Holding Urine for a Prolonged Period of Time and Acute Urinary Retension

Acute urine retention is a common condition affecting most of the elder males. There are several etiological factors for acute retention of urine. Holding urine for a prolonged period of time is one such etiology. How does holding urine for a long period of time cause acute urinary retention.

This can be explained by the LaPlace Law. When you hold urine for a long time, urine accumulate slowly and the bladder volume slowly increases. Finally, the bladder gets over-distended.  When the detrusor muscles are overstretched, they cannot contract. As a result, the bladder cannot empty itself by contracting. This process finally results in acute urinary retention.

Menopausal and post menopausal hair loss

Menopause is an inevitable event in every woman’s life. It occurs at the age of 45-55 years. A woman is considered post menopausal when she has not menstruated for the past 6 months. Post menopausal period is an important time period where the body deprives of female sex hormones, which include estrogen and progesterone. As a result, all the functions carried out by these hormones are deranged. Finally it gives rise to a series of symptoms and sings, which are collectively known as postmenopausal symptoms.

These postmenopausal symptoms include, hot flushes, irritability, reduced sex drive, headacahe, night sweat, reduced sleep, urinary urgency and incontinence and dryness of the vagina. Even though hair loss is not taken as a cardinal feature of menopause, it is commonly seen among females who have reached their menopause.

Generally, females have more hair than males. That is because males lose their hair with time. The hair loss in males is mainly due to the action of male sex hormone, testosterone, on the hair follicles. People with a higher testosterone levels in their body tend to lose their hair fast. Similarly, females also have small amount of testosterone in their blood stream. But, in the premenopausal age the effects of testosterone is less due to the higher concentration of estrogen in their blood stream. Estrogen protects your hair from the action of testosterone. After menopause the estrogen levels drastically decline. The testosterone levels become higher when compared to the estrogen levels. So the protective effect of estrogen against hair loss is lost. Finally, hair loss occurs.

Hormone replacement therapy is the most effective method of treatment for postmenopausal symptoms including hair loss. As with any treatment method, hormone replacement therapy also has its side effects. Therefore, it is continued only for couple of years. It simply replaces the deprived hormones and brings the body’s homeostasis mechanisms to the previous state. It can relieve many postmenopausal symptoms including hair loss.

Apart from hormonal imbalances, other physical as well as psychological changes that occur during menopause can contribute to hair loss. For example, psychological stress is a well known cause for hair loss. Menopause is a stressful period for many women. It can be due to many reasons. This is the time period where women are found to have other diseases such as dyslipidema, diabetes, hypertension, etc. It is also the time period where they experience departure from their loved ones including their parents and children. These events can bring a significant level of stress.  Menstrual irregularities are also very common during perimenopausal period. As a result, you can lose a lot of iron from your body and become anemic. These nutritional deficiencies can also be a cause for hair loss in perimanopausal period.

While many people try to relate most of the symptoms that occur in menopausal period to the deprivation of estrogen, you should always consider other things that can give rise to hair loss. Failure to identify such etiological factors can waste a lot of time as well as money without getting any relief from the symptoms. Thyroid diseases are the commonest causes of hair loss. Both hypothyroidism and hyperthyroidism can give rise to hair loss. Therefore, it is wiser to get a thyroid profile done before you go in to any other intervention.

Why Venous Ulcers Commonly Occur Over the Medial Aspect of the Distal Leg?

Chronic venous insufficiency is a common disorder of legs. Most of the people with chronic venous insufficiency presents with varicose veins or with venous ulcer. One of the complication of varicose veins is lipodermatosclerosis of the medial aspect of the distal part of the leg. In lipodernatosclerosis the  skin gets hyperpigmented, edematous, purplish or reddish with or without ulceration. 

Even though lipodermatosclerosis can occur over the lateral part of the leg as well, the commonest site is the medial site. This is due to the presence of incompetent posterior arch vein perforaters which are present over the medial aspect of the tibia. 

What is Prophylactic Cholecystectomy?

Gall stone disease is fairly common nowadays. Researchers have found out that 17% percent of people are having gall stones at the time of death. Only percent of these people with develop symptoms due to gall stones.

Cholecystectomy is the method of treatment available to treat gall stones. It is usually performed in patients with symptomatic gall stone disease. So, when do we do cholycystectomy in asymptomatic patients?

There are several instances where we do cholecystectomy, even the patient is not symptomatic. That is when,

• the patient is a known diabetic patient
• patients with congenital hemolytic anemias
• in those due to undergo bariatric surgery for morbid obesity

If your are having any of these conditions, your doctor will do an ultrasound scan of the abdomen to detect any gall stones. If they present, he might decide to do a prophylactic cholecystectomy.

Management of Pseudocysts of the Pancreas

Pseudocyst  formation is one of the complications of chronic pancreatitis. The diagnosis of pseudocyst is usually done performing a ultrasound scan. The management of pseudo cyst occurs in a sequential manner. 

• The initial management of all pseudocysts is conservative management. This is because some pseudocysts can disappear spontaneously. Also, the cysts should mature enough to perform any procedures. The maturation of the cyst usually take 6 weeks. Therefore, the patients with pseudocysts are reviewed in 6 months. The size of the tumor predicts the possibilities of disappearing. If the cyst is less than 6 cm wide, there is more chance that it will regress spontaneously. But, if it is more than 6 cm in size, it will persist more often. 

• After 6 weeks another ultrasound scan is done. If the scan shows the persistence of the cyst, it  is removed therapeutically. Several methods are available to do this. They are, 

• Ultrasound guided drainage -

This is a minimal invasive method, but the cyst can recur later some time. Therefore, it is not the ideal way of treating pseudo-cysts. 

• Open cystogastrostomy

In open cystogastrostomy, the abdomen is opened and the anterior and the posterior walls are opened. Then the cyst is also opened and the opening is sutured to the posterior opening of the stomach. The cyst contents will gradually drain in to the stomach and ultimately the cyst will disappear. 

• Laparoscopic cystogastrostomy

In laparoscopic procedures, there is no need of opening the abdomen by using a long incision.

• Endoscopic cystogastrostomy

This is performed by an endoscope send through the mouth. Endoscopic cystogstrostomy is better because it only divides the posterior wall of the stomach.

Chronic pancreatitis is a disease with a lot of morbidity. Managing each of these morbidities is important when managing a patient with chronic pancreatitis. 

How to Know Whether You are Having Hypercholesterolemia Without Doing Blood Test

Nowadays many illnesses are diagnosed by doing investigations. In older days, when there was no sophisticated instruments for investigations, most of the illnesses were diagnosed only by taking a proper medical history and by doing a careful physical examination. Even though the art of eliciting clinical features on becoming less and less, some clinicians still appreciate good clinical skills which makes the field of medicine more interesting. 

So, are you worried about having high cholesterol levels, but still hesitating to do a blood investigation to confirm it? Then the you can look at the following symptoms of hypercholesterolemia to get a clue about what is going on in your body. If you are having any of those features, it is better to meet a doctor and get a lipid profile done to confirm the diagnosis. Once confirmed, you should follow the instructions given by your doctor, because it is very important that you keep your cholesterol levels within the normal range. It is because hypercholesterolemia is associated with many illnesses including atherosclerotic disease which can give rise to ischemic heart diseases, peripheral vascular disease, strokes etc. 

The sings of hypercholesterolemia are,

• Corneal arcus

Corneal arcus is a whites band present around the cornea. This can present in elderly people who has normal cholesterol levels. This is called senile arcus. 

• Xanthalasma

Xanthalasma are seen around the eyes. They occur due to fat collection under the skin. They look like yellowish nodules in the skin around the eye including the eyelids. They are soft to touch with well demacated margins.

• Tendon xanthomas

Tendon xanthomas also appear like xanthalasma, but they occur around tendons. They can easily be found over the achilis tendon. Achilis tendon is a tendon of the leg which inserts to the back of the heel. 

Hypercholesterolemia causes most of the diseases as a result of atheroma formation. People with hypercholesterolemia are more prone to get atherosclerotic disease. The features of atherosclerotic disease are,

• A past history of ischemic heart disease, stroke or peripheral vascular disease.
• Erectile dysfunction
• Thickened arteries

To feel for thickened radial artery, you should first apply pressure over the brachial artery. Then palpate the radial artery and see whether it is thickened. Also the palpate the femoral artery too.

• Locomotor brchialis, radialis and ulnaris

These are sings that occur in arteries as a result of loss of support from surrounding connective tissues plus the tortuocity of the arteries. You may see the tortuous arteries pulsating. 

• Feel for peripheral pulses

The peripheral pulses can be absent when there are atherosclerotic plaques occluding the arteries. 

• Bruits 

You need a stethoscope to hear bruits. Bruits can occur at any portion of the arterial system.

Above mentioned are only few signs of hypercholesterolemia and atherosclerotic disease. If you are having one or more of those symptoms, it is better to see a doctor and get a proper medical evaluation done. If the cholesterol levels are high, your doctor will either manage you with life style modifications. He can also give you drugs. Either way, you should adhere to the advice given. unless, hypercholeterolemia can give rise to diseases with significant rate mortality and morbidity. 

Basic principles of Management of Fractures

The goal of management of fracture is to restore function and structure of the affected part without any cosmetic problems. Management of fractures is carried out according to 3 major basic principles. 

1. reduction (R)
2. Immobilization (I)
3. Rehabilitation (R)

Reduction

Reduction of a fracture restores the distal part of the fracture segment to its normal position. The fractured segment can be displaced or angulated. To achieve this traction is applied along the long axis of the bone and the mechanism of fracture is reversed to put the fractured segment beck in to its normal position. Reduction be achieved either by open method or closed method.The patient is anaesthetised before the procedure because it can be very painful.

Immobilization

Immobilization is achieved by several methods. The appropriate method for a particular person is decided according to the nature of the fracture he or she is having. The following methods are used to immobilize the affected part. They are,

1. Splinting
2. Casting
3. Traction
4. Internal fixation
5. External fixation 

Splinting and casting are applied by using plaster of paris (POP). Splints are also called back slabs. All 5 methods help to keep the fractured segments approximated so they can heal fast. Even though, internal fixation allows early mobility, it does not accelerate the rate of healing process. 

External fixation is applied for compound fractures where internal fixation can not be achieved due to high risk of infection. In such situations the soft tissues should first be healed. 

Is Your Fractured Bone is Healing properly?

Fractures are very common nowadays. Usually, your fractured bone will be immobilized for a long time to allow it to heal. Optimum conditions should be there to allow the fractures to heal properly. These factors include,

• Good blood supply
• Proper nutrition
• Good approximation
• Less movements between the fracture segments

Therefore, any lack of any of above factors can give rise to delayed fracture healing. If you are having a fracture, your fractured area must be wrapped in a plaster cast or a splint and the fractured joint is immobilzed. You must be curious when the fracture will heal. You doctor will explain how long it will take for the fracture to heal. Usually, a fracture takes at least 3 weeks to heel. 

You can assess the progression of the healing process by yourself just by paying attention to the symptoms and signs. If there is pain in the fracture area, it means that the healing process is still going on. If there is no pain at all, it means that the fracture has healed completely. 

If there is no pain, it is better to be aware of the mobility of the fracture site. If the fractured segments are mobile at the fracture site and there is no pain, it means that the healing process has stopped, but the ends has not united. This is called malunion. In such cases, your doctor will have to do a surgery and remove the healed edges and to an internal fixation.

Meanwhile, you should help your body to heal the fracture. You can do this by giving the fracture site the proper environment to heal. Things you can do includes,

• Maintain good nutrition
• Keep the fracture immobilized.
• Avoid infections

Imaging in Fratures

Imaging of fractures involves the rule of two.

1. Two joints - Both joints, proximal and distal to the fracture should be included in the radiograph. 
2. Two views - There should be two views, anteroposterior and lateral. 
3. Two limbs - When the lesion is in a paired organ, you should never forget to compare it with the other. Therefore, a radiograph of the normal limb should also be taken.
4. Two times - radiographs should be taken both before and after the procedure. 

description of radiographs is remembered as the rule of A's.

1. Anatomy - e.g. proximal tibia
2. Articular - e.g. intra-articular, extra-articular
3. Alignment - e.g. first plane
4. Angulation - e.g. second plane
5. Apex - e.g. apex pointing medially
6. Apposition - e.g. 25%, 50%.....

An Overwiew of Fractures

Fracture is defined as disruption in the integrity of a living bone involving injury to the bone marrow, periosteum and the the surrounding soft tissues. Fracture can cause a significant amount of morbidity and therefore, should be prevented at all times. 

How to Prevent Fractures

Prevention of fractures involves the following.

• Increase bone strength

This can be achieved by getting enough calcium through foods. Usually a person should take 1500 micrograms of calcium per day. This amount can easily be achieved only by eating enough calcium containing foods such as small fish, milk and fortified foods or drinks such as orange juice. 

Taking enough calcium diet is not enough to strengthen the bones. The bones get stronger according to the stress they are put in to. This can be achieved by carrying out aerobics and weight training. 

• Avoiding and protecting from potential accidents that can cause fractures. 

Road traffic accidents plays a leading role in fractures. Therefore, various measures has been taken to minimize road traffic accidents. Adhering to these rules and regulations and thereby avoiding accidents can keep you away from fractures. Make sure you and everyone else in the vehicle wears seat belts before starting your vehicle. Never drive when you are drunk. 

Management of Fractures At the Site of the Accident

Management of fracture involves management at the site of the infections and proper medical and surgical management after arrival to the hospital. At the site of the hospital, the following measures should be taken to minimize the complications and to optimize the recovery.

Most of the fractures occurs in poly trauma patients. So, the person should be attended as a whole. The person who have a training in managing fractures should approach the patient safely and carry out A,B,C and stabilize the patient before attending his or her fractures. Once the patient is table the injuries can be managed. Many serious fractures are open fractures and therefore, can bleed continuously, In such situations, you should apply pressure over the wound by putting several layers of gauze or cloth over it. Before doing this you should protect your self by putting on latex gloves or by covering the hands using a polythene bag. When applying the pressure, try not to displace the fragmented bones. 

Then the fracture should be immobilized. Immobilization reduces pain and reduced the chances of the patient going in to shock. Immobilization is done by applying a splint. Splint should be applied to involve both the proximal and distal joints involving the fracture. An umbrella, folded news papers or magazines etc, can be used as a splint. 

You can also immobilize the fractured lower limb by tying it onto the normal lower limb. An injured upper limb can be immobilized by tying it on to the chest wall. If the elbow is bent, you can rest the forearm on a broad arm sling. 

Management of Fractures at the Hospital

Once the patient arrives to the hospital, the doctors take a brief history regarding the incident which lead to the injury. He will also take a brief history regarding the past history of fracture, associated comorbidities and other social factors. Radiographs will be taken.

The management of fractures can be wither operative or non-operative. Non operative management involves closed reduction followed by a period of immobilization with splinting or casting. 

How Can You Get Long Term Sensory Loss of Upper Chest After Clavicle Fracture?

Fracture of clavicle is very common. Earlier these fractures were managed conservatively. People with fracture of the clavicle are diagnosed by taking radiographs. After diagnosis, usually a broad arm sling is given to the patient and the fracture is allowed to heal. But now there are new methods used throughout the world besides conservative management.

The cutaneous nerves supplying the upper chest arise from the spinal cord and pass  downwards towards the upper chest across the clavicle. These nerves can get damaged when the clavicle fractures. In such situations, the patient can suffer long term sensory loss over the upper part of the chest. 

How to Prepare for Whipple's Surgery?

1. Written informed consent

Carcinoma head of the pancreas is a curable cancer if if identified early. The curative surgical procedure is Whipple's procedure also known as pancreaticoduodenectomy. Whipple's procedure is major operation. Your doctor will explain you the condition and the options you have. He will also tell you the risks of the procedure. Then he will take an informed written consent. You should be fit enough to undergo this procedure, because of the cormorbidities associated with the procedure. Therefore, your doctor will ran you through a series of investigations to assess your fitness. 

2. Investigations

 Carcinoma of the pancreas is associated with high level of morbidity. If you are diagnosed to carcinoma of head of the pancreas, you must have suffered months of severe loss of appetite and loss of weight. Severe loss of appetite and loss of wight makes you nutritionally deprived. Therefore, you must be having several deficiencies.

• PT/INR

Vitamin K deficiency is one important nutritional deficiency you can get is you have carcinoma head of pancreas. If you are deprived of this particular vitamin, your blood's ability to clot and prevent bleeding will be impaired. Therefore, your will assess your vitamin k levels by measuring the ability of your blood to coagulate. This is done by measuring the prothrombin time and the international normalize ratio shortly known as PT/INR. If this is high, your coagulation status will be corrected by giving intravenous Vitamin K. Usually 10 mg of vitamin K is given 12 hourly for 3 days. If not you wll be transfused with fresh frozen plasma.

• Serum total protein and albumin levels

Protein and albumin can also be deficient in your body. Hypoalbuminemia is associated with many post-operative complications. Protein deficiency can delay wound healing and thereby increase the hospital stay. When you are deficient of protein, you are a high risk of developing infections, anastomotic leakage, burst abdomen, incisional hernia and intra-abdominal sepsis. Therefore, it is important to measure the serum protein levels and correct them if there is any deficiency. Doing this by increasing oral intake can be a challenge both due to severe loss of appetite and due to malabsorption.

• Full blood count

Usually people who get carcinoma of the pancreas are elderly people. They usually have other cormorbid conditions. Therefore, routine investigations are done to detect those diseases. From the full blood count report your doctor will look at your hemoglobin levels, white cell count, platelet count and the hematocrit. 

• Renal Function Tests

Blood urea, serum electrolyte levels and serum creatinine levels are measured.

3. Routine pre-operative preparations

• Good hydration 

Your doctor will keep you adequately hydrated. It is important to keep your body hydrated because it can prevent post-operative hepatorenal syndrome. Hepatorenal syndrome is renal desfunction occurring along with hepatic disease. 

• Prophylactic antibiotics 
• Six hour fasting
• Booking a intensive care unit bed

Whipple's procedure is a major surgery. You might require intensive care after the procedure. Therefore, your doctor will book a bed in the intensive care unit prior to the surgery. 

Once all above requirements are full filled, you will be sent to the theater. At the theater, the surgeons, anaesthetists and other theater staff will take care of you. All you have to do is try to keep calm.

Why Open Surgery Should not be done for Bladder Tumors?

Bladder tumors are very common. Most of them can be cured easily if identified early. Usually the superficial tumors of the bladder are treated with transurethral resection. They are not resected opening the bladder trans-abdominally. It is because there is a very high risk of tumor deposition along the tract if surgery is done trans-abdomonally.

Can You Get a Fistula Years After Radiotherapy for Cervical Cancer

Cervical cancer is one of the commonest gynecological malignancies all over the world. It can be cured if identified early. Most of the cervical cancers are squamous carcinomas. Squamous carcinomas are highly sensitive to radiotherapy. Therefore, radiotherapy for cervical carcinoma plays a major role in treating cervical cancers. As with any other treatment modality, radiotherapy also has its own set of complication. Fistula formation is one such complication.

A fistula can develop between the bladder and the perineal skin. This occurs as a result of avascular necrosis of the tissues surrounding the bladder. Unfortunately, the fistulas can occur several years after the radiotherapy. The cancer might have disappeared completely by then.  Sometimes ureterovaginal fistula (Between the ureter and the vagina) can coexist with viscicovaginal fistula (between the bladder and the vagina). Therefore, several investigations are done to differentiate one from another. Three swab test is one such investigation.

The three swab test is done by inserting a swab into the vagina and injecting a die through the urethra. The swab will stain with the die, if there is a viscicovaginal fistula. An intravenous urogram (IVU) should be performed to exclude a coexisting ureterovaginal fistula. 

What is Variegated Appearance in Renal Cell Carcinoma

Renal cell carcinomas often affect the upper pole of the kidney. They are usually large, well encapsulated tumours. These tumours are filled with large ammount of cholesterol, which gives them a golden appearance. These large tumours tend to have foci of hemorrhage and necrosis, which gives rise to characteristic Variegated Appearance.

Why Even a Single Episode of Hematuria Needs Investigations?

Hematuria can occur due to various reasons. Out of these reasons urinary tract tumors palys a leading role. Unlike other causes of hematuria, tumors of urinary tract are detrimental unless identified and treated as soon as possible.

Renal cell carcinoma is one such tumor. Renal cell carcinoma is characterized by intermittent episodes of hematuria. Some people can neglect a single episode of hematuria because it can subside without any treatment, but this should not happen. If you ever develop hematuria, you should seek immediate medical help. If not, it will be too late once the tumor has spread throughout the body.

How to Find Out the Cause for Red Colour Urine?

Red coloured urine can occur due to various reasons. Some of the causes of red coloured urine, for example blood in urine, can be very serious. Therefore, it is very important that you seek medical help, if you develop red coloured urine even once.

Red coloured urine does not always mean hematuria (blood in urine). haematuria, haemoglobinuria, myoglobinuria, some foods and some drugs can give rise to red coloured urine. The exact colour of the urine can be helpful to differentiate one from the other. When you say red coloured urine, it can vary from bright red to dark red colour. Dark red or coca cola colour urine indicates myoglobinuria which results from breakdown of muscles. Some drugs can also give a red colour to the urine. Some of these drugs are ethambutol, rifampicin and metronidasole. Some dietary ingredients can also give a red colour to the urine. These instances of red coloured urine are called pseudohaematuria.

The other way to find out the cause of red coloured urine is to know which part of the urine stream do you see the red coloured. Some people have red coloured urine only at the beginning of the stream and some have gross red coloured urine throughout the urine stream and some can complain of red coloured urine at the end of the urine flow.

Hematuria at the beginning of the urine flow is due to urethral strictures or urethral carcinoma. Terminal hematuria is due to a pathology in the bladder neck or the trigone. Even hematuria is often due to a renal pathology..

The commonest causes of hematuria are malignancy, stones and infections. Apart from these three most common causes there are other less common causes of hematuria such as glomerulonephritis, tuberculosis, poly cystic kidney disease, bleeding disorders, some drugs (warfarin, Heparin, Aspirin), benign prostatic hyperplasia and radiation cystitis.

As described above, we can find out the cause of red coloured urine only by describing the nature of it without the help of any investigations. We can always perform investigations to confirm the diagnosis.

What is Von Lindau Hipple Syndrome

Von Hipple Lindau Syndrome is a syndrome associated with renal cell carcinoma. It is characterised by formation of tumors and cysts throughout the body. These tumors and cysts are usually identified during the adulthood. The incidence of this syndrome is 1 in 36 000 people.

The tumors associated with Von Hipple Lindau Syndrome can be either malignant or non-malignant. These tumors can occur in various organs in the body. This syndrome is characterised by having a type of tumor called haemangioblastoma. It is a benign tumour, but can give rise threatening complications.They can occur in the retina, brain and spinal cord and cause serious neurological deficiencies.

The syndrome can give rise to tumours in the kidneys called clear cell renal cell carcinoma. It can also produce adrenal gland tumours callled pheochromocttoma. Pheochromacytoma are benign, but they can produce life threatening coomplications such as very high blood pressure. The syndrome can also present with pancreatic neuroendocrine tumours. Endolymphatic sac tunours are also seen in people with this sndrome.

What is Urine Cytology? How can it Detect Bladder Cancer?

There are several investigations that can confirm bladder carcinoma. urine cytology stays at the top of the list. It is a cery sensitive test to detect carcinoma insitu and high grade transitional cell carcinoma, but it is not sensitive for low grade transitional cell carcinoma.

It is performed in clean catch urine. You should first clean the external genitalia with soap (not with an aniseptic solution). Then you should start pass urine. About 80-100 ml of urine should be collected fron the middle of the urine stream (midstream urine). Then the sample is sent to the laboratory. If there is any delay in transporting the urine sample to the laboratory, it should be stored in a refrigerator. 

The malignant cells can be identified from this urine sample. This test is not recommended for screening purposes, but if it becomes positive , it is a strong marker of bladder carcinoma.

When to Suspect Bladder Cancer?

Bladder cancer is one of the commonest genitourinary tract malignancies. It can be treated and sometimes be cured, if you identify it early. The symptoms of bladder cancer can sometimes be very non specific. Therefore, there should be a high degree of clinical suspicion to identify this disease condition. So, what are the features of bladder cancer?

The most common and highly suspicious clinical presentation of bladder cancer is hematuria. Even a single episode of hematuria is highly indicative of bladder cancer. The other clinical presentations of bladder cancer include,

• Storage symptoms - Storage symptoms include, frequency, urgency, urge incontinence, nocturia and nocturnal enuresis. These symptoms are very non specific and can be the result of other benign conditions of the urinary tract, such as benign prostatic hyperplasia, but urologist always suspect bladder cancer because it is very common and can be cured completely if identified early.
• Dysuria without evidence of infection - Some people with bladder cancer can present with dysuria without evidence of any infection. Evidence of infection include fever with chills and rigors. They complain of pain or burning sensation when passing urine. 
• Recurrent urinary tract infections is another feature of bladder cancer. 
• Microscopic hematuria - Many people with bladder cancer pass red cells with their urine, but the number of red cells in the urine is not enough to give red colour to the urine to be seen in naked eye. These people are sed to have microscopic hematuria. These people are usually detected when a urine full report is performed when they present with any other urinary tract symptom. 
• Pathological fracture - Some people can stay un-noticed for years without developing any symptoms. These people can have advanced bladder carcinoma. The cancer may have spread to distal organs. Bones are a very common site of bladder cancer metastasis. Such people can first present with pathological fractures. The radiographs will show a metastatic lesion and a bladder tumor can be found when looked for a primary site.  
• Obstructive uropathy - Obstructive uropathy is the outcome of obstruction of the urinary tract. One of both ureters can be obstructed due to the tumor. As a result the hydronephroreters develops and the post-renal renal failure can occur. The patient can present with features of renal failure such as generalised body swelling, especially peri-orbital swelling in the morning. 
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Are You at Higher Risk of Developing Bladder Cancer?

There are risk factors for most of the diseases in this world. Similarly, bladder cancer also has a list of its own risk factors. They are,

• Cigarette smoking - 25 -50 %
• Industrial toxins 

Bladder cancer has a very good relationship with industrial toxins such as rubber, leather and textile. Hair colouring agents also makes people more prone to get bladder carcinoma.

•  Radiation 

If you have a history of exposure to radiation, it puts you in danger of developing bladder cancer.

• Chronic inflammation of the bladder

Chronic inflammation of the bladder is another well known risk factor for developing bladder cancer.  if you have past history of recurrent episodes of urinary tract infections or a past history of bladder stones, your bladder has been under chronic inflammatory process.

• High fat diet, fried meat animal fats
• Age - as with many cancers, your chances of getting a bladder tumor increases with advancing age. As you grow old, the cells accumulate mutations and finally can become malignant.
• White race
• Male gender - men are at three times more risk of developing bladder cancer than females
• Lynch syndrome

If you have any of above risk factors, you have chance of developing bladder carcinoma. It doesn't mean that every one exposed to above agents can develop bladder cancer. It also doesn't mean that you will not get bladder cancer if you don't have any of those risk factors. Therefore, there is no need to panic. But, you should be aware of symptoms of bladder cancer to identify it early.

The most common feature of bladder cancer is gross hematuria. Therefore, if you ever develop hematuria, even once in your life, you should immediately seek medical help. 

Why Pressure Flow Studies are preferred over Peak Flow Rate when diagnosing BOO?

Bladder outflow obstruction (BOO) is the combination of low flow rates in the presence of high voiding pressure. The symptoms of BOO can be vague and therefore, not reliable. For example, the patient may complain of poor stream, but it can due to low voiding pressure due to detrusor instability, neurogenic instability or due to poor bladder contraction. Therefore, to diagnose BOO both the flow rate and the voiding pressure should be measured at the same time.

Why Urologist Prefer LUTS over Prostatism?

LUTS – Lower Urinary Tract Symptoms

Not only males, but also females experience lower urinary tract symptoms as they grow older. Many think that the only benign prostatic hyperplasia is the only cause of these lower urinary tract symptoms, but it is not true. It can be due to several reasons. They include,

·         Neurogenic bladder dysfunction as a result of stroke, Alzheimer’s disease, Parkinson’s disease, diabetes and stroke.

·         Idiopathic detrusor overactivity.

·         Degeneration of bladder smooth muscle giving rise to impaired voiding and detrusor instability.

·         Bladder out flow obstruction due to benign prostatic hyperplasia. 

Therefore, a more descriptive term like ‘prostatism’ may not be appropriate to describe most of the lower urinary tract symptoms.

What is LUTS?

LUTS stands for lower urinary tract symptoms. These lower urinary tract symptoms are mainly divided into two categories. There are voiding symptoms and storage symptoms.

Voiding Symptoms

·         Hesitancy

·         Poor stream

·         Intermittent stream

·         Terminal dribbling

·         Feeling of inadequate emptying of the bladder

Storage symptoms

·         Frequency

·         Urgency

·         Urge incontinence

·         Nocturia

·         Nocturnal enuresis