Disease information


Bed-wetting (also called nocturnal enuresis) is when the bladder empties while a child is asleep. This can happen every so often, or every night. Bed-wetting is common. About one in every five children in Australia wets the bed. Bed-wetting can run in families and is more common in boys than girls before the age of nine years. It can be upsetting for the child and stressful for the whole family. The good news is that you can get help.


Wetting the bed is caused by a mix of three things:

  • the body making a large amount of urine through the night
  • A bladder that can only store a small amount of urine at night
  • Not being able to fully wake up from sleep.

Children who wet the bed are not lazy or being naughty. Some illnesses are linked with bed-wetting, but most children who wet the bed do not have major health problems.

Day-time control of the bladder comes before night-time dryness. Most children are dry through the day by the age of three years and at night by school age. However, this can vary, and children may have accidents every so often, both day and night, up until they are seven or eight years of age


It is best to seek help from a health professional with special training in children’s bladder problems, such as a doctor, physiotherapist or continence nurse advisor. They can help children with their bed-wetting from when the child is about six years of age. Before this time it can sometimes be hard to get the child to be helpful. However, in some cases it might be wise to seek help sooner, such as when:

  • The child who has been dry suddenly starts wetting at night
  • The wetting is frequent after school age
  • The wetting bothers the child or makes them upset or angry
  • The child wants to become dry.


Some children who wet the bed at night also have problems with how their bladder works through the day. They may go to the toilet too few or too many times, need to rush to the toilet in a hurry, have trouble emptying out all the urine or have bowel problems. Unless the child has wet underwear, families often do not know about these other bladder and bowel control problems. New day-time wetting by a child who is toilet trained should be discussed with a doctor.


Many children do stop wetting in their own time with no help. Most often, if wetting is still very frequent after the age of eight or nine years, the problem does not get better by itself. There are many ways to treat bed-wetting. A health professional will begin by checking the child to make sure there are no physical causes and to find out how their bladder works through the day. Then, there are a few ways to treat bed-wetting that are most often used

Bladder training programs Teach the child good bladder habits. This means that the child learns to be a good drinker and to empty their bladder well when they need to go to the toilet. This cuts down sudden urges that may cause wetting. Learning to hold lots of urine through the day does not always help dry nights.

Night alarms that go off when the child wets the bed. These work by teaching the child to wake up to the feeling of a full bladder. The alarm is used either on the bed or in the child’s underpants. The results are best when the child wants to be dry, wets very often, has help from a parent through the night, and uses the alarm every night for several months. Some children become dry using an alarm but later start to wet again. Alarms can work again after this relapse.

Drugs or sprays that change how active the bladder is or cut down how much urine is made through the night can be prescribed by a doctor. These drugs can be used to help the bladder work better at night. Drugs alone don’t often cure bed-wetting. Bladder function must be improved or bed-wetting may come back when the drug is stopped.


Seek help from a health professional with special training in children’s bladder problems, such as a doctor, physiotherapist or continence nurse advisor.

Talk to your child about how their body works.

Let your child know what has caused their problem.

Do things with your child that help them feel good about themselves. Praise your child when they follow the health professional’s advice.

Ensure your child drinks five or six glasses of water daily, as many children with bladder problems do not drink enough.

  • Try to cut back how many fizzy drinks your child has.
  • Support your child in choosing to become dry and be positive about the treatments they are using.
  • Watch for constipation as this can make the bladder problem worse.
  • Seek medical help if it is an ongoing problem.
  • If your child is using a bed-wetting alarm, get up when it goes off and help to wake them up and change their clothes or sheet. Make sure there is enough light at night so it is easy to get to the toilet.

There are some things which do NOT help:

  • DO NOT punish for wet beds.
  • DO NOT shame the child in front of friends or family.
  • DO NOT lift the child at night to toilet them. This may cut down on some wet beds, but it does not help the child learn to be dry.
  • DO NOT try to fix bed-wetting when other family members are going through a stressful time.


For more information about Bed wetting in children and its management talk to our Pediatric urologist at APIS KIDNEY CLINIC.

Benign Prostatic Hyperplasia

The prostate is a walnut-shaped gland at the base of the bladder. It’s part of the male reproductive system. Its job is to produce fluid for semen. But when things go wrong, the gland can cause problems with urination, not sex. That’s because the urethra, the tube that carries urine out from the bladder, runs through the prostate (see figure). As men getolder, the gland enlarges, and it may cause benign prostatic hyperplasia (BPH) in the process. Evena small amount of prostate enlargement can makeit hard to urinate.

What Causes BPH?

The cause of BPH is one of the great mysteries of modern medicine. Doctors know that two things are essential: 1) age and 2) testosterone. But they don’t know why some men develop BPH as they age while others don’t. Although the cause of BPH is unknown, there are some important risk factors to know about, such as:

  • Abdominal obesity
  • Cigarette smoking
  • Lack of exercise
  • Poor diet
  • Excessive alcohol intake

These same risk factors contribute to heart disease, cancer, stroke, and diabetes, so healthy living is a smart choice for everyone.


The symptoms of BPH vary. One group of problems is caused by urethra narrowing; picture the way you can slow the flow of liquid through a straw by pinching it between your thumb and index finger. These problems include:

  • Having to strain and wait to start urinating
  • Having a weak, slow stream
  • Taking a long time to urinate and dribblingat the end
  • Not emptying the bladder completely. Some - times this means a man cannot urinate at all, an urgent problem called acute urinary retention. The other group of symptoms is due to irritationof the bladder. They include:
  • An urgent, sometimes uncontrollable needto urinate, often passing only small amounts of urine.
  • Frequent nighttime urination


Diagnosis is easy; your doctor may perform a simple evaluation of symptoms using the AUA index or similar questions. Your doctor may also check for other conditions, such as diabetes and neurological disorders. A digital rectal exam may be needed to evaluate the size of the prostate and to check for abnormalities that could indicate cancer or infection. Urinalysis and blood tests of kidney function are also important.


In a few men, BPH is severe enough to requireimmediate treatment. But because BPH progresses slowly, most men can decide for themselves when and if they should be treated.

Watchful Waiting For men with low AUA scores, it’s the only option. It’s a reasonable choice for men who find that simple lifestyle adjustments can takethe BPH bother out of daily life. Here are a few tips:

  • Reduce your intake of fluids, especiallyafter dinner.
  • Limit your intake of alcohol and caffeine.
  • Avoid drugs that stimulate muscles in the bladder neck and prostate, such aspseudophedrineandother decongestants.

Avoid medications that weaken bladder contractions, such as antihistamines, anti -depressants, or drugs that control spasms.

  • Ask your doctor to lower your dosage orsubstitute another drug for diuretics, which increase the need to urinate.
  • Never pass up a chance to use the bathroom, even if your bladder does not feel full. Takeyour time and empty your bladder as muchas possible.
  • When you are in new places, learn the location of the bathroom before you really need it.If you can live comfortably with BPH, do it. Butif your symptoms bother you, several options areavailable.


Prescription drugs can reduce the symptoms ofBPH.


Although many men with BPH do well withdrugs, others still need surgery.

Transurethral resection of the prostate (TURP) has been the most common BPH treatment. It does notrequire an incision through the skin. However, the90-minute operation does require a hospital stayand anesthesia. A resectoscope is passed through the urethra, cutting away prostate tissue that is slowing the flow of urine. A catheter is left inplace to empty the bladder for a day or two, after which the patient can urinate on his own.

Although results vary, TURP reduces BPHsymptoms in 80% to 90% of patients. Complications may include infection or bleeding, dry ejaculation (50% to 75%), erectile dysfunction (5% to 10%), and incontinence (1% to 3%). Because the prostate can grow back, up to 20% of TURP patients require more treatment within 10 years.

Where can I learn more?

For more information about BPH and its management talk to our urologist at APIS KIDNEY CLINIC.



ED affects as many as 30 million men. Most men haveproblems with erections from time to time. In some men,these problems are regular and more severe. ED, or erectiledysfunction, is when it is hard to get or keep an erectionthat’s firm enough for sex.


While ED becomes more common as men age, growingold is not the cause of the problem. ED can be an earlysign of a more serious health problem. Finding and treating the cause(s) of your ED can improve your overall health andwell-being.ED can result from health or emotional problems, or fromboth combined. Reduced blood flow or harm to nervesin the penis can result in erection problems. These can becaused by heart disease, high blood pressure, high bloodsugar, surgery, injuries and even smoking. Some medicine,as well as alcohol or other drugs may also cause erectionproblems. Emotional (depression, stress or worry) orrelationship problems can cause or worsen ED.


To improve erection problems, your health care providermay need to treat the root causes. Your provider may askyou to change certain habits, such as stopping smoking,drug or alcohol use. Treating emotional problems, such asrelationship conflicts, depression or performance anxietycan also help. Cutting back on or changing certain medscan often improve ED. Do not stop taking your medicineor change any meds without talking to your health careprovider first. If a blood test shows low testosterone levels(low T), testosterone replacement therapy (TRT) mayhelp. However, if a blood test shows you have normaltestosterone levels, adding TRT will not help your erection problems.
Other treatment choices are:

  • Oral drugs, known as PDE-5 inhibitors. These drugs relaxmuscle cells in the penis and increase bloodflow. (Theseare the drugs you see often on TV and internet ads.)
  • A vacuum erection device pulls blood into the penis,causing an erection. An elastic ring is then slipped ontothe base of the penis. This holds the blood in the penis(and keeps it hard) for up to 30 minutes.
  • Self-injection therapy. By injecting this medication intothe penis with a very fine needle, an erection is created.

ED can be treated safely and treatments work well for most men.

Intraurethral therapy. Patients place a tiny medicatedpellet of the drug alprostadil into their urethra. (Theurethra is the tube that carries urine out of the body).This causes an erection.

A urologist can surgically implant one of two types ofpenile prostheses.Ask your doctor which treatment is right for you.

The good news for many men is that ED can be treatedsafely, and treatments can work well. If you have ED, thereis hope. There is help. Talk to your health care provider tosee if one of these treatment choices will work for you.

Where can I learn more?

For more information about Erectile Dysfunction and its treatment talk to our urologist at APIS KIDNEY CLINIC.

Kidney Cancer

What Is Kidney Cancer?

Kidney cancer -- also called renal cancer -- is a disease in which kidney cells become malignant (cancerous) and grow out of control, forming a tumor. Almost all kidney cancers first appear in the lining of tiny tubes (tubules) in the kidney. This type of kidney cancer is called renal cell carcinoma. The good news is that most of kidney cancers are found before they spread (metastasize) to distant organs. And cancers caught early are easier to treat successfully. However, these tumors can grow to be quite large before they are detected.

The kidneys are two bean-shaped organs, each about the size of a fist. They lie in your lower abdomen on each side of your spine. Their main job is to clean your blood, removing waste products and making urine.

Exact causes of kidney cancer are not known. But certain factors appear to increase the risk of getting kidney cancer. For example, kidney cancer occurs most often in people older than age 40. These are some other risk factors for kidney cancer:

  • Smoking
  • Being male. Men are about twice as likely as women to get kidney cancer.
  • Being obese.
  • Using certain pain medications for a long time.
  • Having advanced kidney disease or being on long-term dialysis.
  • Having certain genetic conditions, such as von Hippel-Lindau (VHL) disease or inherited papillary renal cell carcinoma
  • Having a family history of kidney cancer. The risk is especially high in siblings.
  • Being exposed to certain chemicals, such as asbestos, cadmium, benzene, organic solvents, or certain herbicides
  • Having high blood pressure.
  • Having lymphoma. For an unknown reason, there is an increased risk of kidney cancer in patients with lymphoma.

Having these risk factors does not mean you will get kidney cancer. And it's also true that you can have none of them and still get the disease.

What Are the Symptoms of Kidney Cancer?

In many cases, people may have no early symptoms of kidney cancer. As the tumor grows larger, symptoms may appear. You may have one or more of these kidney cancer symptoms:

  • Blood in your urine
  • A lump in your side or abdomen
  • A loss of appetite
  • A pain in your side that doesn't go away
  • Weight loss that occurs for no known reason
  • Fever that lasts for weeks and isn't caused by a cold or other infection
  • Extreme fatigue
  • Anemia
  • Swelling in your ankles or legs

How Do I Know If I Have Kidney Cancer?

To confirm a diagnosis of kidney cancer, you will need a thorough physical exam, health history, and tests. Your doctor will feel your abdomen and side for lumps and check for fever and high blood pressure, among other things. To make a diagnosis of kidney cancer, your doctor will also order one or more tests like these:

  • Urine tests check for blood in your urine or other signs of problems.
  • Blood tests show how well your kidneys are working.
  • Intravenouspyelogram (IVP) involves X-raying your kidneys after the doctor injects a dye that travels to your urinary tract, highlighting any tumors.
  • Ultrasound uses sound waves to create a picture of your kidneys.
  • CT scan
  • Magnetic resonance imaging (MRI)
  • Renal arteriogram. This test is used to evaluate the blood supply to the tumor.

Sometimes, a biopsy will be done to confirm the diagnosis Once your doctor makes a diagnosis of kidney cancer, you may need other tests to tell if the cancer has spread within your kidney, to the other kidney, or to other parts of your body. When cancer spreads from the place where it first started, it has metastasized. You might need further investigation to find out whether the cancer has spread to other organ or not.

What Are the Stages of Kidney Cancer?

Your prognosis depends on your general health, as well as the grade and stage of your kidney cancer. The higher the stage, the more advanced the cancer.
Stage I : A tumor 7 centimeters or smaller, that is only in the kidney.
Stage II :A tumor larger than 7 centimeters that is only in the kidney.
Stage III :A tumor that is in the kidney and in at least one nearby lymph node

  • A tumor that is in the kidney's main blood vessel and may also be in nearby lymph node
  • A tumor that is in the fatty tissue around the kidney and may also involve nearby lymph nodes
  • A tumor that extends into major veins or perinephric tissues, but not into the ipsilateral adrenal gland and not beyond Gerota's fascia
Stage IV
  • Cancer has spread beyond the fatty layer of tissue around the kidney, and it may also be in nearby lymph nodes
  • Cancer may have spread to other organs, such as the bowel, pancreas, or lungs
  • Cancer has spread beyond Gerota's fascia (including contiguous extension into the ipsilateral adrenal gland)

What Are the Treatments for Kidney Cancer?

There are several standard types of treatment for kidney cancer. In most cases, surgery is the first step. Even if surgery removes the entire tumor, though, your doctor may suggest an extra treatment to kill any remaining cancer cells that can't be seen.

Surgery for kidney cancer

These are the main types of surgery for kidney cancer. Which type you have depends on how advanced your cancer is

  • Radical nephrectomy removes the kidney, adrenal gland, and surrounding tissue. It also often removes nearby lymph nodes. It is the most common surgery for kidney cancer and can now be done through a small incision with a laparoscope.
  • Simple nephrectomy removes the kidney only.
  • Partial nephrectomy removes the cancer in the kidney along with some tissue around it. This procedure is used for patients with smaller tumors (less than 4 cm) or in those patients in which a radical nephrectomy might hurt the other kidney.

If surgery can't remove your kidney cancer, your doctor may suggest another option to help destroy the tumor.

  • Cryotherapy uses extreme cold to kill the tumor.
  • Radiofrequency ablation uses high-energy radio waves to "cook" the tumor.
  • Arterial embolization involves inserting material into an artery that leads to the kidney. This blocks blood flow to the tumor. This procedure may be done to help shrink the tumor before surgery.

Targeted therapy for kidney cancer

This therapy uses drugs or other substances to find and target cancer cells with less toxicity to normal cells.

Radiation therapy for kidney cancer

Often used to help with symptoms of kidney cancer or in patients who cannot have surgery, this treatment uses high-energy X-rays or other types of radiation to kill cancer cells or halt their growth. External radiation therapy sends radiation to the cancer from a machine outside the body.

Chemotherapy for kidney cancer

This therapy uses drugs to kill cancer cells or stop them from multiplying. Less effective for kidney cancer than for other types of cancer, chemotherapy is mostly used for a certain type of kidney cancer in which there spindle cells (sarcomatoid variant).

How Can I Prevent Kidney Cancer?

Since the exact causes is not known for kidney cancer, it is not clear how to prevent the disease. However, certain factors are linked to kidney cancer, so you can take certain steps to lower your risk -- quit smoking, maintain a healthy weight, manage your blood pressure, and avoid being exposed to harmful chemicals.

Where can I learn more?

For more information about kidney cancer and its management talk to our urologist at APIS KIDNEY CLINIC.

Kidney Stone

What I Need to Know about Kidney Stones

What is a Kidney Stone?

A kidney stone is a solid piece of material that forms in a kidney out of substances in the urine.A stone may stay in the kidney or break loose and travel down the urinary tract. A small stone may pass all the way out of the body without causing too much pain.A larger stone may get stuck in a ureter, thebladder, or the urethra. A problem stone can block the flow of urine and cause great pain.

Are all kidney stones alike?

No. Doctors have found four major types ofkidney stones.

The most common type of stone containscalcium. Calcium is a normal part of a healthy diet. Calcium that is not used by the bones and muscles goes to the kidneys. In most people, the kidneys flush out the extra calcium with the rest of the urine. People who have calcium stones keep the calcium in their kidneys. The calcium that stays behind joins with otherwaste products to form a stone. The most commoncombination is called calcium oxalate.

  • A struvite stone may form after an infection in theurinary system. These stones contain the mineralmagnesium and the waste product ammonia.
  • A uric acid stone may form when the urinecontains too much acid. If you tend to form uricacid stones, you may need to cut back on theamount of meat you eat.
  • Cystine stones are rare. Cystine is one of thebuilding blocks that make up muscles, nerves, andother parts of the body. Cystine can build up in theurine to form a stone. The disease that causescystine stones runs in families.

What do kidney stoneslook like?

Kidney stones may be as small as a grain of sand or as large as a pearl. Some stones are even as big as golf balls. Stones may be smooth or jagged. They are usually yellow or brown.

What are the symptoms of kidney stone?

Very small stones might pass through the urinary system without causing much pain. Larger stones can block the flow of urine if they get stuck in the ureters or urethra. Kidney stones do not usually cause any symptoms until they start to pass. Some symptoms might include:

  • Extreme pain in your back or side that will not go away
  • Difficulty in micturation
  • Blood in your urine
  • Fever and chills

What can my doctor doabout a problem stone?

If you have a stone that will not pass by itself, your doctor may need to take steps to get rid of it. In the past, the only way to remove a problem stone was through surgery.

Now, doctors have new ways to remove problemstones. The following sections describe a few ofthese methods.

Shock Waves

Your doctor can use a machine to send shock waves directly to the kidney stone. The shock waves break a large stone into small stones that will pass through your urinary system with your urine. The full name for this method is extracorporeal shock wave lithotripsy. Doctors often call it ESWL for short. Lithotripsy is a Greek word that means stone crushing. With most newer machines, you lie on a table. A health technician will use ultrasound or x-ray images to direct the sound waves to the stone.

Key hole Surgery - PCNL

In tunnel surgery or key hole surgery, the doctor makes a small cut into the patient’s back and makes a narrow tunnel through the skin to the stone inside the kidney. With a special instrument that goes through the tunnel, the doctor can find the stone and remove it. The technical name for this method is percutaneous nephrolithotomy.


Aureteroscope looks like a long wire. The doctorinserts it into the patient’s urethra, passes it upthrough the bladder, and directs it to the ureterwhere the stone is located. The ureteroscope has a camera that allows the doctor to see the stone. A cage is used to catch the stone and pull it out, or the doctor may destroy it with a device inserted through the ureteroscope.

How will doctor find outwhat kind of stone I have?

The best way for your doctor to find out what kind of stone you have is to test the stone itself. If you know that you are passing a stone, try to catch it in a strainer. Your doctor may ask for a urine sample or takeblood to find out what caused your stone. You mayneed to collect your urine for a 24-hour period.These tests will help your doctor find ways for youto avoid stones in the future.

Why do I need to knowthe kind of stone?

The therapy your doctor gives you depends on thetype of stone you have. For example, a medicinethat helps prevent calcium stones will not work ifyou have a struvite stone. The diet changes thathelp prevent uric acid stones may not work toprevent calcium stones. Therefore, careful analysisof the stone will help guide your treatment.

What can I do to avoidmore stones?

Drink more water. Try to drink 12 full glasses of water a day. Drinking lots of water helps to flush away the substances that form stones in the kidneys. You can also drink ginger ale, lemon-lime sodas, and fruit juices. But water is best. Limit your coffee, tea, and cola to 1 or 2 cups a day because the caffeine may cause you to lose fluid too quickly. Your doctor may ask you to eat more of some foods and to cut back on other foods. For example, if you have a uric acid stone, your doctor may ask you to eat less meat, because meat breaks down to make uric acid. If you are prone to forming calcium oxalate stones, you may need to limit foods that are high in oxalate. These foods include rhubarb, beets, spinach, and chocolate.The doctor may give you medicines to preventcalcium and uric acid stones.

Points to Remember

  • Most of small stones will pass out of the body spontaneously.
  • See your doctor if you have severe pain in your back or side that will not go away.
  • See your doctor if you have blood in your urine, urine will appear pink.
  • When you pass a stone, try to catch it in a strainer to show your doctor.
  • Drink lots of water to prevent more kidney stones from forming.
  • Talk with your doctor about other ways to avoid more stones.


For more information about Kidney Stone and its management talk to our urologist at APIS KIDNEY CLINIC.


Neurogenic Bladder
When Nerve Damage
Causes Bladder Problems.


Millions of Americans have neurogenic bladder. Neurogenic bladder is when a person lacks bladder control due to a brain, spinal cord or nerve problem. This includes people with Multiple Sclerosis (MS), Parkinson’s disease and spina bifida, and people who have had stroke or spinal cord injury. Major pelvic surgery, diabetes and other illnesses can also damage nerves that control the bladder.


Several muscles and nerves must work together for your bladder to hold urine until you are ready to empty it. Nerve messages go back and forth between the brain and the muscles that control bladder emptying. If these nerves are damaged by illness or injury, the muscles may not be able to tighten or relax at the right time. In people with neurogenic bladder, the nerves and muscles don’t work together well. The bladder may not fill or empty in the right way.


underactive bladder sufferers can get repeated UTIs (urinary tract infections). UTIs are often the first symptom of neurogenic bladder.


The symptoms of neurogenic bladder differ from person to person. Symptoms also depend on the type of nerve damage they have had. Bladder muscles may be overactive and squeeze more often than normal. Sometimes this squeezing causes urine to leak before you’re ready to go to the bathroom (incontinence). With “overactive bladder” (OAB), you feel a sudden urge to go the bathroom that you can’t ignore. After this “gotta go” feeling, some people leak urine—a few drops or a gushing amount. Another OAB symptom is going to the bathroom frequently (more than eight times in 24 hours) In other people, the bladder muscle may be underactive and not squeeze when it needs to. The sphincter muscles around the urethra may also not work right. They may stay tight when you are trying to empty your bladder. With underactive bladder symptoms, you may only produce a “dribble” of urine. You may not be able to empty your bladder fully (urinary retention). And sometimes you may not be able to empty your bladder at all (obstructive bladder). Some people have symptoms of both overactive and underactive bladder. People with MS, stroke and herpes zoster are more likely to have both kinds of symptoms. Both overactive and underactive bladder sufferers can get repeated UTIs (urinary tract infections). UTIs are often the first symptom of neurogenic bladder.


Neurogenic bladder involves the nervous system and the bladder, and doctors will conduct different tests to determine the health of both. Talking to your health care provider about your symptoms can be an important first step. Your provider may ask you for your medical history and your daily habits. They may also give you a physical exam. A physical exam for women may look at the abdomen, pelvis, and rectum. For men, the abdomen, rectum and prostate may be checked. You may also need to leave a urine sample to be tested for infection.
Some patients are asked to keep a “bladder diary” to get a better sense of their day-to-day symptoms. You may also be asked to do a “pad” test. In this, you wear a pad that has been treated with a special dye. This dye changes color when you leak urine. Your health care provider may order other tests (urodynamic testing) to measure how your urinary tract is working. Your provider may also order an x-ray or scan to help diagnose you.


Neurogenic bladder is a serious condition, but when it is watched closely and treated, patients can see large improvements in their quality of life.


For many patients with less serious nerve damage, the first treatments used are lifestyle changes. Also known as “behavioral treatments,” these are changes that people can make in their daily life to control symptoms. Lifestyle changes include:

  • Scheduled voiding: Some people are helped by scheduling regular trips to the bathroom.
  • Diet: Weight loss and limiting intake of “bladder irritating” foods and drinks may be helpful. (Try avoiding coffee, tea, alcohol, soda, other fizzy drinks, citrus fruit and spicy foods.)
  • Double voiding: Urinating and waiting a few minutes before trying to empty your bladder again may help if you can’t fully empty your bladder.
  • “Quick flicks”: These pelvic exercises can help you relax your bladder muscle when it starts squeezing. Your health care provider can explain this exercise in more detail
  • Delayed voiding: If you have OAB symptoms, you start by delaying urination a few minutes. You slowly increase the time to a few hours. This helps you learn how to put off voiding, even when you feel an urge.


When behavioral treatments alone aren’t working well to control your symptoms, drugs or catheters may be prescribed.

  • Drugs for OAB Symptoms: These drugs relax overactive bladder muscles. These may be taken by mouth, or delivered through the skin with a gel or a patch.
  • Drugs for Underactive Bladder: If you need help emptying your bladder, drugs that help make the nerves controlling the bladder more active may be prescribed.
  • Catheter for Underactive Bladder: A catheter is a straw-like tube that you insert to help your bladder empty fully. If you use “continuous catheterization,”your catheter stays in place to drain urine at all times.“ Clean Intermittent Catheterization” (CIC) is where you insert a catheter yourself several times a day. You leave it in only long enough to empty your bladder. CIC can be hard for some people whose nerve damage or other health issue causes hand coordination problems.


If these treatments don’t help, your health care provider should send you to a specialist, such as a urologist who may specialize in neurogenic bladder or incontinence. They may be able to offer other tests and treatments. The treatment choices offered to you will depend on the cause of your nerve damage and what symptoms you have.

Where can I learn more?

For more information about Neurogenic Bladder and its management talk to our urologist at APIS KIDNEY CLINIC.

What You Should Know AboutProstate Cancer

What Is The Prostate?

The prostate is a walnut-sized gland in the adultmale’s reproductive system. It is located rightbelow the bladder, in front of the rectum.

What Is Prostate Cancer?

Prostate cancer is a disease in which cancer cellsgrow in the prostate and then spread to otherparts of the body, especially the bones. It is themost common type of cancer found inmen. The risk of getting prostatecancer increases with age and is mainly found inmen 55 years old and up.

What Are The Symptoms Of ProstateCancer?

Often, there areno symptoms ofprostate cancer.However, thesymptoms of anenlarging prostatemay include:

  • Frequent trips tothe bathroom(especially at night)
  • Pain or burningwhen going to thebathroom
  • Weak or hesitanturine flow
  • Blood mixed Urine
  • Frequent pain orstiffness in thelower back, hipsor upper thighs

A man can have these symptoms without having prostate cancer, or have prostate cancer for a longtime without having any symptoms. If you haveone or more of these symptoms, you should seeyour doctor for a check-up.

Can We Find ProstateCancer Before A Man HasSymptoms?

Yes. Doctors often find prostate cancer beforesymptoms develop. However, the cancer cantake years to grow and it is hard to predict earlyon how the cancer will grow.

What Is A Digital RectalExamination?

The digital rectal examination or DRE is a test forprostate cancer. A doctor wearing lubricatedsurgical gloves inserts afinger into the patient’srectum to feel for hardlumps on the prostate. Iflumps are present, thepatient may haveprostate cancer.

What Is PSA Test?

The PSA test, or prostate specific antigen test, isa blood test to check a man’s PSA protein level.A healthy prostate tends to keep low levels ofPSA, while a diseased prostate raises the PSAlevel. If an average man’s PSA level is higherthan 4.0 nanograms per milliliter, the doctor islikely to suggest tests to evaluate for prostatecancer.

How Am I Likely To getProstate Cancer?

Unfortunately, no one knows for sure right now.We have noticed that some groups are morelikely to get prostate cancer than others. If someone in yourfamily has prostate cancer, you are more likely toget it than someone with no family history ofprostate cancer. Also, older men are likely tohave cancer cells in their prostate, though it maynot need to be treated.

Can Prostate Cancer BePrevented?

Unfortunately, not right now. An ongoingclinical trial is looking at whether the drugfinasteride can help prevent prostate cancer.Other studies show that eating less saturated fatmay help to decrease your risk of gettingprostate cancer.

What Is The Right WayTo Treat Prostate Cancer?

There is no “right” way to treat prostate cancer.Some treatments may work well for one patientbut not for another patient.Four common treatments are:

  • Surgery to remove the prostate
  • Radiation therapy to kill cancer cells withhigh energy rays
  • Cryotherapy or cryoablation to freeze and killthe cancerous prostate
  • Hormonal therapy to stop the cancer fromgrowing

When deciding on a treatment, the doctor andpatient should consider the age and health of thepatient, the severity of the disease, the risks andbenefits of the treatments, and the preferences ofthe patient.Sometimes, it may not be a good idea to rushinto treatment. In these cases, the doctor willcarefully monitor the patient through regularcheck-ups.

Does Treatment Of ProstateCancer Have Side Effects?

So far, all treatments for prostate cancer comewith risks and side effects. You should ask yourdoctor to explain the risks and side effects of thetreatment options.

Where can I learn more?

For more information about Prostate cancer and its management talk to our urologist at APIS KIDNEY CLINIC.

Urinary Incontinence

Most people take bladder control for granted, but that may change if urine leaks when you don’t expect it, or if you find yourself needing the bathroom a lot. Urinary incontinence is the accidental loss of urine, and it’s a condition that’s far more common than you might think.

Bladder control problems occur more often in women. Why? Pregnancy and childbirth can damage the muscles that support the bladder (the pelvic floor). Shifting hormone levels at menopause is another cause. For men, prostate problems and their treatment can also lead to bladder control problems. Aging, medications, nerve damage, and health problems (eg, diabetes) can trigger incontinence in both sexes.

A person with bladder control problems may start to plan his or her day around access to a bathroom or give up their favorite activities, such as exercise, social events, and travel. If this is happening to you, learn about treatments that can cure or greatly improve your symptoms.

Your bladder

Your kidneys are constantly making urine, but you don’t want to be constantly urinating. To allow you to urinate just occasionally, nature gave us bladders. Your bladder is a hollow organ that stretches to hold urine coming from your kidneys. As the bladder gets nearly full, you’ll feel the need to use the bathroom. Your nervous system controls when you urinate by activating two key muscle groups: 1) the bladder wall muscle squeezes (contracts), and 2) the muscles at the bladder outlet relax, allowing urine to pass.

Good bladder control requires three things

1. The muscle in the walls of the bladder can’t contract too soon.
2. The muscles at the outlet of the bladder need to control the flow.
3. The pelvic floor must support the bladder.

Common types of urinary incontinence

Urge incontinence (“overactive bladder”) is most common in older adults. It occurs when the bladder wall muscle suddenly contracts before the bladder is full. The result is a strong urge to urinate. Often, a little bit of urine will leak before a person can get to a bathroom.

Stress incontinence results when the pelvic floor is weak or when the outlet muscles aren’t strong enough to control urine flow. Stress incontinence is common in women who have had many children and in men who have had prostate surgery. A cough, a sneeze, or an exercise increases pressure on the bladder, forcing urine to leak out.

Mixed incontinence occurs most often in older women and is caused by a combination of urge incontinence and stress incontinence.

Overflow incontinence happens when the bladder gets too full. The cause is usually a problem in fully emptying the bladder in the first place. Men with an enlarged prostate may have this type of incontinence. Symptoms include dribbling of urine and urinating often, usually with small amounts coming out each time.

Don’t let shame keep you from seeing your doctor about bladder control problems.

Don’t let shame keep you from seeing your doctor about bladder control problems. These talks with your doctor can help figure out what is causing your incontinence and lead to potential treatment. You can help by keeping a written record of when you urinate. A pelvic exam is important for women; for men, a prostate exam may be of help. Tests might include checking your urine for infection and blood tests to check your kidneys and overall health. Your doctor might also suggest other tests.


Treatment options for urinary incontinence range from simple steps you can take at home to surgery. Your treatment will depend on the cause of your bladder control problems.

Kegel exercises. Kegels are often the place to start for urge and stress incontinence. Practice tightening the muscles you would use to stop the flow of urine or rectal gas. Your doctor can give you specific instructions on doing Kegels.

Bladder training.By following a program of urinating on schedule, bladder training helps you slowly increase the amount of urine you can comfortably hold.

Watch your fluid intake. Drink fluids only when you feel thirsty, and stick to six to eight 8-ounce cups of fluid per day (including soup or milk in your cereal) unless you have a health condition that requires more. Stay away from caffeine and alcohol. They can cause your body to produce more urine.

Drugs. A number of drugs can help with incontinence symptoms.Your doctor may

What type of incontinence do you have?

recommend one of these drugs based on your type of bladder control problem.

Other treatments.The sacral nerve at the bottom of your spine reminds your bladder “not to go” until it is full. Several treatments aim to improve this “hold it” signal in order to relieve overactive bladder.

Surgery. Many procedures for incontinence are now relatively quick and require less recovery time. You may consider surgery if other treatments are unsuccessful or unlikely to help your type of incontinence. Even if you opt for surgery, bladder training and strengthening your pelvic muscles still provide important benefits. They increase the chances that surgery will be successful.

Living with your bladder

Whether your bladder control problems are mild or severe, it can be a frustrating problem to deal with. Although you may feel alone, help is available from many sources. Simply getting treatment can greatly improve well-being.


For more information about Urinary Incontinence and its management talk to our urologist at APIS KIDNEY CLINIC.

UTI in children…

What is a UTI ??

About 8 percent of girls and 1 - 2 percent of boys have had a urinary tract infection (UTI) by the time they are 5 years old. UTIs are caused by bacteria infecting the urinary tract – the organs and tubes in our body that make, store and pass urine. The urinary tract is made up of the kidneys, ureters, bladder and urethra. Bacteria are not normally found in urine. However, they can enter the urinary tract from the skin near the anus. UTIs are more common in girls than boys. In girls, the opening of the urethra is closer to the anus and the length of the urethra is shorter. Infections are more common in the urethra and bladder, which make up the lower part of the urinary tract. Infections that move up the ureters to the kidneys can be more serious. If left untreated, these infections may lead to kidney failure.


UTIs are easier to spot in older children who are toilet-trained and can talk about their symptoms. Some signs of a UTI are:

  • pain, burning, or a stinging sensation when urinating
  • frequent urination or feeling an increased urge to urinate, even without producing urine
  • foul-smelling urine that may look cloudy or contain blood
  • fever
  • low back pain or pain in the area of the bladder

The clearest sign of a UTI in babies may be a fever. Babies with UTIs may also act fussy, vomit and feed poorly. If the UTI becomes a kidney infection, the child or infant is more likely to have a fever with shaking chills, pain in the back or side, or vomiting.


Your child’s health care professional will take a urine sample to test for a UTI. Older children will most often be asked to urinate in a sterile cup. Babies and small children in diapers may need a catheter (tube) to collect urine. The catheter keeps the sample from being contaminated by bacteria on the skin. The urine will then be tested for bacteria. The type of bacteria found may help decide the best drug to treat the UTI, usually antibiotics. It is important for your child to keep taking all the antibiotics, even if he or she is feeling better. Most UTIs will be cured within a week if treated properly. Urge your child to drink plenty of fluids, and keep track of his or her symptoms. If symptoms worsen or do not get better within three days, the child may need to go to the hospital. If a child has more than one UTI, he or she should see a pediatric urologist. They can see if anything is abnormal in your child’s urinary tract. A common problem causing UTIs in children is a backwards flow of urine. When urine flows from the bladder up toward the kidneys, it is called vesicoureteral reflux (VUR).

More than 1.3 million children visit doctors’ offices for urinary tract infections (UTIs) each year. UTIs are the most common urologic reason that children go to the doctor.


Frequent diaper changes can help prevent UTIs in babies and small children. When children start toilet training, it is important to teach them good bathroom habits. After each bowel movement, girls should wipe from front to rear — not rear to front. This keeps germs from spreading from the anus to the urethra. When feeling the urge to urinate, children should also avoid “holding it” if they can reach a bathroom. Urine remaining in the bladder gives bacteria a good place to grow.


For more information about UTI in children and its management talk to our Pediatric urologist at APIS KIDNEY CLINIC.

  • Karnataka

    Ground Floor, Falnir Health Centre
    Near Unity Hospital,Falnir Road,
    Mangaluru- 575002
    0824 428 3528,
    +91 7349484111

  • Kerala

    Apis Kidney Clinic
    Aramana Arcade, Bank Road
    Karandakad -671121
    04994 223111

    Near IMA Hall, Kunnummal -671315
    04672 207090