Hunner's ulcers, simply put are painful ulcers in your urinary bladder. These ulcers are inextricably linked to another disorder called the painful bladder syndrome or intestinal cystitis. They occur in 10 to 15 percent of people with interstitia cystitis. These, in fact, are red patches or lesions on the bladder wall which can stiffen tissue and cause reduced bladder capacity. Hunner s ulcers bleed, ooze pus and can be of different sizes. The ulcers in the bladder can be extremely painful and uncomfortable.

These are called Hunner s ulcers because they were first described by Dr. Guy LeRoy Hunner, a Johns Hopkins gynecologist, in 1915. Since Hunner s ulcers are seen only in people with intestinal cystitis, it s important to know more about this painful life-altering bladder disorder before we can even understand how to deal with them.

Interstitial cystitis (IC)
IC is also called painful bladder syndrome. Another important thing to know about IC is that it strikes more women than men. IC is a chronic disorder and there s no cure for it. It causes recurring bouts of pain and pressure in the urinary bladder and the pelvic area. This is often accompanied by an urgent and frequent need to urinate. Sufferers may have to rush to the  loo  as much as 40, 50, or 60 times a day.

Diagnosis
Hunner's ulcers can only be accurately diagnosed by doing a cytoscopy which involves inserting a fibre-optic tube through the urethra to look at the bladder wall closely. During this procedure, a tissue sample from the bladder wall is usually also taken to rule out bladder cancer. Cytoscopy is usually done with hydrodistention under local anesthesia. This involves filling the bladder with a liquid for stretching it to provide a closer view of the bladder wall. Usually, a urologist performs this surgery along with a gynaecologist. IC and also Hunner s ulcers are both a diagnosis of exclusion. This means that they re diagnosed only after a number of other conditions have been ruled out.

Hence, the urologist will first take your thorough medical history, followed by a physical exam and a pelvic exam for women patients and perform tests for ruling out infection, and other disorders like bladder stones and cancer, kidney disease, multiple sclerosis, endometriosis, sexually transmitted diseases amongst others. Only after these tests are inconclusive or uncertain and if there is blood in urine, will the urologist go for cystoscopy.

Treatment
There's no cure for IC, but Hunner s ulcers can be cured by burning them off the bladder wall. Called fulguration, the process uses electricity or laser to burn the ulcers on the bladder wall. Resection is also used in which skin from around the Hunner s ulcer is cut for removing both the ulcer and the inflamed tissue around it. The problem is that ulcers may recur in the same location.
So, managing IC becomes critical. Your doctor can try to treat the patient with one treatment or with a combination of treatment depending on the condition of the patient.

Pain medicines are the first line of treatment to manage Hunner s ulcers and IC both, and many patients do go in for this. Patients also find relief by modifying their diet to remove foods and drinks like caffeinated beverages- tea, coffee, colas etc. Sodas, artificial sugars and fruit juices, especially Cranberry juice can trigger intense pain and discomfort, so these are usually contraindicated. Another important aspect is patient education about normal bladder function and tips on self-care and behavioural modifications like stress control to manage Hunner s ulcers.

Hunner's Ulcer In Urinary Bladder - How They Can Be Treated?

What are kidney stones?
The primary function of the kidney is to filter the blood and eliminate the waste products through urine. The waste deposition is sometimes in the form of excessive calcium, uric acid and other undesirable contents. It may cause the urine to get highly saturated. This is when stone like formations take place inside the kidneys. Kidney stones are also termed renal lithiasis or calculi. There are different kinds of kidney stones, which are differentiated based on its varied constituents. Kidney stones cause excruciating pain and uneasiness. Frequent urination, extreme discomfort during urinating and presence of blood in the urine are some of the major signs of kidney stones. The symptoms are not evident if the stones are very small in size.

Causes of kidney stones:

Incorrect calcium intake: High amounts of calcium can lead to high calcium depositions in the kidneys. It is important to keep the calcium intake moderate. Calcium supplements must be checked if you have already included dairy products in your diet.
Abnormal rates of sodium in the body: Sodium, just like calcium, gets deposited in the kidneys.
Excessive animal protein intake: Too much of animal protein intake can make the urine turn acidic, leading to uric acid depositions in the kidneys.
Sugary, aerated drinks: These lead to undesirable waste deposition in the blood stream and eventually in the kidneys.
Inadequate water intake: Not keeping the body well hydrated can cause the urine to turn acidic and increase waste deposition.
Potential risks and complications of kidney stones:

Kidney stones may cause an infection in the kidneys which may eventually spread to the other internal organs and surrounding tissues.
Kidney stones block the ureter and cause severe pain and discomfort that make sitting, standing or any other posture difficult.
Kidney stones rarely cause kidney failures but the severe blockage and infection may cause such detrimental results in the human body.

Kidney Stones - 5 Causes Behind It!

Renal Tubular Acidosis is a medical condition. When the kidney is unable to acidify urine, it leads to the accumulation of acid in the body. Usually, when blood is filtered by the kidney, it passes through the tubules of the nephrons (the functional unit of the kidney).

Before it flows into the bladder from the kidney, the urine undergoes an exchange of salts, acids and other solutes. Renal tubular acidosis results in the formation of excessive amounts of acid because the kidneys cannot drain them. This may happen because the kidneys cannot reabsorb the alkaline bicarbonate ions from the urine in the early segment of the nephron or because of inadequate production of acidic hydrogen ions in the latter half of the nephron.

Renal Tubular Acidosis is simply associated with abnormal urinary acidification. Other functions of the kidneys remain unimpaired.
There are several different types of renal tubular acidosis-

  Distal Renal Tubular Acidosis (RTA)
This is the most fundamental form of RTA. It is characterized when the hydrogen ions are not secreted into the lumen of the nephron by the alpha-intercalated cells of the medullary collective duct of the distal nephron. When this happens the pH of urine cannot be brought down below 5.3. Renal excretion is inhibited and hydrogen ions are not eliminated which leads to academia. At the same time, Potassium ions cannot be absorbed by the cell which leads to hypokalemia. The end result is protein retention and potassium excretion. Distal RTA can lead to the urinary stone formation, calcium deposits in the kidney, rickets and osteomalacia and Sjogren s syndrome.

  Proximal RTA
When proximal tubular cells reabsorb 85% of filtered bicarbonates and 60% of filtered sodium from the urine, then this again leads to academia. The distal intercalated cells, however, function normally and so the academia is not as severe as in case of Distal RTA. The alpha-intercalated cells can acidify urine to a pH of 5.3 or less because they produce hydrogen ions. Proximal RTA is also associated with Fanconi Syndrome which is characterized by aminoaciduria, uricosuria, glucosuria, and tubular proteinuria.

  Combined distal and proximal RTA
Inherited carbonic anhydrase II deficit leads to combined distal and proximal RTA. This is accompanied by osteopetrosis, cerebral calcification, and renal tubular acidosis. Cases of combined distal and proximal RTA are very rare.

How is RTA understood?
The following steps are applied to analyze Renal Tubular Acidosis-
  Determining the anion gap in acidosis. The normal Anion Gap is 8-12 (4-6 mEq/L)
  Separating the renal from the extrarenal causes of normal anion gap acidosis
  Classifying the types of RTA
  If it is distal RTA, further tests will be necessary to support the diagnosis

How is RTA diagnosed?
Three types of tests can reveal if a person is affected by Renal Tubular Acidosis-
  Urine test
  Acid load test
  Physical examination

Treatment of RTA-
Doctors prescribe either or both of the following two types of therapies-

  Alkali therapy- The pH level of urine is restored and electrolytes are balanced
  Vitamin D supplements- If RTA leads to bone deformities or rickets, your doctor will prescribe vitamin supplements to strengthen your bones.

Timely diagnosis can prevent the effects of Renal tubular Acidosis from becoming compounded. With the right medication, a person can lead a healthy normal life.

What Should You Know About Renal Tubular Acidosis?

If your doctor ever diagnoses you with chronic kidney disease, he/she will give you two options to choose from. The first option is to undergo dialysis for the rest of your life, while the other option is to undergo a kidney transplant. While you may prefer avoiding a major surgery, such as a transplant, dialysis is not the best solution for your condition.

Here are some reasons why you should consider kidney transplant surgery over dialysis if you are looking for better health for the long-term:

1. Increases your life expectancy: What you may not know is that people on dialysis treatment have a severely reduced life expectancy. For instance, if you are 30 years old when dialysis starts, the treatment will keep you alive at most for 15 more years. Therefore, you may not even survive until your fifties with dialysis treatment for your damaged kidneys.

However, if you transplant a healthy kidney your life expectancy increases by 30 to 40 years. Keep in mind that kidneys from living donors are better and will help you live longer.

2. Eliminates the need for undergoing dialysis: If you choose dialysis over transplant surgery, you will need to undergo the treatment on a daily basis. This is not only costly but also affects your quality of life. For instance, a patient on dialysis will need to make special arrangements if he/she wants to go on a vacation with family so that his treatment continues even during the trip.

With a kidney transplant surgery, once you recover from the operation, you can live a normal life, without the need for daily treatment.

3. Lower cost of treatment: While you may think kidney transplant surgery is the costlier option between it and dialysis, you would be wrong to assume so. In kidney transplantation surgery, you pay a hefty amount at the time of the operation. However, in the case of dialysis, you pay smaller sums over very long periods. When you add up these small sums over 10-15 years of dialysis, you will find that transplantation is the cheaper option.

If you are young and have a long life ahead of you, kidney transplantation should be the first and foremost choice of treatment for chronic kidney disease. You can undergo dialysis while you wait for a donor and then receive a healthy organ.

Why Kidney Transplant Should Be Preferred Over Dialysis?

Enlarged prostate surgery is a very common type of surgery that many have to undergo nowadays. An enlarged prostate causes many health problems including urinary tract obstructions and urinary tract infections. It may also lead to the passing of blood via urine. Thus, enlarged prostate must be treated as soon as possible as neglect may lead to prostate cancer and its associated health issues. There are various types of prostate surgeries that a doctor performs on his/her patients. However, of late, radical prostatectomy is the most popular of them all.

What is Radical Prostatectomy?

This process can be handled in two ways. Firstly, the prostate can be reached through an incision in the abdomen. This would help the doctor work with precision and carefully avoid all the other nerves and muscles in the area the operation take places. The prostate is examined and any nodule or lymph formed over it is carefully removed. The advantage of this surgery is that the patient is less likely to suffer from any erectile problems post- surgery. The second option would be to make an incision between the scrotum and the anus. This process is best for those who are obese. The surgery is performed quickly and there is less loss of blood. Furthermore, the healing time is less too.

How To Recover From The Surgery?

Like most other prostate operations, even in radical prostatectomy, you would have to wear a catheter till you recover completely. For a few days post the surgery your urine would be collected through a urine bag attached to the catheter. One might feel a little sore in his/her genitals after the surgery, but that is quite normal to occur. The soreness is caused due to the surgery and the incisions made and would heal in a matter of a few days. Interestingly, since the urethra plays an important role in this surgery, the catheter has to be in place for at least two to three weeks but the patient can be discharged after a two to three night stay at the hospital. It is advised that the patient takes ample rest. But this does not mean all rest and no work. In fact, it is seen that patients can walk a little and even go back to a normal diet within a week to ten days of the operation. But regular checkups, till the urethra is healed, are compulsory.

Hence, these are some of the recovery procedures after an enlarged prostate surgery. Such surgeries are quite common and heal quickly.

What To Expect Post An Enlarged Prostate Surgery?

Prostate cancer is a cancerous tumor in a man s prostate gland, a small gland that is responsible for producing the seminal fluid which transports and nourishes the sperm. It is a very common type of cancer among men. A few cases of prostate cancer tend to develop slowly while others may progress very fast.
Symptoms-
In the initial stages, prostate cancer may not show any symptom. However, in the latter stages, there may be symptoms such as:
Pain in the bones.
Erectile dysfunction.
Urination can get troublesome.
Presence of blood in the semen.
Pain and discomfort in the pelvic region.
Causes-
The exact causes of prostate cancer are not known. It starts to develop when certain cells in the prostate gland start to mutate. These mutations cause these cells to multiply at a very fast rate and thus, soon form tumors. Although the causes are not known, certain factors tend to aggravate this condition; them being:
Color: According to certain medical reports, a darker skin may mean increased chances of suffering from prostate cancer.
Age: The risk of developing prostate cancer tends to increase with age.
Genetics and Family History: Faulty genes could be another cause of this condition. Also, having some member in the family who is diagnosed with this type of cancer only increases the risks of you suffering from them.
Obesity: If you are obese, then you are more likely to develop prostate cancer.
Treatments-
The treatments for prostate cancer include:
Radiation Therapy: In this procedure, high energy rays are used to target and destroy cancer cells. Usually X-rays or protons are used to treat the cancer cells.
Hormone Therapy: Hormone therapy is a type of treatment wherein certain medications are administered to prevent your body from producing testosterone.
Surgery: If the other treatment methods do not produce desired results, then a surgery is carried out for the removal of the prostate gland. In addition to the prostate gland, some adjoining lymph nodes and tissues are also removed.
Chemotherapy: Chemotherapy is method of destroying cancer cells by injecting chemicals into the body. The medicines are injected into the veins in the arms. 

All About Prostate Cancer

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