WHAT IS HYDRONEPHROSIS?
- Hydronephrosis (hydro=water, nephros=kidney) is a condition in which there is abnormal swelling of the kidney.
- This condition does not always result in damage of the kidney. In some cases, the condition resolves itself when the kidney matures further. However, there are other causes of hydronephrosis that may result in kidney damage, especially during the early years when the kidney is still developing.
- Therefore, it is important to identify and treat these potentially risky conditions early.
CAUSES OF HYDRONEPHROSIS
In children, the most common causes of hydronephrosis that may result in kidney damage are:
- Vesicoureteral reflux: abnormal backflow of urine from the bladder toward the kidney, thus increasing the risk of kidney infections.
- Obstruction (blockage) of the urinary tract. This can occur at several levels:
- Ureteropelvic Junction (UPJ). This is the segment where the kidney basin (pelvis) drains into the ureter. This is the most common site of significant kidney blockage.
- Obstruction (blockage) of the urinary tract. This can occur at several levels:
- Ureteropelvic Junction (UPJ). This is the segment where the kidney basin (pelvis) drains into the ureter. This is the most common site of significant kidney blockage.
- Mid-ureter
- Ureterovesical Junction (UVJ). This is the segment where the ureter enters the bladder. The blockage can sometimes be caused by abnormal insertion of the ureter outside of the bladder or because of a ureterocele (ureter end in a cyst in the bladder)
Urethra. Obstruction at this level most commonly occurs just outside the bladder (posterior urethral valves). As it affects the bladder and both kidneys at the same time, it tends to cause the most severe damage to the entire urinary tract.
TREATMENT
- The treatment for hydronephrosis depends on its cause and its severity.
- Often, close follow up over several months to several years may be necessary to assure that the kidney improves adequately.
- In some cases, the child may be given an antibiotic to take daily to help prevent kidney infections until the kidney gets better by itself or until successful surgery.
Urinary Incontinences
- Urinary incontinence is a problem with bladder and sphincter control. It is the uncontrolled leaking of urine.
- If the fear of leaking urine stops you from doing things you enjoy, then it is time to think about treatment. Do not be embarrassed to talk to your health care team about this medical condition.
Stress Urinary Incontinence (SUI)
Stress Urinary Incontinence (SUI) is a common type of urinary leakage. With SUI, the pelvic floor muscles (which
hold the pelvic organs in place) have become weak and can no longer support the bladder and urethra the way they
should. Coughing, sneezing, bending, lifting, straining or even laughing could put enough pressure on the bladder to cause it to leak.
Overactive Bladder (OAB) / Urgency Urinary Incontinence (UUI)
Overactive Bladder (OAB) is a syndrome that often includes frequent urination and is associated with a sudden strong urge to void. This “gotta go” feeling makes you feel that you will leak if you do not use the bathroom now.
Overflow Urinary Incontinence
This type of incontinence is when the bladder stays full. It cannot empty and so it overflows and leaks. Signs include many, small urinations each day, or ongoing dribbling. This is rather rare in women, but can be seen in people with
diabetes, neurological disorders and/or a non-functional, underactive bladder.
Treatment
Lifestyle Changes
Lifestyle changes, such as changing your diet, should be tried first. With lifestyle changes, you change the way you live day-to-day. This may include what you eat or drink, or practicing other methods that may control symptoms.
Fluid Control
You will likely be asked to track what you drink, when and how much. You may learn you should limit certain things such as caffeine and alcohol.
Limit Certain Foods and Drinks
Some foods and drinks have been found to irritate the bladder of some people. For example, some people have found spicy foods, coffee, tea and colas to be bothersome
Bladder Training
A bladder diary may be the starting point for bladder training. For three days, you write down what and how much you drink, and how often you go to the bathroom. Noting when you leak urine may also be helpful. When you empty your bladder as a routine, you should have fewer leaks.Timed urination, scheduled voiding or double voiding are methods that can help with both OAB and SUI.
Pelvic Floor Exercises
Kegel exercises can strengthen the urethral sphincter and pelvic floor muscles. This works for all genders. Learning to tighten and relax these muscles may help your bladder control. Kegels can help with both SUI (by making the muscles strong) and OAB/UUI (by suppressing the urge feeling). Like any fitness program, you must practice the exercises often to keep helping your body.
When lifestyle changes do not help enough, your health care team may ask you to try prescription medications.
Anticholinergic Drugs
Anticholinergic drugs treat OAB/UUI by helping the bladder muscle to relax. Common medications include oxybutynin, tolterodine and solifenacin. Another medication for OAB is mirabegron.
Other Treatments
- Slings
- artificial urinary sphincter (AUS)
- Intravesical Botox therapy
- Nerve stimulations
Prostatitis
What is Prostatitis?
Prostatitis is an infection or inflammation of the prostate that most often is felt in and around the pelvic zone. It can happen to men of all ages.
There are many symptoms and lab values your doctor can use to find out which you have.
Acute Bacterial Prostatitis (ABP) is an infection of the prostate due to bacteria. Symptoms can come on quickly and include fever, chills, urinary changes, ejaculatory pain and pain in the pelvis or nearby zones. Treatment with antibiotics often leads to quick releif.
Chronic Bacterial Prostatitis (CBP) also occurs from a bacterial infection. Symptoms are often more gradual and may take longer to treat. Fever and chills are not common but pain in the pelvis is still felt along with urinary symptoms and/or ejaculatory pain.
Nonbacterial Prostatitis is inflammation of the prostate that causes pain. It is not due to a bacterial infection and may be from stress, nerve irritation, injuries or past urinary tract infections. This form of prostatitis has no signs of bacteria in the urine or semen.
Chronic prostatitis/chronic pelvic pain syndrome (CP/ CPPS) is an inflammation of the prostate or the nerves to this zone. Pain from CP/CPPS can last for weeks to months to years.
What are My Treatment Options?
Your treatment will depend on your symptoms, lab tests and findings during your visit. Patients may need many treatments.
Antibiotics: often used as a first step to kill any bacteria.
Alpha-blockers: drugs that may help to relax the muscles around the prostate and at the base of the bladder.
Anti-inflammatory Agents: non-steroidal drugs to reduce pain from inflammation in the prostate or muscles.
Prostatic Massage: helps to ease pressure in the prostate. It is done by draining fluid from the prostate ducts.
Pelvic Floor Physical Therapy: a way to learn how to relax certain muscles in your pelvis. It is done with an expert to
help you lessen tension in your pelvic floor muscles.
Undescended Testes
Undescended testicle” is the term used when one or both of the testicles fail to descend into the scrotum. Your baby’s pediatrician will evaluate for this during a routine exam. The scrotum looks and feels empty
About 3 or 4 out of 100 newborn boys (up to 21 out of 100 premature newborns) have this defect. Only 10 out of 100 infants who have undescended testicles have them on both sides. Most of the time there are no other symptoms besides
an empty scrotum.
Testicles that don’t descend into the scrotum won’t work normally. Testicles sit in the scrotum, to be at slightly lower than body temperature in order to keep sperm healthy
Undescended testicles are also linked to a higher risk of:
- Testicular cancer in adulthood
- Testicular torsion (twisting of the blood vessels that bring
blood to and from the testis) - Inguinal hernia (a hernia that develops near the groin)
If your baby’s testicle doesn’t descend into place by 6 months, you should take your baby to see a specialist. A pediatric urologist can talk with you about surgery. Surgery to move testicles into the scrotum is called an orchiopexy