The lower urinary tract consists of the bladder and urethra. If left untreated, disorders of the bladder or urethra can interfere with normal functioning of the urinary tract and lead to kidney damage.
The urethra can become narrowed by scar tissue following catheter placement, surgery, injury, or repeated episodes of urethritis (see page 286). This condition, called urethral stricture, is a common problem following long-term catheter placement. Urethral stricture can interfere with urination and ejaculation. It also can damage the kidneys by causing back pressure (buildup of fluid) in the urinary tract. Urethral stricture also may be a factor in the development of urinary tract infections.
Urethral stricture can be treated in the doctor's office by widening the urethra from within with a thin, flexible instrument called a dilator. Sometimes the scar tissue must be removed surgically using a cystoscope, or a portion of the urethra must be removed surgically. Laser therapy also may be used to remove the scar tissue. Depending on where the stricture is located, a urethral stent (a tiny springlike device that holds the urethra open) can be inserted to keep the passageway open. However, if the stricture is too close to the sphincter muscle (which prevents leakage of urine from the bladder), a stent cannot be used. In some cases the affected segment of the urethra may be surgically reconstructed using tissue taken from another part of the body.
Urethral stricture is a condition in which the urethra (the tube that carries urine out of the bladder) is narrowed, potentially interfering with the flow of urine and with ejaculation. The urethra can become narrowed when scar tissue forms after some medical procedures (such as placement of a catheter), surgery, injury, or recurring infections.
Bladder cancer is the fourth most common type of cancer in men. Transitional cell carcinoma, which develops from the cells that line the bladder walls, is the most common type of bladder cancer. This type of cancer also can occur in the kidneys, the ureters, and the portion of the urethra nearest the bladder.
Transitional cell carcinoma that remains confined to the surface of the bladder lining is called superficial bladder cancer. Superficial bladder cancer is the most common type of transitional cell carcinoma (75 to 80 percent of new cases) and is easy to treat, but it tends to recur. In some cases the cancer spreads beyond the bladder lining and invades the muscular wall of the bladder. This is called invasive bladder cancer. The tumor may continue to grow through the bladder wall and spread to nearby organs. Bladder cancer cells also can spread to surrounding lymph nodes and to distant organs such as the lungs or the bones.
Symptoms of bladder cancer can be the same as those for a bladder infection or other urinary tract disorder. Therefore you should talk to your doctor as soon as possible if you experience any symptoms. The most common symptoms of bladder cancer include blood in the urine, painful urination, frequent urination (without an increase in fluid intake), and an urge to urinate with little urine output. If your doctor thinks you may have bladder cancer, he or she will examine the inside of the bladder with a viewing tube called a cystoscope (see "Diagnostic
Procedures," Cystoscopy, page 298) and use other imaging techniques to determine whether the cancer has spread.
Surgery is the most common treatment for bladder cancer. Superficial bladder cancer can be treated with transurethral resection, in which the tumor is surgically removed through a cystoscope. With invasive bladder cancer, all or part of the bladder is removed using a surgical procedure called cystectomy. Often, surrounding lymph nodes, the prostate gland, and the seminal vesicles also are removed. Additional treatment may include radiation therapy, chemotherapy (treatment with powerful anticancer drugs), or immunotherapy (treatment in which the body's immune system is stimulated to destroy cancer cells), depending on where the cancer has spread and how advanced it is.
When the bladder must be removed, the doctor creates an alternative method for storing and passing urine. The doctor often will use an isolated piece of the person's small intestine to create a new channel between the ureters and an opening in the wall of the abdomen (called a stoma) through which urine can pass. A flat bag is attached to the stoma to collect urine, and the person empties the bag as needed. A portion of small intestine also can be used to create a storage pouch inside the body (instead of an external bag), which the person drains by inserting a catheter through the stoma. The storage pouch also can be attached to the remaining portion of the urethra to allow the person to urinate through the urethra.
Until recently, nearly all men experienced erectile dysfunction after bladder removal surgery, but surgical improvements have reduced the likelihood of this side effect. However, men who have had their prostate gland and seminal vesicles removed no longer produce semen, so they do not ejaculate when they have an orgasm, and they are infertile.
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