Urinary incontinence in women

The complaint of urinary incontinence in adult women can most commonly is either due to wekness of the sphinctor mechanism to keep her dry leading to leakage whenever the abdominal pressure rises like coughing sneezing jumping (Stress incontinence) or due to a bladder which contracts and pushes urine out when it should be holding it in, patient usually finds it difficult to hold whenever she gets this urge to pass urine (urgency to urinate)and cannot make it to the toilet in time (urge incontinence).
There can be quite a few other causes for urinary leakage but most common complaints fall in the above two groups.
The treatment is dictated by the type of incontinence.
With Stress Incontinence the target is to support the and strengthen the muscles that support the urethra and the pelvic organs including the bladder vagina uterus and rectum. treatment methods availible range from pelvic muscle strengthening exercises, abdominal operations to reposition prolapsing pelvic organs and vaginal operations to suuport the organs and to provide extra suppoert to urethra.
For Urge incontinence the aim to calm the bladder to damp down these uncontrolled bladder contractions. Bladder retraining tablets to controll the bladder and operations to paralyse the muscle (botox injection in bladder) or by cutting the nerve supply to bladder or by removing muscle layer partially from the bladder or by putting a piece of bowel in the bladder.

Can teblets controll my waterworks?

The urinary symptoms can simply considered to be of two types i.e. due to obstruction to the urine flow due to enlarged prostate (Hesitancy to start urine flow, weak flow and sense of incomplete emptying)and iritative symptoms due to incomplete emptying or premeture bladder contrations (frequent passing of urine, urgency to pass urine)
The drugs which have been used to controll the prostate related symptoms are of three types, the Alpha Blockers relax the bladder neck and thus reduce the resistance offered by the urethra to the urine flow, they donot effect the prostate size so with time as the prostate grows their effectiveness might go down. The Alpha reductase inhibitors can reduce the prostate volume if teken over an extended period of time. Both of these groups of drugs are focusing on the prostate, trying to reduce the resistance to urine flow by an enlarged or obstructing prostate. The Anti cholinergic medicines act on the bladder bladder, allowing it to hold a larger volume for longer period of time.

Viagra ‘The Miracle drug’

The Phosphodiesterase group of medicines (Viagra, Levitra, Cialis etc.) are a major step forward in the management of this important quality of life issue. These medicines are commonly associated with minor side-effects like, nasal stuffiness, facial flushing, heart burn. People with heart problems should have a frank discussion with their doctor before trying the medicine.
There is evidence that if the first dose doesn’t work still the subsequent dose might, so no need to despair!
It is becoming more and more recognised that a proportion of aging population has low testosterone levels, which are also contributing to the erectile dysfunction and improving the testosterone levels can improve their wellbeing and also increase chances of effectiveness of the Phosphodiesterase group (Viagra, Levitra, Cialis etc.).

Male infirtility

Irrespective of gender the dream of having one's own children is shared by many. The first test test usually requested by GP for male fertility evaluation is Semen Analysis ( examination under microscope of material ejaculated from the penis). The aim is to basically see whether the semen has sperms (besides some other features to ascertain the health of the semen).
If there are no sperms in the semen then either testis are not producing any sperms or the conduction mechanism i.e. the tube from testicles to the urethra is blocked.
The 'testicular biopsy' is commonly used operation to differentiate between the two. If facilities are availible then cryopreservation can be performed at the same time.
In case of obstruction being the cause of absence of sperms, srgical procedure to bipass the operation or direct retrieval of sperms from the testis through a variety of techniques is possible.
In patients with testicular biopsy failing to show any sperms, multiple biopsies might identify an island of sperm genesis.

kidney stones, the boulder in water

Kidney stones are a common urological problem encountered. the kidney stones can lead to a rather interesting course of complete silence with sudden symptoms usually severe excruciating pain (thought to be more severe than child berth!), nausea and vomiting. The kidney stones can pass spontaneously from kidney into the bladder leading resolution of pain but there is an inverse relation between the stone size and it's chance of being passed spontaneously.
the stone formation in the kidneys is a complex process and in simplest terms it can be due to increased concentration of constituents to an extent where they start sedimenting thus laying the foundation of stone formation or the constituent cannot be dissolved in the urine due to any reason and settles down. some stones can be seen on x-ray while other can't.
ways to treat the stones can be divided to non oprative and operative means.

Waterworks and the enlarged prostate

As the hair turn grey the water works can also become an issue. many a people consider prostate enlargement to be the cause. Prostate gland sits at the opening of the bladder and encircles the urethra. the prostatic enlargement can lead to compression of urethra thus compelling the bladder to work harder to push the urine through the tube ( urethra). with time due to slowly increasing obstruction the bladder becomes thicker with increase in its muscle bulk but there is a limit to the extent of force the muscles can generate and then there is the stage of progressive failure of bladder to empty completely and ultimately the bladder can fail completely perform the function of emptying itself (urinary retention needing a catheter in the bladder.
The treatment of urinary symptoms is directed at sorting the patient complaints to prevent a negative impact on one's quality of life. Not every patient with prostate enlargement will have urinary problems and vice versa.
The treatment of urinary symptoms due prostate can vary from just reassurance to tablets or even an Operation.

Erectile dysfunction: the surgical solution

Erectile dysfunction is a major male quality of life issue. the surgical solution of erectile dysfunction is either semi-rigid or inflatable penile prosthesis. It has to be appriciated that the prosthesis which ever type it may be, only provides mechanical means to have penetrative intercourse. the sensations might not be the same as it used to be with spontaneous or sexually stimulated erection. there is usually some loss of length. better understanding of the device that is to be implanted with reasonable expections of the outcome improve the overall satisfaction with this intervention

Bladder Cancer

the management of bladder cancer can be considered a real success story with so much finances being invested in the early detection efforts (hemeturia clinics) within the NHS, but are we really treating the disease the properway? though our main effort is to conserve the organs (i.e. the kidney and the bladder) but the approach being persued to controll the disease i.e. telescopic removal of the tumour through the urethra is less than ideal. we are actually many a times removing the tumour in piecemeal fashion raising the possibility of tumour cells being ejected into the bladder and then implanting at other sites in the bladder causing recurrence of disease at some other site in the bladder which can be considered as a failed operation in terms of acieving a cure though I must confess that tumour development can be a field change i.e. the lining of the bladder becoming unstable and producing tumours at various sites simultaniously or sequentially. a standard procedure capable of completely excising the tumours with a clear margin i.e. removing intact tumour is yet to be develped.

Prostate Cancer

The trend towards preventive medicine has led to an emphasis on screening programs. The prostate cancer screening is still a controversial issue with no strong evidence to point to any advantage in persuing this course but the GPs are routinely performing the PSA screening (blood test) in men above fifty years of age. if the PSA is raised then the person goes through the anxiety and tension involved in the process of further investigation. if the prostate biopsy is negative, that by no means is the end of the process and the person has to remain on the razor edge going through the regular PSA evaluation. Newer developments like PCA3 test (urine test) doesnot help for it only gives an indication of probability of cancer i.e. the result interpretation soesnot give a black and white answer whether to do a biopsy or not. various nomograms which again try to use various resk factors to predict the probability of having prostate cancer, this once again only generates a figure the clinician and the patient being left with the responcibility to decide whether to do a biopsy or not knowing that what ever these clinical exams blood test urine test or nomograms might indicate, there will always be a small but significant possibility of missing a patient with significant cancer

Medicine and information

The field of medicine has been a witness to phenomenal advancements. The interesting fact is that the pace of research and development has widened the gap between the health care providers and the recepient i.e. the patient. A patient with symptoms or complaints comes to doctor to seek a solution a remedy and also reassurance. The doctor's main focus usually is to establish a diagnosis and then institute specific treatment, often it involves more than simple tests requiring a trip to the hospitalor referral to specialist department or clinic. Till the time the results are on the table to be discussed the patient and the relatives can be exposed to lots of anxiety and apprihension. the change of perception from being gods dictating the investigations or the treatment to being a businessman selling one's perception of the cause of problem/ symptoms, proposing the investigations or the management should inturn help in taking the barriers down and also would make health professionals more accessable.