Urinary stones

Urinary stone disease is a common affliction in our society and may affect 1 to 5 per cent of the population. The physician involved in caring for the stone-forming patient must have a thorough understanding of the metabolic as well as anatomic abnormalities that may lead to repeat stone formation. The authors review the common metabolic abnormalities frequently seen in the stone-forming patient and present the current medical management of these problems. Ongoing changes in the surgical approach to urinary stones are also discussed.     

Urinary Fistulas

The four major types of urinary fistulas are renal, ureteral, vesical and urethral. Urinary fistulas may be congenital or acquired. Symptoms depend on the type and site of the fistula. Diagnosis includes recognition of the fistula and determination of its cause. Treatment may require cooperation of the urologist, general surgeon and internist.     

Mammographic microcalcifications associated with schistosomiasis

We have described the first known occurrence of ectopic Schistosoma japonicum of the breast mimicking the mammographic pattern of carcinoma.     

Urinary incontinence

BACKGROUND: One of the more prevalent conditions associated with aging is urinary incontinence (UI), which may affect up to 55% of women and 34% of men older than 65 years. As a result of increasing longevity in developed nations, the proportion of UI-susceptible individuals continues to grow, presenting clinical and economic challenges to healthcare providers. OBJECTIVE: To assist the clinician in making informed decisions regarding UI, provide information on the wider ramifications of the disease, and provide a comprehensive overview of the condition. DATA SOURCES: MEDLINE (1966-December 1998) was searched for relevant publications using the following search terms: UI, UI in the elderly, treatment of UI, oxybutynin, flavoxate, vasopressin, quality of life in UI, and economic impact of UI. DATA SYNTHESIS: Key articles relating to the etiology, diagnosis, classification, economic burden, quality of life, and treatment of UI were retrieved, and this information formed the basis of the review. CONCLUSIONS: Although UI can be controlled relatively well with existing therapies, only about 50% of affected patients may actually seek care. There are a variety of therapeutic options available for the treatment of UI, although pharmacologic intervention is presently a relatively minor component of overall care; this suggests that effective drug therapy might play a more significant role in the future. The economic burden associated with the care of the incontinent patient is substantial, and in the US the direct medical cost of the disease was estimated at $25.5 billion in 1995. The disease also has a large impact on the individual UI patient, negatively affecting many parameters normally associated with a tolerable health-related quality of life.     

Urinary incontinence

Symptoms of urinary incontinence are distressing and disruptive to everyday life. They can also be indicative of more serious underlying disorders. Many methods of symptom management are available. Matching the affected person to the most effective and appropriate treatment method is a significant challenge for nursing. Just as pressing is the need to develop and test a cogent conceptual model for symptom management that includes primary prevention.