Category Archives: Urology (urinary problems)

Acid-Base Balance Regulation, with Animation

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pH is an indicator of acidity. The body’s blood pH is strictly regulated within a narrow range between 7.35 and 7.45. This is because even a minor change in acidity may have devastating effects on protein stability and biochemical processes.

Normal cellular metabolism constantly produces and excretes carbon dioxide into the blood. Carbon dioxide combines with water to make carbonic acid which dissociates into hydrogen ions and bicarbonate.

CO2 + H2O =  H2CO3 =  H+ + HCO3

This is an equilibrium, meaning all the components of the left and right sides co-exist at all times, and the concentration of any component is determined by that of others at any given moment. The rule of thumb is: an increase in concentration of ANY component on ONE side will shift the equation to the OTHER side, leading to INCREASED concentrations of all components on THAT side, and vice versa. This equilibrium is central to understand acid-base regulation. CONTINUED carbon dioxide production by all cells of the body drives the equilibrium to the right to generate more hydrogen ions. Because pH is basically a function of hydrogen ion concentration, more hydrogen means higher acidity and lower pH. Normal metabolism, therefore, constantly makes the blood more acidic. The body must react to keep the blood pH within the normal limits. This is achieved by 2 mechanisms:

  • Elimination of carbon dioxide through exhalation. The amount of carbon dioxide exhaled by the lungs is regulated in response to changes in acidity. A decrease in pH is sensed by central or arterial chemoreceptors and leads to deeper, faster breathing; more carbon dioxide is exhaled, less hydrogen is made, blood acidity decreases and blood pH returns to normal. Pulmonary regulation is fast, usually effective within minutes to hours.
  • Excretion of hydrogen ions and reabsorption of bicarbonate through the kidneys. The kidneys control blood pH by adjusting the amount of excreted acids and reabsorbed bicarbonate. Renal regulation is slower; it usually takes days to respond to pH disturbances.

Renal regulation: Although all of the plasma bicarbonate is filtered in the glomerulus during the first step of urine formation, virtually ALL of it is REabsorbed BACK into the blood. Most of this reabsorption happens in the proximal tubule. The amount of reabsorbed bicarbonate in the proximal tubule is regulated, via a number of mechanisms, in response to changes in blood pH. It increases during acid loads and decreases during alkali loads. While the proximal tubule basically RETURNS FILTERED bicarbonate back to the blood, the downstream collecting duct generates NEW bicarbonate by ACTIVELY SECRETING acids. As protons are depleted from the distal tubular cells, the equation shifts to the right, producing MORE bicarbonate which then exits into the blood. Hydrogen ions secreted into the lumen combine with urinary buffers, mainly filtered phosphate, and ammonia, to be excreted in urine. The ammonia buffering system is particularly important because unlike phosphate, which is filtered in FIXED amounts from the plasma and can be depleted during high acid loads, ammonia production is regulated in response to changes in acidity and its concentration may increase several folds when necessary. Blood pH is the main regulator of acid excretion, but potassium, chloride concentrations and several hormones also play important roles.

Pathologic changes may cause acid-base disturbances. Acidosis refers to a process that causes increased acidity, while alkalosis refers to one that causes increased alkalinity. It’s not uncommon for a patient to have several processes going on at once, some of them in opposite directions. The resulting plasma pH may be normal; too acidic, called acidemia; or too basic, called alkalemia.

Acidosis may result from INadequate function of the lungs which causes arterial carbon dioxide to accumulate. This is RESPIRATORY acidosis. On the other hand, METABOLIC acidosis may result from excessive production of metabolic acids, DEcreased ability of the kidneys to excrete acids, ingestion of acids, or loss of alkali. Metabolic acidosis is characterized by primary DEcrease in plasma bicarbonate.

Alkalosis can also be either respiratory or metabolic. Respiratory alkalosis is caused by INcreased ventilation resulting in excessive exhalation of carbon dioxide. Metabolic alkalosis can result from excess loss of acids through the kidneys or gastrointestinal tract, bicarbonate retention, or ingestion of alkali. Metabolic alkalosis is characterized by primary increase in plasma bicarbonate.

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Formation of Urine – Nephron Function, with Animation.

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The kidneys filter blood plasma, removing metabolic wastes, toxins from the body and excrete them in the form of urine. During this process, they also maintain constant volume and composition of the blood, or homeostasis.
Blood enters the kidney via the renal artery, which divides to smaller arteries and finally arterioles. The arterioles get into contact with functional units of the kidney called nephrons. This is where blood filtration and urine formation take place. The filtered blood is then collected in to a series of larger veins and exits the kidney through the renal vein. The urine is collected in collecting ducts and leaves the kidney via the ureters.
Each kidney contains over a million nephrons. A nephron consists of 2 major parts: a capsule known as glomerular capsule, or Bowman’s capsule; and a long renal tubule. Renal tubules of several nephrons connect to a common collecting duct.
There are 3 steps in the formation of urine:
– glomerular filtration takes place in the Bowman’s capsule
– tubular re-absorption and secretion occur in the renal tubule
– water conservation happens in the collecting duct
Blood enters the Bowman’s capsule via the afferent arteriole, passes through a ball of capillaries called the glomerulus, and leaves via the efferent arteriole. The afferent arteriole is significantly larger than the efferent arteriole, creating a blood flow with a large inlet and small outlet. As a result, the blood hydrostatic pressure in these capillaries is much higher than normal. Hydrostatic and osmotic pressures drive water and solutes from blood plasma through a filtration membrane into the capsular space of nephron. The filtration membrane acts like a sieve allowing only small molecules to pass through. These include water, inorganic ions, glucose, amino acids and various metabolic wastes such as urea and creatinine. This fluid is called glomerular filtrate. The amount of filtrate produced per minute is called glomerular filtration rate, or GFR. The GFR is kept at a stable value by several feedback mechanisms within the kidneys. This is known as renal autoregulation. The GFR is also under sympathetic and hormonal control. GFR control is generally achieved by constriction or dilation of the afferent arteriole, which causes the glomerular blood pressure to fall or rise, respectively.
In a healthy person, the total filtrate volume amounts between 150 and 180 litters a day. However, only about 1% of this is excreted as urine, the rest 99% is re-absorbed back to the blood as the filtrate flows through the long renal tubule. This is possible because the efferent arteriole, after exiting the Bowman’s capsule, branches out to form a network of capillaries, known as peri-tubular capillaries, which surround the renal tubule.
The first part of the renal tubule – the proximal convoluted tubule, re-absorbs about two thirds of the filtrate. In this process, water and solutes are driven through the epithelial cells that line the tubule into the extracellular space. They are then taken up by the peritubular capillaries. Sodium re-absorption is most important, as it creates osmotic pressure that drives water and electrical gradient that drives negatively charged ions. Sodium level inside the epithelial cells is kept low thanks to the sodium-potassium pumps that constantly pump sodium ions out into the extracellular space. This creates a concentration gradient that favors sodium diffusion from tubular fluid into the cells. Sodium is absorbed by symport proteins that also bind glucose and some other solutes. Nearly all glucose and amino acids are re-absorbed back to the blood at this stage. About half of nitrogenous wastes also re-absorbs back to the bloodstream. The kidneys reduce the blood levels of metabolic wastes to a safe amount, but do not completely eliminate them. Some of the re-absorption also occurs by the paracellular route through tight junctions between the epithelial cells.
At the same time, tubular secretion, where additional wastes, drugs and other solutes leave the bloodstream to join the tubular fluid, also takes place.
The processes of re-absorption and secretion continue in the nephron loop – the loop of Henle, and the distal convoluted tubule. However, these parts of the tubule also have some other important functions.
The main function of the loop of Henle is to create and maintain an osmolarity gradient in the medulla that enables the collecting ducts to concentrate urine at a later stage. The ascending limb of the loop actively pumps sodium out making the medulla “salty”. The descending limp of the loop is permeable to water but much less to sodium. As the water exits the tubule by osmosis, the filtrate gets more and more concentrated as it reaches the bottom. The ascending limb, on the other hand, is permeable to ions but not water. As a result, the filtrate loses sodium as it goes up and becomes more diluted at the top of the loop. The medulla is in equilibrium with the loop and hence has the same salinity gradient – saltier at the bottom.
Re-absorption and secretion in the distal convoluted tubule are under control of various hormones. This is how the kidney respond to the body’s needs and adjust the composition of urine accordingly.
The collecting duct receives tubular fluid from several nephrons. The main function of the collecting duct is to concentrate urine and therefore conserve water. This is made possible by the osmolarity gradient generated by the loop of Henle. As it gets saltier deep in the medulla, the filtrate loses more and more water as it flows down the collecting duct. The collecting duct is also under hormonal control so it can adjust the amount of re-absorbed water accordingly to the body’s state of hydration. For example, when the body is dehydrated, more water is re-absorbed back to the blood and the small volume of excreted urine is more concentrated.

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Infecção do Trato Urinário, com Animação.

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A infecção do trato urinário, ou ITU, é uma infecção em qualquer parte do sistema urinário – os rins, ureteres, bexiga e uretra.
Uma infecção da uretra, ou uretrite, pode causar sensação de queimação ao urinar e corrimento esbranquiçado. A infecção da bexiga, ou cistite, pode resultar em dor pélvica, aumento da frequência urinária, dor ao urinar e sangue na urina. Uma infecção renal, ou pielonefrite aguda, podem causar dor nas costas (possivelmente apenas em um lado), febre alta, calafrios e náuseas.
ITUs ocorrem tipicamente quando a bactéria entra no trato urinário através da uretra e multiplica-se na bexiga. Mais comumente, essas bactérias vêm a partir do trato digestivo, através das fezes. ITUs são mais comuns em mulheres devido à sua anatomia. Especificamente, a curta distância do ânus para a abertura da uretra e da bexiga, tornando mais fácil para as bactérias atingirem o sistema urinário a partir do trato digestivo. É por isso que a maioria das ITUs ocorrem, principalmente, em mulheres e afetam a bexiga e a uretra.
Outras bactérias podem ser trazidas com o contato sexual. As mulheres que usam certos tipos de controle de natalidade, como diafragmas ou agentes espermicidas, apresentam maior risco. A deficiência hormonal, durante a menopausa, também torna as mulheres mais vulneráveis à infecção.
Infecção apenas na bexiga pode ser facilmente tratada com antibióticos. No entanto, se não for tratada, uma infecção do trato urinário inferior podem espalhar-se para os rins, tornando-se mais perigosa. Uma infecção renal pode resultar em danos permanentes nos rins. Em casos raros, a infecção também pode se espalhar para a corrente sanguínea, podendo ser fatal.
Infecções do trato urinário podem ser evitadas seguindo os seguintes passos:
• Beber bastante líquidos – pois, aumentará a frequência urinária para expulsar as bactérias.
• Limpar da frente para trás depois de uma evacuação – isso ajuda a impedir que as bactérias nas fezes se espalhem para a uretra.
• Esvaziar a bexiga logo após a relação sexual para expulsar as bactérias.
• Evitar produtos femininos que podem irritar a uretra, como duchas e pós.
• Evitar diafragmas e espermicidas como métodos de controle de natalidade.

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Urinary Tract Infections, with Animation.

This video can be licensed on Alila Medical Media website. Click HERE!


A urinary tract infection, or UTI, is an infection in any part of the urinary system — the kidneys, ureters, bladder and urethra.

Symtomps:

An infection of the urethra, or urethritis, may cause burning sensation when urinating and cloudy discharge. A bladder infection, or cystitis, may result in pelvic pain, frequent, painful urination, and blood in urine. A kidney infection, or acute pyelonephritis, may cause back pain (possibly only on one side), high fever, chills and nausea.

Causes and Risk Factors:

UTIs typically occur when bacteria enter the urinary tract through the urethra and multiply in the bladder. Most commonly, these bacteria come from the digestive tract through fecal matter. UTIs are more common in women because of their anatomy. Specifically, the short distance from the anus to the opening of the urethra and bladder makes it easier for the bacteria from the digestive tract to reach the urinary system. This is why the most common UTIs occur mainly in women and affect the bladder and urethra.
Other bacteria may be brought over with sexual contact. Women who use certain types of birth control such as diaphragms or spermicidal agents are more at risk. Hormonal deficiency during menopause also makes women more vulnerable to infection.

Treatment and Complications:

Infection limited to the bladder can be easily treated with antibiotics. However, if left untreated, a lower urinary tract infection may spread up to the kidneys where it becomes more dangerous. A kidney infection may result in permanent kidney damage. In rare cases, an infection may also spread to the bloodstream and can be life threatening.

Prevention:

Urinary tract infections can be prevented following these steps:
– Drink plenty of fluids – to flush out bacteria more frequently.
– Wipe from front to back after a bowel movement – this helps prevent bacteria in stools from spreading to the urethra.
– Empty the bladder soon after intercourse to flush bacteria.
– Avoid feminine products such as douches and powders, which could irritate the urethra.
– Avoid diaphragms and spermicides as birth control methods

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Hiperplasia Prostática Benigna (HPB) y Tratamientos, con Animación.

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La próstata es una glándula exocrina del tamaño de una nuez del sistema reproductor masculino. Está localizada justo debajo de la vejiga urinaria donde se envuelve alrededor de la primera parte de la uretra masculina. La glándula prostática produce un fluido lechoso que es expulsado dentro de la uretra para mezclarse con los espermatozoides durante la eyaculación. El fluido sirve como lubricante y nutrimento para los espermatozoides.
La hiperplasia prostática benigna, HPB, también llamada hipertrofia prostática benigna o agrandamiento de la próstata, es una condición en la que el tamaño de la glándula prostática está incrementado. Es considerada “benigna” porque no es un cáncer, y no incrementa el riesgo de cáncer. Sin embargo, cuando se hace suficientemente grande, el tejido prostático puede comprimir la uretra y bloquear el flujo de orina causando una serie de problemas de micción e infección del tracto urinario.
La HPB es muy común en hombres a medida que envejecen: aproximadamente el 50% de los hombres presentan cierto grado de HPB a la edad cercana a los 60 años, donde la mitad de ellos demuestran síntomas clínicos significativos. La HPB es un resultado de los cambios hormonales y es considerada una parte normal del envejecimiento masculino. En el tejido prostático que está envejeciendo, la tasa de proliferación celular inducido por las hormonas masculinas de alguna forma excede la tasa de la muerte celular programada o apoptosis. Esto resulta en un aumento en el número de células y el agrandamiento de la próstata.
Hay dos clases principales de medicamentos para el tratamiento de la HPB:
– bloqueadores alfa: estos fármacos relajan el músculo liso de la próstata y del cuello de la vejiga, aliviando así la obstrucción del flujo de orina.
– inhibidores de la 5-alfa reductasa: estos inhiben la producción local de dihidrotestosterona o DHT- la hormona responsable del agrandamiento de la próstata.
Para aquellos que no responden a la medicación, hay tratamientos mínimamente invasivos disponibles. Estas terapias no quirúrgicas usan calor para causar la muerte celular o necrosis en el tejido prostático. El calor es suministrado en pequeña cantidad y a una zona específica para minimizar el daño no deseado. Diferentes procedimientos difieren principalmente en el tipo de energía utilizada.
La resección transuretral de la próstata es un procedimiento quirúrgico para remover el tejido prostático a través de la uretra. Este procedimiento ha estado disponible durante mucho tiempo y todavía es considerado estándar de oro para el tratamiento de HPB severa. En la actualidad, generalmente se realiza cuando los medicamentos y métodos menos invasivos fallan.

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Hiperplasia Prostática Benigna (HPB) e Tratamentos, com Animação..

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A próstata é uma glândula exócrina do sistema reprodutivo masculino do tamanho de uma noz. Ela está localizada logo abaixo da bexiga urinária e envolve a primeira parte da uretra masculina. A próstata produz um fluido leitoso que é secretado no interior da uretra, misturando-se com os espermatozoides durante a ejaculação. O fluido prostático tem a função de lubrificar e nutrir os espermatozoides.
A hiperplasia prostática benigna, ou HPB, também chamada hipertrofia prostática benigna, é uma condição na qual há aumento no tamanho da glândula da próstata. É considerada benigna, porque não é um câncer e não aumenta o risco de câncer. No entanto, quando se torna suficientemente grande, o tecido da próstata pode comprimir a uretra e bloquear o fluxo de urina, causando diversos problemas de micção e infecção do trato urinário.
HPB se torna muito comum à medida que o homem envelhece: cerca de 50% dos homens com 60 anos têm algum grau de HPB, metade deles demonstram sintomas clinicamente significativos. A HPB é resultado de alterações hormonais e é considerada uma parte normal do envelhecimento masculino. No envelhecimento dos tecidos da próstata, a taxa de proliferação celular, induzida por hormônios sexuais masculino, de alguma forma, ultrapassa a taxa de morte celular programada ou apoptose. Isso resulta em um aumento do número de células e a hipertrofia da próstata.
Existem duas classes principais de medicamentos para o tratamento de HPB:
– bloqueadores alfa-adrenérgicos: essas drogas relaxam o músculo liso na próstata e no colo da bexiga, aliviando o bloqueio do fluxo urinário.
– Inibidores da 5-alfa redutase: inibem a produção local de dihidrotestosterona ou DHT- o hormônio que é responsável pelo aumento da próstata.
Para aqueles que não respondem à medicação, tratamentos minimamente invasivos estão disponíveis. Esses tratamentos não cirúrgicos usam calor para causar morte celular ou necrose do tecido da próstata. O calor é fornecido em pequena quantidade e a um local específico para minimizar danos indesejados. Diferentes processos diferem, principalmente, pelo tipo de energia utilizada.
Ressecção transuretral da próstata é um procedimento cirúrgico para a remoção do tecido prostático, através da uretra. Esse procedimento tem sido empregado a um longo tempo e ainda é considerado padrão-ouro para o tratamento da HPB grave. Hoje em dia, geralmente, é realizado quando os medicamentos e métodos menos invasivos falham.

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Treatment for UI in women

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Treatment for UI in women

Treatment depends on the type of incontinence and severity of symptoms. For most people, simple lifestyle changes may be sufficient, for others, medication would be necessary. Finally some women may require surgery to treat the condition.

1. Lifestyle changes and physical exercises


– Limit fluid intake at certain times of the day (such as before going to bed or before a long trip). However, note should be taken to increase fiber content in your meals to prevent constipation.
– Cut down on caffeine, alcohol, keep a healthy weight.
– Try pelvic floor muscle exercises such as Kegel exercises. This is to strengthen the muscles that support your bladder and is particularly recommended after childbirth.
– Timed voiding or bladder training therapy : plan regular trips to the bathroom at set times of the day, gradually increase the interval between trips as you gain control.
– Keep a bladder diary: record the times of incidents to help your doctor identify the best treatment for your case.
– Small leakage can be managed by wearing menstrual pads.
Female reproductive organs labeled.

Fig.1: Female urinary and reproductive organs, median section, side view. Note the pelvic floor muscles that support the urinary bladder and the uterus. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing. 

 

 

2. Medication

– anticholinergics: these act on nerves to block bladder spasms in overactive bladder, for treatment of urge incontinence.
– estrogen: applied as a cream or patch can help to tone muscles and tissue around the urethra to keep it closed. This is a treatment for stress incontinence.
– some medicines used for treatment of other conditions such as high blood pressure or edema may have adverse effect on your bladder, talk to your doctor to find an optimal solution for your case.

3. Non-surgical therapies

pessary: a medical device in the shape of a ring that can be inserted into your vagina to lift up the bladder. This helps if your condition is due to a prolapsed (dropped) bladder or uterus. The ring would need to be taken out and cleaned regularly.
bulking agents injections: bulking materials such as collagen and carbon-coated beads are injected into the area surrounding the urethra to support and keep it closed. It’s a minimal invasive procedure but usually has to be repeated to be effective in the long term.

4. Surgery

Surgical procedures include:
Sacral nerve stimulation: treatment for overactive bladder that does not response to medication. A small pulse generator device is implanted under the skin of the buttock, the device sends mild electrical impulses to the sacral nerve (the nerve that controls bladder activity) to moderate and control bladder spasms.
– A variety of procedures available to create an artificial support for the bladder neck and/or urethral sphincters: bladder suspension, sling procedures. These usually involve tightening of the bladder  neck and/or urethra to strong ligaments within the pelvis or to the pubic bones. 

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Urinary Incontinence in Women

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Urinary incontinence (UI) is twice more common in women than in men. About one out of three women over the age of 60 is estimated to be incontinent. Pregnancy, childbirth, hormonal changes during menopause, and anatomy of the urinary tract account for this difference.

Urinary incontinence is involuntary leakage of urine. Urine is produced in the kidneys and stored in urinary bladder. Urination is the process of emptying the bladder through the urethra that connects the urinary bladder to the external urethral orifice. There are two sphincters (valves) that keep the urethra closed to prevent leak: internal urethral sphincter located at the neck of the bladder, and external urethral sphincter located right above the external urethral orifice and is supported by the pelvic floor muscles (See Fig. 1). The urethra is much shorter in women than in men.

Urinary organs in female, labeled.
Fig.1: Anatomy of female urinary organs. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

 

 

 

 

When the bladder is full, stretch receptors in the wall of the bladder send a signal to the spinal cord and the brain. At times when it’s not appropriate to urinate, the brain sends back an inhibitory signal to keep the sphincters closed and prevent voiding. When you wish to urinate, this inhibition is removed, the spinal cord instructs the muscle of the bladder (detrusor muscle) to contract and the sphincters to open to let the urine out (Fig. 2).

Below is a narrated animation of neural control of micturition. Click here to license this video and/or other urinary system related videos on Alila Medical Media website.

Neural control of micturition, labeled.
Fig.2: Neural control of urine voiding. Sensory nerve sends the signal from the full bladder to the nervous system; motor nerve brings instruction from the nervous system to the muscles. See text for more details. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing. 

 

 

 

 

Causes of urinary incontinence 

– Problems with the nervous system: stroke, multiple sclerosis, Pakinson’ s disease and spinal cord injuries may affect the neural control loop illustrated in Fig.2 and cause incontinence.
– Weakness of sphincters, or lack of support from underneath muscles (muscles of the pelvic floor) making the sphincters weak so they can not close properly.
– Blocked or narrowed urethra, weakness of bladder muscles: bladder can not empty, urine builds up and leaks.
Female reproductive organs labeled.

Fig.3: Female urinary and reproductive organs, median section, side view. Note the pelvic floor muscles that support the urinary bladder and the uterus. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing. 

 

 

Types of urinary incontinence in women and typical cause of each type.

1. Stress incontinence: small amount of urine leakage while sneezing, coughing, laughing or any activity that creates abdominal pressure on the bladder. This usually occurs because the muscles underneath the bladder (pelvic floor muscles) are weakened and can no longer support it  (Fig. 3 and 4). In women, this typically happens as a result of pregnancy, childbirth during which these muscles are overstretched. Stress incontinence symptoms usually worsen during certain times in the menstrual cycle when your estrogen level is low. Incidents are also increased following menopause. This is by far the most common type of incontinence in women.

Stress urinary incontinence
Fig.4: Stress urinary incontinence in women. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing. 

 

 

 

 

Below is a narrated animation of stress urinary incontinence. Click here to license this video (and other related videos) on Alila Medical Media website.

2. Urge incontinence: need to void that can not be deferred, inability to hold resulting in sudden loss of a large amount of urine. This is commonly caused by overactive bladder, a condition in which muscles in the wall of the bladder contract in an uncontrollable manner. The reason why this happens is unclear but it’s likely to involve problems in the nervous system.
3. Overflow incontinence
constant dribbling of urine. This happens when the bladder does not empty properly while voiding making it almost always full and urine overflows. This is due to weak detrusor muscle in the bladder wall or a blocked/narrowed urethra. This type of incontinence is rare in women.

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Urinary Incontinence in Men (continued)


 PREVIOUS PAGE: Anatomy, Types and Causes of Incontinence in Men  

Treatment for UI in men
Treatment depends on the type of incontinence and severity of symptoms. For some people, simple lifestyle changes may be sufficient, for others, medication would be necessary. Finally some men may require surgery to treat the condition.

1. Lifestyle changes
– Limit fluid intake at certain times of the day (such as before going to bed or before a long trip). However, note should be taken to increase fiber content in your meals to prevent constipation.
– Cut down on caffeine, alcohol, keep a healthy weight.
– Try pelvic floor muscle exercises such as Kegel exercises. This is to strengthen the muscles that support your bladder.
Timed voiding or bladder training therapy : plan regular trips to the bathroom at set times of the day, gradually increase the interval between trips as you gain control.

2. Medication
Depending on the cause of incontinence the following types of drugs maybe prescribed:
– Alpha-blockers and/or 5-alpha reductase inhibitors: for treatment of enlarged prostate (BPH). Click on the link to read more about BPH and mechanism of action of these drugs.
– Imipramine, antispasmodics : these act on nerves to block bladder spasms in overactive bladder.

3. Surgery
Surgical procedures include:
– Implantation of artificial sphincter: this is performed when weak sphincter is the source of problem.
Man sling : implementation of an artificial support for the urethra. This is usually recommended for those who have had their prostate gland previously removed.
Urinary diversion: bypass of the bladder and urethra altogether. In this procedure, a reservoir is made to collect urine directly from the ureters and urine is emptied through an opening in the abdominal wall into a bag. This is performed when other methods fail.
– other procedures (non-surgical and surgical) for treatment of enlarged prostate, see the main article on prostate hypertrophy for more details.

Transurethral microwave thermotherapy
Fig. 1 : Transurethral microwave thermotherapy (TUMT) for treatment of enlarged prostate (BPH) incontinence in male. A catheter containing a microwave antenna is inserted through the urethra, a balloon is inflated at the end to keep the catheter in place. The antenna is heating the tissue of the prostate to destroy it. Cooled water is circulating in the wall of the catheter to keep the surface of the urethra safe from heating. See the main article about BPH for more details. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

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Urinary Incontinence in Men

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Urinary incontinence (UI) is involuntary leakage of urine. Urine is produced in the kidneys and stored in urinary bladder. Urination is the process of emptying the bladder through the urethra that connects the urinary bladder to the external urethral orifice. There are two sphincters (valves) that keep the urethra closed to prevent leak: internal urethral sphincter located at the neck of the bladder, and external urethral sphincter located below the prostate gland and is supported by the pelvic floor muscles (See Fig. 1).

Click here to see an animation of male urinary system on Alila Medical Media website where the video is also available for licensing.

Urinary system in male, labeled.
Fig.1: Anatomy of male urinary organs. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

 

 

 

 

When the bladder is full, stretch receptors in the wall of the bladder send a signal to the spinal cord and the brain. At times when it’s not appropriate to urinate, the brain sends back an inhibitory signal to keep the sphincters closed and prevent voiding. When you wish to urinate, this inhibition is removed, the spinal cord instructs the muscle of the bladder (detrusor muscle) to contract and the sphincters to open to let the urine out (Fig. 2).

Click here to see an animation of micturition (urination) control  on Alila Medical Media website where the video is also available for licensing.

Neural control of micturition, labeled.
Fig.2: Neural control of urine voiding. Sensory nerve sends the signal from the full bladder to the nervous system; motor nerve brings instruction from the nervous system to the muscles. See text for more details. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing. 

 

 

 

 

Causes of urinary incontinence

Problems with the nervous system: stroke, multiple sclerosis, Pakinson’ s disease and spinal cord injuries may affect the neural control loop illustrated in Fig.2 and cause incontinence.
Weakness of sphincters, or lack of support from underneath muscles (muscles of the pelvic floor) making the sphincters weak so they can not close properly.
Blocked or narrowed urethra, weakness of bladder muscles: bladder can not empty, urine builds up and leaks.

Types of urinary incontinence in men and typical cause of each type

1. Stress incontinence: urine leakage while sneezing, coughing, laughing or any activity that creates abdominal pressure on the bladder. This usually occurs because the muscles or tissues underneath the bladder are weakened and can no longer support it. In men, this typically happens after the prostate gland is removed for reasons such as prostate cancer.
2. Urge incontinence: need to void that can not be deferred, inability to hold. This is commonly caused by overactive bladder, a condition in which muscles in the wall of the bladder contract in an uncontrollable manner. The reason why this happens is unclear but it’s likely to involve problems in the nervous system.
3. Overflow incontinence:  constant dribbling of urine. This happens when the bladder does not empty properly while voiding making it almost always full and urine overflows. This is due to weak detrusor muscle in the bladder wall or a blocked/narrowed urethra. In men, the major cause for this type of incontinence is a condition called enlarged prostate or benign prostate hyperplasia (BPH) . Click on the link to read more about this condition.

Urinary incontinence in men
Fig.3: Types of urinary incontinence in men and typical cause in each case. The prostate gland (orange color) is located under the bladder where it wraps around the first part of the urethra. See text for more details. Click on image to see a larger version on Alila Medical Media website where the image is also available for licensing.

 

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