Female Urology

Female Urology — Conditions

Urologic conditions affect both men and women, but women may experience disorders differently. Some urologic conditions, such as urinary incontinence (UI) and urinary tract infections (UTIs), are more common in women.
Urinary tract and kidney problems are common in women in part because the urinary tract is much closer to their genital area than in men. As such, pregnancy, childbirth and sexual intercourse can also play a part in urologic conditions affecting women.
The urinary system, also called the urinary tract, is made up of the kidneys, ureters, bladder and urethra. The urinary tract’s main function is to drain the body’s urine and to keep a proper balance of water and chemicals in the body. The urination process starts with blood filters in the kidneys, which pass urine through the ureter to the bladder where urine is held until expelled from the body through the urethra.

General urinary conditions & treatments in women

The most common issues women experience that are related to the general urinary tract are infections, incontinence and fistulas.

Urinary tract infections (UTIs)

UTIs are caused by bacterial infections in the urinary tract causing painful or frequent urination, blood in the urine, cramps or nausea. One woman in five develops a UTI during her lifetime and women are 10 times more likely to have a UTI than men.

Urinary incontinence

Women experience urinary incontinence (UI), the involuntary loss of bladder control, about twice as often as men. This is due to the structure of the female urinary tract and because women experience childbirth and menopause.

Urinary fistula

A fistula is an uncommon connection among any organ or intestine and can occur anywhere in the body. Urinary fistulas include any abnormal connection between the kidney, bladder, urethra, the colon and the vagina. The result can be feces and urine leaking from the vagina due to that abnormal connection.

Pelvic organ prolapse

Pelvic organ prolapse occurs when a woman’s muscles, skin, ligaments and other support structures surrounding the vagina weaken, causing pelvic organs such as the bladder to fall out of their normal position. There are different types of prolapse, named after the organs that are shifting within a women’s pelvic area. Types of prolapse include vaginal prolapse or bladder prolapse.

Typically, pelvic organ prolapses affect older women who have had children.

Voiding dysfunction

The lower urinary tract, which includes the bladder and urethra, allows for storage and discharge of urine. Voiding dysfunction is a general term describing poor coordination between the bladder muscle and the urethra, in which the bladder does not empty properly. Symptoms typically include a strong urge to urinate, frequent urination and the inability to empty the bladder.

Kidney conditions & treatments in women

The kidneys are fist-sized, bean-shaped organs that filter impurities from blood and produce urine that carries those impurities out of the body. They are located behind the abdominal organs, right below a person’s rib cage. The following are common kidney conditions.

Kidney stones

Kidney stones occur when minerals and salts in the urine clump together into “stones.” These clumps range in size from a grain of sand to a golf ball. Smaller stones can pass with the urine, although even those can be very painful. Larger stones require medical treatment and removal.

Chronic kidney disease

More than 25 million people in the world have chronic kidney disease. The most common causes of chronic kidney disease are diabetes and high blood pressure, also called hypertension.

Hydronephrosis

Hydronephrosis happens when one or both kidneys cannot drain urine and become swollen. It can be caused by a kidney stone, a UTI, a blockage, scarring from surgery or injury, a blood clot or pregnancy.

Polycystic kidney disease

Polycystic kidney disease is a genetic disorder that causes multiple cysts to grow in one or both kidneys. These cysts are not cancerous, but they can damage the kidneys.

Bladder conditions & treatments in women

The bladder is a balloon-shaped organ that stores urine. Numerous health conditions can affect the bladder. And the bladder may be involved in several urinary tract conditions, such as urinary incontinence.

The following are some of the bladder-specific issues women may experience.

Overactive bladder

An overactive bladder often causes frequent urges to urinate, inability to hold urine and incomplete bladder emptying. This is a common condition seen in women when the pelvic floor muscles weaken, which often occurs with age. The front wall of the vagina, which supports the bladder, can also weaken with age or after dramatic events such as childbirth.

Painful bladder syndrome (interstitial cystitis)

This is a condition in which the walls of the bladder become inflamed and may cause frequent or painful urination, bladder pressure, pain in the bladder area and sometimes pelvic pain. Both men and women can get painful bladder syndrome, although women are twice as likely as men. It can occur at any age, but it is most common in middle age.

Bladder prolapse

Bladder prolapse is a form of pelvic floor prolapse, which occurs when a woman’s muscles, ligaments and skin surrounding the vagina weaken, causing pelvic organs such as the bladder to fall out of their normal position. Typically, this condition affects older women.

Urethral conditions & treatments in women

The urethra is a tube that is attached to the bladder and carries urine out of the body. The urethra in females is much shorter than in males. Its opening is between the clitoris and the vagina.

Urethral issues affecting women include:

Urethral diverticulum

Urethral diverticulum (UD) occurs when a pocket-like pouch forms next to the urethra. Since it most often connects to the urethra, this pocket repeatedly gets filled with urine thus causing infection and symptoms. Typical symptoms include frequent urination, urgent need to urinate and dysuria (pain during urination). UD is more common in females than in males and usually occurs between the ages of 40 and 70.

Urologic cancers in women

Urologic cancers are fairly common and include:

Bladder cancer?

Cancer in general is the uncontrollable growth of cells that replicate and do not die as normal cells do. The causes of bladder cancer are unknown, but it has been linked to radiation, smoking and chemical exposure.

To understand how bladder cancer grows, it helps to know about the four main layers of the bladder wall. The bladder wall consists of:

• Urothelium, also called transitional epithelium, is the innermost lining that is made up of urothelial cells
• Lamina propria is the thin layer of connective tissue, blood vessels and nerves covering the urothelium
• Muscularis propria is the third layer of the bladder made of thick muscle
• Fatty tissue is the fourth layer outside of the muscle that separates the bladder from nearby organs.

Most bladder cancers start in the urothelium layer of the bladder. As cancer cells grow and spread, they move into or through the other layers of the bladder. Doctors describe bladder cancers based on how far they have invaded into the wall of the bladder:

Noninvasive cancer cells are still in the inner layer of cells (the transitional epithelium) but have not grown into the deeper layers.

Invasive cancer cells grow into the lamina propria or even deeper into the muscle layer. Invasive cancers are more likely to spread and are harder to treat.

Doctors also define bladder cancer by the cells where cancer begins. Transitional cell carcinoma is by far the most common type of bladder cancer and occurs in the cells of the urothelium layer. Transitional cells expand and contract in the bladder as the bladder fills and empties.

What is kidney cancer?

Kidney cancer is the uncontrolled growth of abnormal cells in the kidneys. The kidneys are two bean-shaped organs, each about the size of a fist. They lie in your mid abdomen on each side of your spine. The kidneys are part of the urinary tract. Their main job is to remove waste products from the blood and remove them by making urine.

About 9 out of 10 adults who develop kidney cancer are diagnosed with renal cell carcinoma. There are a few other types of kidney cancer, although they are less common. Young children sometimes have a kidney cancer called a Wilms’ tumor.

Many kidney cancers are found through imaging scans of the abdomen, such as computerized tomography (CT) and ultrasound. Most kidney tumors (85 percent) are found early before they spread. These cancers are easier to treat.

Urethral Cancer?

The urethra is part of the urinary tract. Urine passes through the urethra from the bladder to leave the body. The female urethra is about 1.5 inches long and opens just above the vagina. The male urethra is about 8 inches long and passes through the prostate and penis. The male urethra also carries semen.
Urethral cancer is a disease that occurs when malignant cells grow in the urethra’s tissues. It is a rare cancer, making up just 1 to 2 percent of all urologic cancers. Men or women can have urethral cancer, but it affects women most often. Urethral cancer is most common in Caucasian females age 60 or older.
Urethral cancer can also spread (metastasize) to other tissues around the urethra and often can be found in lymph nodes near the urethra.

There are three types of urethral carcinomas (a cancer that begins in the tissues lining the body’s surfaces). These carcinomas are identified according to the types of cells in which they begin to grow.

Squamous cell carcinoma forms in cells lining the urethra, inside men’s penises and near the bladder in women; it is the most common urethral cancer. Transitional cell carcinoma also forms in cells in the urethra, near its opening in women and in the area of the urethra surrounded by the prostate in men. Adenocarcinoma forms in both men and women in the glands that are around the urethra.