Ms. Miriam A. Jaffee, ARNP

Medication can relieve mild to moderate symptoms of BPH, such as frequent urination, incomplete bladder emptying, a weak urine stream, and straining while urinating. However, other forms of treatment may be more appropriate if an individual has pain with urination, frequent urinary tract infections, or is unable to urinate. The size of the prostate and the severity of their symptoms will determine the type of treatment they need. If the prostate is not very large, doctors will likely recommend a transurethral procedure. This minimally invasive technique involves the insertion of a scope into the urethra. The most common transurethral procedures for BPH are:

• Transurethral incision of the prostate or TUIP, where the surgeon uses the scope to make small cuts in the area of the prostate that meets the bladder. These cuts will open up the pathway for urine and allow it to flow with more ease.
• Transurethral needle ablation or TUNA, where needles are inserted through the scope and into the prostate. The needles use radiofrequency waves to destroy excess prostate tissue.
• Laser prostate ablation, where lasers pass through the scope to melt away the part of the prostate causing urine blockage.
• Transurethral resection of the prostate or TURP, where the inside of the prostate is trimmed and removed one tiny piece at a time using the scope.

If the prostate is too big for a transurethral procedure, an individual may need a simple prostatectomy, which can be done in one of three ways: laparoscopic, robotic, or open. During a laparoscopic simple prostatectomy, a surgeon makes several small incisions on the belly. Then they insert a long tube with a camera into one of the cuts and surgical instruments into the others. Using the camera to see inside the belly, they carefully removes the enlarged part of the prostate. Robotic simple prostatectomy uses the same techniques as the laparoscopic method, but the surgery is done with the help of a robot. For men with very large prostates, open simple prostatectomy may be the best treatment option. This surgery differs from the other approaches in that it requires a much larger incision.

Most transurethral treatments for BPH, like TUIP, TUNA, and laser prostate ablation, are done in the doctor's office or outpatient surgery center. TURP and simple prostatectomy, however, need to be performed in the hospital and require an average stay of one to three days. Patients should wait a week before doing any strenuous activities after a TUIP, TUNA, or laser prostate ablation, and about four to six weeks after a TURP or simple prostatectomy. Although these treatments improve BPH symptoms for most patients, it is important to be aware of the risks involved, such as urine control issues, tightening of the urethra, and erectile dysfunction.

Kidney stones can be smooth or jagged and are yellow to brown in color. They are mostly comprised of the minerals calcium, oxalate, and phosphorus. Examining the stones to see what they are made of can show what caused the stone to be formed in the first place. For example, a stone made of mostly calcium, which is the most common type, can happen any time the urine becomes too concentrated due to dehydration or a blockage in the kidney. A uric acid stone forms when acid levels in the urine get too high, usually due to excessive consumption of animal protein such as meat and fish. A struvite stone is a sign of certain infections, and a cystine stone can be due to a genetic disorder that raises the risk of kidney stones.

The most common symptom of kidney stones is pain, either in the back or lower abdomen, or severe pain when urinating. There may also be blood in the urine. Treatment for kidney stones depends on how large the stone is. Very small stones can pass out of the body on their own, and they do not require treatment other than drinking adequate water and taking pain killers. Larger stones need to be broken apart and removed. The main treatment options are:

• Shock wave lithotripsy, which uses sound wave vibrations to break apart the stone
• Percutaneous nephrolithotomy, or the use of a very tiny tool (like a wire inserted through the back) to break apart and remove the stone
• Ureteroscopy, a thin tube inserted through the urethra and bladder to the stone, where tiny tools can grasp the stone and remove

People who have had one kidney stone are at risk of developing another. To reduce this risk, patients are given instructions specific to the type of stone they developed. Generally the instructions will include drinking more water to dilute the urine, but it may also involve lowering sodium intake or eating less meat.

• The bladder, which stores urine.
• The urinary sphincters, which are muscles around the opening of the bladder that hold urine in.
• The urethra, which is the tube where urine flows out of the body.

Urodynamics tests are normally performed together as one series, but depending on patients' symptoms, only one or some of them may be necessary. The most common tests are:

• Cystometrogram, which measures the amount of urine the bladder can store and how full it is before someone has the urge to urinate. Doctors may order this test if she suspects their patient has a weak bladder.
• Pressure flow study, which measures the pressure in the bladder while urinating. This test helps locate a blockage in the bladder.
• Uroflowmetry, which measures how much and how fast urine flows out of the body. This test is usually recommended when patients have difficulty urinating or they have a slow stream.
• Urethral sphincter electromyography, which measures how strong the muscles and nerves in the bladder and sphincters are. Doctors may request this test if the problem they are experiencing is linked to muscle or nerve damage in the lower urinary tract.
• Urethral pressure profile, which measures the pressure along the urethra while the bladder is gradually filled with fluid. Low pressure could mean someone has a weak urethra, a contributing factor to urinary incontinence (loss of bladder control).

For a few hours following a urodynamics study, patients will likely feel some soreness or discomfort. It is recommended to drink at least one glass of water every half hour for two hours to relieve these symptoms. Holding a warm, moistened washcloth over the area where discomfort is felt or taking a warm bath may also help. Results for cystrometrograms and uroflowmetry are typically available immediately after the test, but results for the other tests may take a few days. When doctors have reviewed a patient's test results, he or she will discuss them with the patient, along with any treatments the patient may need.