Obstruction Of The Urinary Tract Leads To Very Painful Urination
DEAR DR. ROACH: I am a 63-year-old male in good health. A few weeks back, I could not urinate while standing. The only way I could was by laying on my side, and it was very painful with a burning sensation. I went to urgent care and was then sent to an imaging center. My prostate gland wasn't appreciably enlarged, so I was sent to the emergency room and had a catheter inserted.
My primary doctor has referred me to a urologist who is making me wear the catheter for four to five weeks before my appointment. The consultation is for bilateral hydronephrosis. Can you explain this condition to me and what I can expect? -- B.D.
ANSWER: You had obstruction of the urinary tract. In adult men, the most common cause by far is prostate enlargement. The entire prostate needn't be enlarged, only the part where the urethra is, which can get blocked by the prostate tissue. This blockage causes high pressure in the bladder (causing your symptoms), and the high pressure is transmitted to the kidneys (causing "hydronephrosis").
A catheter allows the urine to flow at a low pressure and reverses the swelling. This needs to be done as quickly as possible because continued high pressure in the kidneys causes damage that can eventually become permanent. Many men don't realize they can get permanent kidney damage due to high pressure, even when they are still making urine.
There are other causes of obstruction, such as a stone or tumor, but they wouldn't have you wait such a long time to see the urologist with those. The urologist will discuss your options, including medications and procedures to shrink the prostate.
DEAR DR. ROACH: I am a 78-year-old woman in overall good health. I am not overweight (5 feet, 2 inches tall at 116 pounds) and briskly walk about 8,000 steps per day. I eat a fairly low-fat diet with whole grains, beans, lots of vegetables and fruit, some fish, and a bit of cheese.
Last August, my fasting glucose level was 100 mg/dL, and my A1C was 5.6%. Am I considered prediabetic at these levels? Is there anything I should be asking my primary care doctor about regarding medication or lifestyle changes? -- R.B.
ANSWER: Prediabetes is most commonly defined as an A1C level (a marker of overall blood sugars for the past two to three months) between 5.7% and 6.5%. Diabetes is defined to be 6.5% or higher if the A1C test is repeated. A fasting glucose level of 100 mg/dL is just at the border of prediabetes. Medication is not typically used in situations like yours.
It sounds like both your exercise regimen and diet are pretty healthy. While I recommend you discuss this with your doctor, you might get the most useful information by keeping a careful food diary for at least a few days and meeting with a registered dietician, who can give you personalized information.
Like many systems, the ability of the pancreas to release insulin in response to high blood sugar tends to wane as we get older, and it is very common to see subtle changes in your blood sugar. It's unlikely that you will get damage from this degree of blood sugar elevation, even if you have a longer-than-expected lifespan.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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