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About Arthur Goldstein, M.D.
Expertise
Any problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, impotency, etc.
Experience
I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in male impotence and endourology.
Organizations
American Medical Association, American Urological Association, American College of Surgeons
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You are here: Experts > Health/Fitness > Urology > Urology > Frequent urination after UPJ Obstruction surgery
Expert: Arthur Goldstein, M.D.
Date: 9/10/2008
Subject: Frequent urination after UPJ Obstruction surgery
Question
I am a 30 year female that has had several UPJ obstruction surgeries. I was diagnosed in 2004 with a left UPJ obstruction and had 2 laporscopic surgries to correct the obstruction. In 2005 I came down with a very serious kidney infection and was hospitalized after running tests, the doctors learned that my ureter had become stretched and flopped over kinking any urine flow. I had a open surgery done to correct this. I since then have had a problem with kidney stones. I passed a 13mm stone 3 months after my open surgery and have had problems with blood in my urine and smaller stones in my left kidney. I also have been having spuratic flank pain on my left side. I have been noticing that I am having a problem with frequent urination. I sometimes will get up in excess of 10 times during the night with the feeling of having to urinate, and often I urinate, it seems that my bladder is full, I am not just dribbling. I also have noticed that sometimes after I urinate, I will dribble when I think I am done going. I am just wondering if there is any corelation between my surgery and why I am having such a frequency of urination. Thanks
Answer
Michelle, there are many causes for urinary frequency. The common ones include diabetes, urinary tract infections, excessive fluid consumption (especially coffee, tea and beer which produce an additive diuretic effect), prostate conditions in men, urinary stones, a variety of kidney disorders associated with inability to concentrate the urine properly, urinary stones, several types of urinary bladder diseases (ie neuropathic bladder, stones, interstitial cystitis, etc.) and anxiety. Frequency related to urinary stones are generally due either to infection or stone fragments in the lower ureter (which irritate the bladder causing frequency). Some women develop frequency induced by chemical residues from soaps and detergents in the bath water that may wash up into the bladder and urethra causing inflammation. Because frequency has so many etiologies, the patient is best seen by a urologist. Basic evaluation would include a history, physical examination, urinalysis and, if indicated, a urine culture. Other tests that might be needed to find the cause include imaging of the kidneys, cystoscopy and urodynamic studies.
Dribbling after urination is a very common problem in women. It is due to some trapping of urine in the urethra after voiding. It can be overcome by simply "stripping" the urethra after urinating and then patting dry with a toilet tissue. Sometimes it is due to mild narrowing of the opening of the urethra (meatal stenosis). This can generally be corrected by simple dilation (stretching) of the urethra by your urologist.
I don't know if you have seen my "macro" on kidney stones previously, so I will attach it to this note.
The formation of kidney stones is a very complex process. Obvious predisposing factors such as anatomical obstruction to the flow of urine from the kidneys and urinary tract infections need to be ruled out. In addition, there are many different types of stones (such as calcium oxalate, calcium phosphate, uric acid, calcium ammonium phosphate, cystine, etc.). Furthermore, each type of stone has many potential causes and multiple metabolic factors are involved. Calcium oxalate is the most common stone formed in this country. In recurrent stone formers, therefore, a complete metabolic evaluation is necessary before a proper stone prevention program can be instituted. If you have had 2 or more stones, you would fall into this category. Some stones can be stabilized or prevented by dietary regimens but none are really dissolved by them. Forcing fluids to ensure a urinary output of at least 2,000 cc (2 liters) daily is an essential part of all stone prevention and treatment programs. There is an incorrect belief that by reducing dietary calcium (by eliminating dairy products) in patients with any type of calcium stone prevents calculi. This may help help with some types of stones but may predispose to others. Therefore, metabolic evaluation is recommended in patients with recurrent urinary stones before preventive therapy can be suggested. Metabolic studies are a series of tests to try and determine why a person forms stones. They usually include routine blood chemistries, a serum parathyroid hormone (PTH) level, and a 24 hour urinary assay for those constituents in the urine involved in stone formation. Other specialized studies that measure calcium absorption from the bowel and acid excretion by the kidneys are occasionally necessary as well. If the metabolic cause of the stone is found, a proper diet and medications can prevent recurrences in about 90% of patients. However, it is essential to do the above tests first as a treatment for one type of stone may cause stones of a different variety to grow. I would suggest that these studies be arranged either by your urologist, a nephrologist or a metabolic disease specialist. Good luck.
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