|MadSci Network: Medicine|
Below you will find the answer to your question. http://cpmcnet.columbia.edu/texts/guide/hmg10_0004.html CYSTITIS DEFINITION Cystitis is inflammation of the urinary bladder. Because the bladder is located completely within the body, it normally is not subject to external bacterial infection: Its lining is resistant to the development of infections and the urine is normally sterile. However, the bladder drains externally via the urethra, whose opening (especially in women) is a breeding ground for bacteria that can, under certain circumstances, travel up to the bladder. CAUSE Cystitis in men most often results from an abnormality, such as prostate enlargement, stone disease, or the retention of large amounts of residual urine in the bladder after urination. (Women, however, are especially prone to cystitis even without anatomic abnormality because the short female urethra allows bacteria more ready access to the bladder.) DIAGNOSIS Symptoms of cystitis include frequency of urination and dysuria; the urine may be cloudy, foul smelling, and occasionally bloody. There may also be lower abdominal pain and slight fever. Finding pus in the urine (discovered during urine analysis), or culturing bacteria from the urine, confirms cystitis. Cystoscopy can also be used to examine infection in the bladder. TREATMENT Although antibiotics usually control the bacterial infection, it is apt to recur if the underlying cause is not diagnosed and treated. PREVENTION Sometimes urinary tract infections can be prevented by drinking acidic fluids such as cranberry juice; urinating to completion as the need is felt; and maintaining personal hygiene. URETHRITIS DEFINITION Urethritis is an inflammation of the urethra generally associated with a urethral discharge that may vary in color and consistency from thin and clear to thick and creamy yellow. The major symptoms are urinary frequency and pain on urination or ejaculation. CAUSE Urethritis may be due to nonspecific irritants or infections such as sexually transmitted diseases like gonorrhea and chlamydia. DIAGNOSIS Gonorrhea organisms are relatively easy to identify with culture techniques. Chlamydia, an organism more difficult to identify, is the most likely cause of nongonococcal (nongonorrheal) urethritis. TREATMENT Antibiotics are used to treat urethritis. Generally the symptoms disappear promptly, but since urethritis can be sexually transmitted, the patient's sex partner may require treatment as well. Occasionally, urethritis will be persistent and troublesome to treat, and may cause urethral scarring and stricture. (See box preceding.) PREVENTION When due to sexually transmitted infection, urethritis may be prevented by maintaining a mutually monogamous sexual relationship or by the proper and consistent use of condoms. URETHRAL STRICTURE Injury or chronic urethritis may result in scar tissue, which can narrow or, in extreme cases, obstruct the urethra, making urination increasingly difficult and painful. Stricture may be treated by dilation: The urologist inserts a thin, fle xible instrument into the urethra to stretch it. The frequency of this treatment varies from patient to patient; however, most strictures do recur. The area of stricture may also be sharply incised using a cystoscope in an attempt to reduce the blockage. This approach is less traumatic than dilation and may be more successful in preventing recurrence of the narrowing. Lasers have not been proven more effective in treating urethral strictures than other therapies. Sometimes strictures are so extensive or unresponsive to dilation or incisional therapy that formal reconstructive surgery is required. STONE DISEASE DEFINITION Urinary tract stones may form from the various inorganic minerals that under certain conditions can settle out (precipitate) of urine. Most commonly, a urinary tract stone makes its presence known with the sudden onset of excruciating pain that may result from the stone passing out of the kidney to the bladder. If the stone is in the kidney or ureter, the pain may begin in the flank region and move along the urinary tract to the anterior lower abdomen or, in men, to the tip of the penis. The pain is sharp and colicky (coming in waves) and often associated with profuse sweating, nausea, and vomiting, and sometimes with blood in the urine. Fever does not usually accompany the passage of a stone unless there is a concurrent urinary tract infection. CAUSE There are many causes of stones. In some cases, anatomical abnormalities lead to the pooling (stasis) of urine, resulting in the precipitation of various organic and inorganic compounds and stone formation. Stones can also result from urinary tract infections, which change the acidity or alkalinity (pH) of the urine, and various metabolic abnormalities. Quite often, no cause of the stone formation can be identified. (See chapter 27 for more information on stone formation.) DIAGNOSIS The medical evaluation for urinary tract stones depends on the age of the patient and the size and number of stones. Passage of a stone during childhood or early adulthood, a family history of stone disease, or previous history of a stone passage should lead to a thorough anatomic, as well as metabolic, evaluation. Anatomic evaluation may include an intravenous pyelogram (special x-rays of the kidneys and ureters); metabolic evaluation may include blood chemistry analysis, 24-hour urine collection studies, and perhaps special test diets. TREATMENT If the stones are large, totally or significantly obstructing the urinary collecting system, or causing other damage, treatment is required to prevent permanent kidney destruction. Small stones may not cause total obstruction and may be monitored without treatment to see if they pass through the tract spontaneously. Upper Urinary Tract. Traditionally, stones in the upper urinary tract (i.e., the kidney and upper ureter) have been removed by various surgical approaches. A recently developed procedure enables urologists to remove upper tract stones through tubes placed through the flank into the urinary tract (percutaneous stone removal). This new technique avoids large surgical scars, significantly decreases surgical risk, decreases the risk of kidney damage, and decreases postoperative pain and hospitalization. Not all stones, however, can be removed with this technique. Another noninvasive treatment, extracorporeal shock-wave lithotripsy (ESWL)—the "stone bath"—has revolu-tionized the treatment of upper urinary tract stones. Originally the procedure was performed with either general or epidural anesthesia. Currently, with newer equipment, procedures can be performed with intravenous analgesia and sedation. Occasionally, it can be done completely without medication. Depending on the type of ESWL unit used, the patient is placed either into a water bath or onto a water cushion system equipped with a shock-wave generator. The stones are located with x-rays or ultrasound, or both, and fragmented into sand-size particles by focused shock waves, which are then passed easily and painlessly in the urine. Postoperative discomfort is minimal, and many patients can resume normal activity within a day of receiving treatment. In medical centers where ESWL is performed, it can be used successfully on a large percentage of symptomatic patients with upper urinary tract stones. Three months after treatment, 80 percent of patients are free of stones. Because of the extremely low risk and the rapid recovery involved, ESWL is preferred to surgery and other invasive treatments for the removal of urinary stones. A patient's size, weight, and stone burden (i.e., the number and size of the stones) may make this treatment less feasible, however. Furthermore, not all stones are amenable to ESWL, and percutaneous and surgical techniques may still be required. Lower Urinary Tract. Stones of the lower urinary tract and the bladder can be removed through traditional surgical techniques, as well as with stone basketing. In this technique, either a cystoscope or a ureteroscope is passed into the bladder or through the bladder into the ureter. A basket is attached and used as a snare to engage and extract the stone. Larger stones may be fragmented with ultrasound, shock wave, or laser techniques. PREVENTION Once one has developed a kidney stone, the chance of developing another stone in the future is 50 percent higher than that of someone who has never had a stone. Prevention depends on the type of stone; after passing a stone, it should be saved and brought to a urologist for analysis. Specific recommendations of diet alteration or medication may be made by the urologist depending on the type of stone, the clinical history, and the results of laboratory tests. In general, consuming large volumes of water to dilute the urine helps prevent stones. This is especially important in the summer, when a significant amount of water is lost through sweating, leaving less internal water available for the kidney to produce urine. Concentrated urine is more prone to stone formation. June Wingert Mad Scientist
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