KIDNEY STONES

Kidney stones are formed when excess material crystallizes in the kidney. They affect 10 percent of the population, men more than women. More than 50 percent of patients form another stone within 10 years.

Evaluation
1. Urinalysis
2. Blood tests
3. X-rays

Kidney stone symptoms include back and groin pain, symptoms with urination, and blood in the urine. Some stones also cause urinary tract infections. Occasionally, stones cause no symptoms but can lead to kidney damage.

Treatment
How a particular stone is treated depends on its size and location. The best method to take care of a stone is for the patient to pass it on his or her own.

Treatment Options
1. Extracorporeal Shock Wave Lithotripsy (ESWL)
2. Ureteral stent
3. Ureteroscopy
4. Percutaneous
5. Open surgery (incisional)

Prevention
The single most important way to help prevent kidney stone formation is to stay well-hydrated.

Summary
The key points in evaluating kidney stones are diagnosis, treatment, and prevention.

INCONTINENCE

Urinary incontinence is the involuntary loss of urine. More than 12 million Americans are estimated to have urinary incontinence. Incontinence affects all ages, including 15 percent to 30 percent of people over age 60 who live at home and half of those residing in nursing homes. Women are affected twice as often as men. Because of the social stigma, many do not even report the problem.

Types of Incontinence
1. Stress incontinence is the loss of urine during coughing, laughing, or other physical activities that increase abdominal pressure.
2. Urge incontinence is the loss of urine with a sudden and severe desire to void.
3. Overflow incontinence occurs when the bladder becomes so full that it simply overflows.
4. Transient incontinence results from something that can be easily reversed.
Sometimes incontinence can be a mixture of more than one of the four types.

Evaluation
1. Detailed history and physical exam
2. Urinalysis
3. Post-void residual (PVR)
A more detailed evaluation may require a voiding diary, cystoscopy, intravenous pyelogram (IVP), and urodynamic testing.

Treatment
1. Behavioral techniques
2. Medications
3. Surgery

There are three main types of treatment for incontinence. The best treatment for each patient depends on the specific type of incontinence.

Incontinence is a problem that affects one's emotional, psychological and social well-being. It can make people afraid to participate in normal daily activities. It is particularly important to note that the great majority of incontinence causes can be treated successfully.

HEMATURIA

Hematuria is the abnormal presence of blood in the urine. There are two forms of hematuria. When the urine is visibly pink or red, it is "gross hematuria." When no blood is visible in the urine, but seen under the microscope, it is microscopic hematuria.

Causes of Hematuria
There are many causes of hematuria. The most common causes of significant hematuria are infections, kidney stones, tumors, and trauma. Blood in the urine can come from anywhere along the urinary tract:

• kidneys
• ureters (tubes connecting the kidneys to the bladder)
• bladder
• prostate (in men)
• urethra (tube draining the urine out of the body)

Evaluation
1. Urine specimen
2. Urine culture and sensitivity
3. Blood tests
4. IVP (Intravenous Pyelogram)
5. Cystoscopy

Treatment
The proper treatment for hematuria is dependent on the cause. A small amount of blood can turn the urine bright red and hematuria rarely requires a blood transfusion. Severe gross hematuria with clots requires immediate attention and evaluation. Most hematuria can be evaluated on a less than emergency basis. Hematuria from an infection should be treated with antibiotics. Blood in the urine from a stone or tumor should be treated be addressing that problem. In "idiopathic hematuria," no cause can be determined. This occurs in as many as 20 percent of hematuria patients. These patients should be followed every six to 12 months with a urinalysis and history to see if things change.

Blood in the urine is a warning signal that should not be ignored, and a thorough evaluation is necessary. If the cause is something serious, a physician wants to diagnose it and begin proper treatment.

ERECTILE DYSFUNCTION

Erectile dysfunction, also known as impotence, is the inability to attain or maintain a penile erection sufficient for satisfactory sexual intercourse. This disorder affects one in 10 men and more than 20 million men in the United States. Impotence is a very sensitive topic but, in most cases, can now be treated effectively.

Causes of Impotence
1. Nerve disorders and injuries
2. Blood supply abnormalities
3. Hormone disorders
4. Medications
5. Psychological conditions

Aging causes changes in sexual function with less frequent erections that are also less firm. Also, aging increases the chances for having other causes of impotence. However, age in itself should not cause erectile dysfunction. There is no reason that getting older should prohibit an active sex life.

Evaluation
1. Patient history
2. Physical exam
3. Blood tests

Treatment Options
1. Reversal of potential causes
2. Medications
3. Injection therapy
4. Vacuum pump
5. Penile prosthesis
6. Urethral suppositories

Erectile dysfunction is common and can have many different causes. A detailed evaluation can help reverse potential causes. Many treatment options are available and treatment strategies depend on each individual and his particular situation and expectations. A urologist can help a patient determine which option is best for him.