Today we are going to talk about the drainage system of our body. 

Today we will discuss the urinary system. The urinary system is considered your body's drainage system for removing urine. Urine consists of water and waste products. 

So, before we start our main topic about urinary disorders, let's talk about the urinary system itself. 

The urinary system consists of:

• Two kidneys. They are purplish-brown organs lying below the ribs on both sides of the spine. They remove waste products and drugs from the body, maintain fluid balance in the body, release specific hormones to regulate blood pressure, and have a role in the production of red blood cells. Both kidneys remove a harmful substance from the blood called "urea" through their tiny filtering units, the nephrons. Urea and other waste products form urine while it passes through the nephrons down to the renal tubules of the kidneys.
• Two ureters. They are narrow tubes that carry the urine from the kidneys to the bladder. The ureters have muscles in their walls that continuously contract and relax to force the urine down to the bladder. If the urine flows back to the kidneys or stands still, it will cause a kidney infection. Therefore, the ureters empty small amounts of urine into the bladder every 10 to 15 seconds. 
• The urinary bladder. It is a triangle-shaped hollow organ that lies in the lower abdomen. It is fixed in its place by ligaments that are attached to the pelvic bones and to other organs. The bladder works by relaxing and expanding to accommodate more amounts of urine and then contracting to empty the stored amount of urine. The normal healthy bladder can store about two cups of urine for about two to five hours. 
• Two sphincter muscles. These are two circular muscles that close tightly around the opening of the bladder like a rubber band to prevent urine from leaking. 
• The urethra. It is a tube that allows urine to flow out of the body. When it is the right time and circumstances, the brain signals to the bladder to tighten and squeezes the urine out of the bladder. At the same time, the brain gives orders to the sphincter muscle to relax to allow urine to exit the bladder to the urethra. When all signals occur in the correct order and timing, normal micturition occurs. 

As we mentioned our kidneys filter the blood from toxins and waste products, but where do these waste products come from? 

Normally, the body takes its needs of nutrients from food and then includes these nutrients into multiple cycles to produce energy. However, after the body has taken the food components it needs, there will be waste products left behind in the bowel and the blood. Besides, cycles that produce energy can produce unwanted byproducts as well. 

Waste products in the bowel can be eliminated by defecation. But what about those in the blood? 

The kidney and the urinary system help the body to eliminate waste products in the blood, such as urea, and keep other substances like sodium, potassium and water balanced. 

Urea is the result of the breakdown of proteins in food, it is then transported to the kidney with other wastes from the blood for elimination.

But what happens if this perfect system malfunctions?

This is when urinary disorders occur. Urinary disorders are any diseases, conditions, or disorders that affect kidneys, ureters, bladders, or urethra and affect their functions. They can be caused by cancers, conditions that affect the structure around the urinary tract, infections, inflammations, injuries, scars, nervous system disease, and stones. 

These disorders can have serious life-threatening complications. 

Several identified risk factors increase the risk of urinary disorders. However, not all people with risk factors will get urinary disorders. 

These risk factors include: 

• Birth defects. 
• Smoking. 
• Urinary catheterization. 
• Diabetes. 
• Low fluid intake. 
• Genital piercing. 
• Previous personal history or family history of urinary disorders. 
• Multiple pregnancy and delivery. 
• Trauma. 
• Sexual contact with people who have sexually transmitted diseases. 
• Unsafe sexual practices.
• Chemical or irritant exposure. 
• Use of spermicides or lubricants with irritants. 

But what are these urinary disorders we are talking about? 

Let us dive deeper into each urinary disorder. 

Let’s start with Kidney Stones

A kidney stone, also known as a renal calculus, is a solid crystal that forms in the kidney from salts and minerals in the urine. The most common type of kidney stones consists of calcium salts. 

Kidney stones, if small, can leave the kidneys through the ureters to the bladder then pass from the urethra without causing any symptoms. 

On the other hand, a large stone may cause pain and other symptoms if it passes through the ureter. And if the kidney stone is large enough to block the ureter, it will affect the functions of the kidney and it can even damage it. 

A small kidney stone that causes pain can be treated by pain killers until it passes.

But what about a large stone that can’t be passed and blocks the urinary tract? 

In this case, this large stone is treated with lithotripsy.

It is a medical procedure that applies high-intensity ultrasound pulses on the stone but from the outside to cause fragmentation of the stone into pieces small enough to pass easily in the urine stream. 

Lithotripsy is a non-invasive method; however, it can be damaging to the kidneys. And that’s why there is another alternative method for a stone that blocks the ureter. It is to insert a stent to the ureter. It is a metal or plastic tube that is inserted into the lumen of the ureter to expand it to allow both urine and the stone to pass. 

Some cases might need surgery if the stone is huge.  

Another very common Urinary disorder is Urinary tract infection

It is the type of infection that can involve the urethra and called urethritis, the bladder and called cystitis, or the kidney and called pyelonephritis. 

Normally the urine is sterile and doesn’t contain any bacteria. Urinary tract infections are very common. One out of five women experience a urinary tract infection once in their lifetime. 

They can occur in men, old people, and children but they are more common in women. This is because the urethra in women is shorter and closer to the anus where E-Coli bacteria are common. 

A bladder infection, however, is a specific type of urinary tract infection. It is also called cystitis, as we mentioned earlier. In this type of infection, the bacteria find their way to the bladder and cause inflammation.

When a urinary tract infection occurs, the lining of the urinary system becomes red and inflamed, and this produces some symptoms such as: 

• Pain in the side, abdomen, or pelvic area. 
• Pressure in the lower pelvis.
• Frequent need to urinate. 
• Urine leakage. 
• Frequent urination at night. 
• Abnormal urine colour. 
• The foul odor of the urine. 

Other symptoms that can be associated with urinary tract infection include: 

• Pain during sex. 
• Penile pain. 
• Fatigue. 
• Fever. 
• Vomiting. 
• Confusion or mood disorders. 

Another condition included with urinary tract disorders is urinary incontinence. 

So, what is that? 

The term “incontinence” means uncontrolled leakage of the urine. It is a chronic condition that is very common especially at older ages and especially in women. 

Sometimes urinary incontinence is a sign of other conditions or diseases such as diabetes and obesity. 

Regardless of the underlying cause of it, incontinence alone can affect the quality of life significantly causing embarrassment, inconvenience, and distress. 

In men, the cause is often enlargement of the prostate gland or treatment of prostate cancer. 

In women, there are two common types of incontinence: stress incontinence and urge incontinence. 

Stress urinary incontinence occurs due to loss of support of the urethra. This loss of support happens after childbirth due to the stretch of the pelvic floor muscle. The leakage of urine in this case happens with any increase of the abdominal pressure such as coughing, sneezing or lifting. 

As for “urge urinary incontinence”, it is also called overactive bladder. It happens due to uncontrolled contractions of a muscle that is present in the wall of the urinary bladder called “The detrusor muscle”. It causes the bladder to empty unexpectedly. The characteristic of this case is leakage of large amounts of urine without warning to get to the bathroom at the right time. 

Another common urinary tract disorder is diabetic renal nephropathy. It occurs with diabetes, or better say as a complication of non balanced diabetes. 

It is a progressive kidney disease caused by damage of the capillaries of the kidney 

It is not yet understood how diabetes can lead to this kind of damage, but doctors think that a high level of glucose in the blood is involved in this pathology. It may take up to a decade after kidney damage starts for symptoms to appear. 

Our role today is to answer most of your questions regarding Urinary Disorder. Today we have Dr. Yoon, who is a leading doctor at Ewha Woman’s University Hospital in Seoul. She is going to discuss Urinary Disorder from an experienced medical point of view.

Interview

What is urinary disorder in men and women?

Men and women’s urinary disorders deal with everything related to urination. Some may have hard time controlling the urge to urinate, some may experience frequent urge to urinate, and some may have a hard time releasing urine in full flow, some may have a weak ureter, etc. There are many symptoms to consider but basically if someone has difficulty urinating or controlling can be lumped as urinary disorders. Men and women can both have it. Age is irrelevant as the old and young can both get it.

What re the main types of urinary disorders?

Usually for men the issues are prostate related. The prostate is a gland located below the bladder. If the prostate is inflamed, there might be discomfort and issues urinating. Women don’t have a prostate, instead the ureter is shorter and more delicate and is surrounded by many organs and is subject to more attacks by bacteria. Thus, women tend to be more likely to develop urinary disorders. So, women are subject to bladder inflammation, incontinence and many other issues involving the bladder.

What is it and what are the types of it and what causes it?

Normally, we go to sleep and urinate when we wake up. With enuresis, instead of going to urinate waking up in the middle of the night, bed wetting happens. Urination happens without any self-control. While normally we get up at night if we feel like urinating, but with enuresis, it happens on its own. As kids grow up, they normally control urination, but some keep bed wetting due to lack of a hormone that regulates this control. Or as older adults, instead of being able to control the urination at will, with enuresis, bed wetting happens with constant urination and lack of control. So, both adults and the young can have enuresis.

Why is diagnosis needed in this case?

The reason we need diagnosis is because for example with bladder inflammation, if it lasts, we get stressed from inflammation and pain associated with the bladder infection, likewise the bladder undergoes continued pain. Such patients go to the restroom often and the bladder deteriorates. Life quality suffers fast. In some extreme cases, the bladder becomes hardened and useless and may need surgery to remove it. So, in order to prevent these terrible outcomes, we need to diagnose early. And with prostate issues, it can even affect the kidneys. In order to prevent the kidney's suffering, we need to diagnose it early.

Are there any treatments or prevention way of enuresis?

We can treat enuresis in two ways. One is when urination happens without control overnight, also known as bed wetting. We can prescribe drugs to kids to disable urination while sleeping, until the patient is woken up in the morning to urinate. For adults we can prescribe drugs called antidiuretic hormones to limit the body from making too much urine at night while asleep. Some may need this hormone as the body lacks the ample production for some. Some can benefit from these treatments.

What is exactly neurogenic bladder?

Neurogenic bladder is when the nervous system that controls muscle movements is in disarray or compromised. Neurogenic bladder can happen due to a variety of causes. It can affect the bladder to lose control or not be able to perform its function, at all. Neurogenic bladder can happen due to diabetes, stroke, damage to the spine from car accidents, and these damages to the nervous system can negatively affect the bladder. It can also happen due to cancer treatments that may have damaged the nervous system.

What kind of treatment methods exist for this kind of disease?

Neurogenic bladder treatment depends on the root causes. For those with uncontrolled flow of urine, we can prescribe drugs to limit and control the flow. For those who cannot trigger urination, we can use drugs to encourage free flow of urine. There are situations where drugs are not possible, for example a patient with damage to the kidneys, we can use a treatment called intermittent catheterization to help empty the bladder every three to four hours. We can use various techniques, but we cannot yet utilize robotic assists as the urination process is internal, although such assist robotic wear can help those rehabilitate for walking, for example.

Before treatment how to diagnose the case of…

First, the patient’s history is important – whether he has diabetes, stroke, or trauma from accidents. It is important to know if there is damage to the nervous system. We also test for the bladder’s link to the nervous system – to see if it works as intended. We can use nerve response tests.

Conclusion

The urinary disorders of men and women include everything related to urination. There are a lot of symptoms to consider, but basically if someone is having difficulty urinating or controlling their urination, they may be considered to have a urinary disorder. People can have urinary problems regardless of gender and age.

Usually for men the problems are related to the prostate while women are prone to bladder inflammation, incontinence and many other problems involving the bladder.

Neurogenic bladder is when the nervous system that controls muscle movement is in disarray or compromised. It can occur due to diabetes, stroke, damage to the spine from car crashes, and this damage to the nervous system can negatively affect the bladder. Researching the patient's history and a careful clinical examination will help find the origin and nature of the urinary tract disorder.