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Urology,also known as genitourinary surgery,is the branch of medicine that focuses on surgical and medical diseases of the urinary system and the reproductive organs. Organs under the domain of urology include the kidneys,adrenal glands,ureters,urinary bladder,urethra,and the male reproductive organs.
Benign prostatic hyperplasia (BPH),also called prostate enlargement,is a noncancerous increase in size of the prostate gland. Symptoms may include frequent urination,trouble starting to urinate,weak stream,inability to urinate,or loss of bladder control. Complications can include urinary tract infections,bladder stones,and chronic kidney problems.
Urinary incontinence (UI),also known as involuntary urination,is any uncontrolled leakage of urine. It is a common and distressing problem,which may have a large impact on quality of life. Urinary incontinence is common in older women and has been identified as an important issue in geriatric health care. The term enuresis is often used to refer to urinary incontinence primarily in children,such as nocturnal enuresis. UI is an example of a stigmatized medical condition,which creates barriers to successful management and makes the problem worse. People may be too embarrassed to seek medical help,and attempt to self-manage the symptom in secrecy from others.
Autonomic neuropathy is a form of polyneuropathy that affects the non-voluntary,non-sensory nervous system,affecting mostly the internal organs such as the bladder muscles,the cardiovascular system,the digestive tract,and the genital organs. These nerves are not under a person's conscious control and function automatically. Autonomic nerve fibers form large collections in the thorax,abdomen,and pelvis outside the spinal cord. They have connections with the spinal cord and ultimately the brain,however. Most commonly autonomic neuropathy is seen in persons with long-standing diabetes mellitus type 1 and 2. In most—but not all—cases,autonomic neuropathy occurs alongside other forms of neuropathy,such as sensory neuropathy.
Enuresis is a repeated inability to control urination. Use of the term is usually limited to describing people old enough to be expected to exercise such control. Involuntary urination is also known as urinary incontinence. The term "enuresis" comes from the Ancient Greek:ἐνούρησις,romanized: enoúrēsis.
The pelvic floor or pelvic diaphragm is an anatomical location in the human body,which has an important role in urinary and anal continence,sexual function and support of the pelvic organs. The pelvic floor includes muscles,both skeletal and smooth,ligaments and fascia. and separates between the pelvic cavity from above,and the perineum from below. It is formed by the levator ani muscle and coccygeus muscle,and associated connective tissue.
Pelvic floor dysfunction is a term used for a variety of disorders that occur when pelvic floor muscles and ligaments are impaired. The condition affects up to 50 percent of women who have given birth. Although this condition predominantly affects women,up to 16 percent of men are affected as well. Symptoms can include pelvic pain,pressure,pain during sex,urinary incontinence (UI),overactive bladder,bowel incontinence,incomplete emptying of feces,constipation,myofascial pelvic pain and pelvic organ prolapse. When pelvic organ prolapse occurs,there may be visible organ protrusion or a lump felt in the vagina or anus. Research carried out in the UK has shown that symptoms can restrict everyday life for women. However,many people found it difficult to talk about it and to seek care,as they experienced embarrassment and stigma.
Nocturia is defined by the International Continence Society (ICS) as "the complaint that the individual has to wake at night one or more times for voiding ". The term is derived from Latin nox –"night",and Greek [τα] ούρα –"urine". Causes are varied and can be difficult to discern. Although not every patient needs treatment,most people seek treatment for severe nocturia,waking up to void more than 2 or 3 times per night.
Percutaneous tibial nerve stimulation (PTNS),also referred to as posterior tibial nerve stimulation,is the least invasive form of neuromodulation used to treat overactive bladder (OAB) and the associated symptoms of urinary urgency,urinary frequency and urge incontinence. These urinary symptoms may also occur with interstitial cystitis and following a radical prostatectomy. Outside the United States,PTNS is also used to treat fecal incontinence.
Stress incontinence,also known as stress urinary incontinence (SUI) or effort incontinence is a form of urinary incontinence. It is due to inadequate closure of the bladder outlet by the urethral sphincter.
Solifenacin,sold as the brand name Vesicare among others,is a medicine used to treat overactive bladder and neurogenic detrusor overactivity (NDO). It may help with incontinence,urinary frequency,and urinary urgency.
Bladder sphincter dyssynergia is a consequence of a neurological pathology such as spinal injury or multiple sclerosis which disrupts central nervous system regulation of the micturition (urination) reflex resulting in dyscoordination of the detrusor muscles of the bladder and the male or female external urethral sphincter muscles. In normal lower urinary tract function,these two separate muscle structures act in synergistic coordination. But in this neurogenic disorder,the urethral sphincter muscle,instead of relaxing completely during voiding,dyssynergically contracts causing the flow to be interrupted and the bladder pressure to rise.
Neurogenic bladder dysfunction,often called by the shortened term neurogenic bladder,refers to urinary bladder problems due to disease or injury of the central nervous system or peripheral nerves involved in the control of urination. There are multiple types of neurogenic bladder depending on the underlying cause and the symptoms. Symptoms include overactive bladder,urinary urgency,frequency,incontinence or difficulty passing urine. A range of diseases or conditions can cause neurogenic bladder including spinal cord injury,multiple sclerosis,stroke,brain injury,spina bifida,peripheral nerve damage,Parkinson's disease,multiple system atrophy or other neurodegenerative diseases. Neurogenic bladder can be diagnosed through a history and physical as well as imaging and more specialized testing. In addition to symptomatic treatment,treatment depends on the nature of the underlying disease and can be managed with behavioral changes,medications,surgeries,or other procedures. The symptoms of neurogenic bladder,especially incontinence,can severely degrade a person's quality of life.
Overactive bladder (OAB) is a common condition where there is a frequent feeling of needing to urinate to a degree that it negatively affects a person's life. The frequent need to urinate may occur during the day,at night,or both. Loss of bladder control may occur with this condition. This condition is also sometimes characterized by a sudden and involuntary contraction of the bladder muscles,in response to excitement or anticipation. This in turn leads to a frequent and urgent need to urinate.
The urethral sphincters are two muscles used to control the exit of urine in the urinary bladder through the urethra. The two muscles are either the male or female external urethral sphincter and the internal urethral sphincter. When either of these muscles contracts,the urethra is sealed shut.
Sacral nerve stimulation,also termed sacral neuromodulation,is a type of medical electrical stimulation therapy.
Urogynecology or urogynaecology is a surgical sub-specialty of urology and gynecology.
Urodynamic testing or urodynamics is a study that assesses how the bladder and urethra are performing their job of storing and releasing urine. Urodynamic tests can help explain symptoms such as:
Jerry G. Blaivas is an American urologist and senior faculty at the Icahn School of Medicine at Mount Sinai in New York City and adjunct professor of Urology at SUNY Downstate Medical School in Brooklyn,as well as professor of clinical urology at College of Physicians and Surgeons,Columbia University and clinical professor of Urology at Weill Medical College of Cornell University. He has four patents pending,has received four research grants for which he served as the principal investigator,and served as a major in the United States Army assigned to the Walson Army Hospital. He additionally served as president for the Urodynamic Society.
Prof Clare Fowler CBE is a British physician and academic who created the subspecialty of uro-neurology,a medical field that combines urology and neurology. This work was done at the Institute of Neurology,University College London,where she is an emeritus professor.
References
- ↑ "Lund University–Karl-Erik Andersson".
- 1 2 "Google Scholar–Karl-Erik Andersson".
- 1 2 "22nd Congress of the European Society for Sexual Medicine" (PDF).
- 1 2 "SUFU–Lifetime Achievement Award".
- 1 2 "ICS Members–Karl-Erik Andersson".
- 1 2 "Medals and Awards–2008".
- 1 2 "EAU Opening Ceremony".
- 1 2 "Royal Physiographic Society in Lund–Current Fellows".
- ↑ "ICS Hall of Fame–Karl-Erik Andersson".
- ↑ "Wake Forest University School of Medicine–Alumni News and Notes".
- ↑ Pfeifer, A.; Klatt, P.; Massberg, S.; Ny, L.; Sausbier, M.; Hirneiss, C.; Wang, G. X.; Korth, M.; Aszódi, A.; Andersson, K. E.; Krombach, F.; Mayerhofer, A.; Ruth, P.; Fässler, R.; Hofmann, F. (1998). "Defective smooth muscle regulation in cGMP kinase I-deficient mice". The EMBO Journal. pp. 3045–3051. doi:10.1093/emboj/17.11.3045. PMC 1170644 . PMID 9606187.
- ↑ "Pharmacology of Penile Erection".
- ↑ Michel, Martin C.; Cardozo, Linda; Chermansky, Christopher J.; Cruz, Francisco; Igawa, Yasuhiko; Lee, Kyu-Sung; Sahai, Arun; Wein, Alan J.; Andersson, Karl-Erik (2023). "Current and Emerging Pharmacological Targets and Treatments of Urinary Incontinence and Related Disorders". Pharmacological Reviews. 75 (4): 554–674. doi:10.1124/pharmrev.121.000523. PMID 36918261.
- ↑ Andersson, Karl-Erik; Arner, Anders (2004). "Urinary Bladder Contraction and Relaxation: Physiology and Pathophysiology". Physiological Reviews. 84 (3): 935–986. doi:10.1152/physrev.00038.2003. PMID 15269341.
- ↑ Kanai, A.J.; Andersson, K.-E.; Fry, C.H.; Yoshimura, N. (2023). "Targeting neurotrophin and nitric oxide signaling to promote recovery and ameliorate neurogenic bladder dysfunction following spinal cord injury – Mechanistic concepts and clinical implications". Continence. 6. doi:10.1016/j.cont.2023.100703. PMC 10310066 . PMID 37389025.
- ↑ Andersson, Karl-Erik (2024). "Promising therapeutic targets for the treatment of urine storage dysfunction: what's the status?". Expert Opinion on Therapeutic Targets. 28 (4): 251–258. doi: 10.1080/14728222.2024.2344698 . PMID 38629152.
- ↑ Kanai, A.J.; Andersson, K.-E.; Birder, L.A.; Fry, C.H. (2023). "Soluble Guanylate Cyclase Activators to Treat Benign Prostatic Hyperplasia and associated LUTS". Continence. 6. doi:10.1016/j.cont.2023.100699. PMC 10310070 . PMID 37389026.
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