Common Male Bladder Diseases and Urethral Infections: From Cancer Prevention and Stone Management to Non-gonococcal Urethritis

156. Bladder diseases and their treatment In clinical practice, bladder diseases are relatively rare, but some are more troublesome, and dangerous bladder diseases are more common in men. (1) Bladder cancer: Men are three times more likely to get bladder cancer than women. The average age of diagnosed patients is 65 years, but current unhealthy lifestyles may increase the chances of men getting the disease in the future. 50% of male bladder cancer patients are caused by smoking. Smoking harms people unknowingly and may not cause the disease until after the age of 30 or 40. Symptoms include frequent urgency to urinate and bone pain in the early stages. A characteristic symptom is blood in the urine. This phenomenon occurs in 85% to 90% of cases. Therefore, experts recommend that anyone with blood in their urine without other symptoms should go to the hospital for examination immediately to rule out the possibility of malignancy. If bladder cancer is confirmed, surgery, chemotherapy, radiotherapy and other methods should be used to treat bladder cancer. (2) Bladder stones: According to statistics, 95% of bladder stones occur in men. Symptoms include blood in urine, frequent urination, chronic urethral infection, and bedwetting. Methods to prevent bladder stones from developing further: ① Drink plenty of water. Drinking plenty of water daily helps prevent the growth of urinary stones, whether bladder or kidney stones. Experts recommend that men with a history of stones should drink about 2000 ml of water daily. ② Observe the color of urine. The color of urine can change with energy expenditure. However, if you haven't drunk enough water, your urine will be bright yellow, indicating that it is too concentrated. If you have stones, your urine will not turn yellow due to dehydration in the summer or while working outdoors. ③ Empty your bladder. Your bladder should be completely emptied. If you are drinking water constantly, make sure you urinate constantly as well, as this can prevent complexes in the urine from clumping together. By drinking plenty of fluids and emptying all your urine, small stone crystals will be expelled, preventing them from combining. (3) Bladder shyness: refers to the inability to urinate in public. This is caused by psychological rather than physical reasons. Bladder shyness can be very distressing for those who enjoy concerts, football matches, or other events where they feel compelled to urinate in public. While it's bothersome, it's not dangerous. Solutions include: ① Consult a specialist. First, consult a urologist to determine if the shyness is caused by an underlying medical condition. ② Delay urination. This method is very effective. Instead of futilely urinating in public restrooms, wait to use a stall. For frequently used public restrooms, develop a strategy to avoid peak usage times, such as halftime of a match or football game. ③ Consider medication. One medication for bladder shyness is the vitamin B complex choline, which stimulates urination. However, because it doesn't always work, consult a doctor to find other options.

Clinical Manifestations and Treatment of Nongonococcal Urethritis Nongonococcal urethritis refers to a type of urethritis transmitted through sexual contact. It presents with urethritis symptoms but gonococci cannot be found in urethral secretions. Chlamydia trachomatis and Ureaplasma urealyticum are the main pathogens, with Chlamydia trachomatis accounting for 40% to 50%. It is a highly infectious bacterium that is not easily eradicated by the human body. 10% to 20% of the human population is infected, but infection may not cause disease for a long time. Ureaplasma urealyticum accounts for 20% to 30%, while others include Trichomonas vaginalis, Candida albicans, herpes simplex virus, Giardia lamblia, Chlamydia psittaci, and other microorganisms. (1) Main clinical manifestations of nongonococcal urethritis: ① It is often manifested as itching, stinging, or burning sensation at the urethral opening, which is sometimes mild and sometimes severe. The degree of pain is milder than that of gonorrhea. ② There is discharge and redness and swelling at the urethral opening. The discharge is usually serous, thinner and less abundant than that of gonorrhea. After a long period of not urinating or before the first urination in the morning, a crust formed by the discharge can be found sealing the urethral opening or staining the underwear. The urethral opening is red and swollen during examination. ③ Some patients may be asymptomatic or have atypical symptoms, so a considerable number of patients are easily missed during the initial consultation. In addition, non-gonococcal urethritis often causes complications such as prostatitis, epididymitis, and seminal vesiculitis. (2) Treatment of non-gonococcal urethritis: ① Tetracycline is the first-line drug for the treatment of non-gonococcal urethritis. Chlamydia trachomatis and most Ureaplasma urealyticum are sensitive to it. The usual dose is 500 mg each time, 4 times a day, orally, generally for 2 to 3 weeks. The longer the medication time, the better the treatment effect. ② Doxycycline 100 mg each time, twice a day, orally, for 7 to 10 days. ③ Minocycline 100 mg each time, twice a day, orally, for 10 days. ④ Azithromycin 1 gram, taken as a single dose, should be taken 1 hour before or 2 hours after a meal. It is effective against gonococci, chlamydia, and mycoplasma, with a broad antibacterial spectrum, strong activity, and resistance to acid and enzymes.

Things to note when experiencing urinary incontinence: Urinary incontinence is not a disease, but a symptom of some underlying diseases. Its severity ranges from the urge to urinate to a complete loss of control. Causes of urinary incontinence include bladder muscle dysfunction, nervous system damage, and specific diseases such as multiple sclerosis or diabetes. Urinary incontinence "completely exhausts men," making them lose their masculinity. They not only want to control the condition but also want to cure it completely. Urinary incontinence can be seen as a signal that something is wrong with a part of the body, so when you encounter such a problem, you can ask a doctor for help and pay attention to the following: (1) Check the medications you are taking: If you are suddenly troubled by urinary incontinence, you should check the medications you are taking. Some medications, such as antidepressants and muscle relaxants, can affect urinary control. (2) Schedule your urination: Only by making a urination plan can you better control your urination. Schedule your urination at a fixed time every day, such as once an hour, and then gradually increase the interval to postpone the urge to urinate once every 2 to 3 hours. This technique works by increasing the bladder's capacity, much like gradually increasing the running distance during marathon training. (3) Measure urine volume: Record urine information on paper, including the date and time of each urination, the amount excreted, the amount of fluid consumed in a day, and the amount excreted. To measure urine volume, you can fill an empty milk container with urine. Mark the milliliters along the outer edge of the container before it is full, making it like a measuring cup so that you can see at a glance how much urine has been urinated. (4) Do regular exercises: This helps strengthen pelvic floor muscles, including the muscles that control the flow of urine. Squeeze the muscles that stop the flow of urine for a few minutes, then release. Continue this for a week, doing 5 repetitions 3 times a day, then gradually increase to 5 repetitions per day. This exercise helps strengthen the pelvic floor muscles and control the bladder.