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Pathology of the The Urinary Tract | Pathologies and health.

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Diseases and conditions


  • Glomerulonephritis
  • Nephrotic syndrome
  • Pyelitis and pyelonephritis
  • Renal tuberculosis
  • Floating kidney
  • Traumatic injury of the kidney
  • Kidney stones
  • Hydronephrosis
  • Kidney cysts
  • Kidney tumors
  • Ureterocele
  • Tumors of the ureter
  • Cystoscopy
  • Urinary incontinence: what is it?
  • Cystitis
  • Bladder fistulas
  • Bladder stones
  • Bladder tumors
  • Urethra
  • Urethral caruncle
  • Urethral diverticula
  • Stenosis of the urethra
  • Urethritis

GLOMERULONEPHRITIS

What is Glomerulonephritis?

It is an autoimmune inflammatory disease that affects the kidney glomeruli. If left untreated, can lead to the destruction of these structures, resulting in blockage of renal function. When the disease process involves the entire organ (on both sides), it is called diffuse Glomerulonephritis.

There are several forms of Glomerulonephritis?

Are primary and secondary Glomerulonephritis. The primitives are Glomerulonephritis, postinfettive those from drugs, from hereditary abnormalities (like Alport syndrome and Fabry disease) and idiopathic. The secondary Glomerulonephritis are those that may occur in the course of infectious diseases, those secondary to neoplasms and protein accumulation (as in diabetes), toxic-based ones. You can also distinguish between acute Glomerulonephritis, which can last from a few days to a year, and a chronic form, which lasts longer. It is also known as an intermediate stage, known as subacute Glomerulonephritis.

Because it says it is a disease Glomerulonephritis immune complex diseases?

Because, in General, follows the deposition, in the thickness of membrane
Glomerular filtration, Antigen-antibody complexes. In some forms (rare and serious) settle specific antibodies against antigens of the Glomerular basement membrane.

There are forms that have no immunologic pathogenesis?

Yes, Glomerulonephritis based on hereditary and some secondary forms.

How to confirm the diagnosis of Glomerulonephritis?

Renal ultrasonography and renal tissue biopsy are the main means of investigation.

Is a very common disease?

Glomerulonephritis was once quite common, especially among children.
Now it is not.

At what age are more frequent cases of acute Glomerulonephritis?

The 70% of cases occur before the age of twenty-one years.

What are the causes of acute Glomerulonephritis?

The most frequent form is that which appears postinfectious usually right after a bacterial infection, most often after a streptococcal infection, which is the most frequent cause of pharyngitis and tonsillitis.

What are its symptoms?

Patient history can reveal a previous acute infection, such as a severe form of tonsillitis. Urine albumin and blood are present; There may be a
variable blood pressure increase and tenderness of renal region, lower limb edemas and periorbitari.

What is the normal course of acute Glomerulonephritis?

Usually lasts a few weeks and then disappear spontaneously. It is estimated that 75-90% of children suffering from acute Glomerulonephritis heal without residual renal injury. It is therefore a serious pathologic form but not particularly fearsome.

Can be fatal?

Yes, for the onset of severe hypertensive crisis. It is rare that this occurs in postinfectious form.

You can prevent the onset of acute postinfectious Glomerulonephritis?

Yes, by contacting your doctor time to treat acute infections of the upper respiratory tract caused by Streptococcus.

What is drug-induced interstitial nephritis?

A form of nephritis induced by drugs such as some antibiotics, NSAIDs, allopurinol.
There are caused by acute and chronic forms of cimetidine due to prolonged use of some analgesics.

How to treat these forms of nephritis?

Is employed, in particular chronic forms, Cyclosporine.

What other drugs will be used for treating Glomerulonephritis?

Depending on the case using corticosteroids, cytostatics, interferon-alpha, anticoagulants, platelet aggregation. To dismiss the immunocomplex plasmapheresis may be used. If necessary, the treatment of kidney failure.

NEPHROTIC SYNDROME

What is nephrotic syndrome (or nephrosis)?

A generic term that indicates a morbid framework characterized by severe renal, with presence of edema (collection of fluid in the tissues or in natural cavities) spread to the whole body (anasarcotico); are, and can become visible, especially the facial oedema, abdomen and legs. This situation is caused by the loss of large amounts of protein (proteinuria). In addition to proteinuria, hypoalbuminaemia occurs and hyperlipidemia.

What are the causes of nephrosis?

The causes of nephrosis are numerous and often non-specific, common to those of Glomerulonephritis.

Who is likely suffering from nephrosis?

Children between two and seven years.

Is a very common disease?

No, it is relatively rare.

Which surveys confirm the diagnosis of nephrotic syndrome?

Biochemical examinations and histological examination of renal tissue (taken by biopsy).

How do we cure it?

In general you have to pay attention to diet and limit the use of salt. As to specific therapies, depend on the original cause of nephrosis. In some cases it makes use of cortisone and cortisone, with encouraging results.

Why you should limit the use of salt in your diet?

Why salt retention causes fluid retention, thus aggravating the pre-existing edema.

In cases of nephrosis limit meat, eggs or other protein?

No.

What percentage of healing in case of nephrosis?

In recent years almost half of children with nephrosis died; Today, with new methods of treatment, at least 75% heals.

PYELITIS AND PYELONEPHRITIS

What are the pyelitis and pyelonephritis?

Bacterial infections affecting the kidney, including the excretory tract.
The pyelitis refers to infection of the basinet or pelvis, the receptacle in which urine flows once formed; pyelonephritis refers to inflammation of the body, too, for the kidney urine formation. Pyelitis rarely occurs in isolation, without nephritis.

What caused the pyelitis and pyelonephritis?

Are caused by bacteria which reach the kidney through the blood stream or by extension from other parts of the urinary tract, genitals or enteric, such as bladder, prostate, cervix, vagina, urethra or rectum. Most frequently involved are gram-negative germs.

What are the subjects that can be more easily affected by or pyelitis pyelonephritis?

Often occurs in children pyelitis (for the increased frequency of vescicoureterale reflux, which facilitates the development of infections) as acute infection, but is quite common among adults also. Kidney infection is more common among women, especially pregnant ones, because they have an increased susceptibility to urinary infections.

The same arrangement occurs in diabetics and in people suffering from certain debilitated or neurological disorders.

What are the symptoms of pyelitis or pyelonephritis?

High fever, sometimes accompanied by intermittent chills, back pain, dolo vulnerable to the pressure of renal region (with Jordan positive sign: intense pain caused by a blow given with the hand cut in the lumbar region), frequent and painful urination with blood in the urine. Are common symptoms, although not always present, nausea, vomiting and loss of appetite; laboratory tests may reveal the presence of pus and bacteria in the urine and a high number of leukocytes in the blood. You must then perform a urine culture to identify the germ involved. Also useful, particularly instrumental examinations and ultrasonography urography.

The infection usually affects both kidneys?

No, although sometimes it happens.

How to treat kidney infections?

Drinking lots of fluid) in order to wash the pelvis and ureters;
b) with taking antibiotics, to combat the causative agent of infection;
c) with bed rest and a light diet.

What is the normal course of kidney infections?

If cared for properly, nearly all patients recover well. Very important is to know if the source is an obstruction of the ureter that could have caused a stagnation of urine, became infected, and it is essential to eliminate any other infection anywhere in the body, which could have triggered the kidney infection.

How long do these infections?

From a few days to several weeks.

Antibiotics are effective in the treatment of pyelonephritis and membrane?

Almost always, as long as the specific antibiotic to fight the bacteria responsible for the infection and that you provide to eliminate other possible urinary tract abnormalities. Rarely patients can reach death.

Is hospitalization necessary?

The normal cases can be treated at home. However, if the fever is very high or the renal bascinet fails to delete the infected urine, it is advisable to hospitalization.

You have to resort to surgery for cases of pyelonephritis or membrane?

Not usually. However, if internally or around the kidney forms an abscess, may require surgical drainage. You may need surgery even if the kidney infection is a secondary manifestation of some other disease like Renal stone disease.

Kidney infections have a tendency to repeat itself?

Yes, if you are slow to heal the initial attack or if the treatment was not appropriate.
In these cases you have permanent kidney damage that can forever impairing the function, and then further facilitate functions.

Subsequent and frequent doctor visits help to prevent the recurrence of a kidney infection?

Yes.

It is true that diabetics are more prone to kidney infections?

Yes.

Chronic kidney infection can cause other diseases?

Yes. In individuals with chronic kidney shapes you often stone formation; these patients may also be subject to hypertension and eventually have kidney failure.

RENAL TUBERCULOSIS

Renal tuberculosis is often a primary disease?

No, it is usually a result of pulmonary tuberculosis.

How tuberculosis reaches the kidneys?

The bacilli will arrive through the blood stream.

What symptoms?

Frequent and painful urination and blood in the urine should induce to consider as a possible tuberculosis diagnosis and push in search of specific signs of the disease.

How to diagnose renal tuberculosis?

Identifying the microscopic tubercle Bacillus in the urine. Characteristic findings of urography help diagnose; When tuberculosis was
extended to the bladder, the cistoscopico examination reveals a characteristic appearance; are also some finds in the scrotum (epididymitis) and in the prostate.

How do we cure it?

First you have to establish the classic three antituberculosis therapy drugs. If the disease is limited to only one kidney and has already caused considerable destruction, you may want to administer drugs and remove diseased kidney simultaneously; If both kidneys are affected, it is preferable to the only medical treatment. The drugs most used are streptomycin, isonicotinic acid hydrazide, rifampin and ETHAMBUTOL.

If tuberculosis is limited to only one kidney and that kidney is removed, you can heal?

In the case of tuberculosis is not about healing, but rather (or rather of remission) of the disease. If the disease is limited to a kidney, his removal will stop the disease.

FLOATING KIDNEY

What is a floating kidney or lowered?

A kidney that fell in an abnormally low position compared to its normal.
The process is also called nephroptosis.

Who is more easily subject to have a floating kidney?

Thin people, especially women.

Why?

Because the topic is skinny reduced the amount of fat in the adipose capsule that surrounds the kidney, keeping it in situ.

Whichever is affected more frequently?

The right one.

What symptoms like a floating kidney?

As long as there are, the symptoms consist of backache and abdominal pain.
The twist of the ureter may interfere hindering the flow of urine, and this can lead to a so-called "renal crisis", which manifests itself with severe pain attacks, like colic, renal region.

You need to undergo treatment for a kidney that causes no symptoms?

No.

What are the treatments indicated for a floating kidney that causes the appearance of symptoms?

a) medical treatment, with a special diet to gain weight and the use of a support or a corset to keep the kidney in its exact location;
b) a surgical procedure by which the kidney is adequately secured with sutures in his normal position; This is called nefropessia.

Are serious fixing operations of mobile kidney?

No, this is for normal surgical management. The results obtained with these interventions are good.

Are usually needed blood transfusions, when you run an operation high renal surgery?

Yes.

How long is the recovery time?

A month or so.

TRAUMATIC INJURY OF THE KIDNEY

What are the most common causes of renal lesions?

motor vehicle accidents);
b) sports injuries, as in football or in boxing;
c) falling from a height, with a hit on kidney region;
d) a weapon injury (stab) or from fire.

How can you tell if you have a kidney lesion?

in pain and tenderness) to the pressure in the kidney region;
b) highlighting the presence of blood in the urine;
c) by a renal ultrasound.

How to treat renal lesions?

For minor injuries, which make up the majority of cases, the main form of treatment is bed rest. If bleeding is alarming and if the Ultrasound shows a kidney badly damaged it may be necessary to resort to surgery to remove the organ, or to drain the blood and urine leaked from the damaged kidney.

With surgery you can reconstruct a damaged kidney?

Yes; If the damage is too extensive, rather than remove it you can suture the kidney.

It is often necessary to surgically intervene in event of a renal lesion?

Most cases will heal without surgery.

How do you determine if you have to resort to surgery?

If the urine becomes lighter in color and if there is evidence of a recovery of renal function, the intervention is not necessary. Instead, if urine blood persists and you cannot restore kidney function, or if the patient's general condition worsen and if there is swelling in the lumbar region.

KIDNEY STONES

What are kidney stones formed?

Are a combination of inorganic salts such as calcium, phosphorus, ammonium etc., or can be formed from organic compounds, like uric acid.

Because they are formed?

In some cases the exact cause is unknown; for example, in the gotta has a high concentration of uric acid in the blood, and consequently in kidney secretions, which causes the precipitation of uric acid to form gallstones.
Similarly, in disorders of calcium metabolism, the precipitation of calcium compounds in the urine and kidneys to make calculations. In most cases, however, the exact mechanism of the formation of kidney stones is not known although in this regard there are various theoretical possibilities:
unsuitable diet);
b) imbalances in the chemical composition of urine, water leaks;
c) disorders of endocrine glands, especially the parathyroids;
d) vitamin deficiencies;
and kidney infections);
f) poor drainage in one or more parts of the urinary tract.

Kidney stones strike with the same frequency, both men and women?

No; are slightly more frequent in men.

Can occur at any age?

Yes, but are more frequent in adults between forty and sixty years of age. It is rare that a child is suffering from kidney stones.

Kidney stones tend to be singles or multiples?

In most cases are individual, but can also be multiple; in this case it is likely that both kidneys.

Kidney stones vary greatly in size?

Yes; their size is highly variable: can go from tiny fragments no larger than grains of sand (the arenula and renella) in forming a cast stones or renal calyces mould (mold coralliforme calculation).

What symptoms cause?

In some cases calculations are located, are real estate, do not give any symptoms and can see just randomly. Usually, however, cause severe pain (renal colic), presence of blood or pus in the urine with renal function damage.
The calculations are frequently located in the ureter, the channel that connects the kidney to the bladder, and they give more pain and require surgery more often (see below).

All calculations must be surgically excised?

No, many are deleted spontaneously; also, as mentioned, some cal coli do not move, do not cause pain or infection and do not interfere with kidney function, in which case they can be left alone. The calculations to be removed are those too big to be expelled, the ones that cause obstruction and infection, those causing constant pain or recurring attacks of severe pain, and those who, even
Apparently, cause progressive damage to renal function. Today you can also endoscopic lithotripsy, extracorporeal lithotripsy shockwaves (ESWL) or, as an alternative to this, laser lithotripsy.

What is the lithotriptor?

It is a machine that can produce shockwaves can crush calcific calculations with special features.

There are medicines that can dissolve the calculations?

Only the calculations consist of urate (uric acid salts) can be dissolved with an appropriate medical therapy. In other cases, there are some diets, like the diet low in phosphorus, alkaline diet or a diet, acid that can retard the growth of a calculation or help prevent the formation of new calculations. There are also some medications that have more or less the same effect (salts, acids, alkaline salts, etc.), but cannot dissolve the calculations.

Kidney stones can be reformed after leaving or being cleared?

Yes. However, you can prevent the reform with an appropriate diet, using copious amounts of fluids, taking certain medications and deleting infections and urinary tract obstruction. In a small percentage of cases, the calculations come back up anyway, despite all precautions.

What are the calculations of the ureter?

It is rare that the calculations originally forming the ureter, while often have descending kidney ureter and localize. The calculations in the ureter ureteral calculi are known.

What symptoms?

The main symptom is pain, stabbing, similar to colic, pain can be so keen to stand up to the most powerful analgesics. Common symptoms include nausea, vomiting and
constipation; There may also be a stimulus and frequency in urination, which is painful; in most cases contain blood and urine, if the calculation results in the blockage of urine flow from the kidney, you have fever.

How to treat?

First you need to control pain; then, in case of infection, we must act with antibiotics or sulfa drugs. If you can't adequately control pain and infection, you should perform a kidney drainage, which is achieved by introducing a cystoscope through a catheter into the bladder, ureter, then pushing it beyond calculation. If you cannot pass the catheter over the calculation, we need surgical excision or endoscopic lithotripsy.

It is always necessary to resort to surgical excision for calculations to the ureter?

No; most of the calculations that settled in this location pass spontaneously into the bladder and are deleted. If there is an infection, if not pain logons are repeated and if urine flow is not blocked, it is therefore better to wait the stones pass naturally, which can occur at any time, in the space of several days or weeks.

When is surgery necessary?

When the calculation) is clearly too big to pass spontaneously;
b) when urine block extends;
c) when you have repeated attacks of acute pain;
d) when the infection persists;
and renal function) when it is damaged.

You can grab the computation with appropriate tools, fed through a cystoscope?

Yes; There are tools specifically designed to grab the calculations and sometimes you can get them down the ureter.

Surgical excision of a calculation is a serious operation?

Is an operation which does not involve great risks.

How long does it stay in hospital after a removal of ureter calculi?

Ten to fourteen days.

After such surgery, the patient can lead a normal life?

Yes.

In addition to the removal of calculus, there are other surgical procedures?

Yes, the percutaneous nephrolithotomy and ureteroscopy. The first involves a kidney puncture from the outside, so that you have a "door", through which pass the endoscope (nephroscope) which identifies the calculation and smashes through ultrasound or laser. The ureteroscopy involves the passage of the endoscope through the urethra and bladder (crushing computation takes place, as for the percutaneous ultrasound or laser,).

Those who once had a kidney stone should undergo periodic medical examinations?

Yes; should also comply with all the requirements mentioned above to prevent bacterial regrowth.

HYDRONEPHROSIS

What is hydronephrosis?

This term indicates the dilatation, pathologic of renal and ureteral bascinet homolateral, due to a stagnation of urine cannot drain. The cau se that prevent the outflow can be multiple (calculations, compressions, congenital malformations, etc.); in any case, if the obstacle is located at the exit of the basinet or renal ureter, the pathological process typically affects one kidney; If you reside in the bladder or urethra, you can develop a bilateral hydronephrosis.
The increasing expansion of the bascinet, caused by renal urine pressure exerts on its walls brackish (hit), causes progressive atrophy of the surrounding tissue, resulting in reduced kidney function. If brackish urine develops an infection, resulting in accumulation of pus in the basinet, kidney hydronephrosis becomes in the so-called idropionefrosi or pionefrosi: a secondary complication that can emanate from an inflammatory process also produced in the basinet.

From what can be caused?

Formed in calculations or renal ureter bascinet, congenital malformations, such as the narrowing of the point where the renal ureter passes bascinet or abnormal development of a second soprannumeraria renal artery: in some individuals this crosses the ureter, crushing it. Other possible causes of hydronephrosis are bending or twisting of the ureter, which may occur in the presence of floating kidney, tumors, inflammation, adhesion formation.

How to treat the hydronephrosis and idropionefrosi?

Treatment is usually surgery to remove the obstacle to the flow of urine.
Infectious processes are treated with appropriate medication, while in case of severe unilateral idropionefrosi, may be appropriate surgical excision of the kidney shot, if the other is functioning normally.

KIDNEY CYSTS

What are the main forms of renal cystic diseases?

congenital polycystic kidney disease): is a situation already in existence at birth and is characterized by the presence of numerous cysts, large and small, usually in both kidneys; as the individual grows, renal function is compromised.
Polycystic kidney disease affects more members of one family;
b) solitary cyst of the kidney: usually does not harm renal function;
c) kidney pluricistico: multiple cysts in the kidneys, congenital based not.

What are the symptoms of Polycystic Kidney disease?

As the individual becomes an adult, you may have pain in the kidney area, presence of blood in the urine, infection and high blood pressure.

What are the symptoms of a solitary kidney cysts?

Usually asymptomatic course: sometimes you may have pain and blood in urine.

How do I get to the diagnosis?

With an ultrasound, so that in most cases the diagnosis of solitary cyst is totally random, made during an ultrasound is required for other reasons.

How to treat polycystic kidney disease?

There is no effective cure. If there are any complications, such as infection, formation of stones or acute pain, normal care.
The advent of kidney transplantation helps some of these unfortunate patients.

How to cure a solitary kidney cysts?

Normally you do not need any treatment; Sometimes, to the considerable size of the cyst surgery is required.

KIDNEY TUMORS

Who is more easily subject to renal tumors?

Kidney tumors most commonly affects males, smokers and, for certain types of cancer, obese individuals; They also have a higher risk of developing a kidney cancer the processors or the handling of asbestos and coke ovens. Finally, children may manifest a particular form of cancer, genetic origin, known as Wilm's tumor.

Kidney tumors are all malignant?

No, but those are more frequent malignant to benign ones.

What is the technical term that indicates the malignant tumor that most often affects the kidneys?

The most common kidney cancer is called hypernephroma.

How can you diagnose renal cancer?

First of all in the patient's medical history may be a persistent hematuria (blood in urine) that confirms the urinalysis; the visit may level mass palpating lumbar. You should then get the search on several occasions of neoplasiche cells in the urine (which if positive is diagnostic), proceeding then to investigations, including ultrasonography, urography, CT scan, MRI.

What is the urography?

A radiographic examination is performed by injecting a radiopaque solution into a vein.
The solution is eliminated by the kidneys and act of being eliminated and outlines them allows them to be seen by an x-ray.

The urography is painful or dangerous?

No. However, you must take special precautions before you run it in the case of particularly allergic patients, or in the event of diseases date (for example: Myeloma).

The urography serves to diagnose other diseases besides kidney cancer?

Yes: reveal the presence of many other anomalies along the course of the urinary tract.

How to cure kidney cancer?

With the immediate removal of the entire kidney. In some cases (in the absence of metastases) the conservative intervention, namely the removal of only the tumor.
For some types of kidney tumors (metastasis) is also advisable prior radiotherapy and postoperative radiation therapy. In certain situations it is used immunotherapy with interleukin, possibly associated with interferon.

The removal of a kidney is a serious operation?

Yes, but if the other kidney is normal, a kidney removal does not affect adversely the life.

The removal of a kidney (nephrectomy) is dangerous?

No; in a normal postoperative healing usually follows.

Metastases are frequent in hypernephroma course?

Yes, especially lung and bone. The hypernephroma, however, is unpredictable in its course, much that can mimic other conditions (it is said, "the great mimic").

URETEROCELE

What is ureterocele?

Pseudocistica training at the end of the ureter into the bladder, which due to abnormal opening of the ureter into the bladder. You also have a weakening of the wall of the ureter in the lower part, probably due to a congenital malformation.

What symptoms?

It is possible that the disease may have asymptomatic course and discovered accidentally, during a regular review on the occasion of some other disorder of the urinary tract. The ureteroceli can be due to a chronic infection and bladder and kidney, blocking the flow of urine, also damage the ureters and kidneys.

How to cure a ureterocele?

If it is small, it can successfully treat widening the opening of the ureter into the bladder. Some ureteroceli can be treated in endoscopy through a cystoscope, cauterizing or scraping part of cysts, or by using the laser. If the ureterocele is big, it may be necessary to work and remove it through an opening in the bladder.

Ureterocele operations give good results?

Yes.

Are unsafe?

No.

TUMORS OF THE URETER

Ureteral tumors are very common?

No, they are very rare.

What forms they take usually?

In most cases they are malignant.

What symptoms?

Blood in the urine, preventing the passage of urine in the bladder and ultimately infection.

How is cancer of the ureter?

Radiographic examination of the urinary tract (intravenous pyelogram) detecting an obstruction when you try to insert a catheter into the ureter.

How do we cure it?

Removing the ureter and kidney set to that part of the bladder, surrounding the entrance of the ureter.

Operations of this type are serious?

Yes, but in most cases you can hope in healing.

Surgical excision leads to healing?

Yes, when tumors are detected at an early stage and when the operation is performed in a radical way.

CYSTOSCOPY

What is a cystoscopy?

An exam that consists in the direct observation of the inside of the bladder using a tool shaped like a tube, the cystoscope, inserted through the urethra.
The cystoscope has a lamp and lenses, which provide an excellent view of the Interior of the bladder. This tool also allows you to examine the ureters.

It is a painful examination?

The woman is virtually painless; in humans it causes some discomfort that can be minimized with the use of local anesthetics; in children is performed under general anesthesia.

What are the side effects of cystoscopy?

Some temporary discomfort in urination and blood in the urine; for a day or two can also be a rise in temperature. We recommend, therefore, prophylactic antibiotic coverage.

You must be admitted to hospital?

Not usually. In most cases the cystoscopy can be performed in the doctor's Office of the urologist. Hospitalization is recommended when it is necessary to insert in the kidneys through the ureters, catheters; is required when these catheters must be left in place for a few days.

URINARY INCONTINENCE: WHAT IS IT?

What is urinary incontinence?

Involuntary and uncontrollable emission of urine.

Occurs with frequency?

Yes; involves particularly women and the elderly.

There are different types of urinary incontinence?

Basically stress incontinence and instability. The first is often because a difficult birth that he "stressed out" perineal muscles, decreasing the tone and thus (lowering) prolapse of the bladder and urethra. Instability incontinence depends on the involuntary contraction of the bladder, for various reasons, is not always known.

Female urinary incontinence worsens with age?

Yes. The decrease of estrogen in menopause makes it more fragile the urethra, which faces difficulties to close properly. With aging, atherosclerosis can also cause damage to the brain centers that control bladder Continence.

What is dependent on the male urinary incontinence?

Often the prostate hypertrophy, pressing on the bladder, prevents full depletion; This condition causes excessive filling of the bladder and urine loss for "overflow". Even in men, with advancing age, atherosclerosis can cause damage to the brain centers responsible for controlling bladder Continence.

Which allow investigations to diagnose the different types of incontinence?

Are useful the urinary tract ultrasound, transrectal, and that if necessary the urodynamic tests, which evaluate the functionality of the bladder and urethra.

How to treat urinary incontinence?

Female incontinence from instability can be treated with anticholinergic drugs, while the stress can benefit, in order to strengthen the perineal musculature, physiokinesis therapy or
perineal stimulation associated with exercise or, in some cases, bovine collagen injections into the submucosal tissue. Male incontinence, when is not a consequence of prostatic hypertrophy, can be treated with alfabloccanti.

Even surgical methods are used?

In cases of severe bladder and urethral prolapse can perform the surgery under general anaesthesia classic; in the specific cases of prostatic hypertrophy male incontinence can take away, using different techniques, prostate adenoma.

CYSTITIS

What is cystitis?

An inflammation of the bladder.

Is a common disease?

Yes; is perhaps the most common disorder of the urinary tract and occurs in both children and adults.

What is the most common cause?

A bacterial infection by germs like staph, colibacillus, Proteus, Klebsielle etc.

How these bacteria reach the bladder?

From the outside through the urethra, from infected female genital organs, kidneys and intestine.

Cystitis frequently affects females. Why?

Because:
the female urethra) is short and therefore microorganisms present on the genitals can be traced back to the bladder more easily;
b) in female outlet outside of the urethra is closer-than the uomoall's anal opening and then it is easier to bacterial contamination.

When are more frequent in female cystitis?

After childbirth, for the momentary uterine prolapse; After the removal of the uterus, because the bladder, is no longer supported, tends to subside favouring the stagnation of urine; after menopause, because they are to change the vaginal mucosa and thins.

What are the different forms of cystitis?

Acute);
b) applicant.

What are the symptoms of acute cystitis?

Acute cystitis usually occurs suddenly and is characterized by very painful urination (burning) and frequent; often the presence of pus and blood in the urine.

How is?

With a urinalysis and urine culture with an antibiogram.

How to cure acute cystitis?

With administration of urinary tract disinfectant or, more often, with appropriate antibiotics.

How long is usually an attack of acute cystitis?

If treated promptly and appropriately, the symptoms may disappear within a few days, while some discomfort can persist for one or two weeks and may need an equal period of time because the urine come back clear.

What are the symptoms of recurrent cystitis?

Are the same as acute cystitis, but symptoms can be milder and longer and may have a tendency to repeat itself. In patients with recurrent cystitis, this syndrome may be associated with some other morbid shape in another area of the urinary tract.

You must submit a cystoscopy all patients with cystitis?

It is not necessary if the symptoms and the infection subside quickly. If you have had repeated attacks of disease or if this has become recurring, it would be good to examine the entire urinary tract is the cystoscope is by other means: this is very important in order to identify other more serious diseases (see above, cystoscopy).
This is especially true for young children who may have a vescicoureterale conditioner reflux a susceptibility to infections.

What are the conditions that can cause cystitis?

Essentially an obstruction to the flow of urine for the presence of a calculation, a prostatic hypertrophy, cancer etc.

Sexual intercourse may facilitate the emergence of cystitis in women?

In some cases, Yes, because it can encourage Bacterial colonization.

There are factors that favor Bacterial colonization by intestinal germs?

Yes: the irregularity of the bowel function (constipation, diarrhea), an inadequate personal hygiene and poor fluid intake.

BLADDER FISTULAS

What is a bladder fistula?

An abnormal communication between the bladder and a nearby organ, vagina, bowel, uterus, etc.

What are the causes of formation of such a fistula?

May be due to a serious infection, malignant tumour, to injury, secondary consequence of a difficult birth, or even a complication of surgery.

What is the most common form of bladder fistula?

Communication between the bladder and the colon, secondary to colon inflammation (diverticulitis or Crohn's disease). Another very frequent fistula between bladder and intestine, intestinal cancer secondary.

What symptoms?

If the fistula between bladder and bowel, urine collection the patient will gas and feces. If the fistula communicates between the bladder and vagina, the patient will lose urine from the vagina and will no longer be able to control bladder emptying.

How to treat bladder fistulas?

Depends on the causes that generated. Small, fistulas secondary to infection or injury, can heal spontaneously or can close, de viando urine with a rubber catheter. Most fistulae, however, should be corrected through surgery, if you want to get a permanent healing. If the root cause is a malignant tumour, it is necessary to remove the primary tumor with bladder wall sections involved. If the fistula was caused by diverticulitis (inflammation of the colon), you must remove the diseased section of the colon as well as the party of the bladder wall.

Surgery in case of bladder fistula are serious?

Yes, but are generally followed by healing. If the primary cause was a malignant syndrome, consider extensive surgery.

You can always heal a bladder fistula on the first try?

No; in a limited number of cases the fistula should relapse and again to get satisfactory results.

BLADDER STONES

It's common to find some calculations during an examination of the bladder?

Yes.

What are caused?

to) those which are formed directly in the bladder, are often due to voiding disorders: the urine stagnates and precipitate the calculations;
b) other calculations may be formed as a result of a bladder disease as a chronic cystitis, a tumor or a bladder diverticulum;
c) many calculations originate in the kidneys and then descend into the bladder.

What symptoms cause?

Painful and frequent urination with blood. Sometimes calculations can cause a sudden urinary outlet obstruction, resulting in inability to urinate.

How do I diagnose bladder stones?

Using ultrasound, radiography or direct examination through cystoscopy.

How to treat bladder stones?

If they are small, often come out spontaneously, without the need for treatment. In most cases, however, you must remove both; This is done both surgically opening the bladder, is shattering the calculations with a special tool that is introduced into the bladder through a cystoscope; the latter procedure is called lithotripsy.

When you use the lithotripsy?

When the calculations are few in number and not overly large or compact.
Also, since it is a procedure performed by means of tools, not surgery, is for those people who might not withstand a major surgery.

How do I remove the calculations from the bladder, once crushed?

Using irrigation; in this way they are made out of the bladder.

When should an intervention (cistotomia) to remove the calculations?

When the calculations are very compact and can not frantumarli. Even in the case of very many calculations you need to resort to surgery.
If the bladder is also an enlarged prostate, the surgeon may decide to remove the prostate at the same time.

BLADDER TUMORS

The inside bladder tumors are frequent?

Yes.

Most bladder cancers are malignant?

It is believed that for the most part are malignant or potentially malignant.

There are risk factors for bladder cancer?

Yes: smoking and exposure to certain chemicals such as aniline, used in the rubber industry, leather etc.

What are benign tumors of the bladder?

Lesions are similar to warts, called papillomas.

What is a malignant tumor of the bladder more frequently?

Transitional cell carcinoma.

What are the symptoms of bladder tumors?

The main symptom is the bleeding that occurs during urination and that are painless; sometimes urination is frequent; cystitis can also occur, easy enough complication: in that case you have infected urine emission.

How to diagnose bladder cancer?

By examining urine cistologico and direct Visual inspection of the bladder through a cystoscope; This tool can also be picked up a flap of tissue for microscopic examination.

How to treat?

Depends on the size, location and nature of the tumor. The simple, superficial tumours which do not interfere with the flow of urine from the kidneys and both are easily accessible, are deleted by electrocautery through a cystoscope or, more often, using laser photocoagulation (without anesthesia, outpatient). Larger tumors or those penetrated deep into the bladder wall, must be removed by removing the affected portion of the bladder wall. If a highly malignant tumour involves the bladder extensively, it is necessary to remove the entire structure: this process is known as cystectomy.
In this case you need to make sure that the ureters may provide directly to the expulsion of urine: they are transplanted both ureters into the skin (cutaneous ureterostomy) is in the colon, or you get a kind of pocket from a segment of the small intestine (ileum) and then connect the ureters in this pocket. This process is known as Ileostomy.

How is the urine outflow outside when the ureters are transplanted in the colon?

The urine flows through the rectum.

How is the drainage of urine when the ureters are transplanted in the gut?

The Pocket obtained in the small intestine is brought into contact with the skin surface and is communicating with the outside through an opening connected to a plastic bag or rubber that adheres to the skin.

Transplant operations of the ureters and the bladder removal are serious interventions?

Yes, I am high interventions, but surgery can save lives.

There are other treatments besides surgery for bladder cancer?

If the tumor is not easily removed, radiation therapy is used (even with radioisotopes placed in the bladder). Chemotherapy is used in case of metastasis.
Are in the experimental stage some conservative surgical techniques, combined with chemotherapy and photodynamic therapies (laser light).

URETHRA

What is the urethra?

Is a tubular duct that connects the bladder to the outside; its sole function is to direct the urine.

The urethra of women is very different from that of man?

Yes; in women, the urethra is much shorter and flows between the inner lips of the vulva and the male stretches the entire length of the penis and also has the task of conveying the sperm during ejaculation.

What are the most common diseases affecting the urethra?

in) congenital anomalies (in males: hypospadias and epispadias);
b) urethral caruncle (in females);
c) diverticula;
d) stenosis;
and certain inflammatory processes) from germs or protozoa.

URETHRAL CARUNCLE

What is a caruncle of urethra?

Is a small fleshy excrescence, located at the mouth of the urethra. Occurring exclusively in women and is the result of a localized infection or chronic irritation.

What are the symptoms of a caruncle?

You may have totally asymptomatic course, or it may be that the patient experience pain when the caruncle is touched or when passes over the urine. In some cases you have frequent urination with blood and hardship.

It is always necessary to cure it?

No; only if it is big and causes pain or other symptoms.

How to cure a caruncle?

Urethral caruncles should be surgically removed or with electrocautery or laser; small ones can be cauterized with chemicals.

Wattles have a tendency to recur?

Yes, but not after surgical excision.

URETHRAL DIVERTICULA

What is a diverticulum of urethra?

Is a small dilation of urethral Canal due to a congenital abnormality or secondary manifestation of infection in the wall of the urethra; occurs almost exclusively in women.

What are the symptoms of a diverticulum of urethra?

to) recurrent attacks of bladder infection;
b) impediment of passing urine;
c) painful sexual intercourse;
d) after urination, the patient notes can emit other urine by pressing on the area of the diverticulum.

How do we cure it?

By surgical excision, even in endoscopy; the result is complete healing.

STENOSIS OF THE URETHRA

What is a urethral stenosis?

An abnormal narrowing of the urethra caused by scar tissue.

What are the causes of stenosis?

to) a congenital anomaly (congenital stenosis);
b) an infection of the urethra, usually a result of a final clap.

What symptoms?

in flow and Reduction) of the strength of the urinary flow;
b) urine retention, in case of tight stenosis;
c recurrent bouts of cystitis).

How is?

Noting the presence of an obstruction (through the introduction of a probe into the urethral Canal) and a decreased urine flow.

How to cure urethral strictures?

repeated expansions) performed with the help of catheters or probes of increasing caliber;
b) surgically removing the laser through the stenosis, endoscopy;
c) with plastic surgeries to reconstruct the urethra in severe cases.

If you can't heal with stenosis dilation or surgically, which procedure would you recommend?

Because these conditions are usually associated with the outflow of urine, you should perform a cystostomy to drain urine. In this case, the drainage of urine by abdominal, through a rubber hose attached to a container; Fortunately, these situations occur very rarely now

URETHRITIS

What are the urethritis?

Inflammation of the urethra.

Are very frequent?

Yes.

What is the most common cause of an infection of the urethra?

Gonorrhea, or clap.
.

There are other urethritis, besides that of gonorrhea?

Yes; a whole host of microorganisms can settle into the urethra and cause urethritis.

How to treat?

With specific antibacterial drugs, which change depending on the seed (Staphylococcus, Streptococcus, Trichomonas).

These are serious nongonococcal urethritis?

No, generally are benign and heal in a few days.

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