Dr. Aditya Pradhan

Lower Urinary tract obstruction refers to a condition of hindrance to urinary flow from bladder outwards. This can occur in all the age groups and affect either sex. The symptoms can be poor urine flow, intermittent flow, straining to pass urine or empty bladder, sense of incomplete emptying of bladder, difficulty in starting urination. Other problems can be increased urine frequency and difficulty to hold on with or without occasional urine leak in clothes. The cause and treatment vary in different age groups.

Few common reasons behind Lower urinary Tract Obstruction:

1. Congenital Urethral Stricture and PUV: These defects can be detected either before or after birth and need correction at earliest to avoid long-term complications. It is usually brought to attention by parents who observe abnormal urine flow pattern of their child OR found out during evaluation for repeated urinary tract infections.

2. Neurogenic Bladder: This is caused due to defects of nerves that are responsible for controlling bladder function. This can be due to diseases of brain, spinal cord or peripheral nerves. These defects can occur by birth or later in life. It is very important to take early consult to avoid long-term complications and progression to renal failure.

3. Urethral Stricture: This is narrowing in a long tube that starts from bladder to the external urinary opening. It can be idiopathic, post-traumatic, or due to urethral infections. Usually, a person is able to recognise poor urine flow and bring it to the attention of urologist. Treatment for stricture depends on various factors and range from simple endoscopic surgery to open surgeries.

4. Bladder Neck Obstruction: Bladder neck is a network or a group of muscles that connect the bladder to the urethra. The muscles tighten to hold urine in the bladder, and relax as they release it through the urethra. Urinary tract obstruction occurs when there are abnormalities blocking the bladder neck that restricts its opening during urination.

5. BPH: This occurs due to enlarged prostate obstruction urine flow out of bladder. Prostate enlargement is mostly age-related and rarely due to prostatic tumors. Urinary stones. This can be usually recognized by sudden obstruction to urine flow in person who was voiding normally. These episodes might be recurrent due to movement of stone in between bladder and urethra.

6. Bladder Tumors: The are mostly characterized by blood in urine. Sometimes there might be blood clots that obstruct the urine flow. 

7. Phimosis: Phimosis is another major reason behind urinary tract obstructions.

In case you have a concern or query you can always consult an expert & get answers to your questions!

The prostate gland in males surrounds the urethra, through which urine and sperm are passed out of the body. Its function is to secrete a fluid, which provides nourishment to the sperm. It is about the shape of a walnut and is present between the pubic bone and the rectum.

As a man crosses 40, the prostate gland begins to increase in size due to an increase in the number of cells. This is known as hyperplasia. The condition is usually benign and therefore the name benign prostate hyperplasia (BPH). As it continues to grow, there is an increased pressure on the urethra. Therefore, there can be problems with urination. The bladder, being a muscular organ, compensates to some extent and so the problems with urination are mostly managed. If left untreated, this can continue to be a major problem and the bladder may not be able to compensate. In men who are 60-plus, BPH is very common.

Signs and symptoms 

1. One of the initial symptoms of BPH is when the urine stream begins to grow weak.
2. There could also be a reduced speed of passing urine.
3. Men with BPH never have a feeling of complete emptying of the bladder.
4. On the other hand, there is also a constant difficulty in initiating a urine stream. There could be intermittent breaks in the urine stream.
5. The person may feel the need to strain to initiate the stream and to ensure complete emptying.
6. There could be dribbling of urine after passing urine.
7. The duration between two bathroom visits can constantly reduce, with the constant urge to urinate.
8. There is a constant urge to visit the bathroom, which is more common in the night. One of the most annoying features of BPH is the walking up at night to urinate, but with an inability to initiate a stream and an inability to completely empty the bladder, it leaves the person very irritated and frustrated.
9. There could be blood in the urine. In fact, blood in the urine accompanied by fever, chills, nausea and vomiting are indications of an emergency.
10. There could be blockage of urine completely, if the enlargement is quite severe.

Diagnosis
If you are having any of these symptoms, then the doctor will first test for an enlarged prostate through a digital rectal exam. Then a test is done to check a chemical called prostate specific antigen. Increased levels of this chemical is almost always indicative of BPH. In addition, X-rays and scanning may be used to confirm diagnosis. 

Treatment

Blood test cancer prostate is PSA. It is done only if there is a suspicion of cancer. Most cases can be managed by medication. Surgical removal procedure needs a minimum of 2 to 3 days. If you wish to discuss about any specific problem, you can consult a Urologist.

The prostate gland is a male reproductive organ at the base of the urinary bladder and urethra is a thin tube that carries urine out of the penis. It runs through the prostate gland. A fluid produced by this gland helps to carry sperms produced by the testes outside during intercourse.

Cause of urinary problems in men:

Men experience urinary symptoms either due to inflammation of the prostate gland or prostatitis or symptoms may be the result of a blockage of the passage due to enlargement of the prostate gland.

Symptoms of urinary problems:

1. The need to urinate frequently during the night.

2. Urinating more often during the day.

3. Urinary urgency is the urge to urinate can be so strong and sudden that one may not reach the toilet in time.

4. The urine stream is slow to start.

5. Urine dribbling for some time after finishing urination.

6. A sensation that the bladder is not fully emptied after urination.

7. A lack of force to the urine flow, which makes directing the stream difficult.

8. The sensation of needing to go again soon after urinating

Treatment:

1. A long course of antibacterial medication (for bacterial prostatitis) is prescribed, because infection is difficult to get rid of, the antibacterial medication will need to be taken for many weeks.

2. Medication to improve urine flow and other symptoms (for obstruction caused by an enlarged prostate).

3. Surgical procedures (for blockage caused by an enlarged prostate), such as Transurethral Resection of the prostate(TURP), Laser Resection of prostate, Transurethral Incision of the prostate(TUIP).

UroLift: A new method of treatment for men, where medication has not been successful, but their prostates are not so enlarged that they need more invasive surgery. It involves the Transurethral Insertion of staples to separate the lobes of the prostate. It has minimal side effects and preserves ejaculatory and erectile function.

A number of other procedures that have been developed to reduce urinary symptoms.

Medication for urinary problems:

1. Medications to reduce the tone of the muscles of the urethra and prostate to minimize any obstruction to urine flow caused when these muscles contract.

2. Medication to reduce the size of the prostate gland. These drugs work by blocking the action of male hormones produced by the prostate gland.

3. Medications to relax the bladder, making unwanted contractions less likely and reducing the symptoms of urgency and frequency of urination.

4. Over-the-counter medicine 'Saw Palmetto' (Serenoa repens) is used sometimes. This may help some men, especially if frequent urination at night is a problem. However, recent reviews of the evidence for using Saw Palmetto as a treatment for mild or moderate urinary symptoms did not show any improvement compared to no treatment, in men with BPH. If you wish to discuss about any specific problem, you can consult a Urologist.

Kidneys are an important part of the human body. From filtering wastes from the blood to maintaining the blood pressure and red blood cell count in the body, the kidney does it all. Both the kidneys are essential organs and should there be any discomfort in the kidneys, one should consult a medical practitioner as soon as possible. Kidney failure is a common problem in people. This issue manifests itself with certain signs and symptoms. One should listen to these symptoms and act quickly before the condition worsens. Here are some of the signs and symptoms of kidney failure.

Interestingly, in the initial stages, kidney failure portrays no symptoms. It starts developing slowly and steadily causing discomfort in other parts of the body and hindering the working of other organs.

1. Weakness: If you are suffering from kidney failure, you will start feeling weak. Weakness is however not a symptom which can confirm a kidney failure. Weakness is caused due to many other health issues and thus, you need to verify with other symptoms to be sure of the fact that you are suffering from kidney failure only.

2. Shortness of Breath: You may start experiencing heavy breathing right after doing some rigorous work. In fact, you might feel shortness of breath or be panting for long moments after climbing just a set of stairs. Shortness of breath is quite common indicating that the body is getting tired after doing work. Such indication, more than once a day, calls for an immediate check up of the body.

3. Lethargy: While most people, especially the young generation to those in the early thirties jokingly declare themselves as lazy people; lethargy, however, is a symptom of many diseases. Various health issues develop if you feel lethargic of working. Apart from kidney failure, diabetes is also manifested in lethargic body movements. At times, just getting out of the bed in the morning seems very tiring and one continues to lie on the bed even after he/she is fully awake.

4. Stomach Pain: If you experience pain in the stomach, especially in the sides, then it should be immediately checked by a medical practitioner. Doctors say that kidney failure can bring about stomach pains.

5. Unusual Urine Discharges: This would include clear urine discharges which indicate that the kidney has stopped filtering the waste products.

Thus, these are some of the most important and common symptoms of kidney failure. If you notice any of these, it is advised to visit a doctor for a check up. In case you have a concern or query you can always consult an expert & get answers to your questions!

If you are experiencing pain in urination along with a burning sensation, a health condition known as dysuria is indicated. This condition is usually common in women and men alike. However, older men are more prone to face this problem. Pain during urination may occur because of various reasons. The most common causes are as follows:
Infections

1. Urinary tract infections (UTIs) are a common cause of painful urination. Infections may occur in any part of your urinary tract, such as in the kidneys, bladder, and the ureters. These infections occur due to bacteria, which gets into the urinary tract via the urethra. There are several factors, which increase your chances of being affected by UTI. They include diabetes, an enlarged prostate, old age, pregnancy, and kidney stones. UTI is signified by other symptoms such as fever, bloody urines, flank pain, stronger smelling urine, and an increased urge for urination.
2. At times, painful urination may also be associated with vaginal infections in women, like yeast infection. Vaginal discharge and foul odor are indicated in the case of vaginal infections.
3. Painful urination is also caused because of certain sexually transmitted infections (STIs) such as gonorrhea, genital herpes and Chlamydia.

Inflammation and irritation
There are several problems, which can cause inflammation of your urinary tract and genital region. This further results in painful urination. Inflammation and irritations also occur because of other factors such as urinary tract stones, vaginal changes associated with menopause, certain physical activities and the side effects of several medicines, treatment procedures and health supplements.

Consulting a doctor for painful urination
Your doctor will suggest you to undertake certain laboratory tests for the proper diagnosis of the cause of your painful urination. After this, a suitable treatment method is sought and undertaken. Before this, an overall physical examination is also carried out. Your doctor is likely to ask you some important questions regarding your painful irritation, how the condition worsens, and is felt during the onset of urination. It is also likely for your doctor to know about any other symptoms, which you might be experiencing such as fever, flank pain and vaginal discharge. You must tell your doctor about any changes observed in your urine flow, such as difficulty in initiating flow, an increased urge to urinate, and dribbling.

Apart from these, your doctor may also ask whether you experienced any character in urine after painful urination. These may include colour, amount, cloudiness, presence of pus in the urine and so on.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Urinary incontinence, commonly known as loss of bladder control can really cause embarrassment. The severity of this condition may range from once in a while leaky urine to the sudden and forceful urge to urinate, due to which you end up urinating before reaching the toilet.

Types of Urinary Incontinence:
1. Stress incontinence- When you feel the urge to urinate due to sneezing, coughing, laughing or while doing physical exercise
2. Urge incontinence- When you feel the urge to urinate, suddenly. This may occur during the day and even at night.
3. Functional incontinence- When you cannot reach the toilet on time because of a physical or mental impairment.
4. Mixed incontinence- When you involuntarily urinate due to more than one incontinence

Stress incontinence is the most common type in women. The activities which increase your risk, are:

1. You have had more than one pregnancy and vaginal delivery.
2. You have pelvic prolapse. This is when your bladder, urethra, or rectum slide into the vagina. Delivering a baby can cause nerve or tissue damage in the pelvic area. This can lead to pelvic prolapse months or years after delivery.

Female urinary stress incontinence is the involuntary release of urine during any physical activity that puts pressure on your bladder. This potentially embarrassing condition differs from general incontinence in that it happens when the body is under immediate physical stress. Activities that can put stress on your bladder include coughing, sneezing, laughing, lifting heavy objects, or bending over. This condition is particular to women, many of whom experience symptoms after muscles have been weakened due to a vaginal childbirth, following menopause, or during pregnancy.

Ensure that you consult a doctor:
1. If this condition hinders your day to day activities
2. If the urinary incontinence is the result of a serious underlying problem

Urinary incontinence may be temporary or permanent.

Causes of temporary incontinence are:
1. Alcohol
2. Caffeine and caffeinated drinks
3. Decaffeinated tea or coffee
4. Spicy and sugary foods
5. High intake of Vitamin B or C
6. Urinary tract infection (UTI)
7. Constipation

Causes for permanent incontinence are:
1. Pregnancy
2. Childbirth
3. Old age
4. Menopause
5. Hysterectomy
6. Prostate cancer
7. Enlarged prostate
8. Neurological disorders

Complications:
Chronic urinary incontinence can lead to certain complications like
1. Skin problems- Skin rashes and infections can develop around the vaginal area, because of the constant wetness one feels. It may also cause sores.
2. Urinary Tract Infections- Urinary incontinence can also result in UTI
3. Impact on personal and social life- Urinary incontinence can lead to great embarrassment, thus affecting the social and personal life of an individual.

Treatment for Female Stress Urinary Incontinence:
There are several types of treatment available. Treatment options include lifestyle changes, medications, nonsurgical treatments, and surgeries.

Lifestyle Changes
Make regular trips to the restroom to reduce the chance of urine leakage. Drink fewer fluids and avoid activities such as jumping and running.

Medications
Medications that reduce bladder contractions.

Nonsurgical Treatments
Kegel exercises strengthen your pelvic muscles. Done regularly, these exercises can strengthen your muscles, allowing you to control when urine is released from your body.

Surgery
If other treatments fail, you will have to go for surgical treatment. Types of surgery include:

Injectable therapy, in which collagen is injected into your urethra to reduce incontinence.
Tension-free vaginal tape (TVT) surgery, in which mesh is placed around the urethra to give it support.
Vaginal sling surgery, in which a sling is placed around the urethra to support it
anterior or paravaginal vaginal repair surgery to repair a bladder that is bulging into the vaginal canal.
Retropubic suspension surgery to move the bladder and urethra back into their normal positions.

Some doctors even try electrical stimulation and medication. When the condition is highly advanced interventional therapies and surgery is recommended.

Some interventional therapies are:
1. Bulking material injections
2. Botulinum toxin type A
3. Nerve stimulators

In case you have a concern or query you can always consult an expert & get answers to your questions!

Types of Kidney stones and their formation

Are you suffering from a urinary tract infection and are looking for effective ways to deal with the condition? Urinary tract infection implies infection is either in the urinary bladder or kidneys, while bladder infections are common in women, kidney infections are uncommon. Men by and large don't suffer UTI. So if a male has UTI, evaluation of an underlying cause like stone, benign prostatic hypertrophy etc. should be done. Most urinary tract infections are simple to treat, with some antibiotics for 3 days. In cases of Diabetes, Renal failure, patients with prior surgery, further evaluation and longer therapy are needed. In most cases of recurring UTI, there is an underlying cause. Hence a urological evaluation should be done for recurring UTI. If you wish to discuss about any specific problem, you can consult an urologist.

Kidneys stones are a common condition. They are quite different from Gallstones which are formed in the Gall bladder. Gall stones are from bile concentration in the gall bladder. "Silent" Gallstones which are detected on an ultrasound done for another cause, can be left alone.

However, silent kidney stones should never be left alone. These can silently grow to a large size and cause kidney failure without the patient ever experiencing pain. Every patient of stone needs to be evaluated by blood tests, ultrasound and possibly CT-scan. Small stones 5 mm or less may pass out naturally, but should be monitored on Ultrasound to confirm clearance. Larger stones are cleared by a variety of Endoscopic Operations like Ureterorenorenoscopy, PCNL or ESWL. These need 1-2 days hospitalisation and have quick recovery. The stone removed should be analysed for contents so that appropriate preventive measure in diet and medicines can be started as soon as possible. If you wish to discuss about any specific problem, you can consult a doctor and ask a free question.