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The major genitourinary (GU) problems of terminal illness are incontinence, obstruction, blood in the urine (hematuria), and sexual dysfunction. Urinary problems are strongly associated with bladder (and other regional) cancer, bladder infection, and radiation injury. For a variety of reasons, urinary tract infections are relatively common, especially among people with catheters. GU dysfunction may also signal problems other than within the GU tract, such as spinal cord compression (see chapter on neurological problems). Other problems that often involve the GU tract, but which are discussed in the chapter on skin problems, include candidiasis (”yeast infection”), fistulas, malignant ulcers, and pruritis

Incontinence

Urinary incontinence may be complete, partial, “urgency” or “stress.” Although the focus of care is usually primarily on physical aspects, caregivers should remember that patients sometimes experience incontinence as embarrassing and/or a sign of deterioration. In most cases, incontinence signals significantly increased dependence. Causes and characteristics of incontinence in patients with cancer include the following:

Over-sedation (especially from opioids or tranquilizers): Incontinence primarily at night or while asleep (also see heart failure below).

Diuretics: Incontinence primarily following administration of diuretics. Characterized by frequency, urgency, and large volume of urine.

Other medications that may affect continence include: Anticholinergics such as antihistamines, antianxiety or sleeping medications, antidepressants, antipsychotics (often used to treat nausea), blood pressure medications, and decongestants. Alcohol may also affect continence.

Urinary tract infection: Incontinence accompanied by dysuria (pain or burning with urination), frequency, urgency, or difficult urination.

Stress incontinence: Incontinence resulting from movement, lifting, coughing, laughing, etc.

Problems of access complicated by weakness, tremors, etc.: Incontinence as the result of urgency coupled with inability to reach the toilet or manage buttons, zippers, etc. Also see urgency below.

“Irritable bladder” (detrusor overactivity): Incontinence with sudden urge and partial loss of urine. Detrusor overactivity is common among older people. In patients with cancer, incontinence may be related to irritation to bladder from tumor, medications, other agents.

Frequency due primarily to urinary frequency can result from problems of diabetes, hypercalcemia, and other physical causes.

Retention (bladder unable to empty) or atonic bladder (no muscle tone): Incontinence with no awareness of full bladder or urgency. Among the causes are pelvic lesions, spinal cord injury, diabetic neuropathy, other neurological damage.

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The research is published in the Journal of Pediatrics, March 2008.

According to new research, though male circumcision protects men from HIV, it does not protect them against other common sexually transmitted infections such as chlamydia, genital warts and genital herpes.

The researchers from the University of Otago Dunedin School of Medicine, New Zealand, say while there is “compelling evidence” that male circumcision offers men a level of protection against HIV, but it is unclear whether the procedure lowers the risk of other types of STIs.

In a study involving 499 men born in 1972 and 1973, of whom 40% had been circumcised in early childhood, it was found that up to age 32, there were no statistically significant differences in rates of STIs other than HIV between the two groups even after adjustments were made for sexual behaviour and socioeconomic factors.

It was found that 23.4% and 23.5% of the circumcised and uncircumcised men, respectively, reported having had STIs, the most common of which were genital warts, chlamydia and genital herpes.

Another erstwhile study from New Zealand start going that circumcision appeared toward share in the cost respecting stds toward men spiral so that dodder 25; dickson and his colleagues verbalize that woolgathering was pooped out in a deflated scrape together in relation to individuals with a lower size up of STDs save and except that bruited about irruptive the current study and fewer men in that weigh had been circumcised.

Dr. Nigel P. Dickson who led the research says it appears unlikely that circumcision has a major protective effect against common STIs.