So, You Have Some Blood in your Urine? Possible Causes, What Happens Next, and Treatment Options

By Dr. Bryce Wyatt, M.D.

Seeing blood in your urine can be an extremely dramatic and frightening experience that, unfortunately, many people will experience in their lifetime. Blood in the urine, or “hematuria”, is one of the most common reasons someone will seek the care of a urologist.  While it can be scary and seem like you’re losing a lot of blood, it’s important to remember that just a little drop of blood can make a lot of urine look red, just like a small drop of food coloring will turn an entire glass of water any color you like.

In general, there are two ways to classify hematuria, “microscopic” and “gross”.  Microscopic hematuria means that the blood can’t be seen with your own eyes. Oftentimes, your primary care doctor will mention to you that blood was seen on your urine sample. That is called microscopic hematuria. Gross hematuria is more obvious and is when your urine is red in color or you can see blood clots.  Both types of hematuria should be evaluated by a trained professional and should not be ignored, even if the bleeding goes away.

In this blog, we will talk about a few of the common causes of hematuria, how your doctor will determine why this is happening, and some treatment options for the various causes.

Possible Causes

Blood in the urine can come from anywhere in the urinary system. It can come from all the way up in the kidneys down to the bladder and there are many potential causes.  Furthermore, about one third to half of the time we never find a reason for microscopic hematuria. However, with gross hematuria, it can be easier to nail down a diagnosis.

The following are some of the more common reasons to have blood in your urine:

Urinary Tract Infections (UTI)

UTIs are extremely common and often easily treatable and can cause bloody urine. If you have a history of urinary tract infections, if you are peeing more often, feel pressure in your pelvis, pain in your back, start noticing a strong smell to your urine, it hurts to pee, or your having fevers/chills, you may have a urinary tract infection.

Kidney Stones

Kidney stones or bladder stones can result in severe pain in your back or stomach and can show up as blood in the urine. Kidney stones can sometimes cause damage to your kidneys and should be evaluated right away.

Cancer

The most important reason to be evaluated for blood in the urine is to look for kidney or bladder cancer. Men over the age of 50 with a history of smoking are especially at risk of being found to have cancer.  Depending on the type and stage of cancer when it is found, it can be treated, which is why it’s so important to see a doctor as soon as possible when you have blood in your urine.

Other Causes

Having a large prostate, vigorous exercise, dehydration, sickle cell disease, recent surgeries, catheters, blood thinners, and other medical issues can lead to blood in the urine.

Next Steps

Your doctor has many tools in their belt to identify potential sources of blood in the urine, but, in general, there are four tests they will likely perform.

Urine Culture

Since a UTI is such a common cause of hematuria, oftentimes your doctor will first make sure you don’t have an infection. All you have to do is leave a urine sample for your doctor to test. Once an infection has been ruled out with a negative urine culture, the rest of the investigation will begin. It can take a couple of days for a culture test to result but your doctor may start you on antibiotics just in case before the test comes back.

Urine Cytology

This is another easy test to do. All you have to do is leave a urine sample just like with a culture. By looking at the urine under a microscope, we can identify any abnormalities that may be concerning for possible cancer.

CT Scan

A CT scan is an important part of finding the source of bloody urine. A CT scan can identify kidney or bladder stones, tumors in the kidneys and ureter, and even bladder cancer. Unfortunately, a CT scan does require radiation, but the small amount required is not considered to be harmful.

You will also need to have an IV placed as the CT scan requires an injection of something call “contrast”.  The contrast causes certain parts of the body to light up on the CT scan making it easier for the radiologist to identify any concerning findings. The contrast can make you feel a little funny including warm sensations, a metallic taste in your mouth or even sick feeling.  Rarely, contrast can cause hives, swelling, or skin redness. It’s important to let your doctor know if you have had a reaction to contrast before as special precautions will need to be taken.

Cystoscopy

Last and certainly the least fun of all the studies is the cystoscopy. Cystoscopy is using a small camera inserted into the bladder to get a direct look at the bladder wall. While it can be uncomfortable, it is a very quick and necessary study. The CT scan can only see large bladder abnormalities, but oftentimes bladder cancer can be small and flat appearing that only a cystoscopy will reveal. This is done in the office using a small flexible scope inserted through the urethra after applying some numbing cream to the area.

Treatment Options

Depending on the source of the bleeding, there are many treatment options available:

Urinary tract infection (UTI)

Antibiotics are the mainstay of treatment for UTIs and are typically given for three to seven days depending on how bad the infection is. Sometimes the antibiotics must be changed based on the urine culture result if the bacteria found is resistant to the first antibiotic.

Stones

Stones can be treated in several different ways. Pain pills and medications can help with the passage of kidney stones but sometimes your doctor will have to perform surgery if the stone is too large to pass. Shockwaves can be used to break up the stone into pieces that will pass easily, or your doctor can go into your kidneys with a tiny camera and blast the stones with lasers if necessary.

Cancer

Depending on the type and stage of cancer there are many treatment options available. Kidney cancer is often treated with surgery to remove part of or the entire kidney. Bladder cancer can be treated by using a small camera to enter the bladder and remove the cancerous parts.  Afterward, different medicines can be put into the bladder to help prevent cancer from coming back.  Sometimes if the bladder cancer is severe, the bladder may need to be removed.

Other Causes

There are many different procedures that can help with big prostates and bleeding. If you have difficulty with urination and hematuria, your urologist can discuss some of the many options available to help with both problems.

Hematuria is a very common and very important reason to see your urologist because the causes can range from being nothing at all to dangerous. If you or someone you know has blood in their urine, they should make an appointment right away to get checked out. Click here to schedule an appointment with the urology experts at Georgia Urology!

Dr. Charles Kaplan Participates in International Training Event

Photos of the doctors at the International Training Event

Georgia Urology’s Dr. Charles Kaplan participated in an international training event in Miami that focused on reservoir placement techniques and post-operative implant patient care. Dr. Paul Perito and his team at Perito Urology hosted many brilliant urologists from across the globe for the training event. 

Urologists in attendance included Dr. David Denis from Santiago, Chile, renowned urologist Dr. Bernardo Cisneros from Mexico City, and our own Dr. Charles Kaplan from Austell, GA. 

To learn more about Dr. Kaplan’s involvement in this event, click here.

Dr. Gonzalez Draws Upon His Family’s Own Prostate Cancer Experience to Help Others

Dr. Froylan Gonzalez has a passion for treating cancers of the urinary tract. Although it makes up approximately 85 percent of his practice, the specialty wasn’t his first choice.

Why the switch? It’s personal.

Gonzalez walked into Ohio State University College of Medicine with a game plan. The former college football player with a love for medicine wanted to be an orthopedic surgeon. The idea of melding these two worlds fit nicely like a snug pair of shoulder pads. That was until he found orthopedic surgery rotations not as fulfilling as he once imagined.

In the midst of his fourth year of med school, Gonzalez received word his father had been diagnosed with prostate cancer. “All of a sudden, I went into action mode, because I was the only medical person in the family,” he recalls. “I was going to come up with a plan for dad to get better.”

Gonzalez began studying prostate cancer on his own, devouring medical journals and scouring online articles. He soon learned urology surgeons were the ones tackling prostate cancer. Then he got creative.

“I was in the middle of an orthopedic surgery rotation,” he says, “and I snuck out of those rotations and into one of the urology operating rooms.”

Gonzalez watched in amazement as the surgeon removed a patient’s cancerous bladder and built a new one out of intestine. The process thrilled him. The surgeon, who happened to be the med school’s chairman of urology, was less than impressed by the intruder.

On the verge of being kicked out of the operating room, Gonzalez begged to stay and watch. The surgeon obliged, and this sparked Gonzalez’s newfound interest in urology.

Impressed by the breadth of urology, he continued crashing urology operating rooms, watching everything from kidney stone surgery to a radical prostatectomy. Gonzalez says he became the school’s “urology mascot,” reading, watching, and learning all he could. His interest in urological surgery only grew.

In tandem, Gonzalez remained in his father’s corner during prostate cancer treatment and the subsequent successful surgery, serving as a sounding board, medical interpreter, and cheerleader.

When time came to apply for his residency, Gonzalez managed to jump from orthopedics to urology. Although he had never completed a single urology rotation, his letters of recommendation served him well, and he made it into the Urologic Surgery Residency Program at the Washington University School of Medicine. While completing his residency, he was the Abrams Award recipient for Highest In-service Exam Score 2006. He then served as clinical instructor of the Division of Urology at Washington University from 2006 to 2008 with a clinical specialty in laparoscopic surgery.

Today his father is cancer free, and Dr. Gonzalez performs urology cancer surgeries among other specialties. As he advises and treats patients, Dr. Gonzalez draws from the experience of helping his dad navigate the disease, resulting in a sensitive, relatable perspective.

“A lot times it’s easier for us doctors to make decisions for our patients, because we’re not the ones facing the consequences,” Dr. Gonzalez says. “When I suggest prostate cancer treatment for my patients, I stay in line by asking myself ‘If this was my dad or myself, would I be making this same decision?’ That helps keep things more palpable, more real.”

Should I Get Screened for Prostate Cancer? A Look at the Evidence

Hands Hold Show Light Blue Ribbon Prostate Cancer Awareness

By Dr. Wesley Ludwig, M.D.

Prostate-specific antigen (PSA) is an enzyme secreted by the prostate gland. PSA produced in small amounts in the blood of men with healthy prostates is normal, but PSA is elevated in the presence of prostate cancer.

PSA screening for prostate cancer was done routinely for years but has become a heavily debated subject. Currently, the United States Preventive Services Task Force (USPSTF), a volunteer panel of experts in general disease prevention, has given PSA screening a Grade C for men ages 55 to 69. This means there is moderate certainty in a small net benefit to screening and physicians should selectively offer PSA screening to patients based on professional judgment and patient preference.

The American Urological Association (AUA), an organization of experts in the field of urological diseases, recommends that men ages 55 to 69 undergo shared decision making with their physician and that the greatest benefit to screening is in this age group. As the decision to undergo screening strongly involves patient preference, an understanding of the evidence supporting PSA screening is crucial.

A Brief History of PSA

PSA was first discovered in the 1970’s and was approved in the 1980’s by the FDA to monitor prostate cancer recurrence. In 1991, Catalona et al. published a seminal paper in the New England Journal of Medicine showing that PSA was a good predictor of a prostate cancer diagnosis.[1] PSA soon became a widely used screening test throughout the United States for asymptomatic men.

Following this, the incidence of prostate cancer skyrocketed. The figure below from SEER data displays this rapid increase. Prior to routine PSA testing, 1 in 10 men were diagnosed with prostate cancer. After widespread PSA testing, 1 in 6 men were diagnosed with prostate cancer. Corresponding to this, in the mid 90’s mortality due to prostate cancer began to decline at a rate of approximately 4% per year, as seen in the graph below. This may have been due to an increase in PSA screening, however, some have suggested it is due to earlier and increasingly aggressive prostate cancer treatments beginning around the same time period.

Prostate cancer incidence and mortality before, during and after the introduction of PSA testing, 1975-2011.

PSA and evidence from the screening trials

Eventually, several randomized control trials were performed to determine if screening for prostate cancer using PSA conferred a prostate cancer survival benefit. Perhaps the two best designed studies were the Prostate, Lung, Colorectal and Ovarian Screening Trial (PLCO) and the European Randomized Study of Screening for Prostate Cancer (ERSPC) which are summarized below. [2,3]

PLCO ERSPC
Number of patients 76,693 162,243
Age range 55-74 55-69
PSA interval Annually for 6 years Every 2 to 4 years
Median follow-up ~13 years ~13 years
Contamination ~77% ~20%
Prostate cancer

specific mortality

Risk Reduction

(screen v control)

1.08

0.79

In summary, PLCO is an American trial that enrolled men aged 55-74 to a screening or non-screening arm. After 10 years of follow-up there was no improvement in prostate cancer specific mortality in the screened group. However, this study has been criticized for its high level of contamination. This refers to the fact that a large percentage of men in the non-screening arm (approximately 77%) had a PSA level tested during the study.

PLCO did not compare screening to non-screening; it compared routine screening to opportunistic screening, which is very prevalent in the US.

The ERSPC is a European trial of men aged 55 to 69 randomized to a screened arm that received PSA screening every 2 to 4 years and a non-screening group. The contamination rate was much lower in the ERSPC trial as routine PSA tests are uncommon throughout Europe. The 13-year update of this study shows that a man’s risk of dying of prostate cancer is 21% less when screened for prostate cancer. 781 men would need to be screened and 27 cancers would need to be diagnosed to save one life from prostate cancer.[3] Additionally, subsets of the ERSPC study have been followed for 19 years and have shown an even greater reduction in metastatic disease and cancer-specific mortality in patients that underwent screening [4].

However, there are important negative associations with PSA screening that have been noted in the scientific literature and are summarized in the table below.

Harm Estimate Source
False positive 75.9% Proportion w PSA >3, negative bx (ERSPC)
Overdiagnosis 66%
23-42%
Screen detected, 4 year interval (ERSPC)
Modelling studies (Heijnsdijk et al 2009) [5]
Post-biopsy fever 4% Loeb et al 2012 ERSPC [6]
Post-biopsy hospitalization 1% Loeb et al 2012 ERSPC [6]
Hematuria/hematospermia 20-50% Post-biopsy (ERSPC)
Incontinence/ED 20-30% All treatment types (Chou et al 2011, USPSTF meta-analysis) [7]
Death 1-5/1000 Within 1 month of surgery (Chou et al 2011, USPSTF meta-analysis) [7]

In Summary

  • Professional medical societies recommend discussing PSA screening with your physician and making a shared decision regarding screening.
  • A well-performed clinical trial comparing PSA screening and non-screening found a reduction in metastatic disease and death due to prostate cancer for men that underwent PSA screening.
  • There are several harms associated with PSA screening including overtreatment and complications associated with biopsy and surgery.
  • Patients should weigh the risks and benefits of PSA screening according to their values and preferences and discuss these with their physicians.

REFERENCES

  1. Catalona WJ, Smith DS, Ratliff TL, Dodds KM, Coplen DE, Yuan JJ, Petros JA, Andriole GL. Measurement of prostate-specific antigen in serum as a screening test for prostate cancer. N Engl J Med. 1991 Apr 25;324(17):1156-61. Erratum in: N Engl J Med 1991 Oct 31;325(18):1324.
  2. Andriole GL, Crawford ED, Grubb RL 3rd, Buys SS, Chia D, Church TR, Fouad MN, Isaacs C, Kvale PA, Reding DJ, Weissfeld JL, Yokochi LA, O’Brien B, Ragard LR, Clapp JD, Rathmell JM, Riley TL, Hsing AW, Izmirlian G, Pinsky PF, Kramer BS, Miller AB, Gohagan JK, Prorok PC; PLCO Project Team. Prostate cancer screening in the randomized Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial: mortality results after 13 years of follow-up. J Natl Cancer Inst. 2012 Jan 18;104(2):125-32. doi: 10.1093/jnci/djr500. Epub 2012 Jan 6.
  3. Schröder FH, Hugosson J, Roobol MJ, Tammela TL, Zappa M, Nelen V, Kwiatkowski M, Lujan M, Määttänen L, Lilja H, Denis LJ, Recker F, Paez A, Bangma CH, Carlsson S, Puliti D, Villers A, Rebillard X, Hakama M, Stenman UH, Kujala P, Taari K, Aus G, Huber A, van der Kwast TH, van Schaik RH, de Koning HJ, Moss SM, Auvinen A; for the ERSPC Investigators. Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up. Lancet. 2014 Aug 6. pii: S0140-6736(14)60525-0. doi: 10.1016/S0140-6736(14)60525-0. [Epub ahead of print]
  4. Osses DFRemmers SSchröder FHvan der Kwast TRoobol MJ. Results of Prostate Cancer Screening in a Unique Cohort at 19yr of Follow-up. Eur Urol. 2019 Mar;75(3):374-377. doi: 10.1016/j.eururo.2018.10.053. Epub 2018 Nov 9.
  5. Heijnsdijk EA, der Kinderen A, Wever EM, Draisma G, Roobol MJ, de Koning HJ. Overdetection, overtreatment and costs in prostate-specific antigen screening for prostate cancer. Br J Cancer. 2009 Dec 1;101(11):1833-8. doi: 10.1038/sj.bjc.6605422. Epub 2009 Nov 10.
  6. Loeb S, van den Heuvel S, Zhu X, Bangma CH, Schröder FH, Roobol MJ. Infectious complications and hospital admissions after prostate biopsy in a European randomized trial. Eur Urol. 2012 Jun;61(6):1110-4. doi: 10.1016/j.eururo.2011.12.058. Epub 2012 Jan 5.
  7. Chou R, Dana T, Bougatsos C, Fu R, Blazina I, Gleitsmann K, Rugge JB. Treatments for Localized Prostate Cancer: Systematic Review to Update the 2002 U.S. Preventive Services Task Force Recommendation [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2011

How to Help Children with Urinary Incontinence at School

Children washing their hands at a bathroom school, working against urinary incontinence at school.

By Dr. Wolfgang Cerwinka, M.D.

More than 90% of children will be toilet trained at the age of 5 years. At that age, the most common type of incontinence is bed wetting or enuresis. Urinary incontinence is the involuntary loss of urine and may be caused by a variety of reasons. Bed wetting may be the sole problem or may occur together with daytime urinary incontinence.

If bed wetting is associated with daytime urinary incontinence at school, it may be regarded as the nightly expression of the same problem that occurs during waking hours. Therefore, that issue will respond well to the treatment of daytime urinary incontinence.

Learn more about daytime urinary incontinence at school below!

What Causes Urinary Incontinence at School?

Gaining control over bladder and bowel is a process that depends on normal anatomy (e.g., normal bladder size), function (e.g., the normal ability of the bladder to relax when storing urine) and learned behavior (e.g., ability to sense a full bladder). Bladder and bowel problems occur often together and are summarized under the term bladder-bowel dysfunction (BBD).

The reason for this association is that bladder and rectum share the same embryological origin, the same nervous control, and are located in close proximity. It is easy to imagine how a full rectum with constipation that is located behind the bladder will reduce the space for the bladder to hold urine. Therefore, bladder and bowel problems should be managed in concert. Since behavior and learning are an important part of gaining bladder and bowel control, patients with behavioral (e.g, ADHD) and learning disabilities are often diagnosed with BBD. Training the bladder and bowel is a process that will take time and requires patience.

Children with urinary continence at school typically suffer from urgency incontinence (inability to postpone voiding). These children are initially managed by prolonged toilet training and eventually will see their pediatrician who, if comfortable with this problem, will implement basic treatment. If urinary incontinence persists and is deemed socially unacceptable, patients are referred to a pediatric urologist.

At Georgia Pediatric Urology, patients are seen in the HAWK (“Help Awaiting Wet Kids”) Clinic, which was specifically established for the treatment of BBD. Extended clinic visits allow finding the correct diagnosis and time to discuss treatment options in detail. At the initial clinic visit, besides obtaining the medical history and performing a physical exam, basic tests will be done such as a urinalysis (urinary tract infection may cause incontinence), a renal-bladder ultrasound (verify a normal anatomy), a postvoid residual ultrasound (verify complete bladder emptying) and a uroflow test (verify normal urine flow from the bladder).

How Do You Treat Daytime Urinary Incontinence at School?

Management of urinary incontinence is initially empiric and a step-wise process. This means that treatment is based on what in our experience works best, and, if urinary incontinence persists, to include other treatment options. Basic management encompasses behavioral and dietary modifications and to work with the school to allow children to visit the bathroom as necessary. Further, balancing fluid intake, reducing foods that will cause bladder over-activity (e.g., caffeine), treating constipation, and proper voiding (in a timely fashion and complete) also help.

If urinary incontinence persists, either biofeedback training (if patients have a hard time emptying their bladders completely) or the addition of bladder-relaxing medications are options. If treatment is still not successful, a video-urodynamic study will be scheduled in the office which is a test where a bladder catheter has to be placed to specifically study bladder function and to determine the exact cause of incontinence.

Typically, one or a combination of treatment modalities paired with continued toilet training and time to allow the urinary system to mature will successfully manage urinary incontinence in affected children.

If you have any more questions or concerns about urinary incontinence at school, click here to contact the pediatric urologists at Georgia Urology.

Staff Spotlight: Jacquar Wynn

Georgia Urology is full of incredible, hard-working, and dedicated employees. We’re excited to highlight these wonderful medical professionals who serve our patients every day through monthly Staff Spotlights!

Two photos of Jacquar. The one on the left is her smiling at the Georgia Urology office, and the one on the right is her with her son.

This month, we’re highlighting Georgia Urology’s Front Desk Coordinator, Jacquar Wynn, who has been with us for nine months.

1. What’s the most rewarding part of your job?

The most rewarding part of my job is delivering the best customer service experience by caring for and reassuring patients that they are in good care. Ultimately, providing a wholesome, stress-free and welcoming environment. Knowing that I can put a smile on a patient’s face is magnificent!

2. Do you have any advice for people hoping to work in your field?

My advice for anyone considering entering the medical field is to be compassionate! Patients depend on our compassion and commitment to their overall well-being.

3. What are your favorite hobbies?

My favorite pastime is having family gatherings at my house. I love to pull my family and friends together and fellowship. I also love interior decorating. In my spare time, I often like to re-arrange my home décor or my friend’s and family’s homes.

My son, Taurean, attends The University of Texas. He gives me a sprinkle of his time here and there. When we get together, we’ll attend Cedar Point Amusement Park and have a ball.

GU Pediatric Urology Care Recognized Among Top 10 in U.S. News & World Report Rankings

Congratulations to our pediatric urologists honored among the professionals honored in U.S. News & World Report’s 2019-2020 Best Children’s Hospitals rankings. This annual recognition signifies excellence among the country’s pediatric healthcare landscape.

Our wholly-owned subsidiary, Georgia Pediatric Urology, collaborates with and provides pediatric urological services at Children’s Healthcare of Atlanta, which occupies a top-10 spot in the magazine’s Best Hospitals for Pediatric Urology category.

“The U.S. News & World Report designation is important because it tells the public we are a pediatric urology center dedicated to quality outcomes,” says Dr. Hal Scherz, a pediatric urologist and managing partner of Georgia Urology. “It gives the public a sense of reassurance that the care their children will receive from Georgia Urology is going to be as good as it can be anywhere in the country.”

Of our 45 specialty-trained physicians, the seven making up Georgia Pediatric Urology are fellowship-trained pediatric urologists with expertise in the diagnosis and treatment of urological problems affecting boys and girls, from newborns to late teens. These conditions include congenital abnormalities, genitalia, pediatric urologic cancers, kidney and bladder issues, and more. Our HAWK (Help Awaiting Wet Kids) Center provides specialized care for children with wetting issues and other forms of abnormal urination.

Georgia Pediatric Urology differs in that we are a private practice, pediatric urology group. This allows us to serve through various avenues. In addition to our involvement in the children’s hospital world, we train Emory University residents and offer one of the longest-running pediatric urology fellowships in the country.

“We’ve worked very hard to put together the pieces necessary to establish a top-tier pediatric urology group,” Dr. Scherz explains. “The U.S. News & World Report designation validates all of the hard work and dedication everyone in our group has contributed. And we’re not done yet. We’re always growing, improving, expanding, and making the programs better for children who have pediatric urological problems.”

You can make an appointment with Georgia Urology and Georgia Pediatric Urology can by calling 678-284-4053 or contacting us here.

Infertility in Males — It’s Not Just the Woman

Male and female couple at a doctor's desk, holding hands and discussing Infertility in Males.

By Dr. Lawrence Goldstone, M.D., F.A.C.S.

Infertility is defined as a couples inability to conceive after one year of appropriately timed and unprotected intercourse. It can affect 15% of couples. Typically thought to be a woman’s problem, infertility in males is actually the primary factor in 20-30% of cases, and is a contributor as a combined couples problem an additional 20-30% of the time.

The evaluation of infertility in males is a relatively simple and straightforward process. It begins with a thorough history, focusing on sexual history, the timing of intercourse, and the use of lubricants. A past history of prior surgeries in the pelvis or reproductive tract will be noted, as well as a history of pain, swelling, or infections in that area.

Medicines and lifestyle choices will be carefully reviewed. Smoking (both tobacco and marijuana) and alcohol can affect sperm health. Testosterone supplements and anabolic steroid usage are an increasingly common cause of male factor infertility. Stress, obesity, and even prolonged heat exposure to the genital area may adversely affect sperm quality.

A physical exam with attention to testicular size and quality will be performed. The presence or absence of the vas deferens(the tube that carries sperm from the testicle) can easily be addressed. Your physician will also check for vein swellings in the scrotum called varicoceles that can impact sperm counts and function.

A semen analysis will be arranged if not already performed. This gives valuable information about semen volume, sperm quantity, and quality. Laboratory testing can provide important clues to hormonal imbalances and chromosomal abnormalities that may affect reproductive health. Ultrasound examinations of the genital tract may occasionally be arranged. In summary, the evaluation is relatively quick and simple and can often be accomplished after only one or two office visits.

Treatment of infertility in males will, of course, depend on the underlying factors. It may be as simple as lifestyle modifications and timing and frequency of intercourse. Medications may be used, particularly for hormonal imbalances. Minor surgeries to correct varicoceles can often be helpful. There are even procedures to retrieve sperm from men who were previously thought to be completely sterile and without hope.

In summary, male factor infertility is a common problem and the physicians at Georgia Urology are well-focused on its improvement. Click here to schedule an appointment with us today if you want to discuss further. 

Common Pediatric Urology Sports Injuries

Low Angle View Of Male High School Soccer Players And Coach Having Team Talk about common pediatric urology sports injuries.

By Dr. Edwin A. Smith, M.D., F.A.A.P., F.A.C.S.

Sports are a great way for kids to work on their physical health while also learning important lessons about community, commitment, and responsibility. However, sometimes injuries related to these sports are unavoidable. Issues like concussions and orthopedic injuries are commonly discussed, but did you know there are also very serious urological injuries young athletes can experience? To help you and your children prepare in case the worst happens, we’re discussing common pediatric urological injuries from popular children’s sports.

How common are sports related genitourinary (GU) injuries?

Genitourinary trauma includes injuries to the kidneys, bladder, and genitals (testes, vagina, and penis) is reported to represent an important 10% of all pediatric traumas. Notably, emergency room and hospital-based national injury and trauma registries have identified sporting injury as the cause of one-third of genitourinary injuries in children thereby making it the most common cause of pediatric GU injury. Trauma registries may actually underestimate the real number of injuries because they do not include less serious injuries treated in outpatient clinics and physician’s offices.

What sports activities are most likely to produce genitourinary trauma in pediatric patients?

Involvement in sports activities can be an important part of a child’s development. Knowing which activities are more likely to be associated with injuries helps parents and children become more aware and take proper precautions while still enjoying sports participation. For instance, one-third of genitourinary sports-related injuries occur with bicycling making it the most common activity associated with genitourinary injury. The majority of kids enjoy bike riding so it is not surprising that this activity tops the list. Also, the riskier form of biking including off-road biking and extreme sport biking are becoming more popular.

Injuries related to team sports such as football, baseball or softball, basketball, soccer, and lacrosse are also common, particularly among boys, and combined these activities represent another third of all injuries. Kicks to the groin, helmet contact, or the impact of a fast-moving ball as with baseball or lacrosse can cause serious damage to the testicles. The most serious injuries to the testis occur when the testis is hammered against the pubic bone resulting in a contusion, bleeding inside the scrotum, fracture or rupture of the testis. Some injuries may not be correctable and may result in loss of a testicle. Fortunately, most patients that sustain injuries with team sports are evaluated and treated in the ED without inpatient admission.

How Can Common Pediatric Urology Sports Injuries be Avoided?

Genitourinary injuries from bicycles are usually from falls or straddle injuries and most bike injuries occur from collisions with the “top bar” or the handlebar. Using a properly fitted bike, properly padded seats, padded top bar and attention to speed and surroundings will lessen the likelihood of jury.

Boy athletes that are participating in contact sports including football, soccer, baseball, basketball, lacrosse, and hockey should wear an athletic cup made of hard plastic or metal. Boys should begin to wear a cup as soon as they are big enough for one to fit – usually around age 6 to 8. Proper fit is crucial and the cup must be held in proper position by an athletic supporter, jock strap or compression shorts designed to be fitted with a cup. The cup should fit firmly against the body and not shift out of place during activity. If your son is involved in a non-contact sport that involves lots of running, a jock strap or compression shorts without a cup are sufficient and will help keep the penis and scrotum up and out of the way. If you are uncertain what your son should be using, ask a knowledgeable coach or athletic trainer.

What are the Signs and Symptoms of Common Pediatric Urology Sports Injuries?

Blood in the urine or at the opening of the urethra, inability to urinate, flank or abdominal pain, or swelling, bruising and tenderness of the external genitalia usually accompany genitourinary injury. To reduce the morbidity of the injury it is important to quickly identify and properly manage genitourinary injuries. If an injury has occurred there should not be any delay in getting medical attention for your child. Imaging with X-rays, ultrasound, CT may be necessary to fully assess an injury. While most injuries are managed with monitoring and supportive care and only a few with surgical treatment the determination of the best treatment can only be made after careful evaluation.

Special circumstances: Can my child who has a solitary kidney or testis still participate in contact sports?

Yes, boys with a single testicle or a history of an undescended testicle can participate in contact sports if they wear a protective cup. For children with chronic kidney disease or a solitary kidney, the current policy statement by the American Academy of Pediatrics is a “qualified yes”. This recommendation stems from the recognition that kidney injuries during contact sports are uncommon and catastrophic kidney injuries are even rarer. However, parents of children with kidney problems or solitary GU organs should carefully consider the risks and benefits of their child’s participation in a contact sport and make an informed decision only after consulting with their child’s pediatrician and urologist.

If you have any more questions or concerns about common pediatric urology sports injuries, click here to schedule an appointment with an expert Georgia Urology pediatric urologist.

Percutaneous Nephrolithotomy (PCNL)

Two plastic kidneys with PCNL on a table with two stereoscopes.

By Dr. Jerry Yuan, M.D.

Percutaneous Nephrolithotomy (PCNL) is the procedure of choice when dealing with large bulky renal stones, especially those of dense consistency.

Standard treatments for routine kidney stones, such as shock wave lithotripsy or endoscopic removal via mini-endoscope through the ureter, are effective in dealing with most stones. However, when confronted with large stones of 1-2 cm or more in size compounded by those of very hard chemical makeup, more definitive steps are required. This is where PCNL comes in.

How Does PCNL Work?

PCNL allows for direct contact of the offending stones with full-size endoscopes & lithotripsy (stone busting) devices and simultaneous removal of fragments to achieve the most expedient & complete stone clearance.

During PCNL, an access or accesses are placed by our radiology specialists in the flank.

Xray of Percutaneous Nephrolithotomy, Needle and access placement

Once in place, the access is then dilated to allow placement of working ports gaining entry into the plumbing system of the kidney where stones reside. Various devices including laser, ultrasound or pneumatic jackhammer like probes are then used to disintegrate the stones, sizable fragments are easily evacuated without the need for the passage which often is not feasible when dealing with a large amount of debris.

Videos of PCNL

Three videos are provided to illustrate the large stones we often encounter or the so-called staghorn stones since they take up the entire interior of the kidney.

Video one is Before.

Video 2 is multiple sessions in progress with marked reduction of stone burden and multiple drainage catheters in place.

Video 3 is post-op with minimum debris remaining.

PCNL typically requires overnight stay and most patients are treated with a single session. Some require multiple sessions days apart to effect a satisfactory result.

If you have any more additional questions about PCNL, click here to contact any of our Georgia Urology experts.