Urology Center Of Idaho

Urology Center of Idaho
208.233.3355
500 S 11th Ave # 301

Pocatello, ID 83201

         
 


     

- Urinary Incontinence

- Neurogenic Bladder

- Erectile Dysfunction

- Testosterone
- Urinary Tract Infection

- Epididymitis

 

- Infertility

- Pediatric Urology

     

Urinary Incontinence

Incontinence is defined as any involuntary loss of urine. This is an extremely common problem, and affects women more than men. It also becomes more frequent with age. There are many causes for incontinence and education is important in the treatment of incontinence. There are two types of urinary leakage: Stress incontinence and urgency incontinence. It is important to understand the difference and the function of the bladder.

Bladder Function

The bladder is a hollow muscle, lined with an insulation layer on the inside. Most of the time, its function is to be relaxed, and fill with urine. In a normal situation, once it is full, the bladder sends a signal that it is full, and that is our cue to find a bathroom. This may be surprising: When we feel that there is a lot of ‘pressure’ the pressure in the bladder is actually zero. Once it begins to empty, the bladder contracts to create pressure to eliminate the urine. The second part of bladder function is its closure mechanism. This is a circular muscle wrapped around the outflow of the bladder. This muscle is called the ‘sphincter muscle’. Unlike the bladder, it is active most of the time and only relaxed while emptying.

The sequence of events of contracting detrusor and relaxing sphincter is called the voiding reflex. Incontinence happens when either muscle does not work properly.

Types of Incontinence

Stress Incontinence

Stress incontinence refers to strain such as coughing, sneezing, or lifting something heavy. This strain creates pressure in the abdomen, which in the presence of stress incontinence overcomes the sphincter muscle that keeps the urine in. Fixing this type of urinary incontinence aims at strengthening the sphincter. One way is by medication. These can increase the muscle tone and with this, the urinary incontinence may stop.

Urgency Urinary Incontinence

This type of urinary incontinence occurs when the bladder fails to do its most import job: to store volume without contracting unless its human wants to. Out of the blue, or triggered by a swish of cold air or by hearing water flowing, the bladder starts the voiding reflex. This is called urgency. When we then do not reach the bathroom in time, leakage happens.

To stop this from happening, medication is available which interferes with the contraction of the bladder muscle by blocking the messenger molecule of the nerve-muscle interface called acetylcholine . This makes the contraction slower and weaker, giving you a little more time to reach the bathroom. However, the same neuro-transmitter that triggers the bladder muscle also controls the bowels and saliva production. This means that this medication has side effects of constipation and dry mouth. Sometimes these side effects are so severe that they force you to quit the drug, even though it may have helped.  

There is a new drug which uses a different way to stop bladder over-activity. We all have a built-in mechanism to slow or stop the bladder. It is part of the fight-and-flight response mechanism. This is exploited in a drug called mirabegon (Myrbetriq®). It supports the above mechanism allowing us more time to reach the bathroom. Patients have reported none of the side effects of the antimuscarinics drugs above, and may be used when those fail.

Neurogenic Bladder  

Neurogenic bladder is when the bladder does not fulfill its task because its nerve control is faulty. 

Bladder Functions:  

Storage 

The bladder has two basic functions: The most important is the storage of urine. The bladder is basically a hollow muscle, with a lining in the inside keeping the urine in. Most of the time, the muscle is supposed to be flaccid allowing for low - pressure storage of the fluid. A second muscle called sphincter is wrapped around the outflow tube (urethra) and keeps the urine from running out. If the storage function of the bladder is poor, pressures increase and may eventually cause damage to the kidneys.

Emptying 

Once the bladder reached capacity, it sends a signal to the brain informing the human that it is time to find a bathroom. No pressure is generated yet, the bladder remains relaxed until we actually give the command to empty.

Once at the appropriate location, this command is given, and two things happen: First, the closure mechanism (or ‘sphincter’) relaxes, followed by contraction of the bladder muscle which subsequently leads to coordinated, low pressure voiding.

All of these functions are coordinated by the brain, with the commands transmitted to the bladder by means of nerves traveling though the spinal cord. Imagine what happens if something happens to any of these structures: The bladder and sphincter cannot do their job properly.

Symptoms 

If a neurogenic bladder is present, we will experience a wide variety of symptoms. If the bladder fails to store urine properly, we notice having to go to the bathroom all the time. We may need to get up often throughout the night, or experience involuntary loss of urine (or urinary incontinence).

Diagnosis: Finding out What’s Wrong

A test called urodynamics is done at the office. This involves measuring how the bladder behaves: While the bladder is slowly filled, pressures are measured. Alongside with this, muscle activity of the sphincter is monitored. During emptying, the rate of flow is recorded. 

Careful review of these measurements allows the qualified Urologist to find out what’s wrong with the function of the lower urinary tract, and how to address it.

Reasons why the bladder misbehaves: Brain, Spinal Cord, or Nerve injury 

The brain may get hurt in multiple ways. Trauma, stroke, or diseases such as multiple sclerosis or Parkinson’s disease will lead to compromise of normal bladder function. Depending on severity and location, the urinary tract may still function normally, but without volitional control. This is very annoying since this leads to bladder emptying at inappropriate times, i. e. incontinence. Renal failure in this situation is not typical, and treatment aims at avoiding incontinence with methods such as timed / prompted voiding.

Spinal Cord Injury 

There are two stretches of nerves connecting brain and bladder. One connects the brain to a control center in the spine (about level L1) and the second from this control center to the bladder itself. If the nerves connecting brain and spinal center are damaged, the first thing happening is that the bladder fails to empty. The muscle tone of the sphincter will still be intact keeping urine back, and the bladder remains relaxed causing urinary retention (inability to pass urine). In this phase, bladder emptying must be helped, usually with a small tube inserted into the bladder several times a day.  

After some time, the situation changes: Without nerve input inhibiting the spinal bladder control center, the bladder becomes spastic and overactive. Less and less triggers cause the bladder to contract, effectively making the bladder very small. This is dangerous since the loss of good storage means an increase in pressures which in turn will cause damage of the kidneys. This condition must be recognized, and treatment to relax the bladder started.

Peripheral Nerve Damage 

The nerves from the spine to the bladder are called ‘peripheral’, since the live outside the brain/spine axis. They may be damaged traumatically, or with conditions like diabetes mellitus. This, in turn, leads to an inability to empty the bladder. This may cause urinary retention, with complications of recurrent urinary tract infections or renal failure. Therefore this must be recognized early, and care taken to periodically empty.

A thorough diagnosis is very important when managing a neurogenic bladder. In doing so, the utmost care is taken to keep the kidneys healthy (which is the ‘holy grail’ of Urology) and to improve / maintain the patient’s quality of life.

Erectile Dysfunction 

This condition, formerly called impotence, is the inability of an adult male to achieve and maintain an erection sufficient for sexual intercourse. It is a common problem: 40% of men over 60 years of age have an increasing problem with this. Erectile Dysfunction is not something commonly talked about, and is frequently associated with a degree of embarrassment to the men affected. The condition is caused by a combination of damage to nerves and blood vessels. Atherosclerosis, which is also the cause for heart disease also causes erectile dysfunction. Nerve damage can be caused by surgery of the pelvis, and spinal cord injury. Diabetes mellitus actually can damage both small blood vessels and nerves alike. Hormonal deficiencies such as lack of sufficient testosterone can also interfere with normal erections. Psychological factors were initially thought to be the main cause of erectile dysfunction but this actually plays only a minor role. Fortunately, there now are many ways to address this problem, so that today very few men have to live with it.

Tablets (Viagra, Levitra, Cialis)  

With the development of Viagra, a tablet originally developed to ease problems of pulmonary hypertension, works by taking the drug some time before sexual activity. It increases the half - life of the neurotransmitter which is responsible for erections and therefore relies on at least some nerves still reaching the organ. If this is not the case, this type of medication does not work. Since the tablets are easy to take, they are first line in the treatment of ED today.

Injections or Suppositories 

As mentioned above, if the nerves effecting erections are completely damaged, orally taken medication does not work. In this case, it is possible to replace the neurotransmitter directly. This may be achieved either by using a tiny needle to inject it into the penis, or by inserting a small suppository into the opening of the penis. A cream is also available, but this is much less effective.

Vacuum Erection Device

This method may be used even if the erectile tissue is nonfunctional. It uses two steps: First, a bell is placed over the penis and the air is evacuated with a pump. This will create an artificial erection. In the second step, a rubber band is placed around the base of the penis in order to maintain it.  

Implantable Penile Prosthesis

With this method, two hydraulic cylinders are placed into the penis, along with a small pump for activation and de-activation which goes into the scrotum. This method is the most reliable way to create an erection, but it does require an operative procedure to place it. 

As one can see, there is a way to treat erectile dysfunction on many different levels, depending on the type and severity of ED. Most every man with this problem has a treatment option available.

 

Testosterone

This male hormone has been in the news and ads lately a lot. Any male older than 25 who feels down or a bit out of sorts seems to be encouraged to have his androgen level checked. Heaven forbid it is not in the normal range - there is a pressure to ‘help’ with replacing it.

Aside of low Testosterone there are a lot of conditions can cut down a grown man. Stress like problems in relationships or work can dent a man’s verve. Depression is another very common and under-diagnosed cause for problems with energy and sexual prowess.

Apart from testosterone problems, if the thyroid gland refuses its service the results can be very similar to the symptoms of having a low testosterone level. Anyone who is deprived of a good night’s sleep is liable to have problems with energy and other form of well-being. A sleep study is capable of finding out if the way breathing is impaired at night affects performance.

So it should be clear that testosterone replacement is not the answer-all for problems with performance problems. Most men with issues like this do not have a problem with testosterone, but with other issues. The very few with true hypogonadism, of course, will need professional help.

Testosterone : Hypogonadism

Here we are talking about a really subtle condition. Most men never come forward. Because what is happening to seems too much like what people say happens with 'getting older': The feeling of being tired all the time, and things are just not as fun as they used to be. Even relations with the wife seem to be satisfying any more, and interest is way down. It might even have happened that there was failure to perform.  

 

Urinary Tract Infections 

What is the Urinary Tract? 

The urinary tract is the body’s system to eliminate toxins in the urine. It originates with the kidneys which produce urine. This is flows down to the bladder in two tubes called ureters. Once in the bladder, the fluid does not flow back, but is periodically expelled through the tube called urethra when we urinate.  

What is a Urinary Tract Infection?  

An infection of this system most commonly only involves the bladder. Bacteria enter it by ‘climbing’ back through the urethra, and once there, multiply in numbers. When the body tries to fight this, inflammation occurs. This is what is called a urinary tract infection.

What are the Symptoms of an uncomplicated UTI?

Normally, bacteria only reach the urethra and the bladder. This causes symptoms of having to go often (even at night), having to go very urgently, and pain during urination.

Difference between Men and Women 

In a woman, infections of the urinary tract can occur more frequently than in a male. This is simply because the distance between the outside and the bladder is fairly short, only about 1 to 2 inches. This makes a UTI a fairly common and benign condition, which is simply treated with a course of antibiotics. In men, however, the distance to the bladder is longer, and infections occur less often.

More Serious Infections  

When trying to figure out these infections, a distinction must be made whether the infection reaches the kidneys. If it does, a merely annoying bladder infection becomes a potentially life-threatening kidney infection, or pyelonephritis. The latter is more severe because it involves a solid organ, which means that there is a dangerous possibility of the infection spreading into the blood and with it to the entire body.

Therefore, any fever, chills, flank pain or fatigue which occurs with a urinary tract infection may point to this condition and will need to be addressed right away. Frequently, treatment is not simply done by starting antibiotics, but a urine culture is done, and the cause for the kidney involvement is investigated (typically with special xrays such as a CT).  

Causes for UTIs: Persistent or Recurrent Infections 

Most urinary tract infections are harmless, as explained above, and no further workup looking into why infections occurred is necessary. If infections persist or recur, however, it is time to look into specific causes which may lead to infections

Incomplete Bladder Emptying  

Normally, if the bladder does not empty completely we may have to go more frequently. However, if bacteria are present, these do not get flushed out every time urination happens. This means that the infection has a harder time getting cleared.

Kidney and Bladder Stones 

Stones may occur anywhere in the urinary tract. Sometimes (especially in patients with diabetes mellitus) bacteria move onto them where they can create a protective wall around them putting out of any antibiotic’s reach. Unless the stones are cleared, there is little hope to clear the urinary tract infection.  

Neurogenic Bladder  

If the nerves to the bladder and sphincter do no work properly we speak of a neurogenic bladder. Proper emptying is frequently impossible. If sphincter and bladder do not work in sync, excessive voiding pressures increase the likelihood of infections. Recognizing and treating neurogenic bladder is therefore vital in order to prevent recurrent urinary tract infections. At the Urology Center of Idaho, we are specialized to find out how to best manage Urinary Tract Infections as efficiently as possible.

Epididymitis 

Epididymitis is inflammation of the epididymis—the coiled tube that collects sperm from the testicle and passes it on to the vas deferens. There are two forms of this disease, acute and chronic. Acute epididymitis comes on suddenly with severe symptoms and subsides with treatment. Chronic epididymitis is a long-standing condition, usually of gradual onset, for which the symptoms can be improved with treatment but may not completely be eradicated. Most cases of epididymitis occur in adults.

Symptoms include urethral discharge and urethral pain or itching, pelvic pain and urinary frequency, urgency or painful/burning urination, fever, perineal pain, and flank pain.

In some cases, pain in the scrotum from the local infection is the only noticeable symptom. The pain starts at the back of one testicle but can soon spread to the entire testicle, the scrotum and occasionally the groin. Swelling, tenderness, redness, firmness and warmth of the skin may also accompany the pain. The entire scrotum can swell up with fluid.

Most cases are suspected to be from bacteria and includes at least two weeks of antibiotics. Most cases can be treated with oral antibiotics as an outpatient. Dr. Bjorn Sauerwein at Urology Center of Idaho can choose one of several antibiotics for your treatment.

Tuberculous epididymitis is often treated with anti-tuberculous medications and in some cases surgical removal of the testicle is required because the damage is so severe. Cases of severe infection, with intractable pain, vomiting, very high fever or overall severe illness, may require a hospital visit.

Infertility  

Male infertility can be explained by male factor infertility which accounts for 40% of infertility cases. This diagnosis is often seen in men who have a varicocele which is an enlarged vein within the left testicle. can also occur as a result of trauma or surgery to the testicles. Recent scientific studies have also shown that in some cases of male infertility, there may be a significant genetic component. Despite some causes, a significant portion of male infertility is unexplained. Dr. Bjorn Sauerwein at the Urology Center of Idaho can perform the following infertility tests to pinpoint a possible roadblock and/or your form of treatment.

  • Semen Analysis
  • Anti-sperm antibodies
  • Infectious Screening
  • Karyotype
  • Y Chromosome Testing
  • Sperm Chromatin Structure
  • Cystic Fibrosis Genetic Screening  

 

 


Pediatric Urology

At Urology Center of Idaho in Pocatello, Idaho, we are experts at treating children with many pediatric urological conditions including urinary tract infections, urinary reflux, incontinence, bed wetting, hernias, hydroceles, phimosis and hypospadias.

Pediatric Urology Services: 

  • Testicles and Groin
  • Bladder and Urethra
  • Male Pediatric Urology
  • Female Pediatric Urology
  • Kidney and Ureter


 
 

Urology Center of Idaho
500 S 11th Ave # 301
Pocatello, ID 83201
208.233.3355

 
 
         

Urology Center of Idaho
500 S 11th Ave Ste. 301,
Pocatello, ID 83201
208.233.3355

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98 Poplar St.
Blackfoot, ID 838221
208.785-3800

 

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