When I first signed up for a urology rotation in medical school, I thought I was going to spending the next 6 weeks seeing old men with prostate cancer. I really was not interested in urology at that time, but I needed something to fill my fourth year schedule. What I really wanted to do was anesthesiology: putting in IVs and breathing tubes, lots of fun procedures.
But, the anesthesia rotation was already spoken for. So, now what? Well, I was planning to be a gynecologist, so I thought, well, at least if I do urology, then I’ll get more exposure to the pelvic anatomy. Get a refresher course on all the blood vessels and structures. That will be helpful, right? Even if it is just old men and their prostates.
Well, I couldn’t have been more wrong. Even then I didn’t realize just how wrong I was. Now as I sit here practicing not just urology, but 100% female urology, it is ironic that I thought that it was only prostates!
Of course, urology does encompass prostates in men. It includes everything in the urinary tract from the kidneys through the bladder and out the urethra. Urologists have medical treatments and all kinds of surgeries to treat patients. We treat patients from birth through death, men and women, boys and girls for everything from bedwetting to terrible cancers. It is a great variety surrounding that one part of the body. That’s the reason I fell in love with urology and switched from my pursuit of gynecology.
Female Urology, of course, focuses on the female urological tract. We don’t have prostates, so we don’t need to worry about that (thank God!), but we do have other issues. The most common issue that we have is overactive bladder and incontinence. God made us with short urethras (the pipe that the urine comes through) and a big opening in our pelvis muscles to allow us to have babies. If that opening gets stretched out, such as after having babies, then we start to have problems with organs dropping and having a difficult time controlling our urine. Sometimes it happens even if one has had only C-sections, or has no children.
Female urology is here to help with that! We have everything from physical therapy to medications to surgery to pacemakers, Botox and more. It is a very exciting time because we have some very effective treatments for this now, whereas ten years ago, the options were very limited. You don’t have to live with those pads your whole life!
That is not all that Female Urology entails. It also includes urinary tract infections, painful bladder conditions, kidney stones, evaluation of blood in the urine, slow urinary stream, bladder and kidney tumors, and more.
There is even now a subspecialty, in which I am certified, called Female Pelvic Medicine and Reconstructive Surgery, which focuses on certain conditions of the pelvic floor, especially prolapse (dropped organs) and incontinence. There are even more advanced surgeries that can be used to treat these conditions, including robotic surgery, which I have been doing for several years with beautiful results (beautiful from a pelvic surgeon’s perspective!).
Over the last twelve years, I have narrowed my urology practice down to females only. I couldn’t be more pleased with my choice. I get to treat some lovely women and see them get their life back: from a life of pads and worrying about where every bathroom is to urine control. And for others, it is helping them with infections, pain, stones, or reassuring them that the blood found in the urine isn’t serious for them. Female Urology is my complete career focus and my mission.
It’s a scary thing to find. When a patient sees blood their urine (hematuria), there are often many unknowns that race through their mind. I always stress that patients need to seek medical attention the first time they see it. Don’t even ignore a small amount. Call our office immediately, and make an appointment.
During the appointment, we will look at the entire urinary tract, first with imaging of the kidneys by a CT scan or a renal ultrasound and follow that with a KUB. Then, we will do a scope of the bladder, called a cystoscopy. It is a quick procedure with numbing medicine. While it sounds intimidating, patients are often surprised at how easy it is. The discomfort is similar to a Pap smear.
The most common cause of hematuria is a UTI. The infection can irritate the bladder wall to the point that it often bleeds. Other things we look for are a kidney stone, kidney tumor or bladder cancer.
While it is uncommon, occasionally we find a bladder or kidney tumor as the source of bleeding. Obviously, the sooner that a tumor is found and treated, the better. Tumors in the kidney and bladder will need to be removed surgically. Fortunately, we have great, minimally invasive options to remove these tumors without a large incision.
Often we will see patients for microscopic blood in the urine detected by their primary care doctor. While not as serious, it still requires a complete panel of testing.
Your treatment options will depend on what the testing shows. A UTI will be treated with antibiotics, water and other measures of prevention. If we find a kidney stone, then the treatment could be a number of various options to eliminate the stone, including laser and shock wave therapy, which are both minimally invasive options.
Whatever the cause, it is of the utmost importance to call our office at the first sign of blood in your urine. Our caring staff is here to help you.
– Dr. P
To all of our patients who were impacted by flooding, we are deeply sorry and send our prayers to each and every one of you. We hope that you and your families are all safe and dry, and on your way to recovering from the storm.
In the aftermath of Harvey, I know we are all trying to figure out how to pick up the pieces and start to return our lives to normal. Looking around at all of the devastation, it’s hard to see that things will ever be the same again, but we can start with baby steps and hopeful hearts.
As women, we have been consumed with caring for others. Protecting our families and homes has been our sole focus lately, and there hasn’t been much energy left to look inward at our own well-being. Now that the rebuilding process has begun, it is so important that we rebuild our health, as well.
Hurricane Harvey compromised many of our patients’ urological and pelvic health, and we want to help guide you back to a healthier state. Two female urological problems have come to the forefront during this disaster:
While you are working to restore your sense of normalcy, please remember to take time for yourself. Getting back to a healthy routine will help both you and your families feel better.
Cheers to a healthy you!
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Urinary tract infections (UTIs) are some of the most common conditions that we see in our office every day. Almost every woman will have an infection at some point in her life. UTI is a catch-all term that means an infection anywhere in the urinary tract, which in women could mean kidneys (pyelonephritis, characterized by fever) or bladder (also called “cystitis”, with typical painful urination, frequency, urgency). We often use “UTI” and “bladder infection” interchangeably.
They seem to occur at times of hormonal or sexual change: a young teen starting her period is more prone, a honeymooner beginning to be sexually active, a woman going through or who has gone through menopause. The vaginal pH is very sensitive to estrogen and when that pH is out of whack, the bacterial balance gets off kilter and a UTI is more likely to occur.
UTIs also occur when the body is stressed, either physically or mentally. The immune system is weakened and the normal barriers to infection are not as strong. We see this a lot: after surgery, when a husband dies, or work is super-busy patients are more likely to get infected.
But usually they occur for no good reason at all. As women, we have naturally short urethras (the tube that goes from the bladder to the outside), and bacteria are always getting in there. If we are flushing them out and the local area is healthy, then we don’t get infected. When there is a compromise in the system, we tend to get infected.
What are the natural immune barriers? Well, first of all, if you are overall healthy and exercising, not smoking and taking care of yourself in general, then the blood flow to your pelvis is good and that makes the whole area healthier and able to function normally. Drinking plenty of water to stay hydrated and to flush the bladder regularly will wash out any bacteria that are trying to take an opportunity in the bladder. The bladder itself has a natural layer of glycosaminoglycans that protects the bladder wall from infection. These are the fundamental blocks to infection.
When a patient comes in with recurrent UTIs, we will ask about their fluid intake, sexual correlation, other health issues, surgeries in the area, and menopausal status. We will do a thorough examination of the pelvic area, including measuring how much urine is left behind after voiding to make sure the bladder empties well. And we will look at the urine under the microscope.
If someone has more than 3 UTI in a year, then we will look more in depth: renal ultrasound to look at the kidneys, x-ray to look for stones and a bladder scope (cystoscopy) in the office to evaluate the bladder wall. Sometimes we will order a CT scan if there has been blood in the urine.
Some other causes of recurrent UTI that we are looking for: urinary stones, urinary obstruction, and although unlikely, bladder tumors. In thousands of scopes for UTI, I’ve found two tumors, but I sure wouldn’t want to miss one.
So drink your water, exercise to keep that blood flowing and to help manage stress, and eat lots of fruits and veggies. And hopefully you will be able to stay away from the urology office!