Bladder replacement Health Dictionary

Within a few years medical scientists have introduced into the domestic scene a steroid which has changed the whole course of female history. HRT has solved some basic medical problems by making good the loss of oestrogen in a woman’s body when menstruation is finished and her body learns to adjust.

A lack of oestrogen induces hot flushes, night sweats, thinning of the bones (osteoporosis) with possible fractures, and a wide range of physical and emotional disorders.

HRT also prevents the increased frequency of coronary disease which may follow the menopause. With oestrogen only, HRT appears to increase the incidence of cancer of the uterine body. Use of oestrogen and progestogen avoids this.

HRT is available as a tablet, transdermal patch, implant or topical cream. Most women notice temporary improvement in their appearance and hot flushes as long as treatment is continued. HRT is not prescribed by the herbal practitioner. Soya and Hops are a mild alternative.

Side-effects of such treatment include blood pressure rise, weight gain and periods probably continue with a monthly bleed. Elderly women taking HRT for osteoporosis may develop bleeding problems, the risk of blood clot and gall bladder diseases.

Helonias has proved a useful alternative, effective in eliminating excess fluids, reducing hot flushes, and relieving that bloated feeling, thus helping the older woman to live a normal life.

Damiana. 1 heaped teaspoon leaves to each cup boiling water; infuse 5-10 minutes; strain. 1 cup 2-3 times daily for 3-6 weeks.

Sarsaparilla. 1oz (30g) root in 1 pint (500ml) water; simmer gently 20 minutes; strain. 1 cup 2-3 times daily for 3-6 weeks.

Supplementation. Daily. Vitamin E, 400iu. Vitamin B-complex (high potency). Evening Primrose oil capsules, 500mg morning and evening. Dolomite, for Calcium and Magnesium, 2 tablets morning and evening.

Note: An extensive study of breast cancer risks with HRT revealed a positive link between the risk of cancer and length of use. Risk of the disease increased with all types of women using HRT with every year of use. Pre-menstrual women were more than twice at risk. It would appear that oestrogens cannot be taken without risk. (Centre for Disease Control, Atlanta, USA) See: OESTROGENS. ... hormone replacement therapy (hrt)

See LIVER.... gall-bladder

See ARTHROPLASTY.... joint replacement

A surgical operation to replace a diseased – usually osteoarthritic – KNEE with an arti?cial (metal or plastic) implant which covers the worn cartilage. As much of the original joint as possible is retained. The operations, like hip replacements, are usually done on older people (there is some restriction of movement) and about 90 per cent are successful.... knee-joint replacement

A URINARY BLADDER with complete or partial loss of sensation. As there is no sensation of fullness, the individual either develops complete retention of URINE, or the bladder empties automatically – usually every few hours. The condition predisposes affected individuals to urinary-tract infections and back pressure on the KIDNEYS, leading to renal failure. It may be caused by spinal injury, SPINA BIFIDA or any disorder which produces NEUROPATHY.... neuropathic bladder

The urinary bladder is a highly distensible organ for storing URINE. It consists of smooth muscle known as the detrusor muscle and is lined with urine-proof cells known as transitional cell epithelium.

The bladder lies in the anterior half of the PELVIS, bordered in front by the pubis bone and laterally by the side wall of the pelvis. Superiorly the bladder is covered by the peritoneal lining of the abdomen. The bottom or base of the bladder lies against the PROSTATE GLAND in the male and the UTERUS and VAGINA in the female.... urinary bladder

A surgical procedure to replace all or part of a diseased hip joint with an artificial substitute. The replacement is most often carried out in older people whose joints are stiff and painful as a result of osteoarthritis. It may also be needed if rheumatoid arthritis has spread to the hip joint or if the top end of the femur is badly fractured (see femur, fracture of).... hip replacement

The hollow, muscular organ in the lower abdomen that acts as a reservoir for urine. It lies within, and is protected by, the pelvis. An adult bladder can hold about 0.5 litres of urine before the need to pass urine is felt.

The bladder walls consist of muscle and an inner lining.

Two ureters carry urine to the bladder from the kidneys.

At the lowest point of the bladder is the opening into the urethra, which is known as the bladder neck.

This is normally kept tightly closed by a ring of muscle (the urethral sphincter).

The function of the bladder is to collect and store urine until it can be expelled.

Defective bladder function, leading to problems such as incontinence and urinary retention, can have a variety of causes.

(See also bladder, disorders of; enuresis).... bladder

See URINARY BLADDER, DISEASES OF and GALLBLADDER, DISEASES OF; see also URINE.... bladder, diseases of

The gall-bladder rests on the underside of the LIVER and joins the common hepatic duct via the cystic duct to form the common BILE DUCT. The gall-bladder acts as a reservoir and concentrator of BILE, alterations in the composition of which may result in the formation of gallstones, the most common disease of the gallbladder.

Gall-stones affect 22 per cent of women and 11 per cent of men. The incidence increases with age, but only about 30 per cent of those with gall-stones undergo treatment as the majority of cases are asymptomatic. There are three types of stone: cholesterol, pigment and mixed, depending upon their composition; stones are usually mixed and may contain calcium deposits. The cause of most cases is not clear but sometimes gall-stones will form around a ‘foreign body’ within the bile ducts or gall-bladder, such as suture material. BILIARY COLIC Muscle ?bres in the biliary system contract around a stone in the cystic duct or common bile duct in an attempt to expel it. This causes pain in the right upper quarter of the abdomen, with nausea and occasionally vomiting. JAUNDICE Gall-stones small enough to enter the common bile duct may block the ?ow of bile and cause jaundice. ACUTE CHOLECYSTITIS Blockage of the cystic duct may lead to this. The gall-bladder wall becomes in?amed, resulting in pain in the right upper quarter of the abdomen, fever, and an increase in the white-blood-cell count. There is characteristically tenderness over the tip of the right ninth rib on deep inhalation (Murphy’s sign). Infection of the gall-bladder may accompany the acute in?ammation and occasionally an EMPYEMA of the gall-bladder may result. CHRONIC CHOLECYSTITIS A more insidious form of gall-bladder in?ammation, producing non-speci?c symptoms of abdominal pain, nausea and ?atulence which may be worse after a fatty meal.

Diagnosis Stones are usually diagnosed on the basis of the patient’s reported symptoms, although asymptomatic gall-stones are often an incidental ?nding when investigating another complaint. Con?rmatory investigations include abdominal RADIOGRAPHY – although many gall-stones are not calci?ed and thus do not show up on these images; ULTRASOUND scanning; oral CHOLECYSTOGRAPHY – which entails a patient’s swallowing a substance opaque to X-rays which is concentrated in the gall-bladder; and endoscopic retrograde cholangiopancreatography (ERCP) – a technique in which an ENDOSCOPE is passed into the duodenum and a contrast medium injected into the biliary duct.

Treatment Biliary colic is treated with bed rest and injection of morphine-like analgesics. Once the pain has subsided, the patient may then be referred for further treatment as outlined below. Acute cholecystitis is treated by surgical removal of the gall-bladder. There are two techniques available for this procedure: ?rstly, conventional cholecystectomy, in which the abdomen is opened and the gall-bladder cut out; and, secondly, laparoscopic cholecystectomy, in which ?breoptic instruments called endoscopes (see FIBREOPTIC ENDOSCOPY) are introduced into the abdominal cavity via several small incisions (see MINIMALLY INVASIVE SURGERY (MIS)). Laparoscopic surgery has the advantage of reducing the patient’s recovery time. Gall-stones may be removed during ERCP; they can sometimes be dissolved using ultrasound waves (lithotripsy) or tablet therapy (dissolution chemotherapy). Pigment stones, calci?ed stones or stones larger than 15 mm in diameter are not suitable for this treatment, which is also less likely to succeed in the overweight patient. Drug treatment is prolonged but stones can disappear completely after two years. Stones may re-form on stopping therapy. The drugs used are derivatives of bile salts, particularly chenodeoxycholic acid; side-effects include diarrhoea and liver damage.... gall-bladder, diseases of

See under MENOPAUSE.... hormone replacement therapy(hrt)

These are rare. POLYPS may form and, if symptomatic, should be removed. Malignant change is rare. CARCINOMA of the gall-bladder is a disease of the elderly and is almost exclusively associated with gall-stones. By the time such a cancer has produced symptoms, the prognosis is bleak: 80 per cent of these patients die within one year of diagnosis. If the tumour is discovered early, 60 per cent of patients will survive ?ve years.... other disorders of the gall-bladder

The bladder is a hollow muscular organ with a wall of smooth muscle. It stores urine received from the kidneys which is released via the urethra in an action known as micturition. Common disorders, see: ENEURESIS. FREQUENCY OF URINE. GRAVEL. HAEMATURIA. INCONTINENCE. STONE IN THE BLADDER. STRANGURY. STRICTURE. URETHRITIS. URINE – PAIN ON PASSING. ... bladder disorders

Diseases of the URINARY BLADDER are diagnosed by the patient’s symptoms and signs, examination of the URINE, and using investigations such as X-RAYS and ULTRASOUND scans. The interior of the bladder can be examined using a cystoscope, which is a ?breoptic endoscope (see FIBREOPTIC ENDOSCOPY) that is passed into the bladder via the URETHRA.

Cystitis Most cases of cystitis are caused by bacteria which have spread from the bowel, especially Escherichia coli, and entered the bladder via the urethra. Females are more prone to cystitis than are males, owing to their shorter urethra which allows easier entry for bacteria. Chronic or recurrent cystitis may result in infection spreading up the ureter to the kidney (see KIDNEY, DISEASES OF).

Symptoms Typically there is frequency and urgency of MICTURITION, with stinging and burning on passing urine (dysuria), which is often smelly or bloodstained. In severe infection patients develop fever and rigors, or loin pain. Before starting treatment a urine sample should be obtained for laboratory testing, including identi?cation of the invading bacteria.

Treatment This includes an increased ?uid intake, ANALGESICS, doses of potassium citrate to make the urine alkaline to discourage bacterial growth, and an appropriate course of ANTIBIOTICS once a urine sample has been ana-lysed in the laboratory to con?rm the diagnosis and determine what antibiotics the causative organism is likely to respond to.

Stone or calculus The usual reason for the formation of a bladder stone is an obstruction to the bladder out?ow, which results in stagnant residual urine – ideal conditions for the crystallisation of the chemicals that form stones – or from long-term indwelling CATHETERS which weaken the natural mechanical protection against bacterial entry and, by bruising the lining tissues, encourage infection.

Symptoms The classic symptom is a stoppage in the ?ow of urine during urination, associated with severe pain and the passage of blood.

Treatment This involves surgical removal of the stone either endoscopically (litholapaxy); by passing a cystoscope into the bladder via the urethra and breaking the stone; or by LITHOTRIPSY in which the stone (or stones) is destroyed by applying ultrasonic shock waves. If the stone cannot be destroyed by these methods, the bladder is opened and the stone removed (cystolithotomy).

Cancer Cancer of the bladder accounts for 7 per cent of all cancers in men and 2·5 per cent in women. The incidence increases with age, with smoking and with exposure to the industrial chemicals, beta-napththylamine and benzidine. In 2003, 2,884 men and 1,507 women died of bladder cancer in England and Wales.

Symptoms The classical presenting symptom of a bladder cancer is the painless passing of blood in the urine – haematuria. All patients with haematuria must be investigated with an X-ray of their kidneys, an INTRAVENOUS PYELOGRAM (UROGRAM) and a cystoscopy.

Treatment Super?cial bladder tumours on the lining of the bladder can be treated by local removal via the cystoscope using DIATHERMY (cystodiathermy). Invasive cancers into the bladder muscle are usually treated with RADIOTHERAPY, systemic CHEMOTHERAPY or surgical removal of the bladder (cystectomy). Local chemotherapy may be useful in some patients with multiple small tumours.... urinary bladder, diseases of

Neoplasm of bladder. One third of patients are over 70 years. Most cases today arise from exposure to injurious chemicals only partly eliminated from the body, as from food additives, analine dyes, etc. Evidence also links the disease to excessive coffee-drinking, the general consensus being that caffeine blocks the action of a compound named adenosine – one of the building blocks of DNA – involved in cellular energy. In this way it interferes with natural metabolic processes.

Symptoms: Blood in the urine with absence of pain on passing water in early stages. Then, burning frequency, especially at night. Kidneys become involved. Growths range from papilloma to tumour which may ulcerate in later stages.

The lesion is confirmed by cystoscopy (examination of the bladder by insertion of an instrument to illuminate inner surfaces and makes possible a direct view of the affected tissues). Even when the condition is healed this examination is repeatedly necessary to detect recurrence.

Two kinds: (1) papillary epithelioma (2) squamous cell epithelioma.

Tea. Formula. Equal parts: Marshmallow root, Clivers, Horsetail, Shepherd’s purse. 1-2 teaspoons to each cup boiling water; infuse 10-15 minutes. 2 cups or more daily.

Decoction. Barberry bark cold infusion. 1 teaspoon to each cup cold water. Steep over night. 2 cups or more daily.

Tinctures. Formula. Horsetail 1; Clivers 2; Barberry 1. Mix. 1-2 teaspoons (5-10ml) 2 or more times daily. If inflammation is present add Meadowsweet 1.

Dr William Boericke, physician, advised Dandelion to lessen symptoms.

Diet. See: DIET – CANCER.

Supplements. Emphasis on Vitamins A and C. (Vitamin A in epithelial tumours, ‘New Scientist’ (1975) 303)

Treatment offered as a supportive to specific modern hospital techniques. Treatment by or in liaison with a general medical practitioner. ... cancer – bladder

See bladder tumours.... bladder cancer

A rare birth defect in which the bladder is turned inside out and is open to the outside of the body through a space in the lower abdominal wall.

Usually, there are also other defects, such as epispadias in males and failure of the pubic bones to join at the front.

Surgical treatment involves reconstructing the bladder and closing the abdominal wall.

If the bladder is very small, it is removed and the urine diverted (see urinary diversion).... exstrophy of the bladder

A surgical procedure in which one or more artificial joints made of metal, plastic, or silicone rubber are used to replace finger joints destroyed by disease, usually rheumatoid arthritis or osteoarthritis.

The procedure is usually successful in relieving arthritic pain and enabling the patient to use his or her hands again, but it rarely restores normal movement.... finger-joint replacement

Cholecystitis

Acute or chronic. One of the commonest acute abdominal emergencies. An impressive rise in incidence in the young female population has been linked with the use of oral contraceptives. Other causes: heavy consumption of animal fats, sugars.

Symptoms. Severe upper abdominal pain, often radiating to the shoulder and right midback. Constancy of the pain contrasts with the repeated brief attacks of gall-stone (biliary) colic. Sweating, shallow erratic breathing, tenderness upper right abdomen, distension, flatulence, nausea, intolerance of fatty foods.

In cases of suspected cholecystitis, bitter herbs help liquefy bile and prevent consolidation. Prevention: Blue Flag, or Wild Yam, 2 tablets at night.

For infection: Echinacea.

Alternatives. BHP (1983) selection: Barberry, Mountain Grape, Balmony, Fringe Tree, Wild Yam, Wahoo, Chiretta, Dandelion, Black root; according to individual case. Milk Thistle.

Teas. Agrimony, Milk Thistle, Fumitory, Black Horehound, Wormwood. 1 heaped teaspoon to each cup boiling water, infuse 15 minutes. Half-1 cup freely.

Cold tea. One teaspoon Barberry bark to each cup cold water. Steep overnight. Half-1 cup freely. Tablets/capsules. Blue Flag. Echinacea, Wild Yam, Milk Thistle.

Powders. Equal parts: Echinacea, Wild Yam, Milk Thistle. Dose: 500mg (two 00 capsules, or one-third teaspoon) thrice daily.

Tinctures. Equal parts: Wild Yam, Blue Flag, Milk Thistle. 1 teaspoon thrice daily in water.

Topical. Castor oil pack over painful area.

Diet. Low fat. Avoid dairy products.

Supplementation. Vitamins A, B-complex, C. Bromelain, Zinc. Note. See entry: COURVOISER’S LAW. ... gall bladder, inflammation

Athroplasty. Success rate: high. Commonest indication: osteo- arthritis of hip. A lesser risk of sepsis occurs in first operation than in subsequent ones. Infection is suspected when acetabular loosening is present in conjunction with femoral loosening. Echinacea is the key remedy for combatting infection and for enhancing the patient’s resistance. Comfrey root promotes healing of bone tissue. St John’s Wort gives partial relief in post-operative pain. Horsetail is a source of readily absorbable iron and calcium. For slow healing, a liver agent (Fringe Tree) may be indicated. Alternatives. Teas. Comfrey leaves, Calendula, St John’s Wort, Gotu Kola, Plantain.

Tablets/capsules. St John’s Wort.

Formula. Comfrey root 2; St John’s Wort 1; Echinacea 2; trace of Cayenne (Capsicum). Dose – Powders: 750mg (three 00 capsules or half a teaspoon). Liquid Extracts: 1-2 teaspoons. Tinctures: 1-3 teaspoons. Effect is enhanced when doses are taken in cup of Comfrey herb tea. Other agents to promote renewal of tissue. Slippery Elm bark, Fenugreek seeds, Wild Yam, Carragheen Moss.

Discomfort from a scar. Aloe Vera gel, Calendula, Comfrey or Chickweed cream or ointment. See: CASTOR OIL PACK.

Diet. High protein, oily fish or fish oils.

Supplements. Vitamin C: 3-6g daily. Calcium ascorbate, Zinc. Magnesium. Cod Liver oil for Vitamins A and D; 2 teaspoons daily.

Note: Where titanium alloy implants are used for this operation serum levels of the metal are likely to show up higher than normal. Raised serum titanium has been linked with lung cancer, osteoporosis, and platelet suppression. A New Zealand study has found deaths from cancer were significantly higher in patients having had a metal hip replacement. See: CHELATION.

Comfrey. Potential benefit far outweighs possible risk. ... hip replacement operation

Intermittent, uncontrolled contractions of the muscles in the bladder wall that may cause urge incontinence (see incontinence, urinary). It can occur temporarily if there is a urinary tract infection (see cystitis); a catheter present within the bladder; a bladder stone (see calculus, urinary tract); or an obstruction to the outflow of urine by an enlarged prostate gland. In some cases, symptoms may be relieved by antispasmodic drugs; other treatment is directed at any underlying cause. Bladder training may also be used.... irritable bladder

Preparations containing nicotine that are used in place of cigarettes as an aid to stopping smoking.

Nicotine products are available in the form of sublingual tablets, chewing gum, skin patches, nasal spray, or inhaler.

Side effects may include nausea, headache, palpitations, cold or flu-like symptoms, hiccups, and vivid dreaming.

Nicotine replacement therapy should be used as part of a complete package of measures, including the determination to succeed.... nicotine replacement therapy

A group of disorders affecting the bladder, including inflammation (cystitis) usually caused by a bacterial infection; calculi (stones); impairment of the nerve supply; and tumours. In men, obstruction to urine flow from the bladder by an enlarged prostate gland may cause urinary retention. Tumours of, or injury to, the spinal cord may affect the nerves controlling the bladder, leading either to retention or incontinence. Bladder stones are caused by the precipitation of substances that are present in the urine. Injury to the bladder is uncommon but may occur if the pelvis is fractured when the bladder is full.

Disturbed bladder control can also result from nerve degeneration in conditions such as diabetes mellitus, multiple sclerosis, or dementia. An unstable or irritable bladder is a common condition and is sometimes associated with a urinary tract infection or prolapse of the uterus. Tension or anxiety can cause frequent urination. In children, delayed bladder control (see enuresis) most often results from delayed maturation of the nervous system.... bladder, disorders of

Growths originating in the inner lining of the bladder. Many are papillomas (small wart-like growths), which tend to recur and will eventually become cancerous. Other, more malignant, growths may extend not only into the bladder cavity but may also spread through the bladder wall to involve nearby organs such as the colon, rectum, prostate gland, or uterus.

Bladder cancer is more common in smokers and workers in the dye and rubber industries. Haematuria (blood in the urine) is the main symptom of bladder cancer. A tumour may obstruct the entry of a ureter into the bladder, causing back pressure and pain in the kidney region, or may obstruct the urethral exit, causing difficulty in passing, or retention of, urine.

Bladder tumours are diagnosed using cystoscopy and biopsy of the abnormal area. If small, they can be treated by heat or surgically during cystoscopy. They tend to recur at the same or other sites within the bladder, so that regular follow-up cystoscopy is needed. Bladder tumours that have spread through the bladder wall may be treated by radiotherapy or by surgical removal of part or all of the bladder.... bladder tumours

Another name for irritable bladder.... unstable bladder

A surgical operation to replace a defective or diseased heart valve. (See also heart-valve surgery.)... valve replacement

a surgical technique used to replace a diseased length of aorta, most often the abdominal aorta. It usually involves inserting into the aorta a flexible tube of artificial material, which functions as a substitute for the diseased section.... aortic replacement

(bladder enhancement) a surgical method of increasing the capacity of the bladder to provide a safe, functional, and low-pressure storage reservoir for urine. This is usually achieved by ileocystoplasty or ileocaecocystoplasty (see cystoplasty).... bladder augmentation

an operation that involves an incision through the bladder neck that is extended into the prostate to relieve *lower urinary tract symptoms. This procedure is usually performed under a general or spinal anaesthetic through a cystoscope. It is not as extensive as a transurethral resection of the prostate and is therefore associated with a comparatively lower incidence of side-effects.... bladder neck incision

a combined X-ray and manometry examination of the bladder to look for abnormal function. The bladder is filled slowly with contrast medium using a small urinary catheter and the pressure is monitored during filling and voiding (micturition). X-ray images of the bladder and urethra (see urethrography) are taken. The test is used to differentiate between obstruction to bladder outflow and abnormal involuntary contractions of the muscle in the bladder wall.... bladder pressure study

see detrusor.... overactive bladder syndrome

(PERT) a therapeutic approach using supplements of the digestive enzymes lipase, amylase, and protease (Creon, Pancrex), which are given when there is insufficient endogenous production of pancreatic enzymes: for example, to patients with pancreatic cancer or cystic fibrosis. The capsules must be taken with all meals and snacks to be effective. PERT treats the symptoms of *steatorrhoea.... pancreatic enzyme replacement therapy

a bone that is formed by replacing cartilage with bony material.... replacement bone