Archive for December, 2018

Urethral Stricture: What You Need to Know

December 29, 2018

Andrew Siegel MD  12/29/2018

A urethral stricture is scarring within the urethra (the channel that conducts urine out of the bladder), resulting in a narrowed diameter and obstructive lower urinary tract symptoms.  The urethra is one of the parts of the body that is a particularly bad place for scarring, since it is a highly functional structure that is put into use numerous times daily.

The Male Urethra

2603_Male_Urethra_N

Attribution  of image above: OpenStax Anatomy and PhysiologyOpenStax [CC BY 4.0 (https://creativecommons.org/licenses/by/4.0)%5D, via Wikimedia Commons

 

urethral stricture

Image above indicates the great variety of strictures in terms of length and depth

 

Urethral strictures, although occasionally present in females, are much more common in males. The male urethra begins at the neck of the urinary bladder and ends at the tip of the penis. The innermost portion of the urethral is enveloped by the prostate gland. Thereafter the urethra runs through the perineum (between scrotum and the anus) where it is enveloped by the corpus spongiosum–a thick, vascular, cushiony structure– and thereafter the urethra extends through the penis (also surrounded by the corpus spongiosum) where it ends at the urethral meatus (the slit-like opening).

Urethral scarring results in a narrowed or blocked passageway that can give rise to obstructive voiding including one or more of the following symptoms: slow, weak, hesitant, spraying and intermittent urinary stream, prolonged emptying, incomplete emptying or inability to empty, painful urination and blood in the urine.  It can also cause urinary infections, bladder stones and cause difficulties/pain with ejaculation.

Urethral strictures often result from trauma, infection or inflammation.  External trauma can be caused by either a straddle injury (when the perineum abruptly strikes a fence or bicycle top tube) or a crush injury. Internal injury is often due to passage of urethral instruments, indwelling urethral catheters, or transurethral surgery. Inflammatory processes such as urethritis and sexually transmitted diseases also can result in urethral stricture formation.

When a urethral stricture is suspected, a urinary flow rate and an ultrasound-guided determination of how much urine is left in the bladder after urinating are obtained. These painless and noninvasive procedures will precisely characterize the extent of compromised urinary flow as well as the ability to effectively empty the bladder. Most strictures cause poor flow rates and elevated bladder residuals. Urethroscopy is a procedure in which a narrow, flexible, lighted instrument is placed in the urethra in order to directly examine it, ascertaining the location, extent and length of the stricture.  At times, imaging studies of the urethra–retrograde urethrogram, voiding cysto-urethrogram, or urethral ultrasound are performed to gain further information.  With urethroscopy and imaging studies, the location, length, and depth of the scar and degree of extension into the spongy tissue that surrounds the urethra can be deduced.

Mild strictures can be managed with simple urethral dilation that may be curative. This involves the passage of sequentially larger dilating instruments through the stricture to open up the scar tissue. If a urethral stricture is short and involves only the urethra or superficial spongy tissues in the bulbar urethra (the portion that travels through the perineum), optical internal urethrotomy is often the treatment of choice. This is a procedure done under anesthesia that utilizes an endoscopic instrument to incise open the urethra. Typically, a catheter is left in the urethra for several days thereafter to maintain the opening that has been made.  This procedure can be performed on an outpatient basis.  It will not always be curative because scar tissue can and often does recur. Dilation and optical urethrotomy are best for relative short strictures located in the bulbar urethra with success rates in the 35-70% range, often with the need for a repeat procedure because of recurrent scarring.

A useful tool after dilation or optical urethrotomy is to teach the patient self-catheterization to maintain the urethral opening. If obstructive symptoms recur and studies demonstrate little or no improvement, an open surgical treatment called urethroplasty can be a consideration. It is rarely necessary as an initial therapeutic option, but is appropriate for longer and recurrent urethral strictures or those involving extensive scarring. Excision of the stricture with urethroplasty has a 90-95% success rate, although it is a much more involved procedure than dilation or optical urethrotomy. If the stricture is located in the penile urethra as opposed to the bulbar urethra, urethroplasty should be offered since strictures at this location are less likely to respond to dilation or optical urethrotomy. Lengthy strictures require graft material to repair, often buccal mucosa ( graft material harvested from inside the mouth).

At times the stricture is confined to the part of the urethra located at the tip of the penis where it is known as a urethral meatal stricture.  This situation can be rectified with dilation or a minor procedure called a meatotomy/meatoplasty.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

MPF cover 9.54.08 AM

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

New video on female pelvic floor exercises:  Learn about your pelvic floor

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Female “Prostatitis”: How Is That Possible?

December 22, 2018

Andrew Siegel MD  12/22/2018

The prostate gland is that mysterious male reproductive organ that can be a source of curiosity, anxiety, fear and potential trouble.  Although women do not have a prostate gland, they have a female equivalent, known as the Skene’s glands.  Like the prostate, these glands can be a source of maladies resulting from their infection/inflammation, the female version of prostatitis.

Image below: note Swedish “slida” is vagina (literally “sheath”); note Skenes and Bartholins gland  openings, “urinrorsmynning” = urethra; “klitoris” = clitoris

Skenes_gland-svenska

Attribution of image above: By Nicholasolan (Skenes gland.jpg) [GFDL (http://www.gnu.org/copyleft/fdl.html), CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0/) or CC BY-SA 2.5 (https://creativecommons.org/licenses/by-sa/2.5)%5D, via Wikimedia Commons

The Skene’s glands, a.k.a. the para-urethral glands, are present in all females and are the female equivalent of the male prostate gland. They were first described in 1880 by Dr. Alex Skene, a Brooklyn gynecologist.  These paired glands are located within the top wall of the vagina near the urethra and drain into the urethra and to tiny openings near the urethral opening (see image above).  Like the prostate, these glands envelop the urethra and contain prostate-specific antigen (PSA), an enzyme that can indicate prostate health in males. Although their precise function is unknown, they are thought to provide genital lubrication. At the time of sexual climax, they can release a small amount of fluid into the urethra, paralleling the male release of prostate fluid at the time of ejaculation.

Similar to the male prostate that is subject to inflammation and infections (prostatitis), the Skene’s glands can be similarly afflicted, a condition known as Skenitis.  Skenitis can give rise to the following symptoms:

  • A urinary infection that fails to be cured or reoccurs after appropriate treatment with a course of antibiotics
  • Pain at the urethral opening or at the top wall of the vagina
  • Pronounced tenderness with contact, e.g., touch, tampon insertion, sexual intercourse, tight clothing

Pelvic examination in a patient suffering with Skenitis usually shows the following:

  • Tenderness at the urethral opening or just within the vagina
  • A discharge of pus from the Skene’s glands ducts (tiny openings visible at 10 o’clock and 2 o’clock relative to the urethral opening) that can be expressed by compressing the urethra
  • A red and inflamed mass around the urethra (para-urethral mass)

Treatment of Skenitis usually involves a prolonged use of a potent antibiotic in conjunction with supportive measures, including warm, moist compresses and sitz baths. A 4-week course of antibiotics is often required (similar to the prolonged course necessary for treating prostatitis). At times a Skene’s abscess needs to be aspirated with a needle and syringe, or alternatively drained.  If the Skenitis does not respond satisfactorily to antibiotics and supportive measures, a surgical procedure may be required to remove the diseased portion of the urethra with the infected Skene’s gland.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

New video on female pelvic floor exercises:  Learn about your pelvic floor

Female Urethral Diverticula: What You Need to Know

December 15, 2018

Andrew Siegel MD  12/15/2018

This is a continuation of entries that deal with female urogenital maladies.  Today’s entry is on the topic of urethral diverticula, out-pouchings of the inner lining of the urethral channel that cause a vaginal bulge and often makes for an unhappy patient.  The good news is that this situation can be readily fixed.  (For the record, diverticulum is singular, diverticula is plural.)

IMG_0452

I’m not much of an artist, but I tried my best.  On left is cross section of the urethra and on right side view of bladder and urethra. 

The urethra is the channel that conducts urine from the urinary bladder to its external opening on the vestibule.  A urethral diverticulum is an out-pouching or herniation of the inner lining (mucosa) of the urethra through a defect in the outer urethral supporting tissue (peri-urethral fascia) causing a mass in the top wall of the vagina.  Most urethral diverticula are located in the mid or terminal part of the urethra.

Urethral diverticula, many of which are small and not symptomatic, occur in up to 5% or so of adult females. The average age at presentation is 40 years old. They commonly cause a mass or lump in the anterior (top) vaginal wall as well as dribbling of urine after urinating, burning or pain with urination and pain with sexual intercourse.  They often cause urinary infections that are unresponsive or poorly responsive to antibiotic treatment. On occasion, a urethral diverticulum may cause obstructive lower urinary tract symptoms (a hesitant, weak, intermittent spraying quality urinary stream) and rarely, the inability to urinate.

The classic 3 Ds of urethral diverticula:

  • dysuria (painful and burning urination)
  • dribbling (urinary leakage after finishing urinating)
  • dyspareunia (painful sexual intercourse)

The underlying cause of urethral diverticula is often infection and/or obstruction in the para-urethral glands.  These glands surround the urethra and communicate with it via ducts.  When these ducts become obstructed, the glands can become infected and lead to abscess formation which subsequently ruptures into the urethra. During the healing phase, the cells that line the urethra can then grow out into the cavity formed by the ruptured abscess, forming a urethral diverticulum.

Pelvic exam typically reveals a tender, firm, cystic swelling of the anterior vaginal wall. When the swelling is manipulated, urine or possibly pus may be expressed through the urethra. MRI is the imaging test of choice for further evaluating the anatomical details, location and complexity of urethral diverticula. The MRI will show whether the diverticulum is simple or complex, as occasionally they may be multiple, may encircle the urethra (“saddlebag” diverticulum) or may involve the bladder neck or sphincter. Another important test is urethroscopy, a visual inspection of the urethra using a small, lighted instrument to establish the location of the connection site between the diverticulum and the urethra.

Not all urethral diverticula require treatment, particularly if they are small and not symptomatic. Conservative measures that may relieve symptoms include compressing the diverticulum after urinating to preclude the post-void dribbling, antibiotics and using a needle and syringe to aspirate the contents.

Surgical management of symptomatic urethral diverticula involves excision of the diverticulum (urethral diverticulectomy) with repair of the urethra (urethroplasty). The surgery is performed via a vaginal incision and requires complete removal of the diverticular sac(s) down to the connection with the urethra with a multi-layered, tension-free closure. In the event of an infected diverticulum, it is important to treat with antibiotics prior to the surgery to eradicate the infection as best as possible. The procedure is generally done on an outpatient basis and requires a urinary catheter (typically for 7–14 days) antibiotics, pain medication, and a bladder relaxant.

Urethral diverticulectomy has a high success rate with respect to alleviation of the presenting symptoms and resumption of normal urinary function. As in any surgical procedure, there is always a small risk of complications. In general, the closer a urethral diverticulum is located to the bladder neck (where the urethra and bladder meet), the greater the risk for complications. Risks include bladder or ureteral injury, urinary incontinence, urethral stricture (scarring resulting in narrowing of the channel), urethral-vaginal or vesico-vaginal fistulas (abnormal connection between the vagina and the urethra or the vagina and bladder) and recurrence of the urethral diverticulum.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

New video on female pelvic floor exercises:  Learn about your pelvic floor

Vesico-Vaginal Fistula (VVF): What You Need to Know

December 8, 2018

Andrew Siegel MD 12/8/2018

The last few entries have been geared towards men.  This week’s and next week’s entries address female urogenital maladies.  Today I cover a specific type of fistula–an abnormal connection between two body parts that are normally not connected –specifically one that occurs between the bladder and the vagina and that often leads to miserable urinary leakage issues. 

Vesicovaginal_Fistula

By BruceBlaus [CC BY-SA 4.0  (https://creativecommons.org/licenses/by-sa/4.0)%5D, from Wikimedia Commons

A vesico-vaginal fistula (VVF) is an abnormal hole or connection between the bladder and the vagina that causes continuous and persistent urinary leakage. Urine from the bladder drains from the fistula into the vagina, resulting in high-volume, continuous urinary leakage out of the vagina.

In the USA the most common cause is gynecological surgery, with abdominal hysterectomy accounting for the majority.  Other causes are urological and pelvic surgery, pelvic cancers and radiation therapy. My most recent patient with a VVF had a retained (long forgotten about) pessary used to treat her pelvic organ prolapse, which eroded from the vagina into the urinary bladder creating the fistula.

However, on a worldwide basis, the most common cause of VVF is an obstetrical fistula that occurs in third-world nations, particularly in West Africa. This is the most extreme form of birth trauma, a not uncommon, horrific problem endemic in poverty-stricken countries where pregnant women have poor access to obstetric care. It happens after enduring days of “obstructed” labor, with the baby’s head persistently pushing against the mother’s pelvic bones during labor contractions. This prevents pelvic blood flow and causes tissue death, resulting in a fistula between the vagina and the bladder and/or vagina and rectum. These fistulas are often huge and are totally different entities compared to the fistulas resulting from hysterectomies that are seen in first-world nations. When birth finally occurs, the baby is often stillborn.  The long-term consequences for the mother are severe urinary and bowel incontinence, shame and social isolation.

Fistulas can vary in size from tiny, pinpoint fistulas to those that are several centimeters in diameter.  A simple fistula is solitary and small in diameter; complex fistulas include those that are large, multiple, recurrent after previous repairs and those associated with pelvic radiation.  Most fistulas occur because of tissue “necrosis” (tissue death) and do not cause symptoms for several days to several weeks following the initial instigating surgery. The tissue necrosis is often caused by sutures inadvertently placed in the bladder wall in an effort to control pelvic bleeding.

The classic presentation of a VVF is urinary leakage from the vagina that occurs a few days to a few weeks following a hysterectomy. Evaluation is via pelvic examination in conjunction with cystoscopy (using a small lighted instrument to visualize the bladder) and vaginoscopy (using a small lighted instrument to visualize the vagina).  The location, size and number of fistulas present are determined as well as the extent of inflammation associated with the VVF.

Small fistulas may occasionally heal spontaneously with prolonged urinary catheter drainage.  Tiny fistulas can sometimes be dealt with via cauterization (searing them with electrical current), although most fistulas will be need to be repaired with surgery.

Surgical repair of a VVF can be via a vaginal or abdominal approach depending on circumstances and surgeon preference. In general, simple fistulas involving the more superficial vagina can be treated using vaginal approaches. Advantages of the vaginal approach are avoiding opening the bladder, minimal blood loss and less post-operative discomfort and the ability to do the procedure on an outpatient basis.

Complex fistulas that involve the deeper vagina can be repaired vaginally, although the abdominal approach is often preferred.  Vaginal repair can be facilitated with the use of either a flap of the labial fat pad (Martius repair) or alternatively, with the use of a flap of muscle tissue attached to its blood supply (often gracilis muscle).  Nowadays, the abdominal approach is often a robotic-assisted laparoscopic technique that has numerous advantages over the older, open technique.

In either case, important principles of surgical repair of a VVF are the following:

  • Waiting a sufficient time period after diagnosis to allow the inflammation and tissue swelling to subside to optimize tissue health and suppleness. The repair should not be attempted if devitalized tissues, infection, inflammation or encrusted deposits on the tissues are present. The timing needs to find middle ground between optimal conditions for closure and the desire to minimize the duration of the annoying and distressing constant urinary leakage.
  • Any urinary infection needs to be treated with antibiotics in advance of the surgery
  • Topical estrogen can be used to optimize vaginal tissue integrity
  • Careful tension-free closure of the VVF in several non-overlapping suture lines (bladder layer and vaginal layer) often with interposition of additional tissue (interposition flaps include omentum or peritoneum for abdominal repairs; peritoneum or labial fat for vaginal repairs) between the bladder and vaginal walls to buttress the repair. A flap of vaginal wall is advanced to cover the repair.
  • Urinary catheter for several weeks after the repair for purposes of continuous urinary drainage to facilitate the healing process by keeping the bladder decompressed of urine
  • Bladder relaxant medication post-operatively to minimize involuntary bladder contractions
  • Post-operative antibiotics

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

New video on female pelvic floor exercises:  Learn about your pelvic floor

Medical “Urban” Myths in Urology

December 1, 2018

Andrew Siegel MD  12/1/2018

I am pleased to announce that with this entry I have surpassed 400 blogs composed over the past seven years.

Myth:  a widely held but false belief or idea; a misrepresentation of the truth; a fictitious or imaginary thing; exaggerated or idealized conception

thank you Pixabay for image above

Part I of today’s entry confronts widely held but false medical concepts that run rampant in the general population. Part II addresses widely held but false medical concepts that run rampant within the medical field. The medical mythology I attempt to debunk is largely urological in nature.

General population medical myths: Some myths are perpetuated by the general (non-medical) community, consisting of erroneous beliefs and inaccurate presumptions. These falsehoods often require a great deal of physician time in an effort to disabuse patients of them. 

Medical community medical myths: Some aspects of the practice of medicine are on the basis of customs perpetuated by medical personnel (most often not physicians) that seem logical or justified and ultimately become accepted dogma. However, they often do not hold muster, crumble under scientific scrutiny and can be categorized as medical myths.   

GENERAL POPULATION MEDICAL MYTHS

“A vaccine caused my child’s autism.”

(This is a non-urological myth, but nonetheless needs to be addressed.)

Myth: Vaccines, particularly MMR (measles, mumps, rubella) cause neurological injuries including autism spectrum disorder.

Reality: Scientific evidence overwhelmingly shows no correlation between vaccines in general, MMR vaccine in specific, and thimerosal (a mercury-based preservative) in vaccines with autism spectrum disorders or other neuro-developmental issues. 

We have come a long way on the immunization and vaccination front, wiping out a significant number of diseases completely.  In children, vaccines have been among our most effective interventions to protect individual as well as public health. What a great means of reducing  risk for certain infections that are potentially lethal, if not capable of incurring significant morbidity.  Vaccinations are now available for hepatitis A and B, diphtheria, tetanus, pertusis, polio, hemophilus, measles, mumps, rubella, varicella, meningitis, cervical cancer/human papilloma virus, influenza and pneumococcal pneumonia and herpes zoster (shingles).

“Doing a prostate biopsy will spread any cancer that may be present.”

Myth: Using a needle to obtain tissue samples of the prostate allows cancer cells to seed and implant along the needle track, or alternatively, into blood or lymphatic vessels. 

Reality: Although this is a theoretical consideration, the truth of the matter is that based upon millions of prostate biopsies performed annually in the USA, the incidence of seeding is virtually non-existent and the potential risk can be thought of as being negligible at best.

“Cancer spreads when exposed to oxygen.”

Myth: When a body is opened up and exposed to oxygen any cancer present can readily spread.

Reality: There is no scientific evidence that supports cancer advancing because of exposure to air/oxygen.  At times, upon doing an exploratory surgery, more cancer is discovered than was anticipated based upon imaging studies. This has nothing to do with the surgical incision nor exposure to air/oxygen, but is simply on the basis of cancer that did not show up on the diagnostic evaluation.

“All prostate cancer is slow growing and can be ignored.”

Myth: Prostate cancer grows so slowly that it can be disregarded. 

Reality:  Every case of prostate cancer is unique and has a variable biological behavior.

Yes, some are so unaggressive that no cure is necessary and can be managed with surveillance; however, others are so aggressive that no treatment is curative, and many are in between these two extremes, being moderately aggressive and highly curable. A major advance in the last few decades is the vast improvement in the ability to predict which prostate cancers need to be actively treated and which can be watched, a nuanced and individualized approach.

Those who feel that prostate cancer should not be sought out and treated should be attentive to the fact that it is the second leading cause of cancer death, with an estimated 30,000 deaths in 2018, and furthermore, that death from prostate cancer is typically an unpleasant one

MEDICAL COMMUNITY MEDICAL MYTHS

“Drink lots of fluids to flush out kidney stones.”

Myth: Drinking copiously will help promote passage of kidney and ureteral stones. The rationale of this advice is that by hydrating massively, a head of pressure will be created to help passage of a stone present in the kidney or ureter.

Reality: The presence of a stone often causes urinary tract obstruction.  Over-hydration in the presence of obstruction will further distend the already bloated and inflated portion of the urinary collecting system located above the stone. This increased distension can exacerbate pain and nausea that are often symptoms of colic. The collecting system of the kidney and the ureter have natural peristalsis—similar to that of the intestine—and over-hydration has no physiological basis in terms of helping this process along, being pointless and perhaps even dangerous.  Drinking moderately in the face of a kidney or ureteral stone is sound advice.

“Everyone must drink 8-12 glasses of water a day.”

Myth: Many sources of information (mostly non-medical and of dubious reliability) dogmatically assert that humans need 8-12 glasses of water daily to stay well hydrated and thrive.

Reality: Many people take the 8-12 glass/day rule literally and as a result end up in urologists’ offices with urinary urgency, frequency and often urinary leakage. The truth of the matter is that although some urinary issues are brought on or worsened by insufficient fluid intake–including kidney stones and urinary infections–other urinary woes are brought on or worsened by excessive fluid intake, including the aforementioned “overactive bladder” symptoms.  Water requirements are based upon ambient temperature and activity level. If you are sedentary and in a cool environment, your water requirements are significantly less than when exercising vigorously in 90-degree temperatures.

Humans are extraordinarily sophisticated and well-engineered “machines” and your body lets you know when you are hungry, ill, sleepy, thirsty, etc.  Heeding your thirst is one of the best ways of maintaining good hydration status, in other words, drinking when thirsty and not otherwise. Another method of maintaining good hydration status is to pay attention to your urine color.  Urine color can vary from deep amber to as clear as water.  If your urine is dark amber, you need to drink more as a lighter color is ideal and indicative of satisfactory hydration

“When a patient needs to have a catheter placed because he or she is unable to urinate, clamp the catheter intermittently to allow for gradual drainage instead of allowing it to drain at once.”

Myth: Rapid bladder decompression with a catheter can cause problems including bleeding that may require intervention, kidney failure and circulatory collapse. 

Reality: Science has clearly shown that concerns for kidney failure and circulatory collapse due to rapid bladder decompression are untruths.  Yes, on occasion some bleeding can occur (with or without) rapid decompression, but it is usually self-limited and inconsequential.

“A patient is experiencing leakage around a urinary catheter, so it must be too small and replaced with a larger one.”

Myth: A catheter that leaks needs to be replaced with a larger bore catheter so as to provide a better seal and reduce the leakage. This practice is commonly applied in nursing homes where many patients have long-term indwelling catheters for a variety of reasons.

Reality:  Leakage of urine around indwelling catheters is a common scenario. Although it can be due to a blocked catheter, most often the cause is bladder spasms induced by the catheter or catheter balloon irritating the bladder. The sensible management is to irrigate the catheter to ensure no obstruction, deflate the balloon to some extent, and thereafter consider the use of a bladder relaxant medication to minimize the bladder spasms.  The best practice is always to use the smallest catheter that is effective and remove it as soon as feasible. The longer a catheter stays in, the greater the chance for infections and long-term catheters that are upsized are clearly associated with urethral erosion and urethral stricture (scarring).

“If a patient has bacteria in the urine they must have a urinary infection that needs to be treated.”

Myth: There are bacteria present in the urine on urinalysis, so there must be an underlying infection that demands antibiotic treatment.  This is one of the medical myths perpetuated by internists and general practitioners.

Reality: The thought process that the presence of bacteria in the urine without symptoms means an infection is erroneous. It is vital to distinguish a symptomatic urinary infection from asymptomatic bacteriuria. Asymptomatic bacteriuria, common in elderly and diabetics, is the presence of bacteria within the bladder without causing an infection. This does not require treatment, which is futile and promotes selection of resistant bacteria.  Asymptomatic bacteriuria should be treated only in select circumstances:  pregnant women; in patients undergoing urological-gynecological surgical procedures; and in those undergoing prosthetic surgery (total knee replacement, etc.).

An extension of this myth is that bacteria in the urine in the face of an indwelling catheter is an infection that must be treated. The reality is that in the vast amount of cases, this is bacterial colonization without infection.

Bottom Line: Lay and even medical populations are subject to medical myths—mistaken beliefs that are often passed down like memes with little to no basis in fact. These myths have no place in the art and craft of medicine and need to be challenged with real science.  

“What is dogma today is dog crap tomorrow.”

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area,Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

New video on female pelvic floor exercises:  Learn about your pelvic floor