MadSci Network: Medicine

Re: Will anything happen to the bladder or kidneys if urine is held in too long

Date: Wed Jul 25 14:51:50 2001
Posted By: June M. Wingert , RM(NRM),Associate Scientist
Area of science: Medicine
ID: 990291771.Me

  Below you will find the answer to your question.

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. 

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.) 

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. 

Although antibiotics usually control the bacterial infection, it is apt to 
recur if the underlying cause is not diagnosed and treated. 

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 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. 

Urethritis may be due to nonspecific irritants or infections such as 
sexually transmitted diseases like gonorrhea and chlamydia. 

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. 

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.) 

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. 




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 

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.


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. 

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.) 

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. 

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 

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 

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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