A stone may be as small as a grain of sand or as large as a golf ball. It may stay in the kidney or move into the urinary tract.

The chance of passing a kidney stone depends largely on its type, size and location.

Who is affected?
Men and women of all ages may develop kidney stones. However, men between 30 and 50 are three times more likely to form stones than women of the same age.

The risk of forming stones increases for those who live in a hot climate, such as the Southeast. Other risk factors include:

• Family history of kidney stones
• Diets high in calcium (dairy products) and oxalic acid (colas, chocolate, peanuts, tea)
• Insufficient water intake (fewer than eight glasses a day)
• Repeat kidney infections
• Gout

Pain can come in waves that begin in the lower back and then move to your side or groin. Other symptoms include nausea, fever, bloody urine or a burning feeling when urinating.

Removing stones Traditionally, surgery was how to remove kidney stones. But thanks to new technology, patients have other options that are less painful, costly and time-consuming.

Medical therapy may dissolve certain kinds of stones.

What it is
Urinary incontinence is the inability to control the flow of urine. It is not a disease. Rather, incontinence is a symptom of an underlying problem - sometimes a simple one - that can be managed and, in many cases, cured.

Common types
Stress incontinence - usually affecting women, especially during pregnancy or after childbirth. The person accidentally loses small amounts of urine during exercise, other physical activity, laughing, coughing or even sneezing.

The cause may be weakness in the pelvic floor muscles or a change in the position of the bladder and urethra due to injury, surgery, pregnancy or childbirth.

Overflow incontinence - affecting people of all ages. The bladder remains constantly full, but the person can't release urine. This results in accidental leakage.

Causes include diabetes, medication side effects, spinal cord and other nerve injuries, and obstructions such as an enlarged prostate.

Urgency incontinence - when one feels the urge to urinate, but cannot make it to the toilet in time. This condition can be most bothersome to older people who cannot move quickly to the toilet.

The cause is often a side effect of stroke, senile dementia, Parkinson's disease, multiple sclerosis, radiation treatment, urinary tract infection or bladder irritability.

Bedwetting - usually affecting boys, who pass urine while asleep.

While bedwetting is common among young children, those who do not outgrow it may have a more serious problem. Chronic bedwetting may have emotional roots, such as slow maturation or home and environment changes. Some medications may aggravate the problem.

Other types - Less common is the total incontinence experienced by people with spinal cord injuries, birth defects or other trauma. They can't control their urine, which results in constant leakage or periodic loss of everything in the bladder.

Prevention

• Go to the bathroom at regular intervals. Use a clock or written schedule to help stay on track.
• Wear loose clothing, which is easy to remove - especially if you have arthritis.
• Wear absorbent products such as pants or pads that are comfortable and invisible under clothes. A special drip collector pouch, which covers the penis, is also available for males.
• Use bed protection pads designed for incontinence. They provide sleeping comfort and protect linens and mattresses.

Prostate disease

Problems occur when the prostate enlarges, causing blockage in the urethra. This duct carries urine out of the bladder and through the penis. Blockage interferes with urination and can be life-threatening.

What causes the prostate to enlarge? Infection, benign growth or cancer. By age 50, most men have some prostate enlargement, but problems can occur in younger men too.

Other problems
Benign Prostate Hypertrophy - BPH affects about 60 percent of men older than 60, but is rare in men under 50. The urethral tissue inside the prostate thickens, which slows or shuts off the flow of urine, causing the bladder to swell and weaken. The swollen bladder, which may put pressure on other organs, can become inflamed. This occurs from infection due to lack of drainage. Urine backup can cause kidney damage.

Symptoms of BPH include:

• Frequent urination during the day and especially at night
• Difficulty urinating
• Low pressure flow
• Dripping
• Feeling full but unable to urinate
• Blood in urine
• Urinary tract infections.

Prostatitis - Prostatitis refers to infections of the prostate. Infection may come from viruses, bacteria and untreated gonorrhea. Stress irritation and diminished sexual activity may cause buildup of prostate secretions. Warning signs of prostatitis may include discharge from the penis, frequent urination, fever, and pain during erection or ejaculation. Acute symptoms usually come on suddenly. Pain in the pubic region, low back, groin and genitals indicates a more chronic condition. While very irritating, prostatitis is rarely a major health problem.

Diagnosis
Determining the cause of the problem begins with a complete medical history.

A rectal examination allows the physician to feel the prostate through the rectum wall to find any swelling, tenderness or firmness.

Blood tests and urinalysis can check for infection or abnormal levels of waste products and/or enzymes caused by prostate problems.

Cystoscopy is another diagnostic tool. The physician inserts a scope into the penis to visually examine the urethra, prostate and bladder. An anesthetic may be used during the procedure.

Other tests your doctor may require include X-rays to look for cysts or growths and catheterization to collect urine for further study. The prostate tissue may be biopsied for examination under the microscope to identify any cancerous cells.

Treatment
After a complete diagnosis, your urologist will discuss your best treatment options. Your doctor will consider many factors, such as your age and seriousness of the condition.

Medication
If a prostate problem is due to infection or less acute BPH, your doctor may prescribe drugs and/or oral antibiotics. Sometimes a catheter helps empty a full bladder and relieve pressure.

Sitz baths and prostate massage also may be used to help with drainage and reduce pain.

In some cases doctors recommend sexual intercourse to promote prostate drainage.

Surgery
Surgical prostatectomy is a common procedure to remove larger growths. Urologists make an incision near the tumor to remove the enlarged part of the prostate. During surgery, the doctors check surrounding tissue for other problem areas.

If cancer is present, doctors may stop it from spreading by removing the entire prostate. Radiation and chemotherapy may be used to kill any other cancer cells.

Fortunately, prostate cancer when detected early is treatable, and the survival rate high.

Sex concerns
Men often fear that prostate surgery or treatment may affect their sex life.

Short episodes are common and not necessarily a problem. With stress or excessive alcohol consumption, most men will experience temporary impotence.

However, millions are continually unable to achieve a firm erection, either because of physical or emotional problems.

Types of impotence
Physical - A normal erection depends on healthy nerves and good blood supply. Physical impotence may result from damage to the nerves or blood vessels that control blood flow to the penis. Hormone imbalance also can cause physical impotence. Occasionally, impotence is a side effect of medication, particularly for high blood pressure or depression. Other physical causes of impotence can include diabetes, vascular disease, pelvic surgery or accidents to the spinal cord or genital area.

Psychological - Psychological impotence generally stems from fear, chronic stress, worry, anger or frustration. This type of impotence often develops from "performance anxiety" - a man's fear that he won't be able to perform well during sexual intercourse. Chronic stress caused by job, marriage or financial difficulties also can cause impotence. Contrary to what many believe, impotence has nothing to do with masculinity.

Finding the problem - Diagnosing what is causing impotence begins with a thorough history and physical examination. The patient may also undergo a psychological evaluation, patient/partner counseling, laboratory studies, endocrine and functional evaluation which will include Nocturnal Penile Tumescence Monitoring. This study involves wearing a small monitor, which measures the quality of erections during a normal night's sleep.

Treatment
Many treatments are available depending on the nature of the disorder.

Psychological counseling - A patient diagnosed with psychological impotence will be referred for appropriate counseling. This is a proven technique, particularly when both the patient and his partner take part. For some patients, impotence may disappear when they learn that physical problems are not causing the disorder.

Medication - Impotence caused by hormonal problems can be treated with medication. (If impotence is the result of medication, doctors may prescribe an alternative drug.) Remember that insulin and oral diabetic pills do not cause impotence. It is important not to reduce or change any medication without first consulting your physician. Good regulation of diabetes with diet, exercise and medication may correct impotence caused by poor blood sugar control. Impotence from permanent damage to the blood vessels or nerves also can be treated with penile self-injections. Urologists closely supervise this treatment, and follow-up visits are necessary.

Vacuum erection device - This is a relatively new technique in which a mechanical, non-surgical erection is created by placing the penis in a vacuum cylinder. The vacuum draws blood into the penis. Tension rings at the base of the organ help maintain an erection.

Partners in health
Impotence affects partners as well as patients. That's why the Urology Center staff encourages and welcomes partner participation in the treatment process.