Causes of Urinary Incontinence in Men

Urinary incontinence in men is the unintentional or accidental loss of urine. In the United States, up to 17 percent of men may suffer from urinary incontinence, with the frequency of the condition increasing with age. Urinary incontinence is not a disease but just the symptom of an underlying condition, such as a prostate problem, injury to the urinary tract or a disease of the nerve system.

There are three major types of urinary incontinence in men:

  1. Stress incontinence: It is the leakage of urine that occurs when the pressure inside the bladder increases when doing things such as sneezing, coughing, climbing or lifting.
  2. Urge incontinence: This is the accidental loss of urine that occurs when the need to urinate is too strong and uncontrollable.
  3. Overflow incontinence: This is the unintentional loss of urine characterized by dribbling or leakage of urine in small quantities. It can happen even when you do not feel the urge to urinate.

Causes of Urinary Incontinence in Men

There is no standout factor among the causes of urinary incontinence in men. However, prostate gland problems and their treatment are often the most common causes of UI in older men. The prostate, which is normally the size of an almond, is found at the opening of the bladder. The principal role of the prostate is adding fluid to the semen during ejaculation. The problem with the prostate gland is that it tends to increase in size as a man grows older and extend to the point of impeding or slowing down the flow of urine from the bladder.

Other common causes of male urinary incontinence are muscle and nerve control problems. At the opening of the bladder is a muscle called the urinary sphincter, which controls the opening and closing of the bladder. Anything that affects the muscle or nerve function of the sphincter can result in urinary incontinence. The common underlying factors in urinary incontinence include:

  1. Benign Prostatic Hyperplasia (BPH): Most men experience prostatic enlargement after the age of 40. As the prostate grows bigger, it compresses the urethra and may impede the flow of urine, resulting in urinary incontinence.
  2. Prostate surgery: The surgical removal of the prostate gland during the treatment of prostate cancer or BPH can damage or weaken the muscles controlling urine flow, resulting in stress urinary incontinence.
  3. Urinary tract infections: The infections can cause an overactive bladder, which may be characterized by urinary incontinence
  4. Diabetes: Diabetes can cause damage to the nerves or muscles controlling how the bladder opens and closes. It also can cause frequent urination or an overactive bladder. Obesity, which is quite common in type II diabetes, can make urinary incontinence worse by exerting more pressure on the bladder.
  5. Stroke: Stroke refers to brain damage that is caused by decreased flow of blood to the brain because of a clot or a leaking blood vessel. When stroke occurs there may be loss of muscle control and decreased sensation, which may lead to urinary incontinence. Stroke also can make it difficult for a man to get up and walk to the bathroom, which also contributes to urinary incontinence.
  6. Neurological diseases: The two most common neurological diseases that may cause urinary incontinence are Parkinson’s disease and multiple sclerosis. The conditions make it difficult for nerve signals to be sent and received between the central nervous system(CNS) and the bladder, increasing the risk of urinary incontinence.
  7. Spinal injury: Nerve impulses transmitted between the brain and bladder usually come through the spine. Therefore, any severe injury to the spine can lead to urinary incontinence.
  8. Temporary causes of urinary incontinence: Temporary episodes of urinary incontinence may be caused by drinking too much alcohol or caffeine, constipation, or depression. Medications such as diuretics for treating high blood pressure, medications for depression and over-the-counter medications containing decongestants or antihistamines also can cause urinary incontinence.

When to see a doctor

If you experience urinary incontinence symptoms such as inability to control the urge to urinate, overflowing, or leaking urine under stress, then you need to talk to a urologist. At St Pete Urology, St Petersburg, Fl, we encourage men not to feel embarrassed by the symptoms of urinary incontinence and wait too long before seeing a doctor because the condition can get worse. We have established a multi-disciplinary and compassionate, patient-centric approach to treating urological disorders in order to encourage all men with the symptoms of UI to seek prompt treatment. So, if you are experiencing any UI symptoms, visit St Pete Urology as soon as you can because seeing a urologist early increases the likelihood that you will get an effective treatment that will help you find relief. For more information, visit the “St Pete Urology” site.

6 Reasons Men Should See A Urologist

Given the close relationship between a man’s mental health and his overall health-related quality of life, it is increasingly clear that men suffer a significant burden of mental health issues, most of which go untreated. The situation is worsened by barriers to access to mental health services such as maladaptive coping, stigma and lack of awareness of the support services available in the community. At St Pete Urology, we treat a visit to our facility as the first regular contact between a patient and health care, using the opportunity to attend to a variety of health problems affecting our patients.

Relationship between mental health and urological disorders

At St Pete Urology, we appreciate that specific urological conditions, such as urinary tract infections, urologic cancers, kidney stones, urinary incontinence and erectile dysfunction, are usually accompanied by mental health issues like anxiety and depression. For example, about 10 percent of men with erectile dysfunction usually suffer from depression while 2.5 percent to 37 percent usually suffer from anxiety. Likewise, men with urinary incontinence tend to also have increased psychological distress, with anxiety rates of 3 percent to 10 percent and depression rates of 6 percent to 21 percent. Furthermore, men suffering from prostate cancer are four times more likely to commit suicide than men of similar age without the cancer.

At St Pete Urology, we cherish every contact with each patient and use it to treat urological disorders and associated mental health problems. For instance, when handling a patient with prostate cancer, we also take the role of screening for signs of anxiety and depression, educating him on the diagnosis, treatment and management of related side-effects, and providing support through referral of the patient to psychosocial services and the right rehabilitation programs. Similarly, for a man having urinary incontinence, we perform a functional analysis to assess the effects of the symptoms on daily life, recommend practical solutions like Kegel exercises and offer referrals to psychosocial services to address issues of interpersonal relationships and low self-esteem.

Comprehensive and effective treatments in urology

St Pete Urology offers an all-inclusive, multidisciplinary approach to urology. We emphasize the latest techniques including minimally-invasive, robotic and scarless procedures, develop personalized treatment plans that entail both surgical and medical approaches, and strive to make every visit as convenient as possible.

Our core specialty services include:

  1. Percutaneous nephrolithotomy treatment of kidney stones.
  2. Ureteroscopy for kidney stones and other urological conditions.
  3. Continent urinary diversion.
  4. Caval surgery for kidney and renal cancer.
  5. Treatment of prostate cancer, including nerve-sparing surgery and robotic radical prostatectomy.
  6. Male infertility and male sexual dysfunction.
  7. Vasectomy and vasectomy reversal.
  8. Urinary reconstruction.
  9. Complex urinary incontinence surgeries.
  10. Radiation oncology.
  11. Minimally-invasive treatments for benign prostatic hyperplasia.
  12. Laparoscopic renal surgeries.

A highly specialized care team

If a urology problem is causing you pain, discomfort or embarrassment, turning to a urologist at St Pete Urology who listens, responds compassionately and has the expertise to treat urinary disorders can help you to overcome your problems. Our urologists are a highly-specialized and knowledgeable team that went to the University of Pennsylvania and understand their work well. We have board-certified urologists who are experienced in treating low testosterone, prostate cancer, testicular cancer, enlarged prostate, erectile dysfunction and many other urological conditions.

So why should men visit a urologist?

  1. Recurrent urinary tract infections.
  2. Interstitial cystitis.
  3. Urinary incontinence and overactive bladder.
  4. Male infertility and male sexual dysfunction.
  5. Kidney stones.
  6. Enlarged prostate.
  7. Cancers throughout the urinary tract, such as prostate, bladder, kidney, penile and testicular cancers.

Are you looking for quality treatment for your urological problem? Would you like to be treated by a urologist who will appreciate your mental health issues during the diagnosis and treatment of your urological disorder? If so, then St Pete Urology is the right place for you. Visit St Pete Urology, Florida today for comprehensive, patient-centered medical care. For more information, visit the “St Pete Urology” site.

What is Urinary Incontinence in Men?

What is Urinary Incontinence in MenAccidental or unintentional leakage of urine is called urinary incontinence (UI). While urinary incontinence in men is not a disease, it is usually a symptom of an underlying urinary tract problem, such as overactive bladder muscles, damaged or weak bladder muscles, nerve damage, and certain prostate conditions. In men, urinary incontinence can occur at any age, with young boys being slower than girls in developing bladder control and being more likely than girls to experience bedwetting (nocturnal enuresis). However, due to anatomical differences, adult men are less likely to experience urinary incontinence than adult women. In adult men, the prevalence of urinary incontinence increases with age, though UI is not an inevitable part of aging in men.Reasons for the occurrence of urinary incontinence in men

Urinary incontinence can happen when:

  1. The bladder muscles squeeze at the wrong time or if they squeeze too hard.
  2. The muscles around the urethra are either weak or damaged, allowing urine leakage even when you do not have a problem with your bladder squeezing at the wrong times.
  3. You frequently experience incomplete emptying of the bladder when you void, increasing the volume of urine in the bladder significantly and resulting in loss of urine when the bladder gets too full.
  4. There is a blockage of the urethra which causes urine build-up in the bladder and results in eventual leakage.

Types of urinary incontinence in men

Urinary incontinence can be either a short-term problem or a long-term issue. Short-term urinary incontinence in men is usually caused by an underlying health problem or an ongoing treatment while long-term (chronic) incontinence may be caused by a wide range of physiological problems. The types of urinary incontinence in men include:

  1. Stress incontinence: Leakage of urine when a man sneezes, coughs, laughs, lifts something, changes position, or performs an activity that strains or puts stress on his bladder.
  2. Urge incontinence: It is an urge to urinate that is usually so strong that a man can’t make it to the toilet in time. This type of urinary incontinence can happen when the bladder squeezes at the wrong time, resulting in loss of urine even when the bladder has only a small quantity of urine. Overactive bladder is a common example of urinary incontinence, though not all men with overactive bladder will experience leakage of urine.
  3. Overflow incontinence: Occurs when a man has the urge to urinate but can only release a small amount of urine at a time. Since the bladder does not empty fully as it should, the urine remaining in the bladder leaks at a later time.
  4. Functional incontinence: Occurs when a man cannot make it to the bathroom in time either because he is not able to walk on his own or because something prevents him from reaching the bathroom promptly.
  5. Total incontinence: When a man’s sphincter muscles can no longer work, urine will always leak and the man will have no control on when to urinate. This is called total incontinence.

Causes of urinary incontinence in men

Different types of urine incontinence have different causes.

  1. Stress incontinence: Can occur after the prostate gland is removed or when there is damage to the nerves or the sphincter, which reduces the support afforded to the lower part of the bladder.
  2. Urge incontinence: Occurs when bladder muscles squeeze extremely hard and make it difficult for the sphincter to hold back urine. As a result of hard squeezing, a man will experience a very strong urge to urinate.
  3. Overflow incontinence: Can occur when something blocks the urethra, resulting in the build-up of urine in the bladder. Overflow incontinence may be caused by enlarged prostate, prostate cancer, a narrow urethra, or weakened bladder muscles.

In men, urinary incontinence is usually related to prostate problems and various treatments. Nevertheless, excessive drinking of alcohol may make incontinence worse while over-the-counter or prescription drugs such as antidepressants, sedatives, diuretics, narcotics and sedatives can affect the type of symptoms experienced.

Diagnosis and treatment

The diagnosis of urinary incontinence involves a medical history and a physical examination, but also may include keeping a bladder diary. Your urologist will examine you physically and ask some questions about your past health and current symptoms before ordering any tests. Usually these steps will enable your urologist to determine the cause of your urinary incontinence. But at other times, particularly when your symptoms have more than one cause or have an unclear cause, the urologist may include urodynamic testing and an ultrasound in order to come up with a more accurate diagnosis.

The treatment offered will depend on the type of incontinence and how the condition is affecting your life. Generally, urologists treat urinary incontinence in men using medicines, behavioral treatments (such as Kegel exercises and bladder training), surgery, or a blend of two or more of these therapies. A few men may require surgery to regain their bladder control, but most men do not. Apart from the treatments offered by the urologist, there are a few things that men can do at home to help them regain control over their bladders. Such actions include:

  1. Cutting back on caffeine-containing drinks, such as tea and coffee. Alcohol should be reduced to not more than 1 drink per day while fizzy drinks such as soda pop also should be reduced.
  2. Eating foods highly rich in fiber to prevent constipation.
  3. Keeping a healthy weight.
  4. Stopping cigarette smoking. Talk to your urologist about stop-smoking medicines and programs.
  5. Practicing double voiding whenever you urinate. This means trying to lose as much urine as you can, relaxing for a short while, then going again.
  6. Visiting the bathroom many times per day. It is important to wear clothes that you can remove with ease and make your route to the bathroom as clear and quick as possible.
  7. Engaging in simple pelvic-floor exercises, such as Kegels.
  8. Using a diary to monitor your urinary symptoms and any leakage of urine. This will help you and your urologist choose the best treatment for you.

Are you experiencing symptoms of urinary incontinence? Do not feel embarrassed to inform your urologist about them. Most men with urinary incontinence can be helped or effectively cured. At St Pete Urology located in St Petersburg, Fl., we fix all urinary incontinence issues affecting men. We have done this for many decades and have some of the best technologies and techniques to help men regain control over their bladders. For more information, visit the “St Pete Urology” site.

Treatment Success for Overactive Bladder

Successful treatment of overactive bladder can relieve annoying urinary symptoms and inject new enthusiasm and confidence into your life. While successful treatment may mean different things, it is typically defined by a reduction or an end to annoying and embarrassing bathroom visits that force you to approach everyday activities with fear and anxiety. It is important to know that an overactive bladder is not a disease but a group of urinary symptoms. Knowing this will help you to assess your disease, the range of symptoms and underlying causes and find the right treatment.

Targeted treatment

Treatment results for overactive bladder vary depending on the state of the condition and underlying causes of the symptoms. At St Pete Urology, the urologist will conduct a comprehensive medical history though an open, warm and private conversation to establish the state of your condition and identify potential causes. A physical examination is followed by relevant medical tests to help find the cause of the disorder in order to tailor treatment. The doctor also will create a record of the symptoms to be used later to monitor the success of the treatment.

Patient-oriented goals

Before choosing a treatment or combination of treatments that is ideal for you, the doctor will discuss all the options with you. The treatment chosen will target both the underlying cause and the symptoms. For example, if the underlying cause is a urinary tract infection, the urologist will offer antibiotics to combat the infection as well as provide the medications or recommend the exercises to alleviate the symptoms. The urologist will help you to identify your treatment goals to enable you to find relief as soon as possible. For example, voiding 6-8 times and getting up just once at night may be normal if you are an older adult. So if you have been voiding 12 times a day and 3 times a night, you may set your goal at 6 times a day and 1-2 times a night. When setting your goals, the doctor will explain what is normal and what is not so you can set goals that boost your treatment success..

In many cases, treatment success may be marked by:

  1. Decreased urinary urgency.
  2. No dribbling.
  3. Remaining dry all night.
  4. Sleeping all night or waking up just once to urinate.
  5. Remaining dry all day.
  6. Passing urine every couple of hours.

For instance, if you have been voiding 16 times a day, going down to 3 times a day means your treatment is successful. Likewise, if you previously woke up 3-4 times a night, going down to 1-2 times a night means your treatment is successful. Similarly, if the treatment can help you to stop dribbling on your way to the bathroom and significantly reduce your urinary urgency, then it can be classified as successful. With goals that are specific to your overactive bladder symptoms, you can easily monitor your treatment and increase success.

Tracking your symptoms

Overactive bladder is usually characterized by a sudden and uncontrollable urge to pass urine and the tendency to visit the bathroom several times (8 or more times) during the day and night. Urine also may leak immediately after you experience the urge. With treatment, the urgency and frequency of passing urine may begin to change, while urine leakage may reduce or stop. In order to monitor any improvements as soon as you begin treatment, it is important to record all your symptoms before treatment. At St Pete Urology, the urologist will help with taking your bladder records before treatment begins. The data then is used as treatment progresses to monitor your improvement and evaluate success.

Success rates vary with type of treatment

Outcomes vary from one treatment to another. For example, Botox can provide 80-90 percent success rate when chosen correctly. Likewise, a combination of bladder training, kegel exercises for pelvic floor muscles and anticholinergic drugs can produce a success rate of 70-90 percent when properly deployed. It is important to work with a urologist who has been treating overactive bladder on a regular basis and is knowledgeable and experienced to customize treatments for your condition. At St Pete Urology, we have a pool of skilled urologists who have been treating overactive bladder symptoms for decades. We will help you overcome embarrassing symptoms and get your life back to normal quickly. For more information, visit the “St Pete Urology” site.

How long should it take to pass a kidney stone?

Most kidney stones will pass through the ureter to the bladder and out of the body when given time. In fact, with ample fluid intake, nearly all kidney stones will pass through the urinary tract on their own within 48 hours. Nevertheless, the time it takes for a stone to be passed depends on its size and location in the urinary tract. For instance, smaller stones and those located in the lower portion of the urinary tract (closer to the bladder than the kidneys), have a higher likelihood of passing on their own and tend to pass more rapidly. Larger stones and those located in the kidneys are less likely to pass on their own and tend to pass more slowly.

How long does it take to pass a kidney stone?

According to the American Urological Association, the length of time required to pass a kidney stone located in the ureters (tube that connects kidneys to the bladder), is an average of 8 days if the stone is less than 2mm, about 12 days for a stone between 2mm and 4mm, and 22 days if the stone is between 4mm and 6mm. Generally, however, most kidney stones will pass on their own in 40 days. But when a medical expulsive therapy is applied, a kidney stone (2mm to 6mm) will pass within a few days or weeks provided the patient is in good health. Medications called antispasmodics can be used to accelerate the process of passing a stone. The drugs relax the ureters and increase the speed of passing a stone by up to 5-7 days. A urologist may allow for up to 6 weeks for a kidney stone to pass on its own, but earlier intervention may be necessary if the stone is causing severe pain, gastric discomfort or urinary problems.

Factors affecting the ability to pass a kidney stone

There are several factors that affect the ability to pass a kidney stone. They include:

  1. Prostate enlargement.
  2. Size of the person.
  3. Prior stone passage.
  4. Pregnancy.
  5. Size of the stone.
  6. Location of the stone.

For instance, a kidney stone that is 4mm in size has an 80 percent chance of passing while a stone that is 5mm in size has only a 20 percent chance. Kidney stones that are larger than 9mm-10mm can hardly pass without a doctor’s intervention and require timely treatment to avoid complications. To increase the passage rate of kidney stones, a urologist may recommend certain medications. The medications include alpha blockers such as tamsulosin (Flomax) and calcium channel blockers such as nifedipine (Procardia, Nifediac, Adalat or Afeditab).

Dealing with the symptoms of a kidney stone

Since most kidney stones will eventually pass through the urinary tract and out of the body when given time, treatment is usually directed toward controlling the symptoms. When the stones are passed at home, appropriate interventions usually include increased fluid intake and taking anti-inflammatory drugs such as Ibuprofen. If over-the-counter pain medications are ineffective, stronger drugs such as Ketorolac (an injectable anti-inflammatory drug) and narcotic pain medications are used. In case of severe nausea and vomiting, the doctor may give intravenous medications.

When do kidney stones require removal?

Waiting for kidney stones to pass is not ideal for every case. According to the American Urological Association, kidney stone removal should be considered if a stone fails to pass on its own within 2 months. Likewise, stone removal is necessary if complications arise due to the stone. Complications that require stone removal include ureter blockage or irritation, urinary tract infection, decreased kidney function and uncontrolled pain, nausea or vomiting.

To remove kidney stones, a procedure called lithotripsy is often used. During the procedure, kidney stones are subjected to shock waves, resulting in the breakdown of larger stones into smaller pieces that can easily pass through the urinary tract. When lithotripsy is not effective, surgical techniques may be necessary to remove kidney stones. This may be done either by making a tiny incision in the skin (percutaneous nephrolithotomy) or via an instrument (called ureteroscope) passed through the urethra and bladder into the ureter.

Effective treatment at St Pete Urology

At St Pete Urology, we provide a multidisciplinary approach to treating and managing kidney stones of all sizes. We have assembled a highly integrated team of nephrologists, urologists, radiologists and dietary and metabolic specialists to ensure comprehensive diagnosis, treatment and proper assessment of the risks leading to the formation of kidney stones. By applying the latest technology in treating kidney stones (including state-of-the-art lasers) and a broad range of noninvasive and minimally-invasive procedures for removing small and large stones, we guarantee only the highest quality and successful treatment to all our patients. For more information, visit the St Pete Urology site.

4 Best Treatments for Overactive Bladder

Overactive bladder (OAB) is not just an embarrassing and annoying condition. It can have serious impact on every aspect of your life. For instance, it can compel you to avoid vacations, dinner outings and other social events, miss out on valuable time with friends and family, or lose out on many hours of sleep. Fortunately, there are safe and effective ways to treat the condition and restore your life back to normal. Minor cases of OAB can be effectively treated with pelvic muscle exercises, bladder training and absorbent pads, while severe cases can be successfully treated with medication and surgery.

The 4 best treatments for overactive bladder are:

1. Bladder training

As a non-drug remedy with almost no side effects, bladder training helps to change how you use the bathroom and allows you to gain control over your bladder. Through scheduled voiding (urinating at set times of the day), you can learn to control the urge and gradually overcome embarrassing symptoms. Bladder training should begin with waiting for a few minutes before voiding and progressively increase to one hour or more between your bathroom visits.

2. Pelvic floor exercises

Carefully selected exercises can strengthen muscles that control urination and in turn relieve overactive bladder symptoms. During pelvic exercises, such as biofeedback and kegel exercises, you voluntarily tighten, hold and relax muscles responsible for starting and stopping urine flow and gradually regain control over your bladder.

3. Medications

If a specific cause is identified, overactive bladder can effectively be treated using appropriate drugs. For instance, if a urinary tract infection is the underlying cause, antibiotics can be used to alleviate the symptoms. Likewise, topical application of estrogen vaginal cream can be used to relieve OAB symptoms associated with atrophic urethritis.

Drugs commonly used to treat overactive bladder include:

  • (a) Anticholinergics: This group of drugs relieves symptoms by blocking nerve signals associated with involuntary contraction of bladder muscles. The drugs also reduce the urge to go to the bathroom and increase bladder capacity. Examples of anticholinergics are Darifenacin (Enablex), Tolterodine (Detrol), Fesoterodine (Toviaz), Trospium (Sanctura), Oxybutynin (Oxytrol) and Solifenacin (Vesicare).
  • (b) Antidepressant imipramine hydrochloride (Tofranil), which relaxes the muscles of the bladder and relieves symptoms.
  • (c) Botox: When injected into the bladder muscles, Botox causes them to relax and minimizes involuntary muscle contractions. Botox also boosts bladder capacity. However, Botox is only recommended when oral medications, bladder training and exercises have failed.

4. Surgery

Urologists opt for surgery as a last resort when medications and behavioral therapy have failed. There are many surgical options available for treating overactive bladder, including sacral nerve neuromodulation and percutaneous tibial stimulation, which typically are used for severe overactive bladder symptoms. For successful treatment of OAB, urologists often combine two or more treatments such as combining behavioral interventions with oral medications.

Other measures for alleviating overactive bladder symptoms include:

  1. Limiting the intake of bladder irritants such as caffeine and alcohol.
  2. Cutting down excess weight.
  3. Avoiding spicy foods, citrus fruits, chocolate and tomatoes.
  4. Avoiding artificial sweeteners, which tend to aggravate symptoms.

At St Pete Urology, we have successfully treated overactive bladder for decades. Through open and candid conversations with patients, carefully selected treatments that depend on the underlying cause of symptoms and patient-oriented goals, we can help you to get back to your old routine quickly. Visit us today for evaluation and help with your overactive bladder symptoms. For more information, visit the “St Pete Urology” site.

What do you do for a kidney stone?

Kidney stones can be treated in a number of ways, depending on the cause, size and location of the stones. The treatment and management of kidney stones also depend on your overall comfort level, any complications related to the stones and on your other medical problems. Most kidney stones are small (4mm or less in diameter) and can be passed in urine with the help of medications. The medications are used to keep you comfortable as the stones pass naturally through your urinary tract, with the passage of a stone taking a few days to a few weeks. Larger kidney stones are associated with severe symptoms and may not pass without a medical expulsive procedure.

What should you do with small kidney stones?

Most small kidney stones (4mm or less in diameter) can pass through the urinary tract and out of the body without invasive treatment. To pass such a small stone, you should:

  1. Drink plenty of water: Drinking 2-3 liters of water every day will help to flush out a kidney stone. Unless your doctor says otherwise, make sure to increase your daily fluid intake (mostly water) to increase the rate of passage of any stones you may have.
  2. Use pain relievers: As a kidney stone passes through your urinary tract, it will cause some discomfort. For mild pain, your doctor may recommend over-the-counter medications such as ibuprofen, acetaminophen or naproxen sodium. For severe pain, Ketorolac or narcotics may be recommended.
  3. Medications to increase passage rate: To reduce the time required to pass a kidney stone naturally, your urologist may prescribe medications called alpha blockers (such as tamsulosin) or calcium channel blockers (such as nifedipine) to relax ureter muscles and help you to pass the kidney stone quickly and with minimal pain.

What should you do with larger kidney stones?

Larger kidney stones cannot be treated effectively with conservative measures. Likewise, a kidney stone that is lodged in an area of the urinary tract or that has moved into the ureter and is causing severe pain, bleeding or urinary tract infections may require more extensive treatment. When diagnosed with such a kidney stone, the doctor will recommend that you be admitted to hospital for treatment.

Extensive medical treatment is generally necessary if:

  1. You have a higher risk of kidney failure, especially if you have only one kidney.
  2. Your symptoms are not improving within an hour after taking painkillers or anti-nausea medication.
  3. You are pregnant.
  4. You are dehydrated and vomiting too much fluid.
  5. You are over 60 years of age.

Larger kidney stones (6mm in diameter or more) usually require treatment to remove them. The methods used to remove such stones include extracorporeal shock wave lithotripsy (ESWL), ureteroscopy, percutaneous nephrolithotomy and open surgery. The type of treatment given will depend on the size and location of the stone.

Types of Treatment

1. Extracorporeal shock wave lithotripsy (ESWL)

This is the most commonly used method of removing kidney stones that cannot be passed in urine. The procedure involves application of ultrasound (high frequency sound waves) to identify the location of a stone with more precision. Ultrasound shock waves are then directed at the stone from a machine, breaking down the stone into smaller pieces that can easily pass in urine. ESWL is an uncomfortable procedure and is therefore performed under painkilling medication. More than one session may be necessary for the procedure to successfully treat kidney stones, but ESWL is known to have up to 99 percent efficacy for stones of 20mm or less in diameter.

2. Ureteroscopy

For kidney stones that are stuck in the ureter, the urologist may have to use a ureteroscope (a long, thin telescope) to reach and remove the stones. The thin lighted tube is fitted with a camera to help pinpoint the location of a stone with utmost precision. During the procedure, the ureteroscope is passed through the urethra and bladder into the ureter and to the place where the stone is stuck.
Once the stone is reached, it can be snared or broken down into smaller pieces using laser energy so that the pieces can then pass naturally in urine. Or the doctor may use another instrument to remove the stone without breaking it. Since ureteroscopy is performed under general anesthesia, you will not be able to drive or operate machinery for up to 48 hours after the procedure. Ureteroscopy is highly effective for stones 15mm or less in diameter, but a plastic tube known as stent may be inserted temporarily into your bladder to help drain stone fragments.

3. Percutaneous nephrolithotomy (PCNL)

PCNL is an alternative procedure that is effective for larger kidney stones. It can be used when ESWL is not suitable, such as when the person being treated is obese. Percutaneous nephrolithotomy involves using a thin telescopic device called a nephroscope. The doctor performs the procedure by making a small incision at the back and then passes the nephroscope through the hole into the kidney. Using the nephroscope, the stone is either pulled out or broken down into smaller pieces using pneumatic or laser energy. The procedure is performed under general anesthesia and is 86 percent effective for kidney stones that are 21-30mm in diameter.

4. Open surgery

Nowadays, the use of open surgery for kidney stones is very rare and only performed in less than 1 percent of cases. In fact, open surgery is only recommended when a kidney stone is extremely large or when there is abnormal anatomy in the affected section of the urinary tract. For instance, open surgery may be necessary if the kidney stones (such as calcium phosphate stones) are caused by an overactive parathyroid gland (hyperthyroidism). Removing a tumor that is causing the parathyroid glands to produce excess parathyroid hormone and hence increased calcium levels in the body also may be necessary to treat some kidney stones. During open surgery, the urologist makes an incision in your back and uses the incision to reach the ureter, bladder and kidney. The stone is then removed from its location.

Preventing future kidney stones

After your kidney stones are treated, the doctor will assess your risk of kidney stones and recommend preventive measures. Generally, the formation of kidney stones is prevented using a combination of lifestyle changes and medications.

1. Lifestyle changes

Lifestyle changes that reduce the risk of kidney stones include:
(a) Drinking plenty of water throughout the day: If you have a history of kidney stones, drinking plenty of water (2-3 liters per day) will significantly reduce your risk of having stones in future. You may have to drink even more water if you live in a hot and dry climate. To know that you are drinking enough water, check if your urine is light and clear.
(b) Reduce the quantity of oxalate-rich foods: If you have previously suffered from calcium oxalate stones, then you can reduce your risk of stones in future by scaling down your consumption of foods rich in oxalates. You may have to cut down on your intake of spinach, sweet potatoes, tea, nuts, okra, beets, rhubarb, Swiss chard, soy products and black pepper.
(c) Reduce amount of salt and animal protein in your diet: To avoid kidney stones in future, reduce your salt intake and minimize animal protein in our diet. It is advisable that you use a salt substitute (such as Mrs. Dash) and take non-animal proteins (such as legumes).
(d) Use calcium supplements with caution: Calcium-rich foods will not increase your risk of kidney stones so you can continue eating them unless your doctor says otherwise. However, calcium supplements can increase the risk of kidney stones and should be taken with caution and only after speaking with a doctor or a dietitian.

2. Medications

Certain medications are effective in controlling the quantity of salts and minerals in urine and hence helpful in preventing the formation of stones. However, the type and effectiveness of such medications depend on the type of stone you are have. For calcium stones, thiazide diuretics and phosphate-containing preparations are effective. Allopunirol and alkalizing agents are effective for uric acid stones, small doses of antibiotics can eliminate bacteria and prevent struvite stones, while cystine-reducing medications can prevent cystine stones.
At St Pete Urology, we have established an integrated and multidisciplinary diagnosis, treatment and management program for kidney stones. By bringing together a diverse team of professionals including urologists, nephrologists, clinical nurse specialists, radiologists, nutritionists and other healthcare specialists, we ensure that our patients receive the most compassionate, comprehensive and effective treatment. We offer both surgical and non-surgical treatments with very high success rates. For more help and information on the treatment of kidney stones, visit St Pete Urology’s website.

What is Overactive Bladder?

Overactive bladder (OAB) is a common condition defined by a set of urinary symptoms related to the frequency and control of urination. Most cases of overactive bladder are characterized by a sudden, uncontrollable urge to urinate even when the bladder is not full (urinary urgency), passing urine 8 or more times daily without excessive fluid intake (urinary frequency), and involuntary loss of urine immediately after onset of an urgent need to urinate (urge incontinence). In the United States, the condition affects at least 30 percent of men and 40 percent of women, with about 33 million Americans having bothersome overactive bladder.

Annoying and embarrassing problem

Untreated overactive bladder comes with symptoms that can cause serious embarrassment and get in the way of your social life, work, exercise and sleep. For instance, with lots of bathroom trips associated with the condition, you may begin to shy away from social events or everyday activities for fear of not finding a bathroom when you need one. As you refrain from going out with friends or engaging in everyday activities, you start to feel lonely and isolated and may even experience relationship problems with your spouse and family. Overactive bladder also can rob you of a good night’s sleep and leave you tired and depressed. Likewise, frequent leakage of urine can lead to infections or skin problems.

Causes of overactive bladder

At St Pete Urology, we are keen on identifying the underlying causes of an overactive bladder in order to boost treatment outcomes. We recognize that while an overactive bladder is quite common in older adults, it is not a normal part of aging but a treatable condition with various causes. Generally, OAB occurs when bladder muscles begin to contract involuntarily even when the volume of urine in the bladder is low. It is the involuntary contractions that cause the urgent need to pass urine. The most common causes of an overactive bladder include:
Neurological disorders such as multiple sclerosis, Alzheimer’s disease and stroke.

  1. Catheter use.
  2. Obstructions to bladder outflow, such as enlarged prostate.
  3. Pelvic organ prolapse.
  4. Weakened or stretched pelvic muscles.
  5. Weakened or stretched bladder muscles.
  6. Incomplete emptying of bladder.
  7. Excess consumption of alcohol or caffeine.
  8. Structural problems with bladder.
  9. Stroke and Parkinson’s disease.
  10. Hip problems or hip surgery.

When to see a doctor

If your symptoms disrupt your life or cause distress, speak to your doctor about available treatments. While discussing such a private issue with your urologist may not be easy, doing so may be the beginning of restoring your life back to normal. Make sure to see a doctor if the symptoms disrupt your social interactions, work, sleep or everyday activities.

Safe, confidential and effective treatment

If you have overactive bladder, you should not allow the symptoms to weigh you down. Instead of feeling embarrassed, isolating yourself or limiting your work and social life, you should see a urologist for a brief evaluation to reveal the specific cause of your symptoms and help you to get relief. At St Pete Urology, we recognize that you may feel discouraged from seeking treatment because of the sensitive nature of the condition. For this reason, we offer confidential and patient-oriented services to suit your needs. Our candid and private conversations will help us explore your condition, identify the underlying cause and provide the right treatment. We help with all urinary incontinence problems in men and women, but evaluate men with urinary incontinence further to rule out prostate problems. For more information, visit the “St Pete Urology: site.

Diet Suggestions for Kidney Disease Patients on Thanksgiving Day

As Americans across the country get together with family and friends every fourth Thursday in November to give thanks for all that is good in their lives, most kidney disease patients do so while mindful of their health. And since Thanksgiving Day is also full of food, from turkey to potatoes and to various juices, kidney disease patients are all too aware of the potential damage that holiday foods can have on their lives, including worsening their symptoms. For instance, the holiday fare may be full of salted foods, increasing the level of sodium in the body beyond the limits for kidney patients.

To enjoy Turkey Day to the fullest, kidney disease patients such as those with kidney stones have to look for kidney-friendly foods. Observing certain diet restrictions can ensure that they enjoy themselves without harm to their kidney functions or making their illness worse. So what should you eat or not eat on Thanksgiving Day if you have renal problem?

Generally, the diet principles for kidney patients are high-fiber, high-vitamin, low-salt, low-potassium, low-protein, low-fat and low-phosphorous. Here are some suggestions that can help kidney patients enjoy themselves on Thanksgiving Day without worsening their symptoms or harming their kidney functions.

1. Popular dishes

Turkey is the most common food on Thanksgiving Day but renal patients should opt for natural fresh or frozen turkey. The turkey should be prepared with low-salt broth and salt-free rub. Basted turkey which typically contains too much salt must be avoided. Other popular dishes include green beans, sweet potatoes, celery, parsley, cauliflower and cranberry, which are all good foods for renal patients. However, sweet potato contains a lot of potassium, so its intake should be limited. Pecan pie, apple pie and pumpkin pie are popular and delicious Thanksgiving desserts, but renal patients should minimize their intake.

2. Best drinks

Pure water is the ideal drink for renal patients on Thanksgiving Day. However, those who do not want to drink water can have apple juice and cranberry juice. If you are experiencing fluid retention, often characterized by swelling and edema, then reduce the amount of fluid you take. Avoid alcoholic beverages because too much alcohol can damage your liver and elevate your blood pressure. Likewise, drinks containing caffeine such as strong tea and coffee should be avoided.

3. Increase your calcium, fiber and vitamin intake

If possible, increase the amount of fiber, vitamin and calcium in your Thanksgiving diet because they are good for your health. However, you should limit the intake of excitant and spicy foods and avoid high-fat foods such as spicy chicken wings. Also reduce the quantity of meat in your diet as it may increase your kidney’s burden and elevate your BUN and creatinine levels.

4. Avoid salted foods

Salt contains high quantity of sodium, which is harmful for the kidney. For instance, high quantities of sodium in the diet elevate blood pressure and trigger fluid retention, which is a very common problem in people with kidney disease. Therefore, if you have kidney disease you should avoid salted foods on Thanksgiving Day.

5. Pay attention to your protein intake

For those with early-stage kidney disease, protein intake should be limited to 0.6-0.8 gram per kilogram body weight per day. But if the disease has advanced, the protein intake must be reduced significantly to just 0.2-0.4 g/kg/d. For patients on dialysis, protein intake should be increased to 1.2 g/kg/d because some protein may be lost during dialysis. On Thanksgiving Day, high quality protein such as fish, lean meat and egg whites are recommended.

6. Monitor your potassium level

If the disease has damaged the kidney, potassium level in your blood will easily increase, so you should closely monitor your potassium level and be very careful with your potassium intake. You should avoid foods with high potassium content such as white beans, banana, salmon, white mushroom, nuts and avocados.

While it is not easy to live with kidney disease, prompt treatment and lifestyle changes can significantly improve your quality of life. As you join the rest of your family at the dining table to celebrate Turkey Day, make sure to use the above diet suggestions to avoid any detrimental effects the foods you consume may have on your health. If you have questions or something is unclear, be sure to speak with your urologist about it. At St Pete Urology, we have a team of highly-qualified and experienced urologists to help you overcome your kidney problem. For more information, visit the “St Pete Urology” site.

What does it feel like when you have a kidney stone?

Formed by crystallization of certain substances in urine, kidney stones are hard, pebble-like pieces of materials occurring in one or both kidneys when there are high levels of various minerals such as calcium or uric acid in urine. A kidney stone may be as small as a grain of sand, as big as a pebble or even as large as a golf ball. Generally, the larger the stone the more severe the symptoms. If the stone is very small in size, it can pass through your urinary tract without notice. But a large stone may cause a sharp pain in your side, groin, back or lower abdomen as it passes through the urinary tract.

So what does it feel like when you have a kidney stone?

Typically, kidney stones are formed in the kidney and a stone that remains in the kidney rarely causes pain. But when a kidney stone travels through the tubes of the urinary tract such as the ureter (tube connecting the kidney to the bladder) or the urethra (tube that leads outside the body), it may produce irritation and blockage that result in pain and other symptoms. You may feel the following symptoms depending on the size and location of the stones:

  1. No symptoms, if the stone is very small.
  2. Sudden and severe pain on the side, lower back, groin, abdomen or genitals. The pain gets worse in waves and is often described by people with kidney stones as “the worst pain I have ever experienced.”
  3. Nausea and vomiting, or a persistent stomach ache.
  4. Foul-smelling or cloudy urine
  5. Blood in urine, which occurs whether the stones remain in the kidney or travel through the ureters.
  6. Frequent and painful urination, often occurring when the kidney stone is in the ureter or after the stone has passed the bladder and is located in the urethra. In some cases, painful urination indicates a urinary tract infection occurring concurrently with the stones.

Remember there are other conditions, such as hernias, appendicitis, prostatitis and ectopic pregnancy, which may have the same symptoms. Therefore it is important to see a urologist so your condition is accurately diagnosed.

Abdominal and back pain

Kidney stones may occur in the urinary tract without causing any symptoms. In fact, if you have small stones, they are likely to pass through the urinary tract without causing pain or being noticed. However, this is often only possible before the stones move from your bladder into the ureter. Once inside the ureter or other tube of the urinary tract, kidney stones cause irritation and blockage which may lead to considerable pain and discomfort. The pain may begin while a stone is still in the kidney or after the stone moves into the ureter, urethra or bladder.

If the pain occurs while the stone is still in the kidney, it is felt in the side and on the back, typically on the same side of the body as that of the affected kidney. You also may feel a cramping sensation or a sharp pain in the pelvic area, lower abdomen or in the genitals.When pain is related to the movement of a stone through the urinary tract, it comes in waves and builds in intensity before fading in cycles of every 20-60 minutes.

Physical signs

As kidney stones move through the urinary system, you may feel a strong and frequent urge to urinate. Likewise, the movement of the stone can cause irritation and damage to the lining of the bladder or ureter, causing blood to mix with urine. As a result, you will find yourself passing bloody urine, which appears reddened, pink or rusty in color. The urine also can be cloudy or foul-smelling. Kidney stones may cause gastric distress, nausea and vomiting. If the movement of the stones through the urinary tract triggers an infection, you may experience fever and chills.

Seek prompt treatment

When you feel lasting symptoms or complications due to kidney stones, it is important to seek prompt treatment. At the doctor’s office, you will undergo thorough examination and diagnostic testing to confirm your condition. If you are diagnosed with kidney stones, your treatment will depend on the size and location of the stones. For example, if you have small kidney stones, the urologist may recommend increased fluid intake to enable the stones to pass on their own. But if the stones are large, the doctor may use a scope to remove them. In some cases, surgery may be necessary.

If you suspect that you have kidney stones, visit St Pete Urology for accurate diagnosis, effective treatment and comprehensive care. At St Pete Urology, we have successfully treated kidney stones and other urinary tract problems for several years. For more information, visit the “St Pete Urology” site.