Articles on urinary system

Foreskin Problems in Boys

Dr. Sivasankar Jayakumar, Pediatric Surgeon
Foreskin is the piece of skin that covers the top of the penis. Foreskin problems such as tightness, ballooning, redness are very common. It can affect boys of all ages. Inadequate or incorrect information can cause confusion and anxiety to both patients and parents. This article will help parents to get some understanding on common foreskin problems in boys.Tight Foreskin or PhimosisIn boys, tight foreskin, also called as phimosis is very common. Because of the tightness, Sometimes the foreskin balloons at the time of passing urine. At birth, the foreskin is normally tight (Figure 1). However, as the boys get older, fluid is produced from the undersurface of the foreskin and makes it freely mobile. By the time the boys are around 10 years of age, the foreskin is completely free and mobile. Beyond the age of 10 years,if foreskins are not freely mobile, treatment is usually recommended.Figure 1: Normal tight foreskin    Figure 2: Flower appearanceAlthough tight foreskin is very common in young boys,it can also be seen after infection or inflammation of the foreskin. In a normal tight foreskin (physiological phimosis), pulling the foreskin back will show a flower like pink inner foreskin at the tip, as shown in Figure 2. However, if infection is present (pathological phimosis) the foreskin tip is flat and flower appearance is not seen.Inflamed ForeskinInflammation of the tip of the penis and foreskin (balanitis) are usually caused by chemical irritation, bacterial or fungal infection. The tip of foreskin becomes red, swollen and painful (Figure 3). After some time the inflamed foreskin becomes tight – as shown in Figure 4. Antibiotic and antifungal creams can be applied, along with regular warm sitz (antiseptic) bath and it usually works well.Figure 3: Balanitis         Figure 4: Inflamed & tight foreskin                                                 BXOInfected or inflamed foreskin should always be watched carefully, as they can result in a tight scar formation (BXO -Balanitis xerotica obliterans) (Figure 5). Steroid creams applied over the foreskin may improve the tightness, but not in all patients. In many patients, the tightness comes back immediately after stopping the cream applications. Most patients need circumcision (Removing the foreskin) which will cure the patient.Very rarely, the infection from the tip and head of the penis can spread into the whole penis. The whole penis appears swollen and red (Figure 6)and this condition is called balanoposthitis. Oral antibiotics (tablets and syrup) are usually not enough. Antibiotics given via the veins (intravenous) will reduce the redness and swelling quickly.Figure 5:BXO         Figure 6:Balanoposthitis                                ParaphimosisSometimes boys forget to pull the foreskin forward (back to normal) after cleaning or passing urine. The foreskin becomes red,swollen and appears like a balloon around the head of the penis (Figure 7). This is called paraphimosis and it is an emergency requiring surgery. If noticed early, the foreskin can be gently pulled forward to normal position under anaesthesia, otherwise the foreskin may need to be removed – circumcision.Figure 7: Paraphimosis.   Figure 8:Foreskin cystCysts in the foreskin are very common. The most common cysts are white in color and move along with the foreskin(Figure 8). They are not painful at all but can cause lot of anxiety. The normal fluid produced from the foreskin and glans (smegma) is trapped under the foreskin and forms a cyst. These cysts resolve on its’ own and do not need any surgery.

Bladder Cancer - Risk Factors, Symptoms, Diagnosis

Dr. Anish Kumar Gupta, Andrologist
Risk FactorsLike most cancers, we do not know all the causes of bladder cancer, but there are certain factors which increase the chances of getting bladder cancer.Cigarette, “bidi”and tobacco chewing increases your risk of bladder cancer. In fact, more than half of all bladder cancer cases in India are caused by nicotine. Bladder Cancer develops in smokers 2 to 3 times more than in non-smokers.Long-term exposure to chemicals used to make plastics, paints, textiles, leather and rubber may also cause bladder cancer. Chemicals may cause about 23 out of every 100 bladder cancer cases.Symptoms of Bladder CancerBlood in the urine This is the most Common symptom of bladder cancer, and is generally painless. Not all Blood in urine means bladder cancer. Other commoner reasons are, urinary tract infection or kidney stones. Microscopic amounts of blood might even be normal in some people.Frequent Urination and Pain on Urination (dysuria)Frequent or painful urination is less common. If you have these symptoms, and do not have a urinary tract infection, you should talk to your Urologist to find out if bladder cancer is the cause.DiagnosisThe management of Bladder Tumor falls under the domain of Urology.There is no single test to check for bladder cancer. If you have symptoms of bladder cancer, your doctor may perform 1 or more of the following - History, Examination:This forms the primary part of any consultation with a physician.Urinalysis:  For this test you will have to give a urine sample. You may also be asked to perform urine cytology. Imaging Tests:The urologist may request an Ultrasound scan. A more detailed examination is normally done with a CT Urogram (CT scan focused on the urinary tract). Cystoscopy: For the examination of the inside of the bladder and also to take a biopsy if so required. In most cases you might be asked to take anaesthesia.If tumors are present, the doctor notes their appearance, number, location and size.If initial examination is done under local anesthesia or for only diagnostic purposes, you may be offered a formal Trans Urethral Resection of Bladder Tumor (TURBT). TURBT is done under regional / general anaesthesia and requires hospital stay.Treatment procedures will be covered in subsequent posts.Stop Nicotine Usage, to Prevent Bladder Cancer

Urinary Incontinence - What You Need to know...

Dr. Abhinav Agarwal, Urologist
Urinary incontinence is a health condition in men and women, which causes loss of bladder control. Urinary incontinence usually occurs in cases of medical conditions such as an enlarged prostate, urinary tract infection, Parkinson's disease and diabetes, and may also occur after a prostate surgery. Urinary incontinence is an irritating and embarrassing condition, but with proper treatment, it can be cured.Here are several methods used to treat urinary incontinence:Caffeine, soda, and carbonated drinks cause irritation in the bladder and worsen the symptoms of urinary incontinence. Alcohol is a diuretic and increases the amount of urine too. So abstain from coffee, alcohol, and soft drinks to make a difference.Dietary adjustments are required for the treatment of urinary incontinence. Several spicy and acidic food items can make urinary incontinence worse. Hence, you should avoid having such foods for some time.Urinary incontinence can lead to stress and you must get rid of it for better health. You can try relaxation techniques, such as meditation and breathing exercises. Biofeedback is another option by which you can observe your bladder muscle contractions on a monitor.You should try a behavioral technique known as bladder training. This would require you to urinate every half hour, in spite of not having the urge. Slowly try to increase the time in between the bathroom breaks.You need to flex your muscles to gain control over urinary incontinence. Kegel exercises can be practiced as this boost the strength of your pelvic muscles. You should find the right muscles that are required to stop the passing of gas.Pads and disposable undergarments can be used by men. These help in preventing leaks and also protect the skin from irritation and odor.There are several medicines, which help in the treatment of urinary incontinence. Some of these work to relax muscles for preventing unwanted bladder contractions, while others help in blocking the nerve signals to the bladder. Drugs used for the shrinking of an enlarged prostate may also be used in some cases.Surgery is the ultimate option for the treatment of urinary incontinence. Options include a sling for urinary incontinence. A type of material is wrapped around the urethra for compressing it. Leaks because of coughing, sneezing or laughing are prevented. Artificial sphincter implants may also be used for the treatment of urinary incontinence. A cuff is used in order to close the urethra. Urine is released by squeezing the pump to open the cuff. A device similar to a pacemaker is used to stimulate nerves, which help in relaxing the bladder and pelvic floor.Urinary incontinence is a condition which causes reduced self-confidence. But there are several ways to treat this condition which include home remedies as well as medications and surgery.URINARY INCONTINENCE- TAKING CONTROL OF THE PROBLEM">URINARY INCONTINENCE- TAKING CONTROL OF THE PROBLEM

Diet for Painful Bladder Syndrome

Dr. Anish Kumar Gupta, Andrologist
Painful Bladder Syndrome (PBS) is a chronic health condition that causes pain and pressure in the bladder and pelvic area. It can cause an urgent need to urinate, a frequent need to urinate, or both. Although PBS cannot be cured, it can be treated. Researchers have found there are dietary changes you can make to help manage and avoid flare-ups. Below are just a few examples of foods/beverages that are friendly for such patients and those that are not: FruitsFriendly - Bananas, melons, pears, apples   Avoid - Lemons, limes, oranges, strawberries, pineapple, kiwi fruitVegetablesFriendly - Cucumber, green beans, bell peppers, beans Avoid - Chili peppers, onions, tomato products, picklesMilk/Dairy Friendly - Cheeses, eggs, milk, sherbet / squash (no citrus or chocolate flavors)Avoid - Chocolate ice cream, processed cheeses, soya products, yogurt (lemon, lime, orange or chocolate)BeveragesFriendly - Water, pear juice, milk, tea (peppermint), vanilla milkshakeAvoid - Alcohol, chocolate milkshake, coffee, cranberry juice, soda, tea (regular, green, herbal, iced) tomato juice, sports drinksICN Food ListIf you need help selecting bladder-friendly foods, there's an app for that.  The ICN Food List, available for Android and iPhone, provides a reference guide you can use while shopping and eating out.  The app contains a database with foods divided into three categories: bladder-friendly foods, foods worth trying cautiously and foods to avoid.Happy eating, and have a healthy bladder!

Be Water Wise for Healthy Kidneys

Dr. Deepak Sharma, Nephrologist
Keep your kidneys healthy by being “waterwise.” This means drinking the right amount of water for you. A common misconception is that everyone should drink eight glasses of water per day, but since everyone is different, daily water needs will vary by person. How much water you need is based on differences in age, climate, exercise intensity, as well as states of pregnancy, breastfeeding, and illness.About 60-70% of your body weight is made up of water, and every part of your body needs it to function properly. Water helps the kidneys remove wastes from your blood in the form of urine. Water also helps keep your blood vessels open so that blood can travel freely to your kidneys, and deliver essential nutrients to them. But if you become dehydrated,then it is more difficult for this delivery system to work. Mild dehydration can make you feel tired, and can impair normal bodily functions.Severe dehydration can lead to kidney damage, so it is important to drink enough when you work or exercise very hard, and especially in warm and humid weather.Here are 6 tips to make sure you’re drinking enough water and to keep your kidneys healthy:1.    Eight is great, but not set in stone. There is no hard and fast rule that everyone needs 8 glasses of water a day. This is just a general recommendation based on the fact that we continually lose water from our bodies, and that we need adequate water intake to survive and optimal amounts to thrive. The Institute of Medicine has estimated that men need approximately 13 cups (3 liters) of fluid daily, and that women need approximately 9 cups (2.2 liters) of fluid daily. 2.    Less is more if you have kidney failure (a.k.a. end stage kidney disease). When the kidneys fail, people don’t excrete enough water, if any at all. For those who are receiving dialysis treatment, water must actually be greatly restricted.3.    It’s possible to drink too much water. Though it is not very common for this to happen in the average person, endurance athletes like marathoners may drink large amounts of water and thereby dilute the sodium level in their blood, resulting in a dangerous condition called hyponatremia.4.    Your urine can reveal a lot. For the average person, “water wise” means drinking enough water or other healthy fluids, such as unsweetened juice or low fat milk to quench thirst and to keep your urine light yellow or colorless. When your urine is dark yellow, this indicates that you are dehydrated. You should be making about 1.5 liters of urine daily (about 6 cups).5.    H2O helps prevent kidney stones and UTIs. Kidney stones and urinary tract infections (UTIs) are two common medical conditions that can hurt the kidneys, and for which good hydration is essential. Kidney stones formless easily when there is sufficient water available to prevent stone-forming crystals from sticking together. Water helps dissolve the antibiotics used to treat urinary tract infections, making them more effective. Drinking enough water also helps produce more urine, which helps to flush out infection-causing bacteria.6.    Beware of pills and procedures. Drinking extra water with certain medications or before and after procedures with contrast dye may help prevent kidney damage. Read medication labels and ask questions before undergoing medical procedures involving contrast dyes. Always consult with your healthcare provider first though, especially if you are on a fluid restriction.Remember….when“water wise,” healthy kidneys are the prize!  

Childhood Urinary Tract Infection

Dr. Anish Kumar Gupta, Andrologist
By the time a child is 5 years old, about 8 percent of girls and 1 - 2 percent of boys have had a urinary tract infection (UTI). Bacteria are not normally found in urine. UTIs are more common in girls than boys. Infections are more common in the urethra and bladder, which make up the lower part of the urinary tract. Infections that move up to the kidneys can be more serious. If left untreated, these infections have a risk of leading to kidney failure.Signs and SymptomsSigns of UTI may be difficult to assess in young not toilet trained children.Pain, or burning when urinatingFrequent urination or feeling an increased urge to urinate, even without producing urineFoul-smelling urine that may look cloudy or contain bloodFeverLow back pain or pain in the area of the bladderDiagnosis and TreatmentA sample of urine will be taken for examination. Older children will most often be asked to urinate in a sterile container. Babies and small children in diapers may need a catheter (tube) to collect urine. The catheter keeps the sample from being contaminated by bacteria on the skin. The type of bacteria found may help decide the best drug to treat the UTI, usually antibiotics. It is important to give your child all the antibiotic course, even if he or she is feeling better. Most UTIs will be cured within a week if treated properly. The child should be urged to drink plenty of fluids. If a child has more than one UTI or has fever along with symptoms of UTI, he or she should see a Urologist. A Urologist will see if anything is abnormal in the child’s urinary tract. A common problem causing UTIs in children is a backwards flow of urine,  condition known as VUR.PreventionFrequent diaper changes can help prevent UTIs in babies and small children.When children start toilet training, it is important to teach them good bathroom habits. After each bowel movement, children should wipe from front to rear — not rear to front. When feeling the urge to urinate, children should also avoid “holding it” if they can reach a bathroom. Urine remaining in the bladder gives bacteria a good place to grow.If in doubt, consult a pediatrician or a urologist immediately. 

Ten Preventive Tips for Urinary Tract Infection

Dr. Prashant C Dheerendra, Nephrologist
The urinary tract is comprised of the two kidneys, two ureters, bladder and urethra. An urinary tract infection ('UTI') can involve the bladder ('cystitis') or the kidneys ('pyelonephritis'). Pyelonephritis is a more serious infection than cystitis but thankfully it is less common. Women of reproductive age group are the most susceptible to UTI but no age or gender is immune. The symptoms include frequent urination, burning sensation while passing urine, lower abdominal or pelvic pain in cystitis. High temperature with chills, vomiting and pain over the abdominal flanks are present in pyelonephritis. Some simple steps can help prevent UTIs. 1. Proper toilet hygieneA 'front to back' method of cleaning up after passing stools will avoid the bacteria from rectum getting access to the bladder. It would be prudent not to use a toilet paper twice. 2. Get screened during pregnancyHarmful bacteria may be present in the urinary tract without causing any symptoms during pregnancy. It is a routine practice to screen for bacteria in urine in early pregnancy. A course of antibiotics prescribed by your obstetrician should generally eradicate the bacteria. This will help in preventing more serious infections later in the pregnancy. 3. Prefer sanitary napkins over tampons Tampons might be more friendly towards the infection causing bacteria than sanitary napkins. If one has to use tampons, then remove them before urinating. 4. Don't suppress the urge to urinateThe longer urine lies stagnant in the bladder, the better it is for bacterial growth. On the other hand passing urine every few minutes is impractical. A golden rule is to not suppress the urge to pass urine. Urinating once every 2-3 hours during day should be a reasonable frequency. 5. After sexual intercourseSexual intercourse has the potential to provide the bacteria access to the urinary system. Voiding immediately after intercourse helps 'flush out' the germs that might have gained access. 6. Reconsider contraceptionSome contraceptive methods like diaphragms and spermicidal jellies increase the likelihood of contracting a UTI. Discuss the pros and cons with your doctor if you are using one of these. 7. Use loose garmentsA dry vaginal area is a deterrent to bacterial growth. Tight fitting clothes, undergarments made of non-breathable fabrics promote bacterial growth by increasing moisture in the area. Avoid them ! 8. If post menopausal consider need for estrogen cream Post menopausal status might predispose to bladder infections because of changes in the vaginal skin. Consult your doctor if estrogen creams might benefit you. 9. Cranberry juice is probably helpful Cranberry juice contains chemicals called proanthocyanidins which decrease the stickiness of bacteria to the bladder wall. While not conclusively proven, cranberry juice probably helps prevent UTI in young women. 10. Control blood sugars if you are diabeticDiabetics are one of the groups worst affected by UTIs. The infections can be severe and sometimes life threatening in this particular group. Uncontrolled blood sugar levels over long periods increase the risk of such infections. Meticulous attention to good blood sugar control should decrease the risk significantly. In-spite of above measures sometimes one may get a UTI occasionally. Recognise the symptoms and see your doctor immediately. You will probably need  a short course of antibiotics followed by a reinforcement of the preventive measures!

9 Kidney Damaging Habits

Dr. Richa Garg, Ayurveda
1. Lack of WaterThe kidney’s primary function is detoxification and this is done with the help of water. With insufficient water there is a build-up of toxins in the body, which can affect other functions.2. Excess Salt Salt increases blood pressure which in turn exerts a lot of pressure on your kidneys. Restrict your daily salt intake to around 5 grams a day, which is ideal.3. Restraining UrinationControlling yourself from urinating can increase urine pressure and lead to kidney stones. So be sure to relieve yourself without any delay.4. Excess SugarHigh sugar foods increase the protein content in your system which in turn exerts pressure on your kidneys. Protein amounts in one’s urine is a valid way to check kidney functioning.5. Excess Animal ProteinRed meat in particular increases the metabolic load on your body, especially the kidneys. Regular consumption of red meat can cause dysfunction or failure.6. Lack of SleepSleep deprivation can lead to several health problems including kidney disease. Your body repairs damaged kidney tissue while you sleep, so better sleep means better kidneys.7. Excess CaffeineHigh amounts of caffeine raises blood pressure and exercises the kidneys in excess. Regular consumption of caffeine can cause kidney damage.8. Painkillers They have become a regular in our day to day lives and are used for almost any sort of pain. These pills naturally deteriorate the kidney and liver.9. Alcohol ConsumptionThis legal toxin harshly exercises the kidney and liver so don’t go overboard.