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Bladder

Klein & Birns Urology offers a full range of diagnostic and treatment options for men and women with bladder control and urinary leakage problems.

The bladder is a hollow organ in the lower part of the abdomen. It is shaped like a small balloon and has a muscular wall that allows it to get larger or smaller. The bladder stores urine until it is passed out of the body. Urine is the liquid waste that is made by the kidneys when they clean the blood. The urine passes from the two kidneys into the bladder through two tubes called ureters. When the bladder is emptied during urination, the urine goes from the bladder to the outside of the body through another tube called the urethra.

Overactive Bladder

In people with an overactive bladder (OAB), the layered, smooth muscle that surrounds the bladder (detrusor muscle) contracts spastically, sometimes without a known cause, which results in sustained, high bladder pressure and the urgent need to urinate (called urgency). Normally, the detrusor muscle contracts and relaxes in response to the volume of urine in the bladder and the initiation of urination.

People with OAB often experience urgency at inconvenient and unpredictable times and sometimes lose control before reaching a toilet. Thus, overactive bladder interferes with work, daily routine, intimacy and sexual function; causes embarrassment, and sometimes diminishes self-esteem and quality of life.

Urination

Urination (micturition) involves processes within the urinary tract and the brain. The slight need to urinate is sensed when urine volume reaches about one-half of the bladder's capacity. The brain suppresses this need until a person initiates urination.

Once urination has been initiated, the nervous system signals the detrusor muscle to contract into a funnel shape and expel urine. Pressure in the bladder increases and the detrusor muscle remains contracted until the bladder empties. Once empty, pressure falls and the bladder relaxes and resumes its normal shape.

Incidence and Prevalence

Overactive bladder affects men and women equally. The U.S. Department of Health and Human Services has reported that approximately 13 million people in the United States suffer from OAB and other forms of incontinence.

Urinary Incontinence in Women

What is urinary incontinence?

Urinary incontinence is the involuntary release of urine. It is not a disease but a symptom of a problem with the urinary tract. Urinary incontinence is very common, especially among older adults. For most women, the main effect of urinary incontinence is social or hygienic problems. Urinary incontinence is the same as Overactive Bladder (OAB).

How is urinary incontinence classified?

Urinary incontinence is classified as acute (short-term) or chronic (long-term).

Acute incontinence is a temporary loss of urine control that ends when the problem causing it is successfully treated. Acute incontinence may be caused by a urinary tract infection, a medication side effect, constipation, or bladder stones.
Chronic incontinence is a long-term loss of urine control. There are two main types of chronic incontinence:

  • Stress incontinence is the loss of urine when you put pressure on your abdomen through activities such as sneezing, laughing, or exercising. It is the most common type of urinary incontinence in women.
  • Urge incontinence, also called overactive bladder, is an urge to urinate that is so strong you cannot reach the toilet in time, even when your bladder contains only a small amount of urine.

Less common types of chronic urinary incontinence include:

  • Overflow incontinence, when your bladder becomes overly full and yet you feel no urge to urinate.
  • Reflex incontinence, when your bladder contracts and you are unable to stop it.
  • Functional incontinence, when some obstacle or disability makes it difficult for you to reach or use a bathroom in time to urinate (environmental incontinence).
  • Anatomical incontinence, resulting from problems with the structure of the urinary tract that affect the urine flow.

Urinary Incontinence in Men

What is urinary incontinence?

Urinary incontinence is the uncontrollable release of urine. It is not a disease but rather a symptom of a problem with the urinary tract.

Incontinence affects 13 million Americans, more often in women than in men. Although incontinence occurs more often in older men than in young men, it is not considered a normal part of the aging process.

Classifications

Urinary incontinence may occur for only a short time (acute) or become a continuing condition (chronic).

Acute incontinence is a short-term difficulty controlling urine. Often it is related to other medical problems and treatment, such as surgery for prostate cancer or for an enlarged prostate. Urinary tract infections, medication side effects, constipation, or bladder stones also may cause acute incontinence.

Chronic incontinence is a long-term difficulty controlling urine. It may be caused by nerve problems or injury to the prostate or bladder muscles that control urination.

Bladder Cancer

General Information About Bladder Cancer

Bladder cancer is a disease in which malignant (cancer) cells form in the tissues of the bladder.

There are three types of bladder cancer that begin in cells in the lining of the bladder. These cancers are named for the type of cells that become malignant (cancerous):

  • Transitional cell carcinoma: Cancer that begins in cells in the innermost tissue layer of the bladder. These cells are able to stretch when the bladder is full and shrink when it is emptied. Most bladder cancers begin in the transitional cells.
  • Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells that may form in the bladder after long-term infection or irritation.
  • Adenocarcinoma: Cancer that begins in glandular (secretory) cells. Glandular cells in the lining of the bladder make substances such as mucus. Cancer that is confined to the lining of the bladder is called superficial bladder cancer. Cancer that begins in the transitional cells may spread through the lining of the bladder and invade the muscle wall of the bladder or spread to nearby organs and lymph nodes; this is called invasive bladder cancer.

Risk factors for bladder cancer include the following:

  • Smoking
  • Exposure to certain substances at work, such as rubber, certain dyes and textiles, paint, and hairdressing supplies
  • A diet high in fried meats and fat
  • Being older, male, or white
  • Having an infection caused by a certain parasite

Possible signs of bladder cancer include blood in the urine or pain during urination. These and other symptoms may be caused by bladder cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:

  • Blood in the urine (slightly rusty to bright red in color)
  • Frequent urination, or feeling the need to urinate without being able to do so
  • Pain during urination
  • Lower back pain

Tests that examine the urine, vagina, or rectum are used to help detect (find) and diagnose bladder cancer. The following tests and procedures may be used:

  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • Urinalysis: A test to check the color of urine and its contents, such as sugar, protein, blood, and bacteria.
  • Internal exam: An exam of the vagina and/or rectum. The doctor inserts gloved fingers into the vagina and/or rectum to feel for lumps.
  • Intravenous pyelogram (IVP): A series of x-rays of the kidneys, ureters, and bladder to find out if cancer is present in these organs. A contrast dye is injected into a vein. As the contrast dye moves through the kidneys, ureters, and bladder, x-rays are taken to see if there are any blockages.
  • Cystoscopy: A procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscope (a thin, lighted tube) is inserted through the urethra into the bladder. Tissue samples may be taken for biopsy.
  • Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. A biopsy for bladder cancer is usually done during cystoscopy. It may be possible to remove the entire tumor during biopsy.
  • Urine cytology: Examination of urine under a microscope to check for abnormal cells.

Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery) depends on the following:

  • The stage of the cancer (whether it is superficial or invasive bladder cancer, and whether it has spread to other places in the body). Bladder cancer in the early stages can often be cured.
  • The type of bladder cancer cells and how they look under a microscope.
  • The patient's age and general health.

Treatment options depend on the stage of bladder cancer.

Stages of Bladder Cancer

After bladder cancer has been diagnosed, tests are done to find out if cancer cells have spread within the bladder or to other parts of the body. The process used to find out if cancer has spread within the bladder lining and muscle or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:

  • Cystoscopy: A procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscope (a thin, lighted tube) is inserted through the urethra into the bladder. Tissue samples may be taken for biopsy.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.
  • Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  • Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.

The following stages are used for bladder cancer:

Stage 0

In stage 0, the cancer is found only on tissue lining the inside of the bladder. Stage 0 is divided into stage 0a and stage 0is, depending on the type of the tumor:

  • Stage 0a is also called papillary carcinoma, which may look like tiny mushrooms growing from the lining of the bladder.
  • Stage 0is is also called carcinoma in situ, which is a flat tumor on the tissue lining the inside of the bladder.

Stage I

In stage I, the cancer has spread to the layer below the inner lining of the bladder.

Stage II

In stage II, cancer has spread to either the inner half or outer half of the muscle wall of the bladder.

Stage III

In stage III, cancer has spread from the bladder to the fatty layer of tissue surrounding it, and may have spread to the reproductive organs (prostate, uterus, vagina).

Stage IV

In stage IV, cancer has spread from the bladder to the wall of the abdomen or pelvis. Cancer may have spread to one or more lymph nodes or to other parts of the body.

Recurrent Bladder Cancer

Recurrent bladder cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the bladder or in other parts of the body.

Interstitial Cystitis

Interstitial cystitis (IC), a condition characterized by difficulty in emptying the bladder, primarily affects women, with symptoms including urinary urgency, frequency, and bladder pain. Sexual intercourse can also be painful for patients with IC. Symptoms usually begin around age 40, although 25 percent of those affected are 30 years old or younger. Therefore, physicians often have to rule out a number of other potential disorders before diagnosing a patient with IC.

It is not certain what causes interstitial cystitis, and there is no definitive or single test to determine its presence. Still, through continued research, more cases are discovered each year, as are advances in treatment options.

Individuals may suffer from interstitial cystitis if they:

  • Experience pressure, tenderness, or pain in the bladder and pelvic area
  • Have an urgent and/or frequent need to urinate
  • Have an inability to hold much urine
  • Need to awaken several times a night to urinate
  • Repeatedly receive negative test results for bacterial urinary tract infections (UTIs)

Although interstitial cystitis is treatable, the potentially difficult diagnosis process causes many individuals to give up and live their lives in pain. "We believe that education efforts such as the On Course for Better Health campaign will help demystify the stigmas associated with this condition and encourage those who suffer from IC to see their physician or urologist," said Thomas M. Bruckman, Executive Director of the American Foundation for Urologic Disease (A.F.U.D.). "There are treatment options available, but it is important for sufferers not to become frustrated and give up during the diagnosis process."

At Klein & Birns Urology, our aim is to be the leader in providing the highest quality and most comprehensive urologic care in New York. Find out how Klein & Birns Urology can serve you and your family by calling (212) 744-8700 or by making an appointment.