"Ask the Doctor": Urology

March 8, 2000

The Houston Chronicle presents "Ask the Doctor" with Dr. Fishman discussing urology, the bladder, kidneys, prostate cancer, Viagra, kidney stones, erectile dysfunction, and urinary tract infections.

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HoustonChronicle: The purpose of Ask The Doctor chats is to provide general information and is in no way intended to be construed as medical advice for any visitor's specific disease or condition. For treatment of your specific condition please see your personal physician. This forum is not intended to be used in emergency situations. If you are uncertain of the urgency of your problem or condition, contact your personal physician or the nearest hospital for assistance. Welcome to Ask The Doctor! HoustonChronicle.com and the Talk City Network are proud to present our special guest for today, Irving J. Fishman, M.D. Dr. Fishman, welcome to Talk City!

Dr Fishman: Thank you! Thank you for inviting me to join you, and your discussions on urology. Please feel free to submit your questions to me, and I'll be glad to answer them.

Frustratedmom: My daughter just turned 9 years old, and has had a bed-wetting problem all her life. No doctor has really done any extensive testing. What, if anything, can/should be done?

Dr Fishman: I would first go to your regular pediatrician and have them check her urine for any evidence of infection. Does she cry when she urinates? Does she have problems with wetting during the day as well as during the night? There are several things that the doctor can do to try to alleviate this problem. The first is to try to control the fluid intake in the evening. Perhaps that will decrease the incidence of leakage or incontinence. Alternatively, there's a question as to whether or not this is a persistent problem, or whether there was a time when she was able to control her urine for a period, and then has started leaking again. Another possibility is a problem with the nerves going to the bladder or the sphincter that is controlling her ability to hold back water. If the problem occurs only during the night, then it's unlikely to be due to a true neurological deficit. If the problem is present during day and night then she may well have a neurologic abnormality. The other question is whether or not she is able to control her bowels. Does she have accidents with her bowels as well? If indeed she does have bowel problems, then neurologic deficits should be strongly suspected. There is a variety of training routines that can be purchased through Sears and various other facilities that will try to condition an otherwise normal child to stop urinating at night. One such device is a pad that is placed underneath the bedsheets. It is connected to electrical circuits, low voltage, that trigger an alarm when the pad gets wet, thereby waking the child. After a period of time, they will usually wake up before they get the urge to urinate and may well stop leaking. If this simple routine does not work, then consultation with a urologist would certainly be in order. There are a variety of medications that can be prescribed to prevent children from leaking. Usually these medications are effective in children that are very deep sleepers, and simply do not feel the urge to wake up in order to urinate. But, before prescribing these medications, it would be worthwhile to subject a child who has failed at conventional treatments, to some evaluations such as X-rays of the kidneys and bladder, and urodynamic testing, which encompasses the evaluations of the function of the bladder, both sensory and motor. Again, this should be done under the direction of a urologist.

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