Patient Resources

Prostate gland enlargement is a common condition as men get older. Also called benign prostatic hyperplasia (BPH), prostate gland enlargement can cause bothersome urinary symptoms. Untreated, prostate gland enlargement can block the flow of urine out of the bladder and cause bladder, urinary tract or kidney problems.

There are several effective treatments for prostate gland enlargement, including medications, minimally invasive therapies and surgery. To choose the best option, we will consider your symptoms, the size of your prostate, other health conditions you might have and your preferences.

Bladder cancer is a malignant tumour that starts in the cells of the bladder. The bladder is part of the urinary system and it is a hollow, balloon-shaped organ with a flexible, muscular wall. The bladder stores urine. Urine is made by the kidneys, where it collects in the renal pelvis. It passes to the bladder through 2 tubes called ureters. Urine passes from the bladder and out of the body through a tube called the urethra.

Cells in the bladder sometimes change and no longer grow or behave normally. These changes may lead to non-cancerous, or benign conditions, such as a urinary tract infection. They can also lead to benign tumours, such as papilloma or a fibroma. Benign conditions and tumours are not cancerous. But in some cases, changes to bladder cells can cause bladder cancer.

Most often, bladder cancer starts in cells of the urothelium (also called the transitional epithelium). The urothelium lines the inside of the bladder, ureters, urethra and renal pelvis. It is made up of urothelial cells, or transitional cells. Cancer that starts in urothelial cells is called urothelial carcinoma, or transitional cell carcinoma. Urothelial carcinomas make up more than 90% of all bladder cancers. When the cancer is only in the urothelium, it is called non-invasive bladder cancer. If cancer spreads into the connective tissue or muscle in the wall of the bladder, it is called invasive bladder cancer.

Rare types of bladder cancer can also develop. These include squamous cell carcinoma and adenocarcinoma. Urothelial carcinoma can also start in the renal pelvis or ureters, but this is less common.

Most cancers are the result of many risk factors. Smoking is the most important risk factor for bladder cancer. The risk of developing bladder cancer increases with age. It usually occurs in people older than 65 years of age. Bladder cancer is most common in Caucasians, and men develop this disease more often than women.

In general, the risk factors include:

• Smoking

• Arsenic

• Occupational exposure to chemicals

• Cyclophosphamide

• Exposure to radiation

• Chronic bladder irritation

• Personal history of cancer in the urinary tract

• Bladder birth defects

Bladder cancer signs and symptoms may include:

• Blood in urine (hematuria) — urine may appear bright red or cola colored. Or urine may appear normal, but blood may be detected in a microscopic examination of the urine

• Frequent urination

• Painful urination

• Back pain

• Pelvic pain

Cystitis is the medical term for inflammation of the bladder. Most of the time, the inflammation is caused by a bacterial infection, and it’s called a urinary tract infection (UTI). A bladder infection can be painful and annoying, and it can become a serious health problem if the infection spreads to your kidneys.

Less commonly, cystitis may occur as a reaction to certain drugs, radiation therapy or potential irritants, such as feminine hygiene spray, spermicidal jellies or long-term use of a catheter. Cystitis may also occur as a complication of another illness.

The usual treatment for bacterial cystitis is antibiotics. Treatment for other types of cystitis depends on the underlying cause.

Cystitis signs and symptoms often include:

• A strong, persistent urge to urinate

• A burning sensation when urinating

• Passing frequent, small amounts of urine

• Blood in the urine (hematuria)

• Passing cloudy or strong-smelling urine

• Pelvic discomfort

• A feeling of pressure in the lower abdomen

• Low-grade fever

In young children, new episodes of accidental daytime wetting also may be a sign of a urinary tract infection (UTI). Nighttime bed-wetting on its own isn’t likely to be associated with a UTI.

When to seek medical attention

Seek immediate medical help if you have signs and symptoms common to a kidney infection, including:

• Back or side pain

• Fever and chills

• Nausea and vomiting

Your urinary system includes your kidneys, ureters, bladder and urethra. All play a role in removing waste from your body. Your kidneys — a pair of bean-shaped organs located toward the back of your upper abdomen — filter waste from your blood and regulate the concentrations of many substances. Tubes called ureters carry urine from your kidneys to the bladder, where it’s stored until it exits your body through the urethra.

Bacterial cystitis

UTIs typically occur when bacteria outside the body enter the urinary tract through the urethra and begin to multiply. Most cases of cystitis are caused by a type of Escherichia coli (E. coli) bacteria.

Bacterial bladder infections may occur in women as a result of sexual intercourse. But even sexually inactive girls and women are susceptible to lower urinary tract infections because the female genital area often harbors bacteria that can cause cystitis.

Noninfectious cystitis

Although bacterial infections are the most common cause of cystitis, a number of noninfectious factors also may cause the bladder to become inflamed. Some examples include:

• Interstitial cystitis. The cause of this chronic bladder inflammation also called painful bladder syndrome, is unclear. Most cases are diagnosed in women. The condition can be difficult to diagnose and treat.

• Drug-induced cystitis. Certain medications, particularly the chemotherapy drugs cyclophosphamide and ifosfamide, can cause inflammation of your bladder as the broken-down components of the drugs exit your body.

• Radiation cystitis. Radiation treatment of the pelvic area can cause inflammatory changes in bladder tissue.

• Foreign-body cystitis. Long-term use of a catheter can predispose you to bacterial infections and to tissue damage, both of which can cause inflammation.

• Chemical cystitis. Some people may be hypersensitive to chemicals contained in certain products, such as bubble bath, feminine hygiene sprays or spermicidal jellies, and may develop an allergic-type reaction within the bladder, causing inflammation.

• Cystitis associated with other conditions. Cystitis may sometimes occur as a complication of other disorders, such as diabetes, kidney stones, an enlarged prostate or spinal cord injuries.

Epididymitis is an inflammation of the coiled tube (epididymis) at the back of the testicle that stores and carries sperm. Males of any age can get epididymitis.

Epididymitis is most often caused by a bacterial infection, including sexually transmitted infections (STIs), such as gonorrhea or chlamydia. Sometimes, a testicle also may become inflamed — a condition called epididymo-orchitis.

Signs and symptoms of epididymitis might include:

• A swollen, red or warm scrotum

• Testicle pain and tenderness, usually on one side

• Painful urination or an urgent or frequent need to urinate

• Discharge from the penis

• Painful intercourse or ejaculation

• A lump on the testicle

• Enlarged lymph nodes in the groin

• Pain or discomfort in the lower abdomen or pelvic area

• Blood in the semen

• Less commonly, feve

Chronic epididymitis

Epididymitis that lasts longer than six weeks or that recurs is considered chronic. Symptoms of chronic epididymitis might come on gradually. Sometimes the cause of chronic epididymitis is not identified.

Erectile dysfunction (impotence) is the inability to get and keep an erection firm enough for sex.

Having erection trouble from time to time isn’t necessarily a cause for concern. If erectile dysfunction is an ongoing issue, however, it can cause stress, affect your self-confidence and contribute to relationship problems. Problems getting or keeping an erection also can be a sign of an underlying health condition that needs treatment and a risk factor for heart disease down the road.

If you’re concerned about erectile dysfunction, start by talking to your family doctor — even if you’re embarrassed. Sometimes, treating an underlying condition is enough to reverse erectile dysfunction. In other cases, medications or other direct treatments might be needed.

Erectile dysfunction symptoms might include persistent:

• Trouble getting an erection

• Trouble keeping an erection

• Reduced sexual desire

Sometimes a combination of physical and psychological issues causes erectile dysfunction. For instance, a minor physical condition that slows your sexual response might cause anxiety about maintaining an erection. The resulting anxiety can lead to or worsen erectile dysfunction.

Physical causes of erectile dysfunction

In most cases, erectile dysfunction is caused by something physical. Common causes include:

• Heart disease

• Clogged blood vessels (atherosclerosis)

• High cholesterol

• High blood pressure

• Diabetes

• ObesityMetabolic syndrome — a condition involving increased blood pressure, high insulin levels, body fat around the waist and high cholesterol

• Parkinson’s disease

• Multiple sclerosis

• Peyronie’s disease — development of scar tissue inside the penis

• Certain prescription medications

• Tobacco use

• Alcoholism and other forms of substance abuse

• Sleep disorders

• Treatments for prostate cancer or enlarged prostate

• Surgeries or injuries that affect the pelvic area or spinal cord

Psychological causes of erectile dysfunction

The brain plays a key role in triggering the series of physical events that cause an erection, starting with feelings of sexual excitement. A number of things can interfere with sexual feelings and cause or worsen erectile dysfunction. These include:

• Depression, anxiety or other mental health conditions

• Stress

• Relationship problems due to stress, poor communication or other concerns

As you get older, erections might take longer to develop and might not be as firm. You might need more direct touch to your penis to get and keep an erection. This might indicate underlying health conditions or be a result of taking medications

Various risk factors can contribute to erectile dysfunction, including:

• Medical conditions, particularly diabetes or heart conditions

• Tobacco use, which restricts blood flow to veins and arteries, can — over time— cause chronic health conditions that lead to erectile dysfunction

• Being overweight, especially if you’re obese

• Certain medical treatments, such as prostate surgery or radiation treatment for cancer

• Injuries, particularly if they damage the nerves or arteries that control erections

• Medications, including antidepressants, antihistamines, and medications to treat high blood pressure, pain or prostate conditions

• Psychological conditions, such as stress, anxiety or depression

• Drug and alcohol use, especially if you’re a long-term drug user or heavy drinker

• Prolonged bicycling, which can compress nerves and affect blood flow to the penis, may lead to temporary or permanent erectile dysfunction

Seeing blood in your urine can cause anxiety. While in many instances there are benign causes, blood in the urine (hematuria) can also indicate a serious disorder.

Blood that you can see is called gross hematuria. Urinary blood that’s visible only under a microscope is known as microscopic. Either way, it’s important to determine the reason for the bleeding. Treatment depends on the underlying cause.

The visible sign of hematuria is pink, red or cola-colored urine — the result of the presence of red blood cells. It takes very little blood to produce red urine, and the bleeding usually isn’t painful. If you’re also passing blood clots in your urine, that can be painful. Bloody urine often occurs without other signs or symptoms.

It’s possible to have blood in your urine that’s visible only under a microscope (microscopic hematuria).

In hematuria, your kidneys — or other parts of your urinary tract — allow blood cells to leak into the urine. A number of problems can cause this leakage, including:

• Urinary tract infections. Urinary tract infections often occur when bacteria enter your body through the urethra and begin to multiply in your bladder. Symptoms can include a persistent urge to urinate, pain and burning with urination, and extremely strong-smelling urine.

For some people, especially older adults, the only sign of illness may be microscopic blood.

• Kidney infections. Kidney infections (pyelonephritis) can occur when bacteria enter your kidneys from your bloodstream or move up from your ureters to your kidney(s). Signs and symptoms are often similar to bladder infections, though kidney infections are more likely to cause fever and flank pain.

• A bladder or kidney stone. The minerals in concentrated urine sometimes precipitate out, forming crystals on the walls of your kidneys or bladder. Over time, the crystals can become small, hard stones. The stones are generally painless, and you probably won’t know you have them unless they cause a blockage or are being passed. Then there’s usually no mistaking the symptoms — kidney stones, especially, can cause excruciating pain. Bladder or kidney stones can also cause both gross and microscopic bleeding.

• Enlarged prostate. The prostate gland — located just below the bladder and surrounding the top part of the urethra — often begins growing as men approach middle age. When the gland enlarges, it compresses the urethra, partially blocking urine flow.
Signs and symptoms of an enlarged prostate (benign prostatic hyperplasia, or BPH) include difficulty urinating, an urgent or persistent need to urinate, and either visible or microscopic blood in the urine. Infection of the prostate (prostatitis) can cause the same signs and symptoms.

• Kidney disease. Microscopic urinary bleeding is a common symptom of glomerulonephritis, which causes inflammation of the kidneys’ filtering system.
Glomerulonephritis may be part of a systemic disease, such as diabetes, or it can occur on its own. It can be triggered by viral or strep infections, blood vessel diseases (vasculitis), and immune problems such as IgA nephropathy, which affects the small capillaries that filter blood in the kidneys (glomeruli).

• Cancer. Visible urinary bleeding may be a sign of advanced kidney, bladder or prostate cancer. Unfortunately, you may not have signs or symptoms in the early stages, when these cancers are more treatable.

• Inherited disorders. Sickle cell anemia — a hereditary defect of hemoglobin in red blood cells — can be the cause of blood in urine, both visible and microscopic hematuria. So can Alport syndrome, which affects the filtering membranes in the glomeruli of the kidneys.

• Kidney injury. A blow or other injury to your kidneys from an accident or contact sports can cause blood in your urine that you can see.

• Medications. The anti-cancer drug cyclophosphamide (Cytoxan) and penicillin can cause urinary bleeding. Visible urinary blood sometimes occurs if you take an anticoagulant, such as aspirin and the blood thinner heparin, and you also have a condition that causes your bladder to bleed.

• Strenuous exercise. Although it happens rarely, it’s not quite clear why strenuous exercise may lead to gross hematuria. It may be linked to trauma to the bladder, dehydration or the breakdown of red blood cells that occurs with sustained aerobic exercise. Runners are most often affected, although almost any athlete can develop visible urinary bleeding after an intense workout.

A hydrocele is a fluid-filled sac surrounding a testicle that causes swelling in the scrotum. Hydrocele is common in newborns and usually disappears without treatment during the first year of life. Older boys and adult men can develop a hydrocele due to inflammation or injury within the scrotum.

A hydrocele usually isn’t painful or harmful and might not need any treatment. However, if you have scrotal swelling, see your family doctor to rule out other causes.

Usually, the only indication of a hydrocele is a painless swelling of one or both testicles.

Adult men with a hydrocele might experience discomfort from the heaviness of a swollen scrotum. Pain generally increases with the size of the inflammation. Sometimes, the swollen area might be smaller in the morning and larger later in the day.

Interstitial cystitis, also called painful bladder syndrome, is a chronic condition causing bladder pressure, bladder pain and sometimes pelvic pain. The pain ranges from mild discomfort to severe.

Your bladder is a hollow, muscular organ that stores urine. The bladder expands until it’s full and then signals your brain that it’s time to urinate, communicating through the pelvic nerves. This creates the urge to urinate for most people. With interstitial cystitis, these signals get mixed up — you feel the need to urinate more often and with smaller volumes of urine than most people. Interstitial cystitis most often affects women and can have a long-lasting impact on quality of life. Although there’s no cure, medications and other therapies may offer relief. This condition is often over diagnosed.

Symptoms

The signs and symptoms of interstitial cystitis vary from person to person. If you have interstitial cystitis, your symptoms may also vary over time, periodically flaring in response to common triggers, such as menstruation, sit for a long time, stress, exercise, and sexual activity.

Interstitial cystitis signs and symptoms include:

• Pain in your pelvis or between the vagina and anus in women

• Pain between the scrotum and anus in men (perineum)

• Chronic pelvic pain

• A persistent, urgent need to urinate

• Frequent urination, often of small amounts, throughout the day and night (up to 60 times a day)

• Pain or discomfort while the bladder fills and relief after urinating

• Pain during sexual intercourse

Symptoms severity is different for everyone, and some people may experience symptom-free periods. Although signs and symptoms of interstitial cystitis may resemble those of a chronic urinary tract infection, there’s usually no infection. However, symptoms may worsen if a person with interstitial cystitis gets a urinary tract infection.

Causes

The exact cause of interstitial cystitis isn’t known, but it’s likely that many factors contribute. For instance, people with interstitial cystitis may also have a defect in the protective lining (epithelium) of the bladder. A leak in the epithelium may allow toxic substances in urine to irritate your bladder wall.

Other possible but unproven contributing factors include an autoimmune reaction, heredity, infection or allergy.

Risk factors

These factors are associated with a higher risk of interstitial cystitis:

• Your sex. Women are diagnosed with interstitial cystitis more often than men. Symptoms in men may mimic interstitial cystitis, but they’re more often associated with an inflammation of the prostate gland (prostatitis).

• Your skin and hair color. Having fair skin and red hair has been associated with a greater risk of interstitial cystitis.

• Your age. Most people with interstitial cystitis are diagnosed during their 30s or older.

• Having a chronic pain disorder. Interstitial cystitis may be associated with other chronic pain disorder, such as irritable bowel syndrome or fibromyalgia.

Complications

Interstitial cystitis can result in a number of complications, including:

• Reduced bladder capacity. Interstitial cystitis can cause stiffening of the bladder wall, which allows your bladder to hold less urine.

• Lower quality of life. Frequent urination and pain may interfere with social activities, work and other activities of daily life.

• Sexual intimacy problems. Frequent urination and pain may strain your personal relationships, and sexual intimacy may suffer.

• Emotional troubles. The chronic pain and interrupted sleep associated with interstitial cystitis may cause emotional stress and can lead to depression.

Kidney cancer is cancer that originates in the kidneys. Your kidneys are two bean-shaped organs, each about the size of your fist. They’re located behind your abdominal organs, with one kidney on each side of your spine.

In adults, the most common type of kidney cancer is renal cell carcinoma. Other less common types of kidney cancer can occur. Young children are more likely to develop a kind of kidney cancer called Wilms’ tumor.

The incidence of kidney cancer seems to be increasing. One reason for this may be the fact that imaging techniques such as computerized tomography (CT) scan are being used more often. These tests may lead to the accidental discovery of more kidney cancers.

Kidney cancer rarely causes signs or symptoms in its early stages. In the later stages, kidney cancer signs and symptoms may include:

Blood in your urine, which may appear pink, red or cola colored

Back pain just below the ribs that doesn’t go away

Weight loss

Fatigue

Intermittent fever

It’s not clear what causes renal cell carcinoma.

Diagnosing kidney cancer

Tests and procedures used to diagnose kidney cancer include:

• Blood and urine tests. Tests of your blood and your urine may give your Urologist clues about what’s causing your signs and symptoms.

• Imaging tests. Imaging tests allow your Urologist to visualize a kidney tumor or abnormality. Imaging tests might include ultrasound, computerized tomography (CT) scan or magnetic resonance imaging (MRI).

• Removing a sample of kidney tissue (biopsy). In rare cases, your Urologist may recommend a procedure to remove a small sample of cells (biopsy) from a suspicious area of your kidney. The sample is tested in a lab to look for signs of cancer.

Kidney cancer staging

Once your Urologist identifies a kidney lesion that might be kidney cancer, the next step is to determine the extent (stage) of cancer. Staging tests for kidney cancer may include additional CT scans or other imaging tests your Urologist feels are appropriate.

Then your Urologist assigns a number, called a stage, to your cancer. Kidney cancer stages include:

• Stage I. At this stage, the tumor can be up to 2 3/4 inches (7 centimeters) in diameter. The tumor is confined to the kidney.

• Stage II. A stage II kidney cancer is larger than a stage I tumor, but it’s still confined to the kidney.

• Stage III. At this stage, the tumor extends beyond the kidney to the surrounding tissue and may also have spread to a nearby lymph node.

• Stage IV. Cancer spreads outside the kidney, to multiple lymph nodes or to distant parts of the body, such as the bones, liver or lungs.

Kidney cysts are round pouches of fluid that form on or in the kidneys. Kidney cysts can be associated with serious disorders that may impair kidney function. But more commonly, kidney cysts are a type called simple kidney cysts — noncancerous cysts that rarely cause complications.

It’s not clear what causes simple kidney cysts. Typically, only one cyst occurs on the surface of a kidney, but multiple cysts can affect one or both kidneys. However, simple kidney cysts aren’t the same as the cysts that form with polycystic kidney disease.

Simple kidney cysts are often detected during an imaging test performed for another condition. Simple kidney cysts that don’t cause signs or symptoms usually don’t require treatment.

Simple kidney cysts typically don’t cause signs or symptoms. If a simple kidney cyst grows large enough, symptoms may include:

• Dull pain in your back or side

• Fever

• Upper abdominal pain

Kidney cysts can in rare cases lead to complications, including:

• An infected cyst. A kidney cyst may become infected, causing fever and pain

• A burst cyst. A kidney cyst that bursts can cause severe pain in your back or side

• Urine obstruction. A kidney cyst that obstructs the normal flow of urine may lead to swelling of the kidney (hydronephrosis)

Kidney stones (renal lithiasis, nephrolithiasis) are small, hard mineral deposits that form inside your kidneys. The stones are made of mineral and acid salts.

Kidney stones have many causes and can affect any part of your urinary tract — from your kidneys to your bladder. Often, stones form when the urine becomes concentrated, allowing minerals to crystallize and stick together.

Passing kidney stones can be quite painful, but the stones usually cause no permanent damage. Depending on your situation, you may need nothing more than to take pain medication and drink lots of water to pass a kidney stone. In other instances — for example, if stones become lodged in the urinary tract or cause complications — surgery may be needed.

A kidney stone may not cause symptoms until it moves around within your kidney or passes into your ureter — the tube connecting the kidney and bladder. At that point, you may experience these signs and symptoms:

• Severe pain in the side and back, below the ribs

• Pain that spreads to the lower abdomen and groin

• Pain that comes in waves and fluctuates in intensity

• Pain on urination

• Pink, red or brown urine

• Cloudy or foul-smelling urine

• Nausea and vomiting

• Persistent need to urinate

• Urinating more often than usual

• Fever and chills if an infection is present

• Urinating small amounts of urine

Pain caused by a kidney stone may change — for instance, shifting to a different location or increasing in intensity — as the stone moves through your urinary tract.

Seek immediate medical attention if you experience:

• Pain so severe that you can’t sit still or find a comfortable position

• Pain accompanied by nausea and vomiting

• Pain accompanied by fever and chills

• Blood in your urine

• Difficulty passing urine

Kidney stones often have no definite, single cause, although several factors may increase your risk.

Kidney stones form when your urine contains more crystal-forming substances — such as calcium, oxalate and uric acid — than the fluid in your urine can dilute. At the same time, your urine may lack substances that prevent crystals from sticking together, creating an ideal environment for kidney stones to form.

Types of kidney stones

Knowing the type of kidney stone helps determine the cause and may give clues on how to reduce your risk of getting more kidney stones. Types of kidney stones include:

• Calcium stones. Most kidney stones are calcium stones, usually in the form of calcium oxalate. Oxalate is a naturally occurring substance found in food. Some fruits and vegetables, as well as nuts and chocolate, have high oxalate levels. Your liver also produces oxalate. Dietary factors, high doses of vitamin D, intestinal bypass surgery and several metabolic disorders can increase the concentration of calcium or oxalate in urine. Calcium stones may also occur in the form of calcium phosphate.

• Struvite stones. Struvite stones form in response to an infection, such as a urinary tract infection. These stones can grow quickly and become quite large, sometimes with few symptoms or little warning.

• Uric acid stones. Uric acid stones can form in people who don’t drink enough fluids or who lose too much fluid, those who eat a high-protein diet, and those who have gout. Certain genetic factors also may increase your risk of uric acid stones.

• Cystine stones. These stones form in people with a hereditary disorder that causes the kidneys to excrete too much of certain amino acids (cystinuria).

• Other stones. Other, rarer types of kidney stones also can occur.

Factors that increase your risk of developing kidney stones include:

• Family or personal history. If someone in your family has kidney stones, you’re more likely to develop stones, too. And if you’ve already had one or more kidney stones, you’re at increased risk of developing another.

• Dehydration. Not drinking enough water each day can increase your risk of kidney stones. People who live in warm climates and those who sweat a lot may be at higher risk than others.

• Certain diets. Eating a diet that’s high in protein, sodium, and sugar may increase your risk of some types of kidney stones. This is especially true with a high-sodium diet. Too much sodium in your diet increases the amount of calcium your kidneys must filter and significantly increases your risk of kidney stones.

• Being obese. High body mass index (BMI), large waist size and weight gain have been linked to an increased risk of kidney stones.

• Digestive diseases and surgery. Gastric bypass surgery, inflammatory bowel disease or chronic diarrhea can cause changes in the digestive process that affect your absorption of calcium and water, increasing the levels of stone-forming substances in your urine.

• Other medical conditions. Diseases and conditions that may increase your risk of kidney stones include renal tubular acidosis, cystinuria, hyperparathyroidism, certain medications and some urinary tract infections.

Treatment for kidney stones varies, depending on the type of stone and the cause.

Small stones with minimal symptomsMost kidney stones won’t require invasive treatment. You may be able to pass a small stone by:

• Drinking water. Drinking as much as 2 to 3 liters a day may help flush out your urinary system. Unless a doctor tells you otherwise, drink enough fluid — mostly water — to produce clear or nearly clear urine.

• Pain relievers. Passing a small stone can cause some discomfort. To relieve mild pain, your Urologist may recommend pain relievers such as ibuprofen (Advil, Motrin, Alleve or others), acetaminophen (Tylenol, others) or naproxen sodium (Aleve).

• Medical therapy. Your Urologist may give you a medication to help pass your kidney stone. This type of medication, known as an alpha-blocker, relaxes the muscles in your ureter, helping you pass the kidney stone more quickly and with less pain.

Large stones and those that cause symptoms

Kidney stones that can’t be treated with conservative measures — either because they’re too large to pass on their own or because they cause bleeding, kidney damage or ongoing urinary tract infections — may require more extensive treatment. Procedures may include:

• Using sound waves to break up stones. For certain kidney stones — depending on size and location — a procedure called extracorporeal shock wave lithotripsy (ESWL) may be recommended.
This treatment is generally used for stones less than 1-1.2cm in size that is located in favorable locations in the kidney. It is rarely used to treat kidney stones that have migrated into the ureter. ESWL uses sound waves to create strong vibrations (shock waves) that break the stones into tiny pieces that can be passed in your urine. The procedure lasts about 45 to 60 minutes and can cause moderate pain, so you may be under sedation or light anesthesia to make you comfortable.
ESWL can cause blood in the urine, bruising on the back or abdomen, bleeding around the kidney and other adjacent organs, and discomfort as the stone fragments pass through the urinary tract.

• Using a scope to remove stones. To remove a smaller stone in your ureter or kidney, a thin lighted tube (ureteroscope) equipped with a camera is inserted through your urethra and bladder to your ureter.
Once the stone is located, special tools like a laser can break it into pieces that will pass in your urine. A small tube (stent) will be inserted in the ureter to relieve swelling and promote healing. You will need a short general anesthetic during this procedure.

• Surgery to remove very large stones in the kidney. A procedure called percutaneous nephrolithotomy involves surgically removing a kidney stone using small telescopes and instruments inserted through a small incision in your back.
You will receive general anesthesia during the surgery and be in the hospital for one to two days while you recover. This is usually used to treat stones that are in difficult to access locations within the kidney or if there is a large stone burden (>2cm stone).

Prevention of kidney stones may include a combination of lifestyle changes and medications.

Lifestyle changes

You may reduce your risk of kidney stones if you:

• Drink water throughout the day. For people with a history of kidney stones, Urologists usually recommend passing about 2.5 liters of urine a day. Your Urologist may ask that you measure your urine output to make sure that you’re drinking enough water.

If you live in a hot, dry climate or you exercise frequently, you may need to drink even more water to produce enough urine. If your urine is light and clear, you’re likely drinking enough water.

• Eat fewer oxalate-rich foods. If you tend to form calcium oxalate stones, it is recommended to restricting foods rich in oxalates. These include rhubarb, beets, okra, spinach, Swiss chard, sweet potatoes, nuts, tea, chocolate and soy products.

• Choose a diet low in salt and animal protein. Reduce the amount of salt you eat and choose non-animal protein sources, such as legumes. Consider using a salt substitute.

• Continue eating calcium-rich foods, but use caution with calcium supplements. Calcium in food doesn’t have an effect on your risk of kidney stones. Continue eating calcium-rich foods. You may reduce the risk by taking supplements with meals. Diets low in calcium can increase kidney stone formation in some people.

Medications

Medications can control a number of minerals and acid in your urine and may be helpful in people who form certain kinds of stones. The type of medication your Urologist prescribes will depend on the kind of kidney stones you have as well as the results of your metabolic stone workup. Here are some examples:

• Calcium stones. To help prevent calcium stones from forming, your Urologist may prescribe a thiazide diuretic or a phosphate-containing preparation.

• Uric acid stones. Your Urologist may prescribe allopurinol (Zyloprim, Aloprim) to reduce uric acid levels in your blood and urine and a medicine to keep your urine alkaline. In some cases, allopurinol and an alkalizing agent may dissolve the uric acid stones.

• Struvite stones. To prevent struvite stones, your Urologist may recommend strategies to keep your urine free of bacteria that cause infection. Long-term use of antibiotics in small doses may help achieve this goal. For instance, your Urologist may recommend an antibiotic before and for a while after surgery to treat your kidney stones.

• Cystine stones. Cystine stones can be difficult to treat. Your Urologist may recommend that you drink more fluids so that you produce a lot more urine. If that alone doesn’t help, your Urologist may also prescribe a medication that decreases the amount of cystine in your urine.

During routine visits to your family doctor, you are often asked to give a urine sample for testing. Many tests are done routinely, like checking for sugar (diabetes), bacteria (infection) and blood. Blood in the urine that you do not see is called “microscopic hematuria.” This blood is only visible under a microscope. Often times, your family doctor will have ordered a chemical urinalysis or dipstick urine which is similar to a litmus test for the urine. The results of a dipstick test are not accurate and should always be confirmed with a microscopic examination. To be defined as clinically significant microscopic hematuria, your urine tests should have more than 2-3 red blood cells per high-powered field.

There are many causes of microscopic hematuria such as:

• Urinary tract infection

• Enlarged Prostate in older men

• Kidney or bladder stones

• Period in women

• Prostate infection

• Kidney disease

• Kidney trauma

• Bladder cancer (mostly in smokers)

• Kidney cancer

• Blood-thinning drugs (aspirin, coumadin/warfarin)

• Anti-swelling drugs (joint swelling and pain pills)

• Tough workout

Causes of hematuria may be generally grouped into the site of origin: glomerular or non-glomerular. Glomerular causes arise from the kidney itself. Nonglomerular etiologies can be further subdivided by whether the process is located in the upper urinary tract (kidney and ureter) or lower urinary tract (bladder and urethra). In general, urologists are concerned with structural and pathologic conditions that are visible on imaging and/or endoscopic examination whereas glomerular hematuria is the purview of nephrologists.

When blood is found in the urine, your family physician will want to make sure there is not a serious health issue involved such as a tumor in the kidney or bladder. Urological cancers are rarely the cause of blood in the urine. Only about 2 or 3 of every 100 people with microscopic hematuria are found to have cancer.

The prevalence of microscopic hematuria ranges from 1-20% depending on the population studied. The likelihood of finding significant urologic disease in these patients also varies with associated risk factors which include:

• Older age

• Male gender

• History of cigarette smoking

• History of chemical exposure (cyclophosphamide, benzenes, aromatic amines)

• History of pelvic radiation

• Irritative voiding symptoms (urgency, frequency, dysuria)

• Prior urologic disease or treatment

Cystoscopy is recommended by the Canadian Urological Association guidelines in all patients at least 40 years of age with microhematuria (in all patients at least 35 years of age with microhematuria according to the American Urological Association guidelines) and in all patients who present with gross hematuria. For patients less than 35 or 40 years of age with microhematuria, cystoscopy may be performed at the discretion of the clinician based on the presence of risk factors for malignancy.

Currently, urine cytology or other tumor markers are not routinely recommended in the evaluation of asymptomatic microhematuria but may be considered in patients with risk factors.

Delayed excretory cross-sectional abdominal and pelvic imaging is necessary to evaluate the upper urinary tract and exclude upper tract malignancies. Given its relatively high sensitivity and specificity, CT urography or urogram (CTU) is the preferred modality. If a renal function or iodine allergies preclude the ability to undergo CTU, then ultrasounds, MR urography or retrograde pyelograms with non-contrasted renal imaging can be considered.

With this evaluation strategy, a cause for hematuria is identified in roughly 57% of patients with microhematuria and 92% of patients with gross hematuria. Malignancy is identified in approximately 3-5% of patients presenting with microhematuria and 23% of patients presenting with gross hematuria. Following an unrevealing work-up for hematuria, a urinalysis should be checked annually. Patients with persistent hematuria after a negative initial evaluation warrant repeat evaluation in 3-5 years, especially in those with risk factors for urologic malignancy.

Overactive bladder is a problem with the bladder-storage function that causes a sudden urge to urinate. The urge may be difficult to stop, and overactive bladder may lead to the involuntary loss of urine (incontinence).

If you have an overactive bladder, you may feel embarrassed, isolate yourself, or limit your work and social life. The good news is that a brief evaluation can determine whether there’s a specific cause for your overactive bladder symptoms.

Management of overactive bladder often begins with behavioral strategies, such as fluid schedules, timed voiding and bladder-holding techniques using your pelvic floor. If these initial efforts don’t help enough with your overactive bladder symptoms, second line and third line treatments are available.

With an overactive bladder, you may:

• Feel a sudden urge to urinate that’s difficult to control

• Experience urge incontinence — the involuntary loss of urine immediately following an urgent need to urinate

• Urinate frequently, usually eight or more times in 24 hours

• Awaken two or more times in the night to urinate (nocturia)

Although you may be able to get to the toilet in time when you sense an urge to urinate, unexpected frequent urination and nighttime urination can disrupt your life.

Normal bladder function

The kidneys produce urine, which drains into your bladder. When you urinate, urine passes from your bladder through an opening at the bottom and flows out a tube called the urethra. In women, the urethral opening is located just above the vagina. In men, the urethral opening is at the tip of the penis.

As your bladder fills, nerve signals sent to your brain eventually trigger the need to urinate. When you urinate, nerve signals coordinate the relaxation of the pelvic floor muscles and the muscles of the urethra (urinary sphincter muscles). The muscles of the bladder tighten (contract), pushing the urine out.

Involuntary bladder contractions

Overactive bladder occurs because the muscles of the bladder start to contract involuntarily even when the volume of urine in your bladder is low. This involuntary contraction creates the urgent need to urinate.

Several conditions may contribute to signs and symptoms of overactive bladder, including:

• Neurological disorders, such as Parkinson’s disease, strokes and multiple sclerosis

• High urine production as might occur with high fluid intake, poor kidney function or diabetes

• Medications that cause a rapid increase in urine production or require that you take them with lots of fluids

• Acute urinary tract infections that can cause symptoms similar to an overactive bladder

• Abnormalities in the bladder, such as tumors or bladder stones

• Factors that obstruct bladder outflow — enlarged prostate, constipation or previous operations to treat other forms of incontinence

• Excess consumption of caffeine or alcohol

• Declining cognitive function due to aging, which may make it more difficult for your bladder to understand the signals it receives from your brain

• Difficulty walking, which can lead to bladder urgency if you’re unable to get to the bathroom quickly

• Incomplete bladder emptying, which may lead to symptoms of overactive bladder, as you have little urine storage space left

• Constipation

Often, the specific cause of an overactive bladder isn’t known.

As you age, you’re at increased risk of developing overactive bladder. You’re also at higher risk of diseases and disorders, such as enlarged prostate and diabetes, which can contribute to other problems with bladder function.

Many people with cognitive decline — for instance, after a stroke or with Alzheimer’s disease — develop an overactive bladder. Incontinence that results from situations like this can be managed with fluid schedules, timed and prompted voiding, absorbent garments, and bowel programs.

Your Urologist may order a simple urodynamic test to assess the function of your bladder and its ability to empty steadily and completely. These tests usually require a referral to a specialist. Tests include:

• Measuring urine left in the bladder. This test is important if your bladder doesn’t empty completely when you urinate or experience urinary incontinence. Remaining urine (postvoid residual urine) may cause symptoms identical to an overactive bladder.
To measure residual urine after you have voided, an ultrasound scan of your bladder may be performed.

• Measuring urine flow rate. To measure the volume and speed of your voiding, you may be asked to urinate into a uroflowmeter. This device translates the data into a graph of changes in your flow rate.

• Testing bladder pressures. Urodynamics testing measures pressure in your bladder and in the surrounding region during bladder filling. During this test, your Urologist uses a thin tube (catheter) to fill your bladder slowly with warm water. Another catheter with a pressure-measuring sensor is placed in your rectum or, if you’re a woman, in your vagina.
This procedure can identify whether you have involuntary muscle contractions or a stiff bladder that’s not able to store urine under low pressure. You may be asked to void during the study (pressure-flow study), which can also measure the pressure used to empty your bladder and indicate whether or not you have a bladder blockage (obstruction). An obstruction — from an enlarged prostate in men or pelvic organ prolapse in women — can lead to symptoms of overactive bladder.
This test is generally used for people who have neurologic diseases that affect the spinal cord.

Your Urologist is likely to recommend a combination of treatment strategies to relieve your symptoms.

Behavioral interventions

Behavioral interventions are the first choice in helping manage an overactive bladder. They’re often effective, and they carry no side effects. Behavioral interventions may include:

• Pelvic floor muscle exercises or pelvic physiotherapy

• Maintain healthy weight

• Reduce fluid consumption

• Double voiding

• Scheduled toilet trips

• Absorbent pads

• Bladder retraining or delayed voiding

Medications

Medications that relax the bladder can be helpful for relieving symptoms of overactive bladder and reducing episodes of urge incontinence. These drugs include:

• Ditropan

• Darifenacin (Enablex)

• Fesoterodine (Toviaz)

• Mirabegron (Myrbetriq)

• Solifenacin (Vesicare)

• Tolterodine (Detrol)

• Trospium (Trosec)

Common side effects of most of these drugs include dry eyes and dry mouth, but drinking water to quench thirst can aggravate symptoms of overactive bladder.

Constipation — another potential side effect — can aggravate your bladder symptoms. Extended-release forms of these medications, including the skin patch or gel, may cause fewer side effects. Treating the side effects of a medication that’s working is more important than stopping the medication.

Bladder medications aren’t likely to help with getting up during the night to urinate. Often, this isn’t a problem with the bladder at all, rather it’s related to the way your kidneys and heart manage your body fluids — which can change over time. As you get older, you may make as much or more urine at night than you do during the day.

Other options for treatment of severe urge incontinence include bladder injection with Botox, sacral nerve stimulation, bladder augmentation or bladder removal.

Peyronie’s disease is the development of fibrous scar tissue inside the penis that causes curved, painful erections.

Men’s penises vary in shape and size. Having a curved erection is common and isn’t necessarily a cause for concern. However, in some men, Peyronie’s disease causes a significant bend or pain.

This can prevent a man from having sex or might make it difficult to get or maintain an erection (erectile dysfunction). For many men, Peyronie’s disease also causes stress and anxiety.

In a small percentage of men, Peyronie’s disease goes away on its own. But in most cases, it will remain stable or worsen. Treatment might be needed if the curvature is severe enough that it prevents successful sexual intercourse.

Peyronie’s disease signs and symptoms might appear suddenly or develop gradually. The most common signs and symptoms include:

• Scar tissue. The scar tissue (plaques) associated with Peyronie’s disease can be felt under the skin of the penis as flat lumps or a band of hard tissue.

• A significant bend to the penis. Your penis might be curved upward, downward or bent to one side. In some cases, the erect penis might have narrowing, indentations or an hourglass appearance, with a tight, narrow band around the shaft.

• Erection problems. Peyronie’s disease might cause problems getting or maintaining an erection (erectile dysfunction).

• Shortening of the penis. Your penis might become shorter as a result of Peyronie’s disease.

• Pain. You might have penile pain, with or without an erection.

The curvature associated with Peyronie’s disease might gradually worsen. At some point, however, it stabilizes in the majority of men.

In most men, pain during erections improves within one to two years, but the scar tissue and curvature often remain. For a few men, both the curvature and pain associated with Peyronie’s disease improve without treatment.

The cause of Peyronie’s disease isn’t completely understood, but a number of factors appear to be involved. It’s thought Peyronie’s disease generally results from repeated injury to the penis. For example, the penis might be damaged during sex, athletic activity or as the result of an accident. However, most often, men do not recall specific trauma to the penis.

During the healing process, scar tissue forms in a disorganized manner, which might then lead to a nodule that you can feel or development of curvature.

Each side of the penis contains a sponge-like tube (corpus cavernosum) that contains many tiny blood vessels. Each of the corpus cavernosal is encased in a sheath of elastic tissue called the tunica albuginea, which stretches during an erection.

When you become sexually aroused, blood flow to these chambers increases. As the chambers fill with blood, the penis expands, straightens and stiffens into an erection.

In Peyronie’s disease, when the penis becomes erect, the region with the scar tissue doesn’t stretch, and the penis bends or becomes disfigured and possibly painful.

In some men, Peyronie’s disease comes on gradually and doesn’t seem to be related to an injury. Researchers are investigating whether Peyronie’s disease might be linked to an inherited trait or certain health conditions.

Prostate cancer is cancer that occurs in a man’s prostate — a small walnut-shaped gland that produces the seminal fluid that nourishes and transports sperm.

Prostate cancer is one of the most common types of cancer in men. Prostate cancer usually grows slowly and initially remains confined to the prostate gland, where it may not cause serious harm. While some types of prostate cancer grow slowly and may need minimal or no treatment, other types are aggressive and can spread quickly.

Prostate cancer that is detected early — when it’s still confined to the prostate gland — has a better chance of successful treatment.

Screening for prostate cancer

Whether to test healthy men with no symptoms of prostate cancer is controversial. Medical organizations don’t agree on the issue of screening and whether it has benefits.

Some medical organizations recommend men consider prostate cancer screening in their 50s, or sooner for men who have risk factors for prostate cancer. Other organizations advise against screening.

Discuss your particular situation and the benefits and risks of screening with your family doctor. Together, you can decide whether prostate cancer screening is right for you.

Prostate screening tests might include:

• Digital rectal exam (DRE). During a DRE, a gloved lubricated finger is inserted into your rectum to examine your prostate, which is adjacent to the rectum. If there are any abnormalities in the texture, shape or size of your gland, you may need more tests.

• Prostate-specific antigen (PSA) test. A blood sample is drawn from a vein in your arm and analyzed for PSA, a substance that’s naturally produced by your prostate gland. It’s normal for a small amount of PSA to be in your bloodstream. However, if a higher than normal level is found, it may be an indication of prostate infection, inflammation, enlargement or cancer.

PSA testing combined with DRE helps identify prostate cancers at their earliest stages, but studies have disagreed whether these tests reduce the risk of dying of prostate cancer. For that reason, there is debate surrounding prostate cancer screening.

Diagnosing prostate cancer

If an abnormality is detected on a DRE or PSA test, recommend tests to determine whether you have prostate cancer, may include:

• Ultrasound. If other tests raise concerns, your family doctor may use transrectal ultrasound to further evaluate your prostate. A small probe, about the size and shape of a cigar, is inserted into your rectum. The probe uses sound waves to make a picture of your prostate gland. This is generally not a useful test.

• Collecting a sample of prostate tissue. If initial test results suggest prostate cancer, your Urologist may recommend a procedure to collect a sample of cells from your prostate (prostate biopsy). Prostate biopsy is often done using a thin needle that’s inserted into the prostate to collect tissue. The tissue sample is analyzed in a lab to determine whether cancer cells are present.

Determining whether prostate cancer is aggressive

When a biopsy confirms the presence of cancer, the next step is to determine the level of aggressiveness (grade) of the cancer cells. In a laboratory, a pathologist examines a sample of your cancer to determine how much cancer cells differ from the healthy cells. A higher grade indicates a more aggressive cancer that is more likely to spread quickly. The most common scale used to evaluate the grade of prostate cancer cells is called a Gleason score. Scoring combines two numbers and can range from 2 (nonaggressive cancer) to 10 (very aggressive cancer).

Determining how far the prostate cancer has spread

Once a prostate cancer diagnosis has been made, your Urologist works to determine the extent (stage) of cancer. If your Urologist suspects your cancer may have spread beyond your prostate, imaging tests such as these may be recommended:

• Bone scan

• Ultrasound

• Computerized tomography (CT) scan

• Magnetic resonance imaging (MRI)

• Positron emission tomography (PET) scan

Not every person should have every test. Your Urologist will help determine which tests are best for your individual case.

Prostatitis is swelling and inflammation of the prostate gland, a walnut-sized gland situated directly below the bladder in men. The prostate gland produces fluid (semen) that nourishes and transports sperm.

Prostatitis often causes painful or difficult urination. Other symptoms include pain in the groin, pelvic area or genitals and sometimes flu-like symptoms.

Prostatitis affects men of all ages but tends to be more common in men 50 or younger. The condition has a number of causes. Sometimes the cause isn’t identified. If prostatitis is caused by a bacterial infection, it can usually be treated with antibiotics.

Depending on the cause, prostatitis can come on gradually or suddenly. It might improve quickly, either on its own or with treatment. Some types of prostatitis last for months or years or keep recurring (chronic prostatitis).

Prostatitis signs and symptoms depend on the cause. They can include:

• Pain or burning sensation when urinating (dysuria)

• Difficulty urinating, such as dribbling or hesitant urination

• Frequent urination, particularly at night (nocturia)

• Urgent need to urinate

• Cloudy urine

• Blood in the urine

• Pain in the abdomen, groin or lower back

• Pain in the area between the scrotum and rectum (perineum)

• Pain or discomfort in the penis or testicles

• Painful ejaculation

• Flu-like signs and symptoms (with bacterial prostatitis)

Acute bacterial prostatitis is often caused by common strains of bacteria. The infection can start when bacteria in urine leak into your prostate. Antibiotics are used to treat the infection. If they don’t eliminate the bacteria, prostatitis might recur or be difficult to treat (chronic bacterial prostatitis).

Nerve damage in the lower urinary tract, which can be caused by surgery or trauma to the area, might contribute to prostatitis not caused by a bacterial infection. In many cases of prostatitis, the cause isn’t identified.

Based on your symptoms and test results, your Urologist might conclude that you have one of the following types of prostatitis:

• Acute bacterial prostatitis. Often caused by common strains of bacteria, this type of prostatitis generally starts suddenly and causes flu-like signs and symptoms, such as fever, chills, nausea and vomiting.

• Chronic bacterial prostatitis. When antibiotics don’t eliminate the bacteria causing prostatitis, you can develop recurring or difficult-to-treat infections. Between bouts of chronic bacterial prostatitis, you might have no symptoms or only minor ones.

• Chronic prostatitis/chronic pelvic pain syndrome. This type of prostatitis — the most common —isn’t caused by bacteria. Often an exact cause can’t be identified. For some men, symptoms stay about the same over time. For others, the symptoms go through cycles of being more and less severe.

• Asymptomatic inflammatory prostatitis. This type of prostatitis doesn’t cause symptoms and is usually found only by chance when you’re undergoing tests for other conditions. It doesn’t require treatment.

Testicular cancer occurs in the testicles (testes), which are located inside the scrotum, a loose bag of skin underneath the penis. The testicles produce male sex hormones and sperm for reproduction.

Compared with other types of cancer, testicular cancer is rare. But testicular cancer is the most common cancer in males between the ages of 15 and 35 in North America.

Testicular cancer is highly treatable, even when cancer has spread beyond the testicle. Depending on the type and stage of testicular cancer, you may receive one of the several treatments or a combination. Regular testicular self-examinations can help identify growths early when the chance for successful treatment of testicular cancer is highest.

Signs and symptoms of testicular cancer include:

• A lump or enlargement in either testicle

• A feeling of heaviness in the scrotum

• A dull ache in the abdomen or groin

• A sudden collection of fluid in the scrotum

• Pain or discomfort in a testicle or the scrotum

• Enlargement or tenderness of the breasts

• Back pain

• Cancer usually affects only one testicle.

Upper urinary tract refers to the part of the urinary system that drains the urine into the bladder – the kidneys and the tubes that connect your kidneys to the bladder, the ureters. Urothelial carcinoma, much like bladder cancer, begins in the cells that line the inside of the ureters or kidneys. Cancer of the upper urinary tract is uncommon. It occurs most often in older adults and in people who have previously been treated for bladder cancer.

A urethral stricture occurs when scarring narrows the tube that carries urine out of your body. A structure restricts the flow of urine from the bladder and can cause a variety of medical problems in the urinary tract, including inflammation or infection.

Narrowing of the tube that carries urine out of the body (urethra) can be caused by the buildup of scar tissue due to:

• Tissue damage from a urologic procedure using medical instruments inserted into the urethra, such as an endoscope for viewing urinary tract structures

• Intermittent or long-term use of a catheter, a tube inserted through the urethra to drain the bladder

• Trauma or direct injury to the urethra or pelvis, such as a pelvic fracture

• Enlarged prostate or previous surgery to remove or reduce an enlarged prostate gland

• Cancer of the urethra or prostate

• Sexually transmitted infections

Urethral stricture is more common in males than in females because males have a longer urethra.

Signs and symptoms of urethral stricture disease include:

• Slowing of your urine stream, which can happen suddenly or gradually

• Urine leakage or dribbling after urination

• Spraying of the urine stream

• Difficulty, straining or pain when urinating

• Increased urge to urinate or more frequent urination

• Blood or discharge from the penis

• Pain in the pelvis or lower abdomen

Urinary incontinence — the loss of bladder control — is a common and often embarrassing problem. The severity ranges from occasionally leaking urine when you cough or sneeze to having an urge to urinate that’s so sudden and strong you don’t get to a toilet in time.

If urinary incontinence affects your daily activities, don’t hesitate to see your family physician or be referred to a Urologist. For most people, simple lifestyle changes or medical treatment may ease discomfort or stop urinary incontinence.

Some people experience occasional, minor leaks of urine. Others wet their clothes frequently or may have to wear liner, pads or adult diapers.

Types of urinary incontinence include:

• Stress incontinence. Urine leaks when you exert pressure on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy.

• Urge incontinence. You have a sudden, intense urge to urinate followed by an involuntary loss of urine. You may need to urinate often, including throughout the night. Urge incontinence may be caused by a minor condition, such as infection, or a more severe condition such as neurologic disorder or diabetes.

• Overflow incontinence. You experience frequent or constant dribbling of urine due to a bladder that doesn’t empty completely.

• Functional incontinence. A physical or mental impairment keeps you from making it to the toilet in time. For example, if you have severe arthritis, you may not be able to unbutton your pants quickly enough.

• Mixed incontinence. You experience more than one type of urinary incontinence.

A varicocele is an enlargement of the veins within the scrotum. A varicocele is similar to a varicose vein that can occur in your leg. Varicoceles are a common cause of low sperm production and decreased sperm quality, which can cause infertility. However, not all varicoceles affect sperm production. Varicoceles can also cause testicles to fail to develop normally or shrink. Most varicoceles develop over time. Fortunately, most varicoceles are easy to diagnose and many don’t need treatment. If a varicocele causes symptoms, it often can be repaired surgically.

A varicocele often produces no signs or symptoms. Rarely, it may cause pain. The pain may:

• Vary from sharp to dull discomfort

• Increase with standing or physical exertion, especially over long periods

• Become worse over the course of a day

• Be relieved when you lie on your back

With time, varicoceles may enlarge and become more noticeable. In young men, the presence of a varicocele impairs sperm production and can often be improved with treatment.

A varicocele may cause:

• Shrinkage of the affected testicle (atrophy). The bulk of the testicle comprises sperm-producing tubules. When damaged, as from varicocele, the testicle shrinks and softens. It’s not clear what causes the testicle to shrink, but the malfunctioning valves allow blood to pool in the veins, which can result in increased pressure in the veins and exposure to toxins in the blood that may cause testicular damage.

• Infertility. Varicoceles may keep the local temperature in or around the testicle too high, affecting sperm formation, movement (motility) and function.