Treatment
A primary care health care professional can treat many urinary disorders, but some conditions may require consultation with a urologist, a surgeon who specializes in the treatment of urinary system disorders and conditions affecting the reproductive system. A urogynecologist is a gynecologist who is trained to treat bladder and pelvic floor disorders in women. For kidney disorders, particularly kidney failure, a nephrologist (a medical specialist in kidney diseases) may be needed.
Treatment for cystocele
A grade 1 or 2 cystocele may require no treatment, except avoidance of heavy lifting or straining. For moderately bothersome cystoceles, a pessary (a plastic device that fits into your vagina to help support your uterus, vagina, bladder or rectum) may be fitted to the vagina to hold the bladder in place. A pessary must be removed and cleaned regularly to prevent infection and ulcers.
A large cystocele may require surgery to reposition the bladder. The surgery requires a hospital stay of one to several days and four to six weeks for a full recovery.
In postmenopausal women, hormone therapy (HT) used alone or in combination with pelvic floor muscle exercises can help prevent future cystoceles by strengthening pelvic muscles weakened by declining estrogen levels. Hormone therapy typically refers to a combination of estrogen and a synthetic form of the hormone progesterone (progestin), while estrogen therapy, or ET, refers to the use of estrogen alone.
If you are considering hormone therapy for a cystocele, however, talk to your health care professional about whether the benefits outweigh the risks.
Treatment for kidney stones
Surgery is usually not necessary to remove kidney stones. Drinking plenty of water—two to three quarts per day—and taking drugs which can relax the ureter may allow for the stone to pass down the tract. A health care professional may recommend that you stay home, drink plenty of fluids and take pain medicine as needed. You may be asked to save the passed stone for tests.
Shockwave lithotripsy. The most common method for removing stones is shockwave lithotripsy (SWL), in which shockwaves initiated outside the body travel through skin and body tissues until they hit the stones. The stones disintegrate into sand-like particles and are passed through the urinary tract. The procedure may be done in a hospital or on an outpatient basis; you typically resume your normal activities within a few days, but it may take months for you to pass all the pieces.
Complications may include blood in the urine for a few days, bruising and discomfort of the back or abdomen. To minimize risk of problems after the treatment, you should avoid medications that reduce blood clotting (such as aspirin) for one to two weeks before treatment.
The stone particles may cause pain as they pass through the urinary tract. Your health care professional may insert a small tube called a stent through the bladder into the ureter to help the fragments pass. Some people may need two or more SWL treatments.
Surgery is generally an option when the stone:
does not pass after a reasonable time and causes constant pain is too large to pass on its own or is caught in a difficult place blocks urine flow causes continuing urinary tract infection harms kidney tissue or provokes incessant bleeding is growing (as shown on x-rays)
The two most common surgical techniques for removing stones are:
- Urethroscopic stone removal. This procedure is used for stones lodged in the ureter or for kidney stones. A small fiber-optic instrument called a ureteroscope is passed through the urethra and bladder and into the ureter or kidney. When the stone is found, the surgeon either removes it or shatters it with an instrument that breaks the stone.
- Percutaneous nephrolithotomy. This surgical procedure usually requires a hospital stay and is used for large stones or stones in locations not conducive to SWL. The surgeon makes a small incision in the back, creates a tunnel to the kidney and uses a nephroscope to find and remove the stone. A nephrostomy tube may stay in the kidney during the healing process. Large stones may require use of an ultrasound, electrohydraulic energy probe or laser to break up the stone. One advantage over SWL is that percutaneous nephrolithotomy removes the stone particles rather than leaving them to pass through the kidney.
Treatment for bladder cancer
Treatment for bladder cancer depends on the size and staging of the tumor. For early-stage tumors, the usual treatment is transurethral resection of the bladder, a procedure during which a lighted tube is inserted through the urethra and into the bladder to remove the cancer for biopsy and to cut or burn away any remaining cancer cells. Chemotherapy and immunotherapy may also be used to prevent cancer recurrence. In extreme cases, a cystectomy, or removal of the bladder, may be performed.
Treatment for interstitial cystitis (IC)
Behavioral therapy. Make sure you get enough water, ideally about two quarts a day. Also avoid bladder irritants, including coffee, chocolate, acidic foods or drinks. Controlling stress can also help with symptoms.
Medications. Medications are the primary treatment for IC. The only drug specifically approved for IC is pentosan (Elmiron). Pentosan helps restore the normal bladder lining but may require one to two years to work. Several other medications not specifically indicated for IC may also help reduce symptoms, including nonsteroidal anti-inflammatory drugs (NSAIDs), antihistamines, and antidepressants, particularly amitriptyline. You may require more than one medication.
Bladder instillation. Also called a bladder wash or bath, the bladder is filled with a drug called dimethyl sulfoxide (DMSO, RIMSO-50), which must be held for a specified period of time—usually 10 to 20 minutes—before urinating. This treatment is performed every week or two for six to eight weeks and repeated as needed.
Because DMSO passes into the bladder wall, it reaches tissue more effectively to reduce inflammation and pain. It also appears to prevent the muscle spasms that cause pain and urgent/frequent need to urinate.
Side effects of DMSO include a garlic taste and odor that may last up to three days following treatment. Bladder symptoms may get temporarily worse for a day or so after initial treatments. Blood tests, including a complete blood count and kidney and liver function tests, should be conducted twice a year. Other medications may be added to make a DMSO "cocktail."
Currently, DMSO is the only drug approved by the FDA as a bladder wash for IC.
Bladder distention. This treatment arose from the observation that some patients felt better after undergoing cystoscopy, during which the bladder is filled to capacity with liquid. Symptoms often get worse a day or two after distention but return to pre-procedure levels or improve after two to four weeks. No one knows exactly why this treatment is effective, but one theory is that distention increases bladder capacity by interfering with the bladder's transmission of pain signals. This is not an ideal treatment, however. It only helps small numbers of patients and requires anesthesia.
Surgery. All surgical treatments for IC have unpredictable results and most health care professionals turn to surgery only as a last resort. Surgical procedures include:
- Fulguration, a process in which a cystoscope is inserted through the urethra and Hunner's ulcers (star-shaped lesions found on the bladder walls of some people with IC) are burned off with electricity or a laser.
- Neuromodulation or sacral nerve root stimulation is a newer treatment option that involves stimulating the sacral nerve to help alleviate frequency, urgency and pain. A small electrode is placed under the skin next to the third sacral nerve root in the back. If a test stimulation is effective, a permanent battery is placed under the skin for regular stimulations. Although this can be very helpful in some patients, the results are not always sustained.
- Augmentation is a surgical procedure that enlarges the bladder by removing damaged and inflamed sections of the bladder and rebuilding it with bowel (small or large intestine) tissue. The effect on pain varies, and IC may recur on the bowel tissue used to enlarge the bladder.
The bladder can also be removed entirely in a procedure called cystectomy. The ureters are then attached to a segment of bowel that opens onto the skin of the abdomen. Urine empties through the opening, called a stoma, into a bag outside the body.
Bear in mind that even a cystectomy does not guarantee the end of IC symptoms; some women experience phantom pain. So make sure you explore other options first.
Treatment for urinary tract infections
Luckily, most infections are not serious and can be easily treated with antibiotic medications. However, a urinary tract infection can be stubborn and sometimes recurs a few weeks after treatment.
Nearly 20 percent of women who have a urinary tract infection will have another, and 30 percent of those who have had two will have a third. About 80 percent of those who have had three will have a fourth. If left untreated, urinary tract infections can lead to other more complicated health problems so they should not be ignored. Prevention includes drinking plenty of liquids, frequent urination and taking vitamin C.
Treatment for urinary retention
Treatment for urinary retention may include the insertion of a Foley catheter through the urethra into the bladder to relieve urinary retention. Various urethral dilators may be used to open the channel wide enough to pass a catheter through. If a catheter cannot reach your bladder because of an obstruction in the urethra, a suprapubic tube may be placed through the skin, over the pubic bone and through the lower abdominal wall directly into the bladder. The tube provides temporary drainage until the situation can be managed via a cytoscopic procedure.
Treatment for proteinuria
Treatment for proteinuria starts with controlling hypertension and/or diabetes. Those with diabetes should measure blood sugar levels frequently, eat a balanced diet to appropriately manage diabetes, exercise and take prescribed medicines. Those with high blood pressure are usually prescribed ACE (angiotensin-converting enzyme) inhibitors to control the condition. The drugs protect the kidneys more than other blood pressure medicines. Blood pressure should be kept below 125/75 mm Hg in people with proteinuria higher than 1 gram per 24 hours.
The National Kidney Foundation also recommends limiting salt and protein intake. A consultation with a dietitian may help you develop a kidney-healthy dietary plan.
Treatments for incontinence
A variety of treatments are available to treat incontinence, including:
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Exercises: Pelvic floor exercises known as Kegel exercises can strengthen the muscles you use to stop urinating so you can hold urine in your bladder longer. To do Kegels, squeeze the muscles you use to stop urinating for a few seconds and then relax. Your health care professional can tell you specifically how often and for how long you should do Kegels.
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Medications: A variety of drugs can be used to help control incontinence. Some of them relax bladder muscles, helping your bladder to empty more completely, some help prevent bladder contractions, and others tighten the muscles in the bladder and urethra to reduce leakage.
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Biofeedback techniques: These techniques can help you become more aware of signals from your body so you can gain more control over the muscles in your bladder and urethra.
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Pessary: A vaginal insert that holds up the bladder neck, if present. It may also pinch the urethra closed to help retain urine in the bladder. It is usually not necessary to remove the pessary to urinate. Normal bladder contractions can usually force urine out through the pinched-off urethra.
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Surgery: Surgery can improve incontinence if the condition is caused by a physical problem such as a change in the position of the bladder. Common surgery for incontinence involves changing the position of the bladder or urethra and securing it.
Other Treatments for Kidney Conditions
Dialysis is a procedure in which your blood is circulated out of your body, the wastes filtered out in a machine, and the clean blood returned to the body. Seventy-seven percent of those on dialysis survive one year, 28 percent after five years and 10 percent after 10 years.
Transplants. For some with kidney failure, transplantation is an option. If the donated kidney is not a close match for your body, your immune system will react against it as if it were a virus or bacteria. Drugs that suppress the immune system are used to help the body accept the transplant. Transplant is more effective than dialysis, with a one-year survival rate of 95 percent, and 90 percent at three years. However, the wait for a donor kidney averages 18 months to four years. Living donors can be used to reduce this wait.
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Create Date: 12/1/02
Date Last Updated: 8/6/07
Review Date: 7/1/07
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