Urinary Tract Disease Treatment

Urinary tract diseases are the general name for infections, stone formation, prostate enlargement, and tumors that develop along the kidneys, ureters (the upper urinary tubes connecting the kidneys to the urinary bladder), bladder, and urethra (the external urinary channel through which urine is expelled). The most typical symptoms of these disorders include burning during urination, frequent urination, blood in the urine, lower back pain, and a sensation of incomplete emptying. These processes, ranging from inflammation in the lower urinary system to functional disorders in the kidney parenchyma, indicate a disruption in the body’s fluid drainage mechanism. These symptoms, which directly affect quality of life, vary according to the type of underlying urological condition and provide critical clues that determine the diagnostic and treatment pathway.

How Do Urinary Tract Infections Develop and What Symptoms Do They Cause?

Urinary tract infections, which are very common in daily life, usually begin when bacteria that quietly live in the external environment or intestinal flora, the community of beneficial and protective microorganisms/bacteria in our body, enter through the urinary channel. The most commonly encountered of these uninvited guests is the bacterium called Escherichia coli, also known as E. coli or coliform bacillus. These bacteria attach themselves to the inner surface of the urinary tract as if using tiny hooks. Although our body tries to wash away and remove these bacteria by expelling urine, sometimes the bacteria’s ability to adhere prevails and they begin to multiply there. This condition usually starts in the lower urinary tract, namely the bladder. The inner surface of the bladder becomes irritated, red, and sensitive. The cellular defensive response of the body against this damage caused by the bacteria is called an inflammatory response, and the condition it creates throughout the bladder is called cystitis, or inflammation of the bladder wall.

If the correct intervention is not made at this stage or if the person’s immune system is weak, the bacteria can follow the urinary tract and reach the kidneys. Inflammation of the kidney tissue is called pyelonephritis and is a much more severe condition. It can confine the person to bed and may require inpatient hospital treatment. In men, these bacteria may settle in the prostate gland and cause a condition called prostatitis, which requires patience in treatment and can be quite painful. In diagnosing the disease, urinalysis and, most importantly, urine culture, which shows which bacterium is causing the infection, guide us; thus, we can clearly determine which antibiotic, or bacteria-killing medication, will be effective. In more severe, febrile, and complicated cases in which the infection has spread to the kidneys or bloodstream, advanced blood tests such as a hemogram, complete blood count, CRP and sedimentation, indicators of inflammation, ferritin, and procalcitonin, sensitive tests showing the severity of bacterial infection, are used to determine the severity of the condition. In this way, the extent of the infection in the body becomes clear and the most appropriate treatment protocol is planned.

The most common symptoms of urinary tract infection are as follows:

• A sensation of warmth, burning, or pain during urination
• A mild stinging or aching sensation during or after urination
• A sudden and uncontrollable urge to urinate
• Increased body temperature (high fever)
• Episodes of chills and shivering accompanying fever
• Nausea
• Vomiting

Why Do Urinary Tract Infections in Children and Older Adults Require Special Attention?

The course of diseases can present completely different features at different stages of life. It is a major misconception to regard urinary tract infections seen especially in young children and infants as merely a simple chill. This condition, which manifests in infants with fever, restlessness, and refusal to feed, may be the first sign of an anatomical abnormality in the channels descending from the kidneys to the bladder. The backflow of urine from the bladder toward the kidneys, medically known as vesicoureteral reflux, creates conditions that allow bacteria to reach the kidney directly. Recurrent infections may cause permanent damage and scarring in developing kidney tissue. Therefore, after childhood infections, detailed imaging methods must be used to investigate whether there is an underlying structural problem.

In older age groups, the condition progresses much more insidiously. With aging, the responses of the immune system weaken. An infection that manifests in a young person with severe burning and high fever may cause no typical symptoms in an older individual. Families often notice that their elderly relatives suddenly become confused, want to sleep constantly, or experience deterioration in their general condition. One of the underlying causes of this sudden mental or physical decline may be a urinary tract infection. In addition, incomplete emptying of the urine due to benign prostatic enlargement in older men may cause the residual urine to form a stagnant pool for bacteria and lead to repeated infections.

The hidden and subtle symptoms of infection in older individuals are as follows:

• Extreme weakness and fatigue
• Sudden loss of appetite and inadequate nutrition
• Persistent drowsiness and lack of interest in the surroundings
• Increased heart rate (palpitations)
• Sudden unusual sweating

What Are the Causes of Kidney Stone Formation?

Urinary system stone disease, namely kidney and urinary tract stones, is a serious health problem that is very common in our country and causes patients to rush to emergency departments at some point in their lives. Urine is actually a liquid in which waste products and minerals that our body wants to eliminate are dissolved. However, when insufficient water is consumed, when there is a genetic predisposition, or due to dietary mistakes, the amount of fluid in the urine decreases and the concentration of minerals increases. These minerals come together and first form microscopic crystals, then combine into grains of sand, and eventually transform into hard stones.

A stone resting quietly in the cavities of the kidney often causes no complaints. A patient may live for years without knowing that there is a stone in the kidney. However, things change when this stone moves and falls into the thin channel that carries urine from the kidney to the bladder, namely the ureter. The stone blocking the channel causes urine to accumulate in the kidney and the kidney to swell. The pain that develops as the renal capsule stretches is indescribably severe. This agonizing pain, which starts in the lower back and back, radiates to the groin, prevents the patient from finding a comfortable position, and comes in waves. During diagnosis, computed tomography clearly maps the stone’s millimetric size, location, and hardness.

Common stone types are as follows:

• Calcium oxalate monohydrate stone (the most common hard stone type)
  Calcium oxalate dihydrate stone (a relatively easier stone type to break)
• Calcium phosphate stone
• Uric acid stone
• Magnesium ammonium phosphate stone (Struvite; infection stone)
• Cystine stone (a rare genetic stone type)

Which Modern Methods Are Used in Kidney Stone Treatment?

In the past, kidney stone surgeries were operations that required opening the kidney through a long incision made across the patient’s back and involved a very long and difficult recovery process. Today, these traditional open surgeries have almost completely become history. Thanks to remarkable advances in medical technology, kidney stones can now be treated without making any incision in the body or by entering through openings only as small as the tip of a pencil.

If the stone is below a certain size and is not very hard, shock wave lithotripsy, SWL, is applied from outside the body. In this procedure, high-energy sound waves are focused on the stone and break it into small grains of sand. The patient then drinks plenty of water and passes these particles through the urine. However, if the stone is larger, harder, or located in the lower parts of the kidney, endoscopic laser treatments come into play. With the help of a flexible ureteroscope, a bendable camera system that can be advanced through the urinary tube, this method, medically known as Retrograde Intrarenal Surgery, or flexible laser surgery performed through the urinary channel, involves entering entirely through the natural urinary tract and reaching the kidney chambers using extremely thin, snake-like flexible camera-equipped instruments. The stone is turned into dust in place using a laser. After the procedure, the patient can usually return to normal life the following day. In much larger stones that fill the kidney, the kidney is entered through a tiny tube opened from the back, and the stones are broken inside and removed. The most important part of treatment is determining why the stone formed and taking the necessary precautions to prevent recurrence.

Approaches for preventing stone formation are as follows:

• Consuming approximately 2-3 liters of water/fluids per day
• Consuming lemon, which is effective due to the citrate it contains
• An active lifestyle and exercise
• An appropriately arranged diet and nutrition plan
• Reducing salt (sodium) consumption
• It is important not to blindly eliminate dietary calcium (milk, yogurt) and to consume it in a balanced manner with meals to maintain the oxalate balance

What Are the Symptoms of Prostate Cancer and What Should Be Done for Early Diagnosis?

Prostate cancer is one of the most common malignant tumors in men and is known for its insidious progression. If you imagine the prostate gland as a walnut, this cancer usually begins to develop from the outermost shell of the walnut. The urinary channel passes directly through the center of this walnut. Because the cancer begins on the outer surface, it does not press on the urinary channel for a long time and causes no symptoms such as difficulty urinating, bleeding, or pain. This may cause prostate cancer to progress silently and sometimes remain unnoticed until it spreads to other parts of the body.

Our greatest strength against this insidious enemy is detecting the disease through regular screenings while it is still confined within the prostate and at a very early stage. Regular urological examinations are vital from the age of 50 for men with no family history of prostate cancer, and from the age of 45 for high-risk individuals whose first-degree relatives developed prostate cancer at an early age. The PSA, prostate-specific antigen, blood test and physician examination are the first steps. If there is a suspicion in the tests, today we use intelligent technologies instead of performing blind biopsies. Multiparametric MRI, a high-resolution medical imaging method for the prostate, is used to create a three-dimensional, high-resolution map of the prostate. MRI points out suspicious areas that may contain cancer. These images are then combined with ultrasound, and targeted samples are taken only from those suspicious areas using the MRI-TRUS fusion biopsy method. In patients diagnosed at an early stage, the prostate is completely removed using robotic surgery. Thanks to the high-resolution view and mobility provided by the robot, care is taken to preserve the nerves responsible for urinary continence and sexual function, with the aim of supporting quality of life.

Risk factors are as follows:

• Age; over time, deterioration of cell renewal in our body and an increase in risk may occur
• Genetics; a history of diseases such as prostate and breast cancer, especially in first-degree relatives
• Obesity; it may accelerate tumor growth by triggering hormonal imbalances
• Nutrition; a diet high in saturated fat and red meat while avoiding vegetables may increase cancer risk

Which Warning Signs Indicate the Risk of Bladder Cancer?

Bladder cancer is a disease that develops when the cells lining the inner surface of the urinary bladder multiply uncontrollably, and its treatment is highly successful when detected early. The greatest undisputed trigger of this disease is the use of tobacco and tobacco products. Toxic chemicals in smoke inhaled into the lungs enter the bloodstream, are filtered by the kidneys, and reach the bladder together with the urine. When the urinary bladder remains in contact with these chemicals for a long time, the structure of the cells on its inner surface begins to deteriorate.

The most important and loudest warning the body gives us regarding bladder cancer is blood in the urine, medically known as hematuria. This painless bleeding, which appears suddenly and may sometimes contain clots, should never be ignored by saying, “I must have caught a chill” or “It will pass.” For definitive diagnosis, a thin camera-equipped instrument is inserted through the urinary channel to observe the inside of the bladder, and this procedure is called cystoscopy. When a suspicious mass is seen, the tumor is scraped away and removed through the same route without making any incision, using a method called TUR-M. If the disease is superficial, medication is administered into the bladder after the tumor is removed to stimulate the immune system and try to prevent recurrence. However, if the disease has reached the muscle layer, more extensive and life-saving surgeries are performed, such as complete removal of the bladder through radical cystectomy and creation of a new urinary bladder from the intestines.

Bladder cancer risks are as follows:

• Smoking; the greatest factor triggering cancer because the toxic substances it contains come into direct contact with the bladder wall
• Chemicals; exposure to harmful substances used in the petrochemical, plastics, and rubber industries
• Dyes; inhalation of or contact with certain industrial colorants used in the textile, printing, and hair dye industries
• Radiation; previous cancer treatments applied to the pelvic region may disrupt tissue structure

How Does Benign Prostatic Hyperplasia (BPH) Affect Quality of Life?

The prostate of every aging man gradually begins to enlarge as part of a natural process, just like hair turning gray. Benign prostatic hyperplasia, medically known as BPH, is not cancer and does not turn into cancer. However, as this gland, which is located immediately at the outlet of the bladder and surrounds the urinary channel like a ring, enlarges, it begins to compress the urinary channel passing through its center. This physical pressure makes it difficult for urine to flow out comfortably. The bladder has to contract more and exert greater force to expel the urine.

Over time, the bladder muscles become tired and thickened. Patients notice during the day that they have to wait before urination starts, that the urine stream is no longer as strong as before, that they urinate intermittently, and that their bladder does not feel completely empty after leaving the toilet. The most troublesome part begins at night. Due to the enlarged prostate and thickened bladder wall, urine storage capacity decreases. The person suddenly feels an urgent need to urinate, may sometimes have difficulty reaching the toilet in time, and has to wake up repeatedly during the night to go to the toilet. The constant interruption of deep sleep causes extreme fatigue the next day, loss of concentration, and an overall decline in quality of life. Patients become afraid of taking long bus journeys and begin looking for the location of the toilet first whenever they go somewhere new.

Symptoms of prostate enlargement are as follows:

• Weak and low-pressure urine flow; loss of the previous strength of urine flow rate and pressure
• Involuntary dribbling at the end of urination; involuntary leakage after urination is completed, although a certain amount may also normally occur
• A sudden and unavoidable urge to urinate
• Repeated interruption of sleep due to the urge to urinate at night
• Split or scattered urine flow
• The need to strain while urinating
• Inability to urinate due to complete obstruction and the need for catheter placement
• The complaint of taking a long time to urinate

What Do Laser and Steam Methods Offer in the Treatment of Prostate Enlargement?

When complaints caused by prostate enlargement begin to make the patient’s life difficult, the first step is generally medication treatments that relax or slightly shrink the prostate. However, when medications are insufficient, cause side effects, or the patient does not want to use medication for life, modern surgical treatments can offer highly effective alternatives. Traditional open prostate surgeries have now largely been replaced by technological procedures performed through the urinary channel.

Especially in prostates that have reached very large sizes, the most successful and permanent solution is HoLEP, holmium laser enucleation of the prostate. To understand this method, you can imagine the prostate as an orange. The urinary channel is entered using a camera system, and high-energy laser is used to completely separate the fleshy part of the orange from its outer peel. This separated large tissue is pushed into the bladder, where it is fragmented using a special device and vacuumed out. Since the enlarged portion of the prostate is largely removed, the risk of the disease recurring years later is quite low, and the amount of bleeding is significantly less compared with open surgery.

On the other hand, in elderly patients for whom anesthesia is very risky or in patients who aim to preserve sexual functions after surgery, water vapor therapy called Rezum may be an innovative alternative. In this procedure, which takes only minutes, pure water vapor heated using radiofrequency energy is injected into the enlarged prostate tissue. The vapor gradually dissolves the excess tissue and opens the urinary channel. The patient can walk home a few hours after the procedure.

Minimally invasive methods include:

• Laser technologies that peel prostate tissue away from its capsule using high-energy beams (HoLEP, ThuLEP, ThuFLEP)
• Water vapor systems that dissolve tissues using the power of pure water heated by radiofrequency (Rezum)
• Plasma technology that reduces bleeding by vaporizing tissues with electrical energy (Bipolar/Plasma TURP)
• A method that cleans the prostate under computer control using a high-pressure water jet (Aquablation)

Is Urinary Incontinence the Fate of Women?

Urinary incontinence is a condition that is very common, especially in postmenopausal women and mothers who have undergone difficult vaginal deliveries, and can seriously affect the patient’s social life, yet can be treated with appropriate options. In our society, this condition is often regarded as a “natural consequence of aging” and tends to be concealed. However, urinary incontinence is not inevitable at any age.

There are two main types of urinary incontinence. The first is stress urinary incontinence, which develops due to physical exertion. Here, the word stress does not refer to psychological tension, but to an increase in intra-abdominal pressure. In situations such as coughing, sneezing, climbing stairs, lifting a heavy bag, or laughing, the muscles beneath the bladder cannot remain strong enough, and urine leaks out in drops or suddenly. The second is urge urinary incontinence. It occurs when the bladder muscle suddenly contracts on its own even though the patient does not want it to. The person suddenly feels a very strong need to use the toilet and leaks urine while trying to reach it. In diagnosis, detailed tests called urodynamics, which measure bladder pressure and urinary function, are used to assess bladder pressure and muscle coordination. Treatment options range from exercises that strengthen the pelvic floor muscles, Kegel exercises, to medications that calm the bladder, Botox applications into the bladder, and minor sling surgeries that take a very short time and provide support to the urinary channel, TOT / TVT surgeries.

Some situations in which stress urinary incontinence is observed due to increased intra-abdominal pressure are as follows:

• Coughing
• Laughing
• Heavy lifting
• Climbing or descending stairs
• Intense physical activities
• Exercise

What Is Urethral Stricture and How Is It Treated?

The urethra, the pathway through which urine exits the bladder and leaves the body, is like a flexible tube. However, severe infections in the past, trauma such as catheter insertion into the urinary channel, or traffic accidents may cause scar tissue to form inside this flexible tube. Just as a deep wound on our skin hardens and contracts while healing, the inside of the urinary channel similarly contracts and narrows. This condition is called urethral stricture.

A person who develops urethral stricture notices that the urine stream becomes weaker day by day. The urine begins to come out as thin as a thread and may sometimes be split or scattered. It becomes necessary to remain in the toilet for a long time and strain to empty the bladder. To see the location and length of the stricture, a special fluid is injected through the urinary channel and an X-ray is taken; this method is called urethrography. If the stricture is very short and recent, the channel is widened through a minimally invasive procedure called internal optical urethrotomy, using a laser or a small blade to make an incision. However, if the disease is persistent and repeatedly recurs, performing minimally invasive procedures again and again causes further damage to the channel. In this case, open urethroplasty, urinary channel reconstruction, may be performed with the aim of providing permanent recovery. The narrowed section is completely removed, and a new, wide, and healthy pathway is created in the urinary channel using tissues such as buccal mucosa taken from the inside of the patient’s cheek.

The consequences of urethral stricture are as follows:

• Weak and thin urine flow; loss of the previous strength of urine flow rate and pressure
• Split or scattered urine flow
• The need to strain while urinating
• Taking a long time to urinate
• Becoming obstructed and unable to urinate, with the catheter failing to pass despite an attempt at catheter placement

Frequently Asked Questions