Genito-urinary and kidney conditions

Incontinence

The treatment of urinary incontinence varies according to the type of incontinence, how troubling it is and the patient's general level of fitness. The majority of people with a minor degree of urinary incontinence can be effectively managed in general practice without the need for surgical treatments. Ask your doctor what non-surgical alternatives exist and how long it will be before you can expect to see results.

There are several well established operations used to cure stress incontinence. They are all aimed at assisting the function of the pelvic floor muscles by either lifting the neck of the bladder to help it remain closed or simply supporting it so that it does not leak when it is put under stress by coughing or other sudden increases in pressure inside your abdomen. Ask your doctor about the chances of a complete cure for incontinence in each of these surgeries.

Surgery to treat incontinence is fairly major involving general anaesthetic and a hospital stay. Ask your doctor how long you will be in hospital and off work if you decide to have surgery.

Keyhole surgery is sometimes used to do the same operation. This may reduce your stay in hospital and length of convalescence. Ask your doctor how the results compare with more traditional surgery.

One of the most popular ways to treat incontinence is creating a sling using 'vaginal tape'. The operation is usually performed under local anaesthetic and your stay in hospital and convalescence will be much shorter than for traditional operations. Ask your doctor for information on long-term results or possible later complications.

In many cases incontinence can be managed by changes to your lifestyle. Weight loss is by far the most useful way of preventing problems. Ask your doctor how changes to your diet and daily routine could minimise the problem.

Urinary tract infections and cystitis

The doctor may identify bacteria and red and white blood cells in the urine and prescribe a course of antibiotics. Ask about the side effects and whether any other medication you are taking could interfere with the antibiotics.

Antibiotics usually clear up the infection within days, although in some cases a longer-term dosage is required. Ask your doctor what you can do to prevent recurrence and what other conditions could develop through the prolonged use of antibiotics.

A type of cystitis, called interstitial cystitis, is a debilitating bladder disease. Treatment can range from oral medication to the 'installation' of various solutions into the bladder. Ask your doctor about the pros and cons of all these treatments and which one would best fit into your lifestyle.

Sexually transmitted infections

A number of sexually transmitted infections are easily treated with antibiotics. If untreated, they can spread to other reproductive organs causing serious health problems, including infertility. Ask your doctor about treating your partner to prevent re-infection.

Genital warts are treated with a chemical lotion or cream, freezing them off or removing them by laser treatment or surgery. They do not cause any serious health problems but the virus always remains in the body. Ask your doctor about the slightly increased risks of cervical cancer in women where the wart virus is present.

With genital herpes, the virus always remains in the body and no treatment can remove it completely. Ask your doctor what you can do to avoid triggering an attack.

HIV/AIDS

There is no cure for HIV. However, drugs are available to slow down the damage that HIV does to the immune system. People who are HIV positive can now stay healthy for many years with anti-HIV drugs. Ask your doctor about the part lifestyle can play in prolonging your life expectancy and find out about any clinical trials.

Benign prostate disease

If your symptoms are mild or not very bothersome, your doctor may not prescribe any treatment. Ask your doctor about 'watchful waiting' and regular re-examinations.

Mild to moderate symptoms may be treated with drugs. Two classes of drugs are used. The first work within weeks but may lower blood pressure. The second type, called reductive inhibitors, take longer to work and may have an impact on your sex life. Ask your doctor about possible impact on your sex life and the potential risks to a foetus conceived whilst a man is taking these drugs.

An operation is usually recommended if your symptoms cannot be controlled by drugs or if you have other complications. Some men opt for surgery rather than taking medication. Ask your doctor what the success rate of these operations is.

A surgical procedure, called TURP, which is when the prostate tissue obstructing the urethra is cut away and a catheter is temporarily inserted to drain off the urine. Ask your doctor how long the convalescence period lasts and what side effects you should be aware of.

Another treatment involves making one or two cuts in the bladder neck and prostate to reduce the pressure and make passing urine easier. Ask your doctor how successful this type of surgery is.

Another procedure involves removing part of the prostate through a cut in the lower abdomen. This sort of surgery is very rare. Ask your doctor about scarring and recovery period and the likelihood of needing further treatment in the future.

Almost half of all men will suffer some form of benign enlargement of the prostate gland at some point in their lives. Ask your doctor what lifestyle and dietary changes you could make to minimise the risks of recurrence.

Erectile dysfunction

If lifestyle changes such as stopping smoking, reducing alcohol and reducing stress have failed to result in any improvement you can undergo a series of tests to decide on treatment. Ask your doctor to suggest other changes which could prevent problems (such as changing any prescription medicine).

When psychological factors or difficulties in the man's relationship with his partner are considered a cause for erectile dysfunction, a course of sex or couples therapy might be recommended. Ask your doctor if you can undergo this treatment if necessary and if it can be combined with other forms of treatment.

Several different types of manual devices are available to tackle impotence. They cause blood to be drawn into the penis, which immediately enlarges in a similar way to a natural erection. Once an adequate erection is produced, a tension band is slipped around the base of the penis to maintain the erection. Ask your doctor about the pros and cons of this technique.

Injection therapy involves the patient injecting a drug directly into the shaft of the penis. An erection usually follows within fifteen minutes of the injection. Ask for guidance for both you and your partner on how to administer the drugs and potential side effects.

There are currently four oral drugs licensed for the treatment of erection problems. All four drugs are effective and do not cause an erection unless the man is sexually stimulated. Ask your doctor which is most appropriate for you and your level of sexual activity.

Hormone treatment is used in a small proportion of cases. A testosterone replacement is usually prescribed. Ask your doctor for a test to confirm a testosterone deficiency (if one has not been done) and for information on the potential side effects of hormone treatment.

Splints can be used to treat erection problems. They are inserted surgically in to the penis. Ask your doctor what long-term effect these implants can have.

A few cases, where there are problems with blood-flow into and out of the penis, can be treated by surgery. Ask your doctor about waiting times and success rates for this operation.

Kidney failure

There are a number of known causes of kidney failure. The commonest causes are diabetes, high blood pressure and a painless inflammation of the kidneys, cysts in the kidneys, repeated kidney infections or kidney infections in childhood. Ask your doctor if your cause is one that can be controlled so as to prevent recurrence.

Regular blood tests will be required and treatment with a variety of drugs may be needed. Your treatment may change quite frequently based on the results of your blood tests. You may require dialysis at some time. Ask your doctor what the side effects are of all the different treatments and find out if you have a choice of drugs.

Healthy kidneys play an important part in removing some drugs and medicines from the body. So, when this function is impaired, these drugs will not be effectively removed. This can make it difficult to prescribe medication for the treatment of kidney disease itself. Ask your doctor how your condition will affect the way you are treated for other unrelated illnesses and whether there are any drugs in particular you should avoid.

One of the main effects of kidney failure is fluid overload, when the body fails to get rid of excess fluid. It may eventually contribute to heart disease. If not treated, the excess fluid can settle in the lungs and can be life-threatening. Ask your doctor what your daily recommended fluid intake is and how you can keep thirst under control.

Healthy kidneys produce the hormones needed to make red blood cells, which transport oxygen around the body. In kidney failure, the body cannot make this hormone, leading to anaemia. Hormones can be prescribed to keep the red blood cell count up. Not everyone needs this, however. Ask your doctor if you need hormone treatment, and if you do, ask about the possible side effects.

Most patients are prescribed iron tablets to help counteract anaemia and some people need vitamin supplements, usually vitamin B, sometimes vitamin C and a special form of vitamin D. Vitamins B and C are water-soluble, so they can be lost during dialysis. But excessive amounts of these vitamins can be harmful. Ask your doctor if you should stop taking any over the counter multivitamins and avoid any foods high in certain vitamins.

Constipation can be a problem, particularly for dialysis patients because their fluid intake is so restricted. Ask your doctor if you feel you may require laxatives.

It is possible to restore kidney function through dialysis - an artificial way of getting rid of toxins. How a patient is feeling and blood tests determine when it is necessary to begin dialysis. Some patients do not need to start until some time - occasionally years - after diagnosis. There are two different kinds of dialysis, one where the blood is cleaned outside the body via a machine, and one where the cleaning is done inside the body. Ask your doctor about the different options available, what they involve and which is most appropriate in your case.

You will need training on how to use both forms of dialysis and if you opt for home dialysis the training required will be considerably longer. Ask your doctor which type will fit in best with your lifestyle - i.e the nature of your job, the hours you work and any caring responsibilities you may have.

Not everyone chooses to have a transplant - some prefer dialysis and feel well enough - and there are sometimes medical reasons why a transplant operation is not possible. Ask what the transplant success rate is and if your previous medical history makes you a suitable candidate for a transplant.

The waiting list works on the principle of finding the right patient for the right kidney. So, although the average time spent on the waiting list is two years, it could be much less - or much longer - for you. Ask your doctor what you can do to prepare for a transplant at short notice.

Kidney cancer

If one of the inherited syndromes that increases the risk of kidney cancer runs in your family, you may be offered screening. This means having a scan every year. Further genetic tests may become available in the future. Ask if your family history makes you a candidate for regular screening.

It can be very difficult for GPs to decide who may have a suspected cancer and who may have something much more minor that will go away on its own. But there are particular symptoms that mean your GP should refer you to a specialist straight away. Ask your doctor to talk it through with you and decide together whether you need to see a specialist and if so, how soon.

There are various methods used to test if you have kidney cancer. Ask what the tests involve and how long it will be before you get the results.

Treatment depends on the severity of the cancer. It can range from chemotherapy and radiotherapy to removal of the kidney. Ask your doctor about the benefits and risks of all the treatments deemed suitable in your case and what impact they can have on your lifestyle.

In serious cases the kidney and/or the cancer may need to be removed followed by careful monitoring. Ask what the success rates of this surgery are, whether they outweigh the risks involved and what the follow-up will consist of.

Surgery and treatment can affect people in different ways depending on their age, general health and outlook. Ask your doctor for details of associations that can put you in touch with fellow sufferers.

Kidney cancer can come back despite treatment. Ask if there is anything you can do to improve your chances of remaining in remission and what the next options are should the cancer return.

Bladder cancer

At the moment there is no reliable screening test for bladder cancer. Doctors are looking into whether home testing for blood in the urine would be a reliable test. Testing for blood in the urine would not be a useful screening test for the general population because blood in urine can be caused by other conditions apart from cancer; for example, a urine infection or kidney problems. Ask your doctor if you can have regular check ups if you are considered at particular risk.

Anyone who sees blood in their urine should be examined for bladder cancer. Even if the symptoms go away, ask to be examined.

If you have early stage bladder cancer, you will need to have the tumours in your bladder removed. This is done during an operation, called a cystoscopy, under spinal, epidural or general anaesthetic. Ask your doctor what follow-up treatment will involve and possible side effects are.

Bladder cancer may spread to other parts of the body including the lungs and liver. Ask your doctor about the specific symptoms of cancer spread and what can be done to prevent it.

Advanced bladder cancer can require chemotherapy, radiotherapy or surgery, or a combination of these. It can be difficult to decide which treatment to try. Ask your doctor about the possible effect on your quality of life while having treatment and whether the possible benefits are worth it. Ask if there are any alternatives.

Prostate cancer

Hormone therapy works wherever the cancer is in the body. It does not work indefinitely and is not a cure, but all being well it will keep the cancer in check for some time. Ask what the recurrence rates are and how long it will be before you can say you are cured.

In both locally advanced and advanced prostate cancer, treatment will probably involve hormone therapy, either on its own or in addition to some other treatment. Elderly men with locally advanced prostate cancer may initially be offered monitoring instead of direct treatment. Ask your doctor what treatment you will be eligible for depending on your age and state of health.

When a cancer is aggressive or is locally advanced you may have surgery or radiotherapy plus hormone therapy. Ask your doctor what effect these treatments could have on your general health, sex life and fertility.

Though prostate cancer is unusual because it does not respond well to chemotherapy in the early stages, chemotherapy can still help. Ask your doctor whether it would be useful in your case to delay the cancer's progress.

Whatever treatment you have your progress will be closely monitored. Ask your GP whether you will be able to have your regular tests carried out at the hospital or at the GPs surgery.

Testicular cancer

If ultrasound or blood tests confirm testicular cancer, the affected testicle will usually be removed surgically. Ask your doctor what the success rates are at preventing the cancer from coming back after the testicle has been removed.

In the rare instance that a tumour develops in a man with only one testicle it is sometimes possible to use chemotherapy to avoid losing it but in serious cases surgery is the only option. Ask your doctor about the possibility of inserting an artificial testicle at the time of surgery.

X-rays and scans are then performed to see if the cancer is spreading. If caught early enough, no further treatment may be needed. If it has spread, chemotherapy is usually given for between two and three months. Ask about the side effects on your fertility, sex life and general quality of life.

Being more aware of changes in your testicles are vital to early detection of a recurrence. Ask your doctor how to perform self-examination.

Bladder and kidney stones

There are many ways of removing stones that involve passing a small telescope via the bladder through which a variety of stone disintegrators can be used. Occasionally, a small opening is made directly into the kidney for large stones. But it is very rare for patients to need open surgery. Ask your doctor about the new techniques available and the success rates of each.

A bladder stone can be detected through an x-ray with or without a dye test or ultrasound. It can also be found by cystoscopy- which is when a tube-shaped instrument is inserted into the bladder. Smaller bladder stones can be removed during this examination. When they are bigger, it may be necessary to operate. Ask your doctor how changes to your lifestyle can help prevent them from recurring.

An alternative treatment available in some centres is called lithotripsy. This is when the stone is reduced to smaller fragments by sound energy. Ask what the side effects of this treatment can be.

Repeated bladder or kidney stones can be a factor in developing bladder and kidney cancer. Ask for regular check-ups to ensure early detection.

---

« Back to main menu