scan. This is the preferred method of evaluating kidney masses and is the best modality for the evaluation of urinary stones. Recently many urologists have been using CT urography. This allows the urologist to look at the kidneys and ureters with one X-ray test. In patients with an elevated creatinine or an allergy to X-ray dye, magnetic resonance imaging (MRI) or retrograde pyelography is used to evaluate the upper urinary tract. During retrograde pyelography, the patient is taken to the operating room and dye is injected up the ureters from the bladder and then images are taken.

The main limitation of these imaging studies is the inability to evaluate the bladder; therefore a cystoscopic evaluation is required. This is usually performed in the office under local anesthesia with either a rigid, or more commonly, a flexible cystoscope. After applying a topical analgesic to the urethra the urologist inserts an instrument called a cystoscope through the urethra and into the bladder. Looking through the cystoscope the doctor can examine the inner lining of the bladder and urethra for abnormalities.

What happens if no abnormality is found?

In at least eight to 10 percent of cases no cause for hematuria is found. Some studies have demonstrated an even higher percentage of patients have no cause. Unfortunately, studies have shown that urologic malignancy is later discovered in one to three percent of patients with negative work-ups. Therefore, some form of follow-up is recommended. Recommendations regarding follow-up are sparse and no clear consensus has been agreed upon. Consideration should be given to repeating the urinalysis and urine cytology at six, 12, 24 and 36 months. Immediate re-evaluation with possible cystoscopy and repeat imaging should be performed in the face of gross hematuria, abnormal urinary cytology or irritating urinary symptoms such as pain with urination or increased frequency of urination. If none of these symptoms occur within three years, no further urologic testing is needed.

How will hematuria be treated?

Treatment will be based on a physician’s evaluation of the patient’s condition, symptoms and medical history along with the cause of the hematuria.

Prostate cancer

  Prostate cancer is the most common non-skin cancer in men in the United States, and the second leading cause of cancer death in men. The American Urological Association Foundation (AUA Foundation) is concerned that recent studies about prostatespecific antigen (PSA) testing may present conflicting information to patients about the value of this critical prostate-cancer screening test. The benefits of regular screening and early detection should not be discounted in the overall population. The AUA Foundation believes that the decision to screen is one that a man should make with his doctor following a careful discussion of the benefits and risks of screening. In men who wish to be screened, the AUA recommends getting a baseline PSA, along with a physical exam of the prostate known as a digital rectal exam (DRE) at age 40. What is PSA? Prostate-specific antigen (PSA) is a substance produced by the prostate gland. The PSA level in a man’s blood is an important marker of many prostate diseases, including prostate cancer. If your PSA is high for your age or is steadily rising, (with or without an abnormal physical exam of your prostate with a DRE) a biopsy may be recommended. The doctor should consider other risk factors for prostate cancer such as family history, and ethnicity before recommending a biopsy. The biopsy will determine if cancer or other abnormal cells are present in the prostate. The goal of early detection is to reduce death from prostate cancer in men. Early stage prostate cancer offers many options for treatment and cure. Some men may be candidates for careful surveillance of their cancer instead of receiving immediate treatment. Ideally, the characteristics of each man’s prostate cancer will guide an informed discussion with his doctor. Consider these important factors from the American Urological Association to help you decide if prostate screening with PSA testing is right for you.

Kidney Cancer

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 Bladder Cancer

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Duis tincidunt, dui non pretium molestie, turpis tellus mollis elit, vitae cursus magna mi pulvinar magna. Donec velit ipsum, placerat ac libero sed, sagittis efficitur nibh. Mauris facilisis, augue ac bibendum luctus, velit dui vulputate nisl, eget placerat neque ex quis tellus. Maecenas tempor in enim quis hendrerit. Vestibulum ante ipsum primis in faucibus orci luctus et ultrices posuere cubilia Curae; Sed augue tellus, pellentesque at mollis eget, congue eget libero. Ut nec condimentum eros, id eleifend leo.

Mauris sit amet dolor lorem. Nunc quis felis purus. Quisque vel lectus in lectus pretium iaculis. Donec sed nibh pharetra, ullamcorper lorem a, volutpat purus. Nulla facilisi. In luctus nisl id est ornare convallis. Cras ut iaculis nisl, imperdiet molestie lectus. Praesent varius iaculis quam, ut luctus magna fermentum quis. Sed id augue pharetra enim aliquet efficitur molestie et sapien. Nam ornare sit amet lorem ac sodales. Vivamus dignissim nec erat vitae pretium. Proin bibendum ultrices augue in maximus.

Curabitur vel aliquet velit. In vehicula purus quis elit convallis, nec eleifend metus suscipit. Class aptent taciti sociosqu ad litora torquent per conubia nostra, per inceptos himenaeos. Mauris id elit in diam tincidunt condimentum. Nulla ligula nisi, convallis sit amet imperdiet quis, hendrerit fringilla dolor. Nulla egestas nisi mi, quis ultrices odio elementum vel. Nulla facilisi. Quisque placerat vulputate tellus, cursus maximus massa aliquam et. Donec consectetur commodo orci sed hendrerit. Pellentesque venenatis mollis urna, vitae feugiat magna commodo sit amet. Donec eget mauris quis enim blandit tristique ut a est.

Overactive Bladder

Overactive bladder, or OAB, is a condition in which the bladder muscle, called the detrusor, becomes hyperactive and contracts intermittently and suddenly resulting in the sensation significant urge to urinate more frequently than is normal.

An estimated 30 million people in the United States alone suffer from this condition. Urge urinary incontinence or UUI, is a severe form of overactive bladder where the intermittent contractions are strong enough that you start to urinate before making it to the bathroom. This is different from stress incontinence (SUI) in which leakage occurs with sudden increases in abdominal pressure like coughing because of weakening of muscles surrounding the bladder. However, many people experience both stress and urge incontinence, termed mixed urinary incontinence.
There are many causes of OAB and UUI, but there are also many treatment options. Some of the common symptoms of OAB including:
– Frequency — having to urinate more than 8 times over 24 hours, often including 2 or more times a night.
– Urgency — frequent, sudden, strong urges to urinate with little or no chance to postpone urination.

About 60% of patient with OAB experience only urinary frequency and urgency whereas the other 40% have incontinence in addition to these symptoms. Common triggers for symptoms include hearing running water, standing up after sitting for extended period of time, and arriving home/to a pre-meditated destination (“garage door syndrome” or “key in door syndrome”)

What are treatment options?

There are many things that can be done to improve symptoms. Simple changes such as limiting acidic fluids such as coffees, teas and sodas can make a big impact on symptoms. Physical therapy for pelvic floor muscles with a program called Biofeedback can also control symptoms. There are also many medications that can help. If one medication doesn’t work, oftentimes another medication will.

If these measures fail to control symptoms there are additional treatment options. One such option includes injecting Botox into the bladder. This is a simple procedure performed in the office and the effects can last 6-9 months at a time. Another option is the Interstim in which a small pacemaker for the bladder is implanted under the skin in your lower back. It sends a continuous signal to your bladder to decrease the hyperactivity. This is a permanent treatment solution. Lastly, another option is called percutaneous tibial nerve stimulation where a small needle, the size of a needle used for acupuncture, is temporarily placed above your ankle. This is connected to a battery that sends a signal to your bladder to relax. There is no pain and the treatment session lasts for 20 minutes and is repeated on a weekly basis until symptoms are controlled.

Urinary incontinence

Urinary incontinence occurs when a person leaks urine involuntarily and unexpectedly. It is a troubling condition that can affect both men and women but is nearly twice as common in woman. Although the incidence goes up with age, younger people can experience incontinence as well. For men with incontinence issues please click here for more information.

The incidence of incontinence increases as you age: as many as 1 in 4 women between the ages of 20 and 39 are affected and nearly 40% of all woman over the age of 80 experience urinary incontinence. You are not alone, and it is not something you have to live with. Many things can be done to treat your symptoms and stop the unwanted leakage. There are two main causes of urinary incontinence and many patients may experience both:
– STRESS URINARY INCONTINENCE (SUI)
– Urine leaks with activities
– Coughing, sneezing, laughing, lifting, exercising
– OVERACTIVE BLADDER AND URINARY INCONTINENCE
– “Gotta go now” (urgency)
– “Gotta go now” with leakage (urge incontinence)
– “Gotta go often” (frequency)
– Going often during the night (nocturia)
– OTHER TYPES
– Mixed incontinence (stress and urge)
– Continuous (unpredictable) incontinence
– Neurogenic bladder

Vaginal Prolapse

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Pellentesque sed vestibulum eros. Sed at risus sit amet ligula blandit auctor. Aliquam erat volutpat. In sit amet libero nisl. Aliquam erat volutpat. Lorem ipsum dolor sit amet, consectetur adipiscing elit. Phasellus dui quam, feugiat sed risus vel, faucibus vulputate neque. Etiam sed ultrices odio.

Donec mi justo, aliquam non pellentesque vel, tincidunt et mauris. Cras semper orci non euismod congue. Donec velit erat, commodo vitae neque et, viverra placerat quam. Donec porta eget purus quis ultrices. Morbi eu hendrerit nibh, eget pharetra massa. Mauris ullamcorper quis leo ut rutrum. Praesent nec luctus ligula. Suspendisse nec faucibus mauris, vel venenatis tellus. Integer pretium nulla id dapibus cursus. Nunc sollicitudin massa dolor, eu cursus velit congue id. Maecenas ligula turpis, bibendum vel ultrices et, auctor a felis.

Duis tincidunt, dui non pretium molestie, turpis tellus mollis elit, vitae cursus magna mi pulvinar magna. Donec velit ipsum, placerat ac libero sed, sagittis efficitur nibh. Mauris facilisis, augue ac bibendum luctus, velit dui vulputate nisl, eget placerat neque ex quis tellus. Maecenas tempor in enim quis hendrerit. Vestibulum ante ipsum primis in faucibus orci luctus et ultrices posuere cubilia Curae; Sed augue tellus, pellentesque at mollis eget, congue eget libero. Ut nec condimentum eros, id eleifend leo.

Mauris sit amet dolor lorem. Nunc quis felis purus. Quisque vel lectus in lectus pretium iaculis. Donec sed nibh pharetra, ullamcorper lorem a, volutpat purus. Nulla facilisi. In luctus nisl id est ornare convallis. Cras ut iaculis nisl, imperdiet molestie lectus. Praesent varius iaculis quam, ut luctus magna fermentum quis. Sed id augue pharetra enim aliquet efficitur molestie et sapien. Nam ornare sit amet lorem ac sodales. Vivamus dignissim nec erat vitae pretium. Proin bibendum ultrices augue in maximus.

Curabitur vel aliquet velit. In vehicula purus quis elit convallis, nec eleifend metus suscipit. Class aptent taciti sociosqu ad litora torquent per conubia nostra, per inceptos himenaeos. Mauris id elit in diam tincidunt condimentum. Nulla ligula nisi, convallis sit amet imperdiet quis, hendrerit fringilla dolor. Nulla egestas nisi mi, quis ultrices odio elementum vel. Nulla facilisi. Quisque placerat vulputate tellus, cursus maximus massa aliquam et. Donec consectetur commodo orci sed hendrerit. Pellentesque venenatis mollis urna, vitae feugiat magna commodo sit amet. Donec eget mauris quis enim blandit tristique ut a est.

Recurrent Urinary Tract Infections

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Pellentesque sed vestibulum eros. Sed at risus sit amet ligula blandit auctor. Aliquam erat volutpat. In sit amet libero nisl. Aliquam erat volutpat. Lorem ipsum dolor sit amet, consectetur adipiscing elit. Phasellus dui quam, feugiat sed risus vel, faucibus vulputate neque. Etiam sed ultrices odio.

Donec mi justo, aliquam non pellentesque vel, tincidunt et mauris. Cras semper orci non euismod congue. Donec velit erat, commodo vitae neque et, viverra placerat quam. Donec porta eget purus quis ultrices. Morbi eu hendrerit nibh, eget pharetra massa. Mauris ullamcorper quis leo ut rutrum. Praesent nec luctus ligula. Suspendisse nec faucibus mauris, vel venenatis tellus. Integer pretium nulla id dapibus cursus. Nunc sollicitudin massa dolor, eu cursus velit congue id. Maecenas ligula turpis, bibendum vel ultrices et, auctor a felis.

Duis tincidunt, dui non pretium molestie, turpis tellus mollis elit, vitae cursus magna mi pulvinar magna. Donec velit ipsum, placerat ac libero sed, sagittis efficitur nibh. Mauris facilisis, augue ac bibendum luctus, velit dui vulputate nisl, eget placerat neque ex quis tellus. Maecenas tempor in enim quis hendrerit. Vestibulum ante ipsum primis in faucibus orci luctus et ultrices posuere cubilia Curae; Sed augue tellus, pellentesque at mollis eget, congue eget libero. Ut nec condimentum eros, id eleifend leo.

Mauris sit amet dolor lorem. Nunc quis felis purus. Quisque vel lectus in lectus pretium iaculis. Donec sed nibh pharetra, ullamcorper lorem a, volutpat purus. Nulla facilisi. In luctus nisl id est ornare convallis. Cras ut iaculis nisl, imperdiet molestie lectus. Praesent varius iaculis quam, ut luctus magna fermentum quis. Sed id augue pharetra enim aliquet efficitur molestie et sapien. Nam ornare sit amet lorem ac sodales. Vivamus dignissim nec erat vitae pretium. Proin bibendum ultrices augue in maximus.

Curabitur vel aliquet velit. In vehicula purus quis elit convallis, nec eleifend metus suscipit. Class aptent taciti sociosqu ad litora torquent per conubia nostra, per inceptos himenaeos. Mauris id elit in diam tincidunt condimentum. Nulla ligula nisi, convallis sit amet imperdiet quis, hendrerit fringilla dolor. Nulla egestas nisi mi, quis ultrices odio elementum vel. Nulla facilisi. Quisque placerat vulputate tellus, cursus maximus massa aliquam et. Donec consectetur commodo orci sed hendrerit. Pellentesque venenatis mollis urna, vitae feugiat magna commodo sit amet. Donec eget mauris quis enim blandit tristique ut a est.

Interstitial Cystitis

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Pellentesque sed vestibulum eros. Sed at risus sit amet ligula blandit auctor. Aliquam erat volutpat. In sit amet libero nisl. Aliquam erat volutpat. Lorem ipsum dolor sit amet, consectetur adipiscing elit. Phasellus dui quam, feugiat sed risus vel, faucibus vulputate neque. Etiam sed ultrices odio.

Donec mi justo, aliquam non pellentesque vel, tincidunt et mauris. Cras semper orci non euismod congue. Donec velit erat, commodo vitae neque et, viverra placerat quam. Donec porta eget purus quis ultrices. Morbi eu hendrerit nibh, eget pharetra massa. Mauris ullamcorper quis leo ut rutrum. Praesent nec luctus ligula. Suspendisse nec faucibus mauris, vel venenatis tellus. Integer pretium nulla id dapibus cursus. Nunc sollicitudin massa dolor, eu cursus velit congue id. Maecenas ligula turpis, bibendum vel ultrices et, auctor a felis.

Duis tincidunt, dui non pretium molestie, turpis tellus mollis elit, vitae cursus magna mi pulvinar magna. Donec velit ipsum, placerat ac libero sed, sagittis efficitur nibh. Mauris facilisis, augue ac bibendum luctus, velit dui vulputate nisl, eget placerat neque ex quis tellus. Maecenas tempor in enim quis hendrerit. Vestibulum ante ipsum primis in faucibus orci luctus et ultrices posuere cubilia Curae; Sed augue tellus, pellentesque at mollis eget, congue eget libero. Ut nec condimentum eros, id eleifend leo.

Mauris sit amet dolor lorem. Nunc quis felis purus. Quisque vel lectus in lectus pretium iaculis. Donec sed nibh pharetra, ullamcorper lorem a, volutpat purus. Nulla facilisi. In luctus nisl id est ornare convallis. Cras ut iaculis nisl, imperdiet molestie lectus. Praesent varius iaculis quam, ut luctus magna fermentum quis. Sed id augue pharetra enim aliquet efficitur molestie et sapien. Nam ornare sit amet lorem ac sodales. Vivamus dignissim nec erat vitae pretium. Proin bibendum ultrices augue in maximus.

Curabitur vel aliquet velit. In vehicula purus quis elit convallis, nec eleifend metus suscipit. Class aptent taciti sociosqu ad litora torquent per conubia nostra, per inceptos himenaeos. Mauris id elit in diam tincidunt condimentum. Nulla ligula nisi, convallis sit amet imperdiet quis, hendrerit fringilla dolor. Nulla egestas nisi mi, quis ultrices odio elementum vel. Nulla facilisi. Quisque placerat vulputate tellus, cursus maximus massa aliquam et. Donec consectetur commodo orci sed hendrerit. Pellentesque venenatis mollis urna, vitae feugiat magna commodo sit amet. Donec eget mauris quis enim blandit tristique ut a est.