American Medical Association Family Medical Guide - American Medical Association [536]
Diagnosis
If you have an injury to the bladder, urethra, lower abdomen, or urinary tract, see your doctor immediately. He or she may order X-rays of your abdomen and bladder, a CT scan (see page 112) to examine the abdomen and pelvis, and cystoscopy (see page 805) to examine the bladder.
Treatment
If you have an injury to your bladder or urethra, you will be hospitalized and probably given antibiotics to prevent infection. If your bladder is ruptured but urine does not leak into the abdominal cavity, you may need to have a catheter (a thin, flexible tube) placed inside the bladder to allow urine to drain from your body and to prevent urine from leaking into your abdomen. Use of the catheter allows the rupture to heal while preventing the bladder from filling with urine and stretching. If urine leaks from the bladder into the abdominal cavity, the doctor will perform surgery to drain the leaking urine and, if possible, repair the injured bladder. If the urethra is damaged, the doctor will probably insert a catheter into the bladder through the abdominal wall for several days to drain urine. Although the urethra usually heals on its own, surgery is performed occasionally to repair an injured urethra that has not healed within 3 to 6 months.
Urinary catheter
A urinary catheter is a long, flexible tube that is inserted through the urethra into the bladder to allow urine to drain from the body.
Cysts, Tumors, and Stones
The urinary tract can be affected by two kinds of growths—cysts and tumors. Cysts are usually soft, fluid-filled sacs and are usually, but not always, benign (noncancerous). Solid tumors are usually cancerous. Other types of growths, such as kidney stones or bladder stones, occur more frequently. Stones are hardened accumulations of particles (usually mineral salts) that form in the urine. Although stones can cause great discomfort, they are usually not life-threatening.
Simple Kidney Cysts and Acquired Kidney Cysts
There are three major types of kidney cysts—simple cysts, acquired cysts that result from kidney failure (see page 816), and cysts that develop in polycystic kidney disease (see next page). Simple cysts, which are the most common type, are soft, fluid-filled pouches lined with cells called renal epithelial cells. Simple cysts can be single or multiple and can occur in both kidneys. They usually cause no symptoms and are often detected by tests performed for another purpose. It is estimated that about one of four people over age 50 has simple kidney cysts.
Acquired cysts occur only in kidney failure. They develop in the nephrons (the basic filtering units of the kidneys) and increase in number and size as the kidney failure progresses. More than 75 percent of people who receive dialysis (see page 818) develop acquired cysts after 5 years of treatment. Doctors monitor these cysts closely because they can develop into adenomas (noncancerous tumors that could become cancerous) or adenocarcinomas (cancerous tumors). Cysts that develop on the kidneys of people who are on dialysis are often cancerous.
Symptoms
Simple kidney cysts usually do not cause symptoms; many people who have simple kidney cysts don’t know it. Rarely, a simple cyst grows large enough to cause pain in the back or in the abdomen. Blood in the urine is another possible symptom. Acquired cysts rarely cause symptoms.
Diagnosis
Simple kidney cysts are usually detected during an ultrasound (see page 111), CT scan (see page 112), or MRI (see page 113) performed for another purpose. Because of the slight possibility that cancer cells are present in the cyst, your doctor may order an aspiration biopsy of the cyst, in which a small sample of fluid and cells is withdrawn through a hollow needle (guided by ultrasound, CT, or MRI) and examined under a microscope. Aspiration of a kidney cyst is usually painless with the use of a local anesthetic.
Treatment