Patient Care in WNY

General Urology includes all diseases of the urinary tract including infection, inflammation, and cancer. Below you will find various conditions that require diagnosis and treatment from a urologist.

  • Elevated PSA – PSA is a blood test used as a screening tool for prostate cancer. A high PSA level should be evaluated by a urologist as it could be a result of an enlarged prostate, a urinary tract infection, prostate infection, or prostate cancer.
  • Hematuria (blood in the urine) – A presence of blood in the urine could be benign or an indication of a more serious problem. If you or your doctor detects blood in your urine, you should make an appointment.
  • Hydrocele – A hydrocele is a fluid-filled sack around the testicles that causes the scrotum to swell.
  • Vasectomy – A vasectomy is a procedure for men who no longer wish to have children. This procedure prevents sperm transportation by blocking the vas deferens. This method of birth control is irreversible.

What is an Enlarged Prostate? An Enlarged Prostate (Benign Prostatic Hyperplasia) is a condition that affects the prostate gland in men. As men age, the prostate gland slowly enlarges. As the prostate gets bigger, it may press on the urethra and cause the flow of urine to be slower and less forceful. According to John Hopkins, one-third of men experience enlarged prostate symptoms by age 50, and 70% have them by age 70.

What causes Enlarged Prostate? Enlarged Prostate is probably a normal part of the aging process in men, caused by changes in hormone balance and in cell growth.

What are the symptoms of Enlarged Prostate?

  • Hesitation. Having to wait for the urinary stream to begin. Hesitation occurs because the enlarged prostate prevents the urethra from opening wide right away.
  • Starting and stopping. When it’s a struggle to keep the urine flowing, the bladder muscles eventually become overgrown, damaged, and weakened. Muscles may react with a series of weak pushes that cause the urinary flow to stop and start.
  • Weak stream. The bladder muscles have been weakened by repeatedly trying to push the fluid through the narrowed prostate.
  • Dribbling. When the urinary system has been weakened by BPH, more than a few drops remain in the bladder or urethra waiting for your final push. You think you’re done, but you’re not.
  • Frequent urination. The trigone, a part of the bladder that tells the brain when it’s time to urinate, becomes more and more sensitive as the bladder muscles become overgrown. Simply put, the trigone sends off too many “gotta go” messages.
  • Incomplete urination. Eventually, a weakened bladder can become unable to empty itself completely, leaving some urine behind. It refills faster, which then triggers the urge to urinate sooner than expected.
  • Frequent nighttime urination (nocturia). Men with BPH may need to get up and go to the bathroom two, three, or more times a night.
  • Urgency. An overworked and damaged bladder becomes overly sensitive and sends emergency signals to the brain that you need to go immediately.
  • Urinary tract infections. Urine that is left behind in the bladder can become a breeding ground for bacteria, resulting in urinary tract infections.
  • Incontinence. Men with BPH may experience this problem if damage to the bladder is extensive, making it impossible to control the flow of urine.Inability to urinate. If the prostate overgrowth becomes too severe, the flow of urine may be blocked completely, causing acute urinary retention, which is an emergency.
  • Inability to urinate. If the prostate overgrowth becomes too severe, the flow of urine may be blocked completely, causing acute urinary retention, which is an emergency.

How is Enlarged Prostate treated? Once we are sure that your symptoms are caused by benign growth of the prostate gland, we may suggest that you wait to see if your symptoms get better. Sometimes, mild symptoms get better on their own. If your symptoms get worse, we may suggest another treatment option. Risks are generally small, and include bleeding, infection or impotence.

What is Erectile Dysfunction? Erectile Dysfunction, also known as impotence or ED, refers to a man’s inability to sustain an erection which is sufficient for sexual intercourse. If the inability to reach or maintain an erection persists for more than a few weeks or months, medical help should be sought. We will assess your general state of health, because ED may be a sign of a more serious health condition, such as heart disease, diabetes, hypertension or something else. If an underlying health problem is detected and treated effectively, the Erectile Dysfunction may well resolve too.

What are the symptoms of Erectile Dysfunction?

  • Difficulty in achieving an erection
  • Inability in sustaining an erection
  • Reduced libido
  • Only being able to achieve an erection during masturbation, but not during sexual intercourse. Most men occasionally experience problems in gaining an erection. It becomes a problem only if it occurs regularly.

What causes Erectile Dysfunction? There can be a large number of conditions that contribute to Erectile Dysfunction, including:

  • Diabetes. This chronic disease can damage the nerves and blood vessels that aid in getting an erection. When the disease has not been well controlled over time, it can double a man’s risk of erection problems.
  • Kidney disease. Kidney disease can affect many of the things you need for a healthy erection, including your hormones, blood flow to your penis, and parts of your nervous system. It can also sap your energy level and rob you of your sex drive. Drugs for kidney disease can also cause ED.
  • Neurological (nerve and brain) disorders. You can’t get an erection without help from your nervous system, and diseases that disrupt signals between your brain and your penis can lead to ED. Such diseases include stroke, multiple sclerosis (MS), Alzheimer’s disease, and Parkinson’s disease.
  • Blood vessel diseases. Vascular diseases can block the blood vessels. That slows the flow of blood to the penis, making an erection difficult to get. Atherosclerosis (hardening of the arteries), high blood pressure, and high cholesterol are among the most common causes of ED.
  • Prostate cancer. Prostate cancer doesn’t cause ED, but treatments can lead to temporary or permanent erectile dysfunction.
  • Surgery. Surgery for both prostate cancer and bladder cancer can damage nerves and tissues necessary for an erection. Sometimes the problem clears up, usually within 6 to 18 months. But the damage can also be permanent. If that happens, treatments exist to help restore your ability to have an erection.
  • Injury. Injuries to the pelvis, bladder, spinal cord, and penis that require surgery also can cause ED.
  • Hormone problems. Testosterone and other hormones fuel a man’s sex drive, and an imbalance can throw off his interest in sex. Causes include pituitary gland tumors, kidney and liver disease, depression, and hormone treatment of prostate cancer.
  • Venous leak. To keep an erection, the blood that flows into your penis must stay in your penis. If it flows back out too quickly—a condition called venous leak, in which the veins in your penis don’t constrict properly—you will lose your erection. Both injuries and disease can cause venous leak.
  • Tobacco, alcohol, or drug use. All three can damage your blood vessels. That makes it difficult for blood to reach the penis, which is essential for an erection. If you have hardened arteries (arteriosclerosis), smoking will dramatically raise your risk of ED.
  • Prescription drugs. There are more than 200 prescription drugs that can cause ED.
  • Prostate enlargement. Prostate enlargement, a normal part of aging for many men, may also play a role in ED.

How is Erectile Dysfunction treated? Erectile Dysfunction can be treated at any age. Treatment depends on your overall health and the underlying cause of the problem.

What is a Fistula? A fistula is an abnormal connection between two organs that are not usually connected, such as the vagina and bladder, or between an organ and another structure, such as the skin. The types of fistula of the pelvis involve abnormal connections between the bladder, bowel and/or vagina.

  • Vesicovaginal fistula—a connection between the vagina and the bladder.
  • Enterovaginal fistula—a connection between the vagina and the small intestines.
  • Rectovaginal fistula—a connection between the vagina and the rectum.
  • Enterovesical fistula—a connection between the small intestine and the bladder.
  • Colovesical fistula—a connection between the large intestine (colon) and the bladder.

What causes a Fistula? Fistulas are usually caused by tissue damage. This damage leads to inflammation and eventually can form an abnormal tract between two organs or an organ and the skin.

There are a number of risk factors for developing Fistulae in the pelvis:

  • Prior surgery in the pelvis, vagina or rectum. The most common cause of a vesicovaginal fistula in the United States is prior hysterectomy.
  • Radiation for cancer in the pelvis (cervical, vaginal (vulvar), bladder, rectal or prostate cancer).
  • Inflammatory bowel conditions, including Crohn’s disease, ulcerative colitis, and diverticulitis.
  • Tear in the vaginal wall during childbirth or an infected episiotomy.

What are the symptoms of a Fistula? Fistulae are usually painless. Depending on the two areas that are connected, you may experience a variety of symptoms.

If the bladder is involved, you may experience:

  • Symptoms of a Urinary Tract Infection, such as burning with urination, urinary frequency, urgency, blood in urine.
  • Passage of air while urinating.
  • Passage of stool contents in the urine.

If the vagina is involved, you may experience:

  • Continuous leakage of urine from the vagina (continuous incontinence).
  • Leakage of stool contents from the vagina.
  • Foul odor, discharge or gas from the vagina.

If the rectum is involved, you may experience:

  • Watery stools and/or urgency to pass bowel movements.
  • Continuous or frequent urine leakage from the rectum.

How is a Fistula diagnosed? A physician will talk with you about your symptoms and perform a physical exam, including a pelvic exam or prostate exam. A urine sample is often requested to look for any signs of infection.

Imaging of the urinary tract, bladder or bowels might be necessary to identify the exact site of the abnormal connection. This may be performed with an x-ray of the bladder while filling your bladder with dye through a catheter (cystogram) and/or dye given orally or in the rectum.

If your symptoms involve a possible connection to the bladder, a cystoscopy (looking into the urethra and bladder with a camera) might be performed to find the fistula site.

How is a Fistula treated? Most fistulae are treated with surgery. The timing of surgery depends on a number of factors, including the cause and site of the fistula, as well as any other procedures that might need to be performed related to the cause.

Many fistulae to the vagina can be managed with surgery through the vagina, but some cases do require surgery through the abdomen. Fistulae involving the intestines may require the help of a general surgeon or colorectal surgeon to manage the bowel portion of the fistula.

What are kidney stones? All urine contains dissolved minerals and salts. When your urine contains a high volume of calcium, oxalate or uric acid, these minerals crystalize and form stones.

What are the symptoms of kidney stones? Kidney stones can go undiagnosed because they sometimes present no symptoms or pain. When stones become lodged in the ureter, the flow of urine from the kidney is blocked, causing swelling, which is why kidney stones are often painful. Symptoms include:

  • Sharp pains in the back and side towards the groin or abdomen. The pain often comes and goes as the body tries to dispose of the stone.
  • An intense feeling of needing to urinate
  • Burning sensation during urination
  • Nausea or vomiting
  • Dark colored urine or urine that contains blood

How are kidney stones diagnosed? Your urologist will conduct a CT scan if a stone is suspected.

How are kidney stones treated? There are a few different treatments for kidney stones, depending on factors like size of the stone and the severity of your symptoms. If there is no sign of infection and the pain is tolerable, stones can often pass on their own without medical intervention. Options for treating kidney stones include:

  • Medication – Your urologist may prescribe medications to help your stone(s) pass easier.
  • Surgery­­ – If the stone doesn’t pass on its own or with medication, is extremely painful, or if the patient has repeated infections, minimally invasive surgery may be required. Surgery requires little down time.

Male infertility is often a problem related to abnormal sperm production. If you’ve been unsuccessful in conceiving with your partner, male infertility may be the cause. Rest assured, there are several treatment options available. To diagnose and treat the cause of infertility, your urologist will ask you about your health history and give you a physical exam. From there, he or she will conduct a routine semen analysis. Your semen sample will be studied to look for infertility causes such as low sperm count, improper movement, or poor structure. Additional analysis may include an ultrasound, biopsy or hormone study. Creating healthy sperm is dependent on several factors and your urologist will work with you to find the best treatment for you.

What is Neurogenic Bladder? Neurogenic Bladder (NGB) is the loss of normal bladder function, caused by damage to part of the nervous system. This can lead to bladder overactivity, when the bladder contracts frequently, or bladder underactivity, when the bladder does not contract enough to empty or does not contract at all. Some patients may also have injuries to the nerves supplying the sphincter muscle controlling urine flow, possibly leading to incontinence or inability to empty the bladder.

What causes Neurogenic Bladder? Any disease that affects the nervous system may lead to dysfunction of the bladder. This includes conditions patients are born with, trauma, or long-term diseases that lead to nerve damage, including:

  • Spina bifida (spine abnormality of newborns)
  • Tumors of spinal cord or brain
  • Spinal cord injuries
  • Stroke or brain injuries
  • Multiple sclerosis
  • Parkinson’s disease
  • Pelvic surgery or radiation
  • Long-term diabetes

What are the symptoms of Neurogenic Bladder? Neurogenic Bladder may have a variety of symptoms. The inability to control urination is quite common. This may occur along with urinary urgency, with or without leakage and urinary frequency (daytime or nighttime). Often your bladder cannot hold as much urine as a normal bladder.

Some patients may not be able to urinate at all. Commonly after a traumatic injury or stroke, patients undergo a “shock” phase, which causes Urinary Retention. This is usually temporary, lasting six weeks to three months. Some patients have long term Urinary Retention because the sphincter muscle that normally keeps patients dry between urination is unable to relax when the bladder tries to empty.

The bladder normally stretches easily and stores urine at a low pressure. Some patients with NGB develop bladders that do not stretch well and cause pressure to the kidneys. This could lead to kidney damage long term if not treated. The increase in bladder pressure does not necessarily cause symptoms.

What are the risks of Neurogenic Bladder? Patients who have Neurogenic Bladder are at risk of developing various problems over time, including:

  • Stones—These may develop in the kidney or the bladder.
  • Urinary tract infections—Patients who do not empty the bladder well or manage their bladder with catheterization are at increased risk of infection in the urine.
  • Reflux—Urine can back up into the kidneys if bladder pressures are too high. If a patient also has an infection, the infection may be transferred up to the kidneys causing a more serious infection called pyelonephritis.
  • Kidney damage—If the bladder is not managed appropriately, recurrent infections or high pressures might cause kidney damage over time.

How is Neurogenic Bladder Diagnosed? Neurogenic Bladder is a clinical diagnosis, meaning patients with bladder symptoms or problems who also have a neurologic disease are considered to have NGB. When you have symptoms, a physician will talk with you about your symptoms and perform a physical exam, including a pelvic exam or prostate exam. A urine sample is often requested to look for any signs of infection.

Baseline tests to look at the urinary tract and how the bladder functions are often performed, including:

  • Renal and bladder ultrasound and abdominal x-rays that examine the anatomy of your urinary tract and look for stones.
  • Imaging of the spine and/or brain may be performed as part of the work up of a your neurologic disease.
  • Urodynamics (bladder pressure testing) are performed to establish a pattern of how your bladder behaves while it is filling and emptying.
  • A cystoscopy (looking into the urethra and bladder with a camera) may be performed to look into your bladder and ensure there are no anatomical abnormalities.

Often many of these tests are repeated on a regular basis depending on how your bladder is behaving or if treatments have changed.

How is Neurogenic Bladder Treated? The main goals of treatment of NGB are to prevent kidney damage and minimize bothersome bladder symptoms, such as urinary incontinence.

Patients who are unable to empty their bladder are often started on Clean Intermittent Catheterization (CIC). This is a method of emptying the bladder by placing a catheter into your bladder multiple times a day to empty the bladder and then remove the catheter after you are empty. Patients who are unable to do CIC on their own sometimes have the help of a caregiver. If a patient does not have access to a regular caregiver and is unable to do CIC, an indwelling catheter can be considered.

Patients who urinate on their own or perform CIC who experience inability to control their urine (Urinary Incontinence) are often initially managed with oral medications. If medications do not work, surgical options can be considered, including injection of medication into the bladder to help it relax, or surgery to make the bladder larger (bladder augmentation).

Below is a short summary of the different types of cancers that affect the urinary tract and their treatments. The suspicion and diagnosis of cancer can be scary, but with timely diagnosis, these types of cancers are often treatable. If you’re experiencing any symptoms, you should contact your urologist for an appointment.

  • Adrenal Tumors – Your adrenal glands are located on top of your kidneys. Adrenal glands are vital to your hormonal system, affecting your body’s metabolism and response to stress. Symptoms of adrenal tumors are often not present, but if apparent, can include high blood pressure, increased heart rate, nevousness and anxiety, excessive perspiration, diabetes, unexplained changes in weight or change in sex drive. Your urologist can test for adrenal tumors through a blood and urine test, a biopsy, imaging scan or MIGB scan (a procedure more advanced than a typical X-ray). Depending on several factors, treatment options include surgery, hormone therapy, chemotherapy or radiation.
  • Bladder Cancer – Symptoms of bladder cancer include visible and microscopic hematuria (blood in the urine) or painful urination. It’s important to note that blood in the urine and painful urination are also symptoms of other urinary tract conditions like a urinary tract infection or kidney stones. If you’re experiencing either of these symptoms, you should make an appointment with a urologist. To test for bladder cancer, your urologist may perform one of several tests, including a urine test, a CT scan, a cystoscopy (test to look into the bladder with a small telescope), or biopsy. Treatment is based on your stage of diagnosis and can range from surgery, chemotherapy treatments directly in the bladder, radiation or chemotherapy.
  • Kidney Cancer – In adults, the most common type of kidney cancer is renal cell carcinoma. In its earliest stages, kidney cancer often doesn’t present with symptoms. In some cases, symptoms can include blood in the urine, back pain that won’t go away, unexplained weight loss, fatigue and fever. Testing for kidney cancer includes blood and urine tests, imaging tests, or a biopsy. There are many treatment options available including surgery, cryoblation (freezing of the cancer cells), radiofrequency ablation (heating of the cancer cells), radiation or chemotherapy or immunotherapy.
  • Prostate Cancer – Prostate cancer is one of the most common types of cancer in men and with early detection, it’s one of the most treatable. In its early stages, prostate cancer presents few or no symptoms. In later stages, symptoms may include trouble urinating, blood in the semen, pelvic discomfort, bone pain and erectile dysfunction. Prostate cancer testing includes a digital rectal exam, Prostate-specific Antigen (PSA) test, ultrasound, or biopsy. There are several ways to treat prostate cancer from surveillance (in some cases, treatment isn’t necessary), radiation, hormone therapy, surgery, cryoblation (freezing of the cancer cells), or chemotherapy.
  • Testicular Cancer – Men with testicular cancer often notice a lump or an enlarged testicle, heaviness or fluid in the scrotum or pain in the testicle or scrotum. If any of these symptoms are present, you should make an appointment with your urolgoist. To test for testicular cancer your physician will conduct an ultrasound, blood tests or surgery, depending on your symptoms. There is treatment available for testicular cancer including surgery, radiation or chemotherapy.

What is Overactive Bladder? Overactive Bladder (OAB) impacts millions of men and women. In fact, 30% of all men and 40% of all women in the U.S. live with OAB symptoms, and those figures may be much higher because many others suffer in silence. OAB isn’t a disease; rather, it is a group of troubling urinary symptoms. The most prevalent symptom is a sudden, strong urge to urinate that you can’t control. Some people with OAB also have “urgency incontinence,” meaning urine leaks after they feel the sudden urge to go. This is different from incontinence that leads to leaking urine when you sneeze, cough or do other physical activity. With OAB, you may also experience frequent urination or waking at night to urinate.

What causes Overactive Bladder? As you grow older, the risk for OAB symptoms increases. For women who have gone through menopause and men who have had prostate problems, the risk for Overactive Bladder is higher. Often, the specific cause of an OAB is unknown. However, there are several factors that can contribute to signs and symptoms of OAB, including:

  • Neurological disorders, such as Parkinson’s disease, strokes, spinal cord injury and multiple sclerosis
  • High urine production that can occur with high fluid intake, poor kidney function or diabetes
  • Medications that cause a rapid increase in urine production or require that you take them with lots of fluids
  • Factors that block bladder outflow, such as enlarged prostate, constipation or previous surgeries to treat other forms of incontinence
  • Excess caffeine or alcohol consumption or other dietary triggers

What are symptoms of Overactive Bladder? OAB is itself a group of symptoms, not a disease. Signs of Overactive Bladder include feeling a sudden urge to urinate that’s difficult to control, urge incontinence or leaking urine immediately following an urgent need to urinate, or urinating frequently—usually eight or more times in 24 hours, and awakening two or more times during the night to urinate (Nocturia).

How is Overactive Bladder diagnosed? A physician will talk with you about your symptoms and perform a physical exam. A urine sample and blood test may be requested, and you may be asked to keep a bladder diary for several days to provide the doctor with as much information as possible to determine the cause of your OAB. Other special tests might include measuring the amount of urine left in the bladder with an ultrasound, testing bladder pressure, or looking into the bladder with a camera (cystoscopy).

How is Overactive Bladder treated? OAB may require a combination of treatments, including specific behavioral interventions. We will take your history and do a thorough exam to recommend the treatments best suited to you. Rest assured that we always try to suggest the least invasive treatments first.

The first type of therapy for OAB involves behavioral therapy and lifestyle changes. This can be as simple as watching fluid intake throughout the day and scheduling time to use the bathroom (timed voiding), as well as making sure that the bladder is emptying by urinating again a few minutes after first emptying the bladder (double voiding). It also may include dietary changes to avoid foods and drinks that irritate the bladder, as well as weight loss. Exercises to help relax the muscles in the pelvis when the bladder is overactive may help. Working with a pelvic floor physical therapist may help with these exercises.

Multiple medications are available to help with OAB symptoms. The most common medications, anticholinergics, have been used for many years. Common side effects include dry mouth and constipation, which can cause worsening of bladder symptoms, so management of constipation before you start these medications is crucial.

A newer medication, Mirabegron, is now available for treatment of OAB. This medication doesn’t have the same side effects of dry mouth or constipation, but may cause a slight rise in blood pressure.

Injecting the bladder with onabotulinumtoxinA (Botox®) is a third line therapy, if medications and behavioral therapy fail. The medication helps by paralyzing the muscle of the bladder so that it doesn’t contract as often. The biggest side effects are Urinary Retention, Urinary Tract Infections, and blood in the urine. The effects of the medication last 6 to 9 months, on average.

Nerve stimulation is another third line option. The nerves of the bladder can be stimulated through the ankle (peripheral tibial nerve stimulation or PTNS), which requires weekly treatments for 12 weeks. If this option works well, continued monthly treatments are needed. A more permanent nerve stimulation called Sacral Nerve Stimulation is like a pacemaker for the bladder. A test is performed in the office to see if you are a good candidate before the stimulator is placed.

If all of these options are unsuccessful, surgery can be performed to make the bladder larger using a piece of intestine. In the most severe cases, the bladder can be removed and a new bladder can be surgically created using the intestines.

Can Overactive Bladder be prevented? While nothing can completely prevent OAB, there are some steps you can take to reduce your chances of being affected or the severity of symptoms. Managing chronic conditions like diabetes, staying at a healthy weight, watching fluid intake, and smoking cessation can also help.

UBMD Urology provides a high-level of care to patients of all ages including children and adolescents. Our urologists provide our youngest patients with the extra special care they need. Our care providers diagnose and treat pediatric urology conditions including:

  • Hernias/Hydroceles
  • Undescended Testis
  • Urinary Tract Infection
  • Vesicoureteral Reflux
  • Voiding Dysfunction

What is Post-Prostatectomy Incontinence? Post-prostatectomy urinary incontinence (PPI) is the involuntary leakage of urine following radical prostatectomy to treat prostate cancer or after surgical treatment for BPH. PPI represents a specific form of stress urinary incontinence where increased abdominal pressure from a cough, sneeze, or simple physical straining results in the leakage of urine. Under normal conditions, this increase in abdominal pressure is managed uneventfully by contraction of the external urinary sphincter, the muscle surrounding the early part of the male urethra, preventing loss of urinary control. During PPI, this sphincter mechanism is insufficient in maintaining closure of the urethra, permitting urinary leakage.

There are three types of incontinence seen following prostate surgery, stress incontinence, total (dripping faucet) incontinence, and detrusor instability (caused by bladder muscle and nerve instability seen following many types of pelvic surgery). As many as 30% of patients undergoing prostate cancer surgery will notice some degree of urinary incontinence postoperatively. The majority of these patients will, however, regain urinary control within the first post-operative year and require no additional therapy.

What causes Post-Prostatectomy Incontinence? The prostate gland surrounds the male urethra, the tube that urine passes through from the bladder to the outside. If cancer grows in the prostate, it squeezes the urethra causing an obstruction that allows less and less urine to pass, and the bladder has to work harder to force the urine out. Both stress incontinence and total incontinence are caused by injury to the urethral sphincter muscle during surgery. The prostate itself also contributes a great deal to continence in males, as it contains a large amount of smooth muscle that helps control urinary flow.

What are the symptoms of Post-Prostatectomy Incontinence? Most men experience some urine leakage or urinary incontinence (UI) after surgery (post-prostatectomy) but the UI usually resolves. Men can experience urine leakage with a cough, change in position, or for no reason at all and it can be as minor as a few drops of urine lost or cause experiences of sopping wet clothes and furniture. The urinary incontinence can be devastating as men wait for the problem to resolve over time.

How is Post-Prostatectomy Incontinence treated? Many times patients will have transient forms of any of these types of incontinence that will resolve with time or conservative measures.

Nonsurgical Treatment Options

  • Biofeedback and pelvic floor physical therapy. Patients who have very mild incontinence may benefit from this therapy.

Surgical Treatment Options

Surgical procedures may be used as treatments for urinary incontinence that is caused by damage to the sphincter.

  • If nonsurgical treatment options did not improve symptoms or the patient would like to achieve further improvement, urethral bulking agents and male slings are available. Urethral bulking agents are injected through the urethra through a scope placed into the urethra.
  • One is the insertion of an artificial urinary sphincter. Approximately 89% of men receiving this treatment achieve total dryness.

What is Stress Urinary Incontinence? Stress Urinary Incontinence—the loss of urine control—is a common and often embarrassing problem. Some women may leak urine while coughing, sneezing or running. The effects of SUI can range from slightly bothersome to completely debilitating. For some women, SUI keeps them from enjoying activities with their family and friends for fear of public embarrassment.

What causes Stress Urinary Incontinence? SUI is twice as common in women as in men. Age, pregnancy, childbirth, and menopause are the primary causes. Other factors that may worsen SUI include obesity, smoking or illnesses that cause chronic coughing, excessive caffeine or alcohol use, or high impact activities or exercise for many years.

What are symptoms of Stress Urinary Incontinence? Patients with SUI may experience leakage of urine with coughing, sneezing, standing up, exercising, lifting heavy objects, laughing or sexual activity. Leakage may occur all the time or only occur when your bladder is full.

How is Stress Urinary Incontinence diagnosed? One of the fellowship-trained physicians at the Buffalo Niagara Center for Pelvic Health will talk with you about your symptoms and perform a physical exam. A urine sample and blood test may be requested, and you may be asked to keep a bladder diary for several days to provide the doctor with as much information as possible to determine the cause of your SUI. Other special tests might include measuring the amount of urine left in the bladder with an ultrasound, testing bladder pressure, or looking into the bladder with a camera (cystoscopy).

How is Stress Urinary Incontinence treated? Treatment for Stress Urinary Incontinence depends on the severity of your problem and the root cause. We will take your history and do a thorough exam to recommend the approaches best suited to you. This may include a combination of treatments. Rest assured that we always try to suggest the least invasive treatments first.

The first type of therapy for SUI involves behavioral therapy and lifestyle changes. This can be as simple as watching fluid intake throughout the day and scheduling time to use the bathroom (timed voiding). It also may include smoking cessation, weight loss, and treating chronic cough or asthma. Exercises to help strengthen the muscles in your pelvis (Kegels) may also be suggested.

Another option for treatment of SUI is placement of an incontinence pessary. This is a ring placed in the vagina with a bump that sits on the urethra. The physician will place the pessary initially to make sure it fits and is comfortable. The pessary needs to be removed and cleaned regularly by the physician or a nurse. This is a good option if you do not want to undergo surgery.

Multiple surgical options are available for treatment of SUI.

  • Sling—A piece of synthetic material, graft material, or a piece of the patient’s own tissue is used to create a hammock underneath the urethra to prevent leakage. This is the most common surgical procedure for SUI.
  • Injectables—A material is injected around the urethra to “bulk up” the muscle and allow the urethra to close more easily. This may be done with a local anesthesia or light sedation. It is generally reserved for patients with mild SUI and may require more than one injection.

Can Stress Urinary Incontinence be prevented? While you can’t completely prevent SUI, there are some steps you can take to reduce your chances of being affected or decrease the severity of symptoms. Doing pelvic floor (Kegel) exercises can help strengthen your pelvic muscles. Staying at a healthy weight and smoking cessation can also help.

Bladder Reconstruction
Patients need bladder reconstruction for various reasons including trauma, cancer, and incontinence. Bladder reconstructions sometimes involve removal of your bladder but can also involve making your existing bladder larger. Reconstruction can lead to the creation of a stoma or bag on the abdomen to collected urine. Sometimes a channel is created on the abdominal wall to allow passage of a catheter into the bladder to empty it. Some patients are able to urinate on their own after bladder reconstruction. The type of surgery chosen is dependent on multiple factors and your urologist will discuss all of the options to help make the best decision for each patient.

Urethral Reconstruction
Urethral reconstruction is often necessary when a patient is suffering from urethral strictures. A urethral stricture is narrowing of the urethra, usually due to scar tissue caused by trauma to the urethra. A stricture causes a significantly weaker urine stream causing difficulty in urination. To repair the urethra, your urologist removes the affected scar tissue and sometimes needs to replace it with healthy tissue from the cheek. Following surgery, the patient may have to use a catheter to drain the bladder while healing takes place. After the urethra is healed, the urinary stream returns to normal.

What is Urinary Retention? Urinary Retention is the inability to empty the bladder. With chronic urinary retention, the patient may be able to urinate, but has trouble starting a stream or emptying their bladder completely.

What are the symptoms? The patient may urinate frequently; feel an urgent need to urinate but have little success; or feel they still have to go after they’re finished urinating. With Acute Urinary Retention, it may be impossible to urinate at all, even with a full bladder. Acute Urinary Retention causes great discomfort, and even pain. Anyone can experience Urinary Retention, but it is most common in men in their 50s and 60s because of prostate enlargement.

What causes Urinary Retention? Urinary Retention can be caused by an obstruction in the urinary tract or by nerve problems that interfere with signals between the brain and the bladder. If the nerves aren’t working properly, the brain may not get the message that the bladder is full. Even if the bladder is full, the bladder muscle that squeezes urine out may not get the signal that it is time to push, or the sphincter muscles may not get the signal that it is time to relax. A weak bladder muscle can also cause retention.

Chronic Urinary Retention, by comparison, might cause mild but constant discomfort. Patients have difficulty starting a stream of urine. Once started, the flow is weak. They may need to go frequently, and once they’re finished, still feels the need to urinate. They may dribble between trips to the toilet because the bladder is constantly full, a condition called overflow incontinence.

How is Urinary Retention treated? Treatments to relieve prostate enlargement range from medication to surgery. With Acute Urinary Retention, treatment begins with the insertion of a catheter through the urethra to drain the bladder. This initial treatment relieves the immediate distress of a full bladder and prevents permanent bladder damage.

If you have retention after surgery, you will probably regain your ability to urinate after the effects of the anesthesia wear off. In such cases, you may need to have a catheter inserted once or twice with no other treatment required after you have shown you can urinate on your own. If you have Chronic Urinary Retention, or if acute retention appears to become chronic, further treatment will be necessary.

Treatments for men with urethral stricture may involve a procedure called dilation, in which increasingly wider tubes are inserted into the urethra to widen the stricture. Strictures can be treated using a cystoscope and a knife or laser, or more extensive surgery to remove the narrowing and repair the scarred area.

What is a Urinary Tract Infection? Urinary Tract Infections (UTIs) can involve any part of your urinary system—kidneys, ureters, bladder and urethra. However, the most common infections involve the bladder and the urethra. Women have a higher risk of developing UTIs than men. An infection that is limited to your bladder can be painful or uncomfortable, but if a UTI spreads to your kidneys, serious consequences can occur. Because Urinary Tract Infections in men are quite rare, most men who are diagnosed with a UTI will be advised to have other tests to determine if something else is responsible.

What causes a Urinary Tract Infection? Urinary Tract Infections typically occur when bacteria enter the urinary tract through the urethra and begin to multiply in the bladder. The most common UTIs are cystitis (bladder) and urethritis (urethra).

  • Cystitis is typically caused by Escherichia coli (E. coli), a type of bacteria that is commonly found in the gastrointestinal (GI) tract. Sexual intercourse can lead to cystitis. However, women who are not sexually active are also at risk because of the short distance from a woman’s urethra to the anus and from the urethral opening to the bladder. Women who have gone through menopause and women and men who do not empty the bladder completely are also at higher risk.
  • Urethritis can occur when gastrointestinal bacteria spread from the anus to the urethra. It can also be caused by sexually transmitted infections, such as herpes, gonorrhea and chlamydia.

What are symptoms of a Urinary Tract Infection? You may or may not experience symptoms with a Urinary Tract Infection. If you do, they can include:

  • A strong, persistent urge to urinate
  • A burning sensation when urinating
  • Passing frequent, small amounts of urine
  • Urine that appears cloudy
  • Urine that appears red, bright pink or cola-colored—a sign of blood in the urine
  • Strong-smelling urine
  • Pelvic pain, in women
  • Rectal pain or perineal pain in men (pertaining to the area between your scrotum and rectum)

UTIs may be overlooked or mistaken for other conditions in older adults. The physicians at Buffalo Niagara Center for Pelvic Health can help.

How is a Urinary Tract Infection diagnosed? There are a number of tests and procedures that the physicians at UBMD Urology may use to diagnose Urinary Tract Infections, including:

  • Urine sample—Your specimen will be analyzed to look for white blood cells, red blood cells or bacteria.
  • Urine culture—This test uses your urine sample to grow bacteria in a lab. This tells the doctor what types of bacteria are causing your infection and which medications will be most effective.
  • Ultrasound or a computerized tomography (CT) scan—If the doctor suspects that an abnormality in your urinary tract is causing frequent infections, these tests may also be used.
  • Cystoscopy—If you have recurrent UTIs, your doctor may use a long, thin tube with a lens (cystoscope) inserted through the urethra to see inside your urethra and bladder.

How is a Urinary Tract Infection treated? UTIs are typically treated with antibiotics. The specific drugs that are prescribed for you and the length of time you need to take them will depend on your health condition and the type of bacteria found in your urine. Although the symptoms may clear up within a few days of treatment, it’s important that you continue the antibiotics for the full course prescribed by the physician to ensure that the infection is completely gone. The doctor may also prescribe a pain medication that numbs your bladder and urethra to relieve burning while urinating.

Can Urinary Tract Infections be prevented? Although there is no way to entirely prevent Urinary Tract Infections, there are steps you can take to reduce your risk. Drinking plenty of liquids—especially water—helps dilute your urine and ensures that you’ll urinate more frequently, allowing bacteria to be flushed out before infection can begin. Wiping from front to back helps prevent bacteria in the anal region from spreading to the vagina and urethra. Emptying your bladder soon after intercourse and drinking a full glass of water can also help flush out bacteria. Also, avoiding potentially irritating feminine products, such as deodorant sprays, douches and powders that can irritate the urethra will help.