common urological problems in male an females

1. Topic – Common Urological Problems in
Men and Women
Dr Nazeer Ahmed D Mulla MS DNB(Urology)
Consultant Urologist and Transplant Surgeon
Thumbay Hospital New Life
Chaderghat, Hyderabad

2. INTRODUCTION
• Urology specialty focuses on the urinary tract which encompasses the
system responsible for creating and removing urine from the body,
which includes the kidneys, bladder, ureter, urethra, and the
reproductive system of men.
• It’s very likely that most people will at some point in their lives have a
urological problem as a result of aging, injury, illness, or birth defect.

3. • When such an issue comes up, it is important for men and women to
seek the advice and help from a urologist.
• Following are few common conditions which people should know and
understand so that they can approach urologist timely.

4. 1) BPH
2) UTI
3) Kidney stones
4) Incontinence
5) Prostate Cancer
6) Male Infertility

5. 1. Benign Prostatic Hyperplasia (BPH)
• BPH refers to an enlarged prostate and is common in older men.
• It’s not exactly clear what is the reason behind an enlarged prostate,
though prostate continue to grow throughout a man’s life.
• There is some association with obesity, genetics, type 2 diabetes and
overall poor health.

7. • If it does turn out you have a benign prostatic hyperplasia, know
that you’re not alone! “About one-third of men experience
moderate to severe symptoms by age 60, and about half do so by
age 80.”

8. • Symptoms of BPH can include:
 Increased night time urination
 Difficulty initiating urination
 Weak urination stream
 Dribbling at the end of urination
 Urge to urinate
 Feeling of fullness in the bladder due to incomplete urine emptying

9. • BPH usually occurs in males more than 50 years
• Tests to diagnose enlarged prostate may include
• Digital rectal exam
• A urine test
• A blood test
• Radiological tests.

10. TREATMENT
• Medical Management
- Drugs
• Surgical Management
- Latest treatment LASERS
• Complications
- UTI
- Renal Failure

11. 2. Urinary Tract Infection (UTI)
• Urinary tract infections (UTIs) affects all ages and both men and women.
• Reason behind them may change with the circumstances and the
individual.
• A bladder infection is a urinary tract infection, but a urinary tract infection
may not be a bladder infection.
• The urinary tract consists of kidneys, ureters, the bladder, and the urethra.

12. Urinary Tract

13. • An infection can take hold in any of these parts of the body.
• The most dangerous is a kidney infection, which can become serious
and life-threatening.
• Women are more prone to UTIs because their urethra is shorter than
in men.

14. What are the causes of UTI?
• Normally, urine is sterile.
• An infection occurs when tiny organisms, usually bacteria from the
digestive tract, adhere to the opening of the urethra and begin to
multiply.
• Most infections arise from one type of bacteria, Escherichia coli (E.
coli), which normally lives in the colon.

16. • An infection limited to the urethra is called urethritis.
• If bacteria move to the bladder and multiply, a bladder infection,
called cystitis will result.
• If the infection is not treated promptly, bacteria may then travel
further up the ureters to multiply and infect the kidneys.
• A kidney infection is called pyelonephritis.

18. Who is at risk?
• Any abnormality of the urinary tract that obstructs the flow of urine.
• An enlarged prostate gland.
• A common source of infection is catheters, or tubes, placed in the
urethra and bladder.
• A person who cannot void or who is unconscious or critically ill often
needs a catheter that stays in place for a long time.

19. • People with diabetes.
• Any other disorder that suppresses the immune system rises the risk
of a urinary infection.
• UTIs may occur in infants, both boys and girls, who are born with
abnormalities of the urinary tract, which sometimes need to be
corrected with surgery.

20. What are the symptoms of UTI?
• Not everyone with a UTI has symptoms, but most people get at least
some symptoms.
These may include
• Frequent urge to urinate
• Painful, burning feeling in the area of the bladder or urethra during
urination.
• Often women feel an uncomfortable pressure above the pubic bone.

21. • The urine itself may look milky or cloudy, even reddish if blood is
present.
• Normally, a UTI does not cause fever if it is in the bladder or urethra.
• A fever may mean that the infection has reached the kidneys.
• Other symptoms of a kidney infection include pain in the back or side
below the ribs which might be associated with nausea, or vomiting.

22. How is a UTI treated?
• UTIs are treated with antibacterial drugs.
• The choice of drug and length of treatment depend on the patient’s history
and the urine culture tests that identify the offending bacteria.
• The sensitivity test is useful in helping the doctor select the most effective
drug.
• If you are experiencing symptoms of a urinary tract infection, consult with
your doctor before it affects your kidney function.

23. 3. Kidney Stones
• According to the National Kidney Foundation, one in ten people will
have a kidney stone over the course of their lifetime.
• This kind of pain can be unforgettably excruciating.
What are kidney stones?
• Kidney stones are collections of minerals and salts that form inside
the kidneys and can travel throughout the urinary tract, becoming
lodged and causing infections or complications.

25. • Preventing kidney stones involves lifestyle changes.
• Drinking water and staying hydrated is key to prevent stones from forming.
• When the body is dehydrated, the urine becomes more concentrated with
minerals.
• The higher the concentration, the higher the risk of developing kidney
stones.
• Choosing a low sodium diet can also help prevent kidney stones.

26. What are some early-warning signs of kidney stones?
1. Pain in stomach, back side
2. Pain during urination
3. Increase urinary frequency.
4. Blood in urine
5. Cloudy/odorous urine
6. Inability to empty bladder
7. Nausea/ Vomiting
8. Fever with Chills

27. • Seek immediate medical attention if pain is severe, accompanied by
nausea and vomiting, fever, blood in urine or difficulty passing urine.

28. 4. Female Related Urinary Complaints
• Women with urological problems might not know how common and
treatable they are, which keeps them from seeking proper care.
• Another potential deterrent: About 92 percent of urologists are men.
• A urologist’s gender shouldn’t prevent a woman from making an
appointments.

29. Incontinence
• Urinary incontinence is the involuntary leakage of urine.
• According to the American Urological Association, one quarter to one
third of men and women in US experience urinary incontinence.
• Urinary incontinence is more common among women than men.
• An estimated 30 percent of females aged 30-60 are thought to suffer
from it, compared to 1.5-5 percent of men.

31. Types
• Stress incontinence: Urine leaks out while coughing, laughing, or doing some activity, such as
running or jumping
• Urge incontinence: There is a sudden and intense urge to urinate, and urine leaks at the same
time or just after.
• Overflow incontinence: The inability to empty the bladder completely can result in leaking
• Total incontinence: The bladder cannot store urine
• Functional incontinence: Urine escapes because a person cannot reach the bathroom in time,
possibly due to a mobility issue.
• Mixed incontinence: A combination of types

32. Symptoms
• The main symptom is the unintentional release (leakage) of urine.
• When and how this occurs will depend on the type of urinary incontinence.
• Stress incontinence
• This is the most common kind of urinary incontinence, especially among
women who have given birth or gone through the menopause.
• In this case "stress" refers to physical pressure, rather than mental stress.

33. • When the bladder and muscles involved in urinary control are placed
under sudden extra pressure, the person may urinate involuntarily.
• The following actions may trigger stress incontinence:
Coughing, sneezing, or laughing
Heavy lifting
Exercise

34. Urge Incontinence
• This is the second most common type of urinary incontinence.
• There is a sudden, involuntary contraction of the muscular wall of the
bladder that causes an urge to urinate that cannot be stopped.
• When the urge to urinate comes, the person has a very short time
before the urine is released, regardless of what they try to do.

35. • The urge to urinate may be caused by:
A sudden change in position
The sound of running water
Bladder muscles can activate involuntarily because of damage to the
nerves of the bladder, the nervous system, or to the muscles
themselves.

36. Overflow incontinence
• This is more common in men with prostate gland problems, a damaged
bladder, or a blocked urethra.
• The bladder cannot hold as much urine as the body is making, or the
bladder cannot empty completely, causing small amounts of urinary
leakage.
• Often, patients will need to urinate frequently, and they may experience
"dribbling" or a constant dripping of urine from the urethra.

37. Risk factors
• The following are risk factors linked to urinary incontinence:
• Obesity
• Smoking
• Gender
• Old age
• Some diseases and conditions: Diabetes, kidney disease, spinal cord injury, and
neurologic diseases, for example, a stroke, increase the risk.
• Prostate disease: Incontinence may present after prostate surgery or radiation therapy.

38. Diagnosis
• A bladder diary
• Physical exam
• Urinalysis
• Blood test
• Post void residual (PVR) measurement
• Pelvic ultrasound
• Stress test
• Urodynamic testing
• Cystoscopy

39. Treatment
• Treatment will depend on several factors, such as the type of
incontinence, the patient's age, general health, and their mental
state.
• Stress incontinence
• Pelvic floor exercises, also known as kegel exercises, help strengthen
the urinary sphincter and pelvic floor muscles - the muscles that help
control urination.

40. Bladder training
• Delaying the event: The aim is to control urge. The patient learns how to
delay urination whenever there is an urge to do so.
• Double voiding: This involves urinating, then waiting for a couple of
minutes, then urinating again.
• Toilet timetable: The person schedules bathroom at set times during the
day, for example, every 2 hours.
• Bladder training helps the patient gradually regain control over their
bladder.

41. Medications for urinary incontinence
• If medications are used, this is usually in combination with other
techniques or exercises.
• The following medications are prescribed to treat urinary
incontinence:
• Anticholinergics
• Topical estrogen

42. • Botox (botulinum toxin type A): Injected into the bladder muscle,
this can help those with an overactive bladder.
• Bulking agents: Injected into tissue around the urethra, these help
keep the urethra closed.
• Sacral nerve stimulator

43. Surgery
• Surgery is an option if other therapies do not work.
• Sling procedures: A mesh is inserted under the neck of the bladder to
help support the urethra and stop urine from leaking out.
• Colpo suspension: Lifting the bladder neck can help relieve stress
incontinence.
• Artificial sphincter: An artificial sphincter, or valve, may be inserted to
control the flow of urine from the bladder into the urethra.

45. Complications
• The inability to retain urine can sometimes lead to discomfort,
embarrassment, and sometimes other physical problems.
• These include:
• Skin problems - a person with urinary incontinence is more likely to
have skin sores, rashes, and infections because the skin is wet or
damp most of the time.

46. • This is bad for wound healing and also promotes fungal infections.
• Urinary tract infections
• Embarrassment can cause people to withdraw socially, and this can
lead to depression.
• Anyone who is concerned about urinary incontinence should see a
doctor, as help may be available.

47. 5. Prostate cancer
• The second leading cause of cancer death in men is prostate cancer.
• Prostate cancer begins when cells in the prostate gland start to grow
uncontrollably.
• Age, race/ethnicity and family history are some of the main risk
factors for a man developing this disease.

48. • The key to finding and treating prostate cancer successfully is early
detection.
• Starting at age 40, all men should have a yearly prostate specific
antigen (PSA) test along with a digital rectal exam.
• Depending on the stage of prostate cancer, treatment can include
surgery, radiation therapy or active surveillance.

49. 6. Infertility
• Men having trouble being able to conceive a child may have infertility.
• Causes of male infertility could be
• Abnormal sperm production
• Undescended testicles
• Genetic defects

50. • Health problems including diabetes, prior infections such as mumps,
trauma or prior surgeries on the testicles.
• To get a proper diagnosis, a urologist can determine what the cause
of infertility may be and depending on the cause, can help create a
treatment plan.

51. Keeping Your Bladder Healthy
• Although it may not be discussed often, the health of your bladder is
extremely important to your every day well-being, especially as you
grow older.
• While you can’t prevent aging, you can take steps to keep your
bladder healthy.

52. • Healthy Bladder Tips
• 1. Drink a lot of fluids (especially water). Water helps to flush out
bacteria from your system.
• A general recommendation includes drinking six to eight glasses of
water each day, however some individuals may have to drink less
water due to health conditions such as kidney failure or heart disease.
• Check with your doctor if you have any of these conditions.

53. • 2. Limit alcohol and caffeine consumption (coffee, soda etc.). Alcohol
and caffeine heightens bladder activity, which can lead to leakage.
• 3. Avoid smoking. Smoking can increase risk for bladder cancer.
• 4. Eat high-fibre foods, drink water and exercise to reduce
constipation.
• 5. Maintain a healthy weight.

54. • 6. Try pelvic floor muscle exercises (kegels) to strengthen the muscles.
This can help prevent leaks.
• 7. Don’t hold in your urine. Holding in urine can make you more
prone for bladder infections.
• 8. Don’t rush while urinating — this can lead to the bladder not being
fully emptied, which can lead to bladder infections.

55. • 9. Relax when you urinate — it’s easier to urinate without straining.
• 10. Wear cotton or loose-fitting clothing to keep the urethra and the
area around it dry.
• Trapped moisture leads to the growth of bacteria, which can lead to
bladder infections.

56. Eating certain foods can also help in maintaining bladder health.
Foods include:
-Fruits and Vegetables
Fruits and vegetables can promote urinary tract health and
provide protection against infection.
-Yogurt
Studies have shown that yogurt may decrease the risk of urinary
tract infection and bladder cancer.
-Fibre
Fibre fights constipation, relieving pressure on your bladder.

57. • Ideally everyone should be under primary care provider from internal
medicine or family medicine for your baseline care.
• We should feel our body like our cars.
• Just as we go in for tire rotations, oil changes and general service
inspections, we want to make sure our body is running well.
• Your primary care provider can help with this — by making sure your
cholesterol, blood pressure, blood sugar and weight aren’t creeping
up, and that you’re exercising.

58. • The more you heed your primary care provider’s advice and keep
these factors under control, the lower your risk will be for heart
disease, urinary related diseases and other problems later in life.
• Basically, we want to see you whenever you think you may need a
urologist or whenever another care provider thinks we can help you
with something.

59. To Summarise
• One’s urological health is not to be ignored.
• It’s important to pay attention to all symptoms and understand
what they might mean.
• Your urinary tract consists of your kidneys, ureters, your bladder
and the urethra.
• A problem or infection in one area can affect the rest of the tract.

60. • One of the best ways to keep your urinary tract healthy is keep yourself well hydrated.
• Avoid putting on weight as obesity puts a strain on all bodily functions, and it’s a risk
factor for prostate cancer.
• It’s also important to get evaluate for your urinary symptoms at the earliest, before it
affects your kidney function.
• Make sure that you are educated about how to keep yourself healthy and get yearly
physicals to stay at your best!