Urinary Tract Infection (UTI)
Urodynamic Testing
Sacral Neuromodulation
Urinary Incontinence
Painful Bladder Syndrome
Urinary Tract Infection (UTI)
Urinary Tract Infection (UTI) denotes an infection of any part of your urinary system (kidneys, ureter, bladder and urethra). Most of the infections involve the lower urinary tract, which is the bladder and urethra. Some examples of urinary infections include cystitis (bladder infections), pyelonephritis (kidney infections), prostatitis, urethritis and epididymo-orchitis (testis and epididymis infections).
Causes
UTI’s are usually caused by the person’s own bacteria entering the urinary tract, mostly through the urethra (a place where these bacteria shouldn’t be). The bacteria then multiply in the bladder, and the body responds with an inflammatory reaction, which is what causes most of the symptoms. Women are at greater risk of contracting a UTI compared to men are because women have a shorter urethra. Other risk factors include urinary tract abnormalities, such as being born with an abnormal kidney, blockages in the urinary tract, a suppressed immune system, urinary catheter use or a recent medical procedure.
Symptoms
UTI can present with a variety of symptoms:
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Cystitis typically presents with urinary urgency, a persistent need to urinate and difficulty in deferring urination
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Dysuria, a burning sensation when urinating
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Urinary frequency, the frequent passing of tiny amounts of urine
Other symptoms and signs may include:
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Fever
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Cloudy and/or smelly urine
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Urine that is red, bright pink or cola-coloured — which is a sign of blood in the urine
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Pelvic or bladder pain
Investigating Urinary Tract Infections
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Physical exam and a detailed medical history
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Analysis of a urine sample, including urine cultures by a laboratory
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Ultrasound of renal tract
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Cystoscopy
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CT and MRI images of your urinary tract may be necessary
Treatment
Antibiotics are usually the first-line treatment for UTIs. The role of the urologist is to determine why the infection occurs, and to try to prevent recurrent infections. Your general practitioner will often refer you for further investigation.
Urodynamic Testing
Urodynamic testing is used to simulate normal bladder function and to evaluate how well your bladder works.
The study looks at how well or poorly the bladder, sphincters and urethra are storing and releasing urine. It is diagnostic testing, which helps identify the type and source of the problem. This allows the treating Urologist to make treatment decisions based on accurate information, resulting in better outcomes.
The testing is minimally invasive, and involves placement of a urinary catheter as well as a rectal catheter with the aid of local anaesthetic topical gel. These catheters measure the pressures in the bladder and abdominal cavity. A flow meter allows for assessment of flow rate, as well as the pressure at which urination is taking place. Leak points (important in patients with urinary incontinence) are recorded, and co-ordinated or disco-ordinated activity of the pelvic floor is noted.
The procedure takes about 60-90 minutes to do, and patients can drive themselves to and from the appointment.
Sacral Neuromodulation
Also known as sacral nerve stimulation, sacral neuromodulation is an established and effective therapy for both overactive as well as underactive bladder dysfunction.
Since its introduction in the mid 1990’s, hundreds of thousands of patients worldwide have benefitted from the treatment. It involves placement of a device and lead close to the nerves, which control the bladder. These nerves receive continuous low-level electrical stimulation, which balances nerve activity of the bladder.
The procedure is minimally invasive, and usually requires a one night in hospital stay. It is done as a two-stage procedure. The advantage of this is we can establish efficacy, prior to placement of a permanent device.
Suitable candidates for this treatment include patients with an overactive bladder which has not responded to traditional oral medications, as well as patients with non-obstructive urinary retention, who are currently managed with intermittent self catheterisation, or indwelling catheterisation.
Urinary Incontinence
Urinary incontinence is the involuntary loss of urine via the urethra. Urologists like to differentiate the various types of urinary incontinence, for example:
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Stress incontinence: When urine leaks while you cough, laugh or sneeze, or when performing activities such as running or jumping.
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Urge incontinence: Urine leakage associated with a sudden strong need to urinate, or leaking on your way to the toilet.
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Overflow incontinence: This is when your bladder is over full (sometimes without you realising it) and urine leaks out, often when you are asleep.
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Mixed incontinence: A mix of the first two.
Investigations
A careful and thorough history will often lead to a diagnosis. Tests may be needed and may include:
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Urinalysis: A urine test done in the examination room.
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Ultrasound of the urinary system with post: Void residual measurement
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Urodynamic testing: Measuring the capacity and pressures of your bladder and urinary sphincter muscle.
Treatment options
Treatment depends very much on the type and cause of incontinence. Accurate diagnosis is critical.
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Lifestyle modification: Especially weight loss.
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Pelvic floor exercises: Physiotherapists can help with exercises to strengthen your pelvic floor muscles.
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Medication: Used to help relax the bladder muscle and give you time to reach the toilet.
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Botox injections in the bladder: Can be used to help decrease frequency and urgency.
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Sacral nerve stimulators: Implanting a device to help the nerves to the bladder.
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Urethral bulking agents: Minimally invasive bulking injections around your urethral sphincter to augment your control.
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Mid urethral sling procedures: This involves the surgeon inserting a natural tissue sling or synthetic mesh under your urethra to help keep you dry.
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Prolapse surgery: This involves repairing the weakened pelvic floor tissues with the use of your own tissue, to support the pelvic organs. This may include lifting the bladder/uterus.
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Laparoscopic sacro-colpopexy: Key-hole surgery to address prolapse from the inside.
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Artificial sphincter: Implanting a device that helps close the urethra
Painful Bladder Syndrome
Painful bladder syndrome (PBS), also known as interstitial cystitis, is a chronic bladder condition which causes a variety of symptoms, often including bladder pressure, bladder and pelvic pain and urinary symptoms.
Symptoms
Signs and symptoms of painful bladder syndrome differ from person to person. The symptoms may include:
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Pain in your pelvis or between your vagina and anus
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Frequent urination and a persistent urge to urinate
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Discomfort or pain while your bladder fills and relief after urinating
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Pain during sexual intercourse
Investigations
To diagnose PBS your urologist first has to exclude other causes for your symptoms, including conditions that may be dangerous to your health. Some of these investigations are:
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Urinalysis and urine culture: This is done to check for any urinary infections.
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Ultrasound of the kidneys and bladder: This test involves measuring the amount of urine that remains in your bladder after urinating.
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Bladder inspection and biopsy: During cystoscopy, the doctor takes tissue samples from your bladder to be tested.
Painful bladder syndrome treatment options
To relieve interstitial cystitis symptoms, your urologist at Cape Urology may recommend some of the following treatment options to help relieve symptoms:
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Medication: Tablets often relieve most of the symptoms
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Bladder hydrodistention: This procedure diagnoses and treats painful bladder syndrome by stretching the bladder during anaesthesia
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Bladder instillation: This in-office procedure involves the insertion of medication into the bladder via a urinary catheter.
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Botox injections in the bladder: These are used to relax the muscle of the bladder and increase storage capacity.
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Psychotherapy and bladder retraining exercises
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Sacral nerve stimulation: This procedure involves the urologist placing a thin wire near the sacral nerves between the spine and your bladder. Electrical impulses will then be sent through the wire to your bladder to help regulate it and reduce the urgency to urinate and urinary frequency.
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Bladder augmentation surgery: Although rarely performed, this surgery involves the surgeon inserting a patch of the intestine in the bladder to increase its capacity.