A Guide to Common Urological Conditions

By understanding the factors that contribute to urological health issues, individuals can take proactive steps towards prevention, seek timely medical advice, and explore the most effective treatment options available.

Whether you’re seeking to broaden your knowledge for personal health management or to support a loved one facing a urological condition, this article serves as a valuable guide through the complexities of urological health, offering hope and practical solutions for those affected.

Don’t forget that if you’re worried about any symptoms you may have, you can get in touch. Find out more about our urology centre.

Urinary Tract Infections (UTIs)

Urinary Tract Infections (UTIs) occur when bacteria enter the urinary tract through the urethra and begin to multiply. In women, this typically manifests as a bladder infection (cystitis). Untreated this can lead to a kidney infection (pyelonephritis). In men, ascending urinary tract infections can also reach the prostate or testicles causing prostatitis or epidididymorchitis.

UTIs are more common in women primarily because of their anatomy. The short distance from the urethra to the anus and the urethral opening to the bladder makes it easier for bacteria, usually E. coli from the digestive tract, to enter and infect the urinary tract.

UTIs can be a sign there is a problem with the way the urinary tract stores or empties urine, stones, an enlarged prostate, prostate or bladder cancer, and may require further investigation by a urologist.

UTI symptoms

• A strong, persistent urge to urinate
• A burning sensation when urinating
• Passing frequent, small amounts of urine
• Cloudy, dark, bloody, or strange-smelling urine
• Pelvic pain, especially in the centre of the pelvis and around the area of the pubic bone

Treatment options

• Antibiotics are the standard treatment for UTIs guided by the analysis of urine via microscopy and culture.
• In those who are sexually active, we may offer a screen for sexually transmitted infections (STIs)
• Drinking plenty of water to help flush the bacteria from the urinary system.
• Pain relief medication may also be recommended to alleviate the burning sensation during urination.
• Further investigations may well include an ultrasound of the urinary tract, assessment of bladder emptying, flexible cystoscopy
• Uromune UTI Vaccine
• Prescription of urinary antiseptic medication such as methanamine.

How to reduce the chances of developing a UTI

• Wipe from front to back after using the toilet.
• Urinate after sexual intercourse.
• Avoid potentially irritating feminine products.
• Change your birth control method if it’s contributing to recurrent UTIs.

READ: How to prevent a UTI: 19 Do’s and Don’ts

Urinary Incontinence

Urinary incontinence, the involuntary leakage of urine, is a common and often embarrassing problem suffered by at least 30% of the population. The types of urinary incontinence range from leaking urine when you cough or sneeze (stress incontinence) to having an urge to urinate that’s so sudden and strong you don’t get to a toilet in time (urge incontinence). While it occurs more frequently as people get older, urinary incontinence isn’t an inevitable consequence of ageing.

Urinary incontinence can develop due to various reasons, affecting both men and women. Factors include ageing, childbirth, menopause, prostate conditions including prostatectomy and radiotherapy, obesity, neurological disorders including spinal injury, and urinary tract infections. These conditions can weaken the pelvic floor muscles, affect the bladder nerves, or damage the urethral sphincter, reducing support for the bladder and urethra and leading to incontinence.

Symptoms

• Leakage of urine when pressure is exerted on the bladder by coughing, sneezing, laughing, exercising, or lifting heavy objects (stress incontinence).
• Sudden, intense urge to urinate followed by an involuntary loss of urine (urge incontinence).
• Frequent urination and nighttime urination (nocturia).
• The amount of leakage can vary from a few drops to soaking pads, depending on the type of incontinence.
• A vaginal prolapse, in particular, a cystocoele can be associated with both stress and urge incontinence in women.

Treatment options

• Pelvic floor exercises (Kegels) to strengthen the muscles of the pelvic floor can be beneficial for stress and urge incontinence.
• Medications to calm an overactive bladder
• Surgical options for stress incontinence: natural body tissue (autologous) sling procedures bladder neck suspension (colposuspension), urethral bulking or artificial urinary sphincter can provide the necessary support for urethral hypermobility or intrinsic sphincter deficiency and significantly improve leakage or prolapse.
• Non-surgical treatments like pessaries or urethral inserts, particularly for stress incontinence.
• Lifestyle changes, including weight loss, fluid management, and dietary adjustments to reduce bladder irritants.

How to reduce the chances of developing urinary incontinence

• Regularly perform pelvic floor exercises to strengthen the muscles, which can be beneficial for all types of urinary incontinence.
• Maintain a healthy weight to reduce pressure on the bladder and pelvic floor muscles.
• Avoid bladder irritants, such as caffeine and alcohol, which can exacerbate symptoms of urge incontinence.
• Manage chronic conditions, like diabetes and high blood pressure, that can contribute to urinary incontinence.
• Practise good bathroom habits, such as going to the bathroom at regular times to train the bladder, which can help manage urge incontinence.
• Understanding the type and cause of urinary incontinence is crucial for effective management and treatment. If you’re experiencing symptoms of urinary incontinence, consult a healthcare provider for a proper diagnosis and personalised treatment plan.

READ: Urinary incontinence: 5 ways you may be making your symptoms worse

Kidney Stones

Kidney stones are hard deposits made of minerals and salts that form inside the kidneys. They can affect any part of the urinary tract – from the kidneys to the bladder. Often, stones form when the urine becomes concentrated, allowing minerals to crystallise and stick together.

Kidney stones can develop for several reasons, including diet, excess body weight, certain medical conditions, and certain supplements and medications. Lack of water intake can also increase the risk, as it leads to more concentrated urine.

Symptoms

• Severe pain in the side and back, below the ribs
• Pain that radiates to the lower abdomen and groin
• Pain during urination
• Pink, red, or brown urine
• Nausea and vomiting
• Persistent need to urinate, urinating more often than usual, or urinating in small amounts

Treatment options

• Drinking water to pass the stone
• Pain relievers
• Medical therapy to help pass the stone
• Procedures to remove or break up larger stones, such as lithotripsy, ureteroscopy, or percutaneous nephrolithotomy

How to reduce the chances of developing kidney stones

• Stay hydrated, especially if you exercise a lot or live in a hot climate.
• Eat fewer oxalate-rich foods if prone to forming calcium oxalate stones.
• Limit salt and animal protein in your diet.
• Get the calcium you need from food rather than supplements.

Overactive Bladder (OAB)

Overactive Bladder (OAB) is a condition characterised by sudden, involuntary contractions of the bladder muscle, leading to a frequent and urgent need to urinate. This can result in urge incontinence, where there is involuntary loss of urine following an urgent need to urinate.

The exact cause of OAB is unknown, hence the term ‘idiopathic’ detrusor overactivity, but the issue lies with a misfiring within the nerves and muscle within the bladder wall. Factors that may increase the risk include ageing, neurological disorders, diabetes, urinary tract infections, bladder stones, enlarged prostate in men, urethral stricture disease, high-tone non-relaxing sphincter (Fowler’s syndrome) in women, and radiotherapy.

Symptoms

• Frequent urination, usually eight or more times in 24 hours
• Urgency to urinate
• Urge incontinence
• Waking up two or more times in the night to urinate (nocturia)

Treatment options

• Bladder training and exercises
• Medications that relax the bladder
• Nerve stimulation therapies (PTNS, SNS)
• Botox injections into the bladder muscle
• Augmentation Cystoplasty +/- Mitrofanoff formation
• Ileal Conduit

How to reduce the chances of developing an overactive bladder

• Perform pelvic floor exercises to strengthen the muscles that control urination.
• Manage fluid intake to avoid overwhelming the bladder.
• Limit caffeine and alcohol, which can increase urine production and bladder symptoms.
• Maintain a healthy weight to reduce pressure on the bladder.
• See a urologist at the first sign of urinary symptoms.

Interstitial Cystitis (IC)/Painful Bladder Syndrome

Interstitial Cystitis (IC), or Painful Bladder Syndrome, is a chronic condition characterised by bladder pressure, bladder pain, and sometimes pelvic pain. The symptoms vary from person to person and can range from mild to severe. The exact cause of IC is unknown, but it may be related to a defect in the bladder lining, autoimmune response, infection, ketamine or allergy. It’s more common in women than men.

Symptoms

• Chronic pelvic pain
• Blood in the urine (haematuria)
• Pain in the bladder area and sometimes in the genitals
• Frequent urination, often of small amounts, throughout the day and night
• Pain or discomfort while the bladder fills and relief after urinating

Treatment options

• Dietary modifications to avoid trigger foodsOral medications
• Physical therapy
• Bladder instillations
• Pain management techniques
• Botox to the bladder wall
• Sacral nerve stimulation
• In salvage cases, cystectomy or reconstruction of the urinary tract including continent and incontinent urinary diversion.

How to reduce the chances of developing interstitial cystitis

There’s no proven way to prevent IC, but managing stress and avoiding foods or liquids that irritate your bladder may help reduce symptoms.

Haematuria is the presence of red blood cells in the urine, making the urine appear red, pink, or cola-coloured. It can be a sign of various urological or medical conditions, ranging from benign to serious diseases. Up to 20% of patients with painless visible haematuria will have bladder cancer and thus requires urgent referral to a urologist.

Haematuria can develop due to infections or inflammation of the urinary tract or bladder, prostatic enlargement, kidney or bladder stones, intrinsic kidney disease, cancer or the urinary tract including kidney, ureter, bladder and prostate, or after a trauma to the kidneys or urinary tract including radiotherapy.

Symptoms

• Visible blood in the urine (gross haematuria)
• Microscopic haematuria (blood detected through a dip-stick urine test or microscopy)
• In some cases, no other symptoms are present

Treatment options

Treatment for haematuria depends on the underlying cause and thus requires prompt and thorough investigation with imaging (typically ultrasound or CT scan) and a camera test of the urethra and bladder (flexible cystoscopy). It may include antibiotics for infections, medication shock wave therapy or endoscopic surgery for stones, surgery for tumours or other serious conditions.

How to reduce the chances of developing haematuria

• Stay well-hydrated.
• Avoid smoking, as it is a significant risk factor for bladder and kidney cancer.
• Use caution with medications that can cause bleeding, such as anticoagulants.
• Manage chronic conditions like high blood pressure or diabetes that can affect the kidneys.

Bladder Cancer

Bladder cancer starts when cells in the bladder lining begin to grow uncontrollably. It’s more common in older adults and can be detected early since it often causes blood in the urine. The exact cause of bladder cancer is unknown, but risk factors include smoking, exposure to certain chemicals, chronic bladder inflammation, and previous cancer treatment such as radiotherapy.

Symptoms

• Blood in the urine (haematuria)
• Frequent urination
• Painful urination
• Sterile pyuria
• Back or pelvic pain

Treatment options

• Surgical removal of cancer cells – Transurethral resection of Bladder Tumour (TURBT)
• Intravesical chemotherapy for early-stage cancer (Mitomycin, BCG)
• Radical Cystectomy for high-risk or muscle-invasive bladder cancer
• Chemotherapy
• Radiation therapy
• Immunotherapy

How to reduce the chances of developing bladder cancer

• Avoid smoking.
• Limit exposure to chemicals in the workplace.
• Drink plenty of fluids, especially water.
• Eat a diet rich in fruits and vegetables.

Kidney Infections

Kidney infections (pyelonephritis) are usually caused by bacteria that have spread from the bladder to one or both kidneys. Kidney infections typically occur when bacteria enter the urinary tract through the urethra and begin to multiply. They can also occur as a complication of a urinary tract blockage, kidney stones, or from bacteria entering the kidneys through the bloodstream. Kidney Infections are serious conditions that require prompt treatment.

Symptoms

• High fever
• Chills and shaking
• Pain in the side, back, or groin
• Frequent urination
• Strong, persistent urge to urinate
• Cloudy, dark, bloody, or foul-smelling urine
• Nausea and vomiting

Treatment options

• Antibiotics are the primary treatment.
• Hospitalisation may be required for severe infections.
• Pain relievers and fever reducers.
• Prompt investigation of the underlying cause (typically Ultrasound or CT scan, assessment of bladder emptying, cystoscopy)

How to reduce the chances of developing kidney infections

• Practise good personal hygiene.
• Stay hydrated.
• Urinate frequently.
• Treat and prevent UTIs promptly.

Chronic Kidney Disease (CKD)

Chronic Kidney Disease (CKD) is the gradual loss of kidney function over time. Urological causes of CKD are prolonged high pressure within the urinary tract which can include: stones, effect of spinal injury on the bladder (neuropathic bladder), benign prostatic hypertrophy, repeated kidney infections, complex voiding dysfunction, radiotherapy effects on the urinary tract.

Medical causes of CKD can be caused by diabetes, high blood pressure, chronic glomerulonephritis, polycystic kidney disease,. As the disease progresses, waste products can build up in the body, leading to other health problems. Patients on dialysis have the most severe form of CKD and require a kidney transplant. A deterioration in renal function with signs or symptoms within the urinary tract should prompt referral to a urologist.

Symptoms

• Nausea
• Vomiting
• Loss of appetite
• Fatigue and weakness
• Sleep problems
• Changes in urine output
• Decreased mental sharpness
• Swelling of feet and ankles

Treatment options

• Medical causes of CKD are managed by a nephrologist with medications to control symptoms and complication including Changes in diet and lifestyle
• A urologist will investigate for underlying causes within the urinary tract with an assessment for obstruction and bladder function typically involving: Blood and urine tests, Ultrasound, CT
• Scan or MRI scan, urodynamics, cystoscopy, nuclear imaging.

How to reduce the chances of developing chronic kidney disease

• Manage blood sugar and blood pressure.
• Maintain a healthy weight.
• Avoid tobacco and excessive alcohol use.
• Stay hydrated and limit intake of over-the-counter painkillers.
• Ensure you have your kidney function checked along with urine dipstick check for blood, glucose and protein.

Urethral Stricture

Urethral stricture involves a narrowing of the urethra, often resulting from inflammation, injury, or infection. This can lead to reduced urine flow and other urinary problems. Causes include trauma or injury to the urethra or pelvis, infections (especially sexually transmitted infections), procedures involving the urethra, and inflammation.

Symptoms

• Decreased urine stream
• Difficulty starting urination
• Urinary tract infections
• Pain during urination
• Inability to completely empty the bladder

Treatment options

• Urethral dilation including Optilume
• Urethroplasty (surgery to remove the stricture)
• Urinary catheters or stents
• Complex Reconstruction or Diversion

How to reduce the chances of developing urethral stricture

• Practise safe sex to prevent STIs.
• Avoid activities that increase the risk of pelvic injury.
• Seek prompt treatment for UTIs or any signs of urethral infection

If you’re worried about any symptoms you may have, you can get in touch or find out more about our urology centre.