Kidney & Urinary Issues
Kidney Stone Treatment
Physicians at Associated Medical Professionals are trained in a variety of treatment options for both acute kidney stone attacks that require urgent care and treatment, as well as evaluation and treatment of non-obstructive and asymptomatic kidney stones. In addition, we provide chemoprevention of patients who are chronic kidney stone formers.
Most patients are unaware of the presence of kidney stones until they end up in the emergency room with an acute attack of renal colic, which typically means severe back and flank pain that may radiate into the groins. Other symptoms include blood in the urine, severe nausea, vomiting, possible fever, or chills and passage of stone-like material. It can also lead to irritated urinary symptoms of voiding more frequently and urgently, as well as loss of bladder control.
Kidney stones are typically found on radiologic imaging, commonly including a CT scan of the abdomen and pelvis performed urgently in the office or in the hospital setting.
The initial management can include conservative therapies including pain control, increased hydration, straining of the urine to assess for passage of the stone as well as medical expulsive therapy, which includes medication to assist in passage of the stone without surgical intervention. The symptoms of kidney stones can be associated with more serious disease, including cancer, that need to be carefully evaluated by a urologist.
Treatment options for kidney stones include observation, since the majority of smaller stones will pass on their own or medical expulsive therapy, which may include medications to help the stone pass more easily. Other options include in-office procedures, such as removal of the stone using telescopes; shockwave lithotripsy, typically performed under mild sedation, which fragments the stone into smaller passable fragments; interventions with endoscopes, which is the removal of the stone either by basketing smaller stones or performing laser procedures or other modalities to fragment the stone and remove it which are typically performed in an ambulatory setting. Percutaneous methods are also used to extract stones, particularly from the kidney, that are more problematic. Laparoscopic and da Vinci robotic-assisted techniques are considered for larger and more problematic stones.
A major portion of kidney stone evaluation and treatment includes the prevention of stones following the acute episodes, including possible 24-hour urine collections and evaluation of any stone material which may be passed to try to minimize any further stone production in patients who have recurrent problems or patients who are young.
Urinary Tract Infections
Simple urinary tract infections are relatively easily treated using antibiotics if they occur infrequently. Progressive urinary tract infections can be signs of more serious urologic disease, including obstruction of urinary passage from the kidney or bladder; kidney stones; and frequent urinary tract infections. These symptoms can lead to more extensive urologic issues in the future. The signs and symptoms of more serious urinary tract infections can include fever, nausea, lower abdominal pain, flank pain, lower back pain, blood in the urine, foul smelling urine, cloudy urine, irritative urinary symptoms (including burning), going more often, urge to void frequently and incontinence.
Workup of more serious urinary tract infections typically includes radiologic imaging with renal ultrasound or a CT scan to assess for kidney infections or obstruction, as well as possible cystoscopy to assess the bladder and urine cultures to be sure that the appropriate antibiotics are delivered with follow-up urine evaluations to be sure that it is fully treated.
Urinary Incontinence
Physicians at Associated Medical Professionals are well trained and can treat most forms of urinary incontinence in men and women. Urinary incontinence can be a sign of other significant medical issues including neurologic disease, progressive dementia, anatomic abnormalities, and complications from previous gynecologic or urologic procedures; neurologic and urologic malignancies; or other serious issues that need to be carefully evaluated. Evaluation typically includes urinalysis, possible urine cultures, complete urologic physical examination, possible cystoscopic examination, urodynamic testing to better evaluate bladder function and possible obstruction, neurologic evaluation and history.
Multiple treatment options include conservative measures such as Kegel exercises and biofeedback, as well as bladder training; medical management with multiple medications that are available for improving bladder control, including pills and jells; and implantable devices in the lower back that can better control bladder function including, InterStim.
Surgical treatment options including bladder slings; intraurethral bulking agents, including collagen; pelvic floor reconstruction, including cystocele; and rectocele repair, including da Vinci robotic-assisted and laparoscopic techniques in order to improve incontinence.
Pelvic floor therapy is a conservative, non-surgical therapy used to treat incontinence, urgency, pelvic pain, or to re-educate the pelvic floor muscles to restore and maintain health. Using the pelvic floor therapy technology, a computer recorder monitors the strength of your pelvic muscles and your progress throughout the therapy. This computerized technology allows you to immediately see results as you contract and relax the correct group of muscles according to a present pattern of exercises.
Urodynamics
Urodynamics refers to a group of diagnostic procedures that are performed to evaluate voiding disorders. The goal of diagnosis and treatment of these disorders is to protect the kidneys and keep the patient dry. Urodynamics are primarily performed for evaluation of the lower urinary tract. These tests include Uroflow, CMG, flow/pressure, UP, UPP and EMG.
