Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua
Hospital
The bladder stores urine before it leaves the body. Sometimes
we need to sample this urine or sometimes there is a block in
the tract further down from a stricture or a large prostate.
To drain urine we generally have two options: catheter and
suprapubic aspiration. Since normal functioning kidneys make
about 50 cc of urine an hour, a catheter can measure urine
output and tell us if a patient has enough fluid in his
body.
As such, catheters are generally inserted in trauma patients
to help us detect occult bleeding. Blood tests are generally
not enough. Often they are inserted in the elderly who are
incontinent or in paralyzed patients, but a permanent
catheter does predispose to infection. Other ways of dealing
with incontinence are preferred.
We spoke about urine infections in small children that are
often missed, and that urine must be tested in a feverish
child without a source for the infection. Urine bags are
often used. They do not provide us with a sterile urine but
they do tell us if there are any white blood cells, a sign of
infection. Catheters can be inserted in small children if a
urine test is needed quickly or under sterile conditions, but
suprapubic aspirations are easier and safe, even though it
involves putting a needle through the abdominal wall into the
bladder.
An important disease of the bladder is TCC or a cancer of the
bladder. This used to be a disease seen just in people
exposed to toxins in the work place, but it is very common in
Israel. I am not sure why, but I might guess that the way
Israelis treat their environment may have something to do
with it. It usually presents with blood in the urine.
Prognosis is generally fair.
Urinary retention is a problem in older men. Women can have
it, especially after birth. In the past, this problem in
women was thought to be due to psychological problems. We now
know it is due to mechanical problems.
In men, the prostate mysteriously grows as men get older, and
as it sits behind the bladder and around the urethra it can
strangle the tract and lead to inability to urinate. The
prostate can grow due to cancer or just because of age. If
age is the reason, a catheter is inserted to keep the urine
draining, and an operation is generally done to remove some
of the prostate. Medication can also be used to shrink the
prostate. However, cancer can be hard to detect, and is a
devastating disease as it is one of the cancers that spreads
to bone and this is a cause of intense pain. Early detection
is the key, and we will discuss this next week as we close
this series and start a new one.
A message from Glaxo, sponsor of this column.
Hypertension is high blood pressure and is easily treated.
But what if it is pulmonary hypertension? This is a
devastating disease that is not easily treated, as the only
area of high blood pressure is in the lungs. Flolan is the
only medication approved for the treatment of this disorder.
It gives hope where before there was none.
