What Causes Kidney Stones?

---

Transcript

Chrissy Billau:

Welcome to Prescribed Listening from the University of Toledo Medical Center. On this podcast, we interview our experts to get the answers you need and can trust. I'm your host, Chrissy Billau, and today we are diving into some of the top Googled health questions from 2020 and 2021 with Dr. Ahmed El-Zawahry, who works in the urology department at UTMC. Dr. El-Zawahry, thank you for joining us.

Dr. Ahmed El-Zawahry:

Thank you for inviting me and thank you for the audience to be with us in this interesting conversation.

Chrissy Billau:

What causes kidney stones? What can we do to prevent them? If you've had one, what now? Let's ask the expert. Dr. El-Zawahry here is one of the top Googled health questions. What causes kidney stones? What are they? What causes them? How do you get one?

Dr. Ahmed El-Zawahry:

If you want to bring the answer to me, I'll take the $1 million and Nobel prize. The reason for this, it's very difficult to understand really the causes for the kidney stones. Any disease we have usually depends or has multiple factors, so it's not only one thing, it's not something you're doing or something I am doing or something nature is doing, it's a collection of stuff. The most important is going to be genetics. Once you have this in your genes is going to be running in your family. You have one patient with stones, his sons or daughters are going to have a high risk of stones. If someone has his parents, or even can be grandparents, then it can cause stones in the future.

Dr. Ahmed El-Zawahry:

Every time you're going to see a urologist, they're going to ask you, do you have a family history of stones or do you have your own history of stones? Why? Because once you have a stone, you are always going to have a stone, you cannot run away from it. Genetics is number one player. The other thing that plays is environmental factors. Heat is going to play a role, so if you are having too much of hot weather and you don't have enough fluid to drink to hydrate yourself, then you can have a problem with kidney stones. Of course, again, it's not everybody, it's going to be depending on your genetics that have favorable genes for stones.

Chrissy Billau:

That's interesting. Do you see that, in terms of the heat stuff, do more people closer to the equator have them or more people in the summer up here have them?

Dr. Ahmed El-Zawahry:

Actually, when you look into the stone belt in the United States, for example, it is very interesting because Ohio is one of the stone belt. It goes all the way down to Georgia, and it's not only the hot hot, but it's also the amount of fluid you're drinking. If you are in a heat weather and you're not drinking enough liquids, this means you are going to be higher risk of stones. The next one will be also the diet, some of the diet issues can cause some of the stones. If you are drinking or eating something that have a lot of high protein, for example, this can cause stones. In the past, we used to accuse calcium, but now we know that calcium really by itself is not a cause of kidney stones. It can be contributing factor in certain situations, but it's not a main source of that. Some diseases, some people would have metabolic issues. Sarcoidosis, parathyroid hormone, high calcium level, cystine stones in kids, these are all things can cause increased chance of stones. People with Crohn's disease, or diabetes, obesity, they might have increased risk of stones. Of course, it doesn't mean that everybody is obese going to have stones because we have other factors playing in, but they are going to increase little bit of risks for having the stones.

Chrissy Billau:

What are some signs that you may have kidney stones? I've heard that foamy urine is one.

Dr. Ahmed El-Zawahry:

Foamy urine is not really by itself. Foamy urine is a symptom of having some high protein in urine, but it's not only one time. When someone wakes up in the morning with a full bladder and fill the bathroom with detergents from urine, that foamy urine, it can be just because of the overnight accumulation. Whenever you are having foamy urine, every time you go to the bathroom, then it is a symptom of a kidney disease, not particularly stone, but a kidney disease.

Chrissy Billau:

Okay. What are signs that you may have kidney stones?

Dr. Ahmed El-Zawahry:

This is a very interesting question. You can imagine everything under the sun. You can have nothing, so you come and by chance you have a CT scan or an x-ray or ultrasound, and you find that, oh, you have a kidney stone. This way is like, oh my God, I have a kidney stone, I didn't know about that before, but yes, this can happen. Another is going to be pain, and pain can be very characteristic, however, it's not for everybody. Someone come with pain in the flank, in the back, or sometimes they come with pain in the lower groin, bladder. These are situations where you can have the pain because of the location of the stone. This gives us an idea that you have a long urinary tract, kidneys, then ureters, and the ureter itself is about 12 inches, and the bladder.

Dr. Ahmed El-Zawahry:

Whenever the stone is located in each of these locations, you can have different type of pain. A lot of times it can be typical, but sometimes it can be a typical. When you have a pain somewhere and you say, oh, this looks like a kidney stone, and you come to the physician and they examine you or evaluate you. They say, no, you don't have a kidney stone. Why? Because it can be something else overlapping. It's not very characteristic, but we have to be careful with that. The other thing, blood in urine. Sometimes you can have blood in urine, you can have some burning when you pee. All of these are particularly not a stone related 100%, but it can be related to the stone. When someone have pain with blood in urine, it may be a stone because I have seen a lot of patients, they think, oh, I have a stone, and it is a stone, but it can be another disease. We have to think about multiple overlapping symptoms together.

Chrissy Billau:

If you think you have one, you have the pain, you come in, they do a scan, you do have one.

Dr. Ahmed El-Zawahry:

Yes.

Chrissy Billau:

What do you do? What's the treatment?

Dr. Ahmed El-Zawahry:

That's an excellent question, and again, it depends on the situation. If you have pain, then that is an acute situation, meaning it is sudden, we have to deal with the pain before we deal with the stone. My goal is to relieve the pain, and whenever someone has pain, we have to think about what is the consequences of this pain? What I mean is there are consequences on the patient, consequences on the kidneys. The patient is going to be agonized, but also the kidney can be agonized. When the kidney is agonized, it can be because the kidney is obstructed, blocked, and when the kidney is obstructed, this can damage the kidney over a long time. This is why we have to intervene relatively quick.

Dr. Ahmed El-Zawahry:

Another thing is infection. If the kidney is complaining of pain, because it is obstructed and infected, this is an emergency, which means that someone has this situation, has to run to the ER, run to have management, because a delay can be very, very risky for the patient. In these situations, we have to intervene emergently, relieve the obstruction, sometimes we put a stent, which is a small spaghetti tube, very tiny tube between the kidney and the bladder. A lot of times you come to the ER and we tell you, this is going to happen, because we want to unblock the kidney, and in the same time, it can help with kind of opening the ureter and decrease the pain. In very rare situation, we can go and hunt for the stone. If the stone is easy and close by, we can get the stone and come out, but most of the time in emergencies, with pain, we are going to go and put something just to relieve the pain and come back later.

Chrissy Billau:

You often hear, you have to pass the kidney stone. Does that happen more often than surgery?

Dr. Ahmed El-Zawahry:

There are multiple factors. See, medicine's not easy, it's complicated. It depends on, to make it simple, depends on the patient, the person, depends on the stone, depends on the urinary tract. The patient, if he or she had passed a stone before, then the chance of them having that stone pass is a little bit higher than the regular one. If the stone is small in size, so if the stone is five millimeter, six millimeter, or less, then the chance of passing the stone is relatively high. If the stone is in lower end of the ureter versus up high, then the chance is going to be even higher, because when you think about it, it's a long distance. If the stone pass this whole distance down to the ureter, close to the bladder, then we have a chance of passing the stone.

Dr. Ahmed El-Zawahry:

These are all the factors that we have to think about. Also, if the patient has blockage in his urinary tract. If someone has blockage in the tubes, and this blockage is below the stone, well do whatever you want, it's not going to pass. This is why it is kind of evaluation and evaluating process. The other thing, if you come to me, for example, God forbid, and you have a stone and you are in pain, I'm not going to give you a chance to pass a stone. We have to do something because you are going to be tortured with this pain. All of these are factors that we have to put in mind whenever we think about it.

Chrissy Billau:

If it's left untreated, if you don't know you have it, is there long term damage to it? Could you live with one and never know it?

Dr. Ahmed El-Zawahry:

Wonderful question. Yes, you can have that situation. This is why when someone we treat with a stone, we put them under a [inaudible 00:10:21], we keep following them. Why? Because you can have a stone that is causing very mild pain and you don't feel, it's like normal pain, I experience this pain all the time. This stone can cause blockage and that blockage can damage the kidney. This is why, a lot of times, we have to keep an eye on the kidney. One of the long term consequences, problems with the stones, if we leave them without treatment can damage the kidney. We call it acute obstruction, so this is when you come with pain and we tell you, oh, the stone is blocking the kidney, we have to do something. It's because if we do not intervene within six weeks to drain the kidney, the kidney is getting more damage every day. We can lose the kidney if we are not treating it in the proper timing. If there is an infection with the stone, that damage to the kidney is even faster, so these are situations where we have to intervene quickly.

Chrissy Billau:

Are men's experiences with kidney stones different from women's experiences with them?

Dr. Ahmed El-Zawahry:

It depends. Women can get more stones during pregnancy, but they are lucky because most of these stones can pass, because in women, with the hormones during pregnancy, their calcium in the urine is going to be higher, their kidney is going to be functioning faster, so they might have more stones. But whenever we have the hormones, it makes the ureters wide open, more dilated, so it allows the stones to pass easier. This is a situation where women can have more stones. Usually men have slightly more stones than women, but it depends on the belt, and where is the geographic location. Men little bit higher than women with stones.

Chrissy Billau:

Can children get them?

Dr. Ahmed El-Zawahry:

Yes, and this is very important because when a child gets a stone, we have to think about metabolic problems, so kids can get cystine stones. Also malnutrition, if you have, like in Africa or areas where they have some problems with feeding, malnutrition, their kids can have more metabolic stones and we can see this more in kids.

Chrissy Billau:

How does the pediatrician check to see or do they during the annual?

Dr. Ahmed El-Zawahry:

They don't particularly do any check because whenever we do, the checks it's going to be by x-ray, CT scan, or ultrasound. X-ray and the CT scan have some radiation effect, although now it's very, very low, it's not so much damaging, but we always think about the cumulative effect because if you have an x-ray today, x-ray tomorrow, x-ray again next week, it's not going to be healthy. Ultrasound will be the best option, but I have to have some kind of clues there is something wrong. If the mom is coming and telling me the patient have, or my kid have some pain, he's twisting in an odd way, then we start exploring these options. We do ultrasound or see what is going on with the symptoms and try to come with workup and evaluation. Of course, ultrasound is going to be the easiest way, fastest way, so we use ultrasound most of the time with kids.

Chrissy Billau:

Once you've had a kidney stone, is it one and done, or can you get them again? Are there long term consequences for one?

Dr. Ahmed El-Zawahry:

That is very good. Once you have a stone, you are always going to have a stone, it's a matter of when. Whenever someone has a stone, whenever they are younger age, 15, 16, 20, this means they have a long life, then there are many chances of stones. This is why we tell them about some, kind of call it prevention of stones, but it's not really preventing the stones, but it helps to overcome the chance of stones coming back. Usually, depending on the study you look at, there are 20 to 50% chances of having the stone comes back again within 10 years.

Chrissy Billau:

Oh no.

Dr. Ahmed El-Zawahry:

Yes.

Chrissy Billau:

What can you do to prevent it?

Dr. Ahmed El-Zawahry:

For us, so far, we don't have 100% evidence that one thing works, but the most important that we always stress on, is fluid intake. Fluid intake is a very, and the most important, one mean or method, to prevent storms. Why? Because think about this, if you have a glass of water, and I get salt, every time I add a spoon of salt, it's going to be dissolved more difficult than the next one, and the next one, until at certain point that salt's going to be precipitated and form some salt on the bottom of the glass. The kidneys are in that situation where if you add little bit more salt, it's going to start forming stone. The best way is to add more water or more fluid.

Chrissy Billau:

More fluid like water, milk?

Dr. Ahmed El-Zawahry:

That's a very important question. People always say fluid, water, and if you think about it, water is the best. The problem comes is, I don't like water.

Chrissy Billau:

Yes.

Dr. Ahmed El-Zawahry:

Right? A lot of people don't like water, and I always think about, if I am the patient, how am I going to think? I like my patient to follow what I need them to do. I try to have liquid in general is good, as long as you drink about 60, 70 ounces of liquid a day, that is more than enough to protect against stones. The trick is we need to have citric acid in that liquid, which is very, very rich in lemon or lime. The easy way is, I tell patient, try to have lemonade or water with lemon, or something that has citric acid. Some people have Mountain Dew or Sprite or some of the over the counter drinks that have some of the citric acid. Although it's not going to be the same, like lemon or lime, but it will be helpful over long time.

Chrissy Billau:

Soft drinks?

Dr. Ahmed El-Zawahry:

Not dark ones.

Chrissy Billau:

Okay.

Dr. Ahmed El-Zawahry:

Coffee, tea, Coke, Pepsi, these are the... Stones, if we go back one little step, stones are made of calcium oxalate in 70% of the time, this is kind of a compound. When you have calcium oxalate, oxalate is coming from black drinks, coffee, tea. If you're drinking so much coffee, then it can cause oxalate high in your body. This is why we have to alternate, so I tell my patient, I drink Pepsi, I drink Coke, I'm not going to tell you don't drink those. But, what you need to do is don't drink the whole 80 ounces or 70 ounces, one drink, alternate. When you alternate, you are going to get the benefit of the fluids, but you don't have the side effects, I call it, of the stuff that's in there. Some food is having higher oxalate level, that makes people have chance or higher risk of stones like pistachio, spinach, strawberries.

Dr. Ahmed El-Zawahry:

If you like those, you don't go and dive in a whole bag of strawberries or pistachio and say, oh, I love those, no, you have to be moderate. I remember a patient came to me and she had stone after a stone, like three months and a stone, three months and a stone. I start investigating what's going on, and sometimes I spend time with my patients, and finally she admitted that she owns a store that have pistachio and nuts and all those stuff, and she loves the pistachio. So all the day she's eating what? Pistachio. We all like, hey, we are successful here, pistachio is causing this, you need to stay away from it, or you can eat it, but don't overdo it. This is where it is very important, when you think about what I'm eating, and I wouldn't say avoid it, but don't overdo it.

Chrissy Billau:

What about alcohol?

Dr. Ahmed El-Zawahry:

Alcohol actually is good and bad. It's good because it is like a water pill, so it makes you make a lot of urine, which is very good for us. The problem with alcohol, it's dehydrating for the next day. If you're not catching up on your fluid the next day, then you are behind and this can cause problems. Of course, we're talking about, if you're drinking on a weekend or something, it's not a big deal, but if you are chronically every day, every day, but you're not catching up on your fluid intake, then you're going to be a little bit of higher risk.

Chrissy Billau:

I'd like to look a bit at the big picture. What is the role of our kidneys? What is their job in our body?

Dr. Ahmed El-Zawahry:

Kidneys have... They are the master, so we have certain organs that are playing a very important role in our body. Of course, every organ has very important role. The kidneys have multiple function. Number one is, get rid of extra fluid. If someone has too much fluid in her or his body, then you need to get rid of those. This is where the kidney comes in play. Number two, the kidneys have some hormone that helps with producing red blood cells. If you have someone with kidney problems, they're going to have anemia, because they don't have that hormone. Number three, the kidneys have, of course, regulatory function for the blood pressure for the heart. Some of the hormones that the kidney is producing help to adjust the blood pressure.

Dr. Ahmed El-Zawahry:

It is kind of playing role by making the blood vessels dilated or contract depending on your blood volume, and this helps with the blood pressure control. The other thing is, also the kidney plays a very important role in adjusting the homeostasis of the body. Meaning your body can be acidic or alkaline, depending on the oxygen level, depending on the CO2 level, depending on what you're eating. All of these need to be adjusted. What is going to adjust, is the kidney. The kidneys comes in play, by, okay, we have little bit of more acid, we need to secrete more acid in the urine, or we have little bit more alkaline, we need to increase more of the alkaline that's coming out of urine. The kidneys play a lot of role in adjusting the balance inside your body.

Chrissy Billau:

This is a complicated web of body plumbing.

Dr. Ahmed El-Zawahry:

Yes, it's very complicated. Every part of our body has really a very complicated function. When you think about it, it's very amazing how everything in our body is working.

Chrissy Billau:

It's a beautiful thing too.

Dr. Ahmed El-Zawahry:

It is.

Chrissy Billau:

For our kidney health, and overall health, I know we've touched on this briefly, but I'd like to focus on it. How much water should we be drinking every day?

Dr. Ahmed El-Zawahry:

That is very important question, because I am tortured with patients coming with that every day. The healthy amount of water, there's no actual science or research coming with what is the real amount of water. People tell you have to drink eight glasses of water a day, okay, where is the science behind this? Nobody has science. Some people tell you drink a gallon of liquid a day, and they get you all these big things that everybody's moving with and drink it. If we think about it, all our ancestors, all the time, they didn't have the eight glasses of liquid, they drank whenever they felt I'm thirsty to drink. I always tell people, it's like, okay, if you have a dog or a cat, you don't go and tell them, you have to have the eight glasses of liquid, you just tell them, okay, here's the water you drink whenever you need.

Dr. Ahmed El-Zawahry:

For us, if we translate into real, what is important for us, science. The amount of fluid that we need to have the kidney in the proper function, and we get rid of the waste in our body, is about 20 ounces. Below 20 ounces, that is where it's not appropriate. Above 20 ounces is good, but with 20 ounces, the problem is your urine is going to be very concentrated. We are going to come back to the stones, so we have to have dilution of urine. We are going to say, it's important, depending on your body function and if you are healthy, I would say about 60 to 70 ounces is appropriate. It doesn't need to be one kind of liquid, but it's alternation of different types of liquids.

Dr. Ahmed El-Zawahry:

Water will be a good thing, if you drink about 20, 30% of this liquid water. Can I drink a gallon of liquids? Yes, but you have to be willing to pay the price. What is the price? If you think about it, how big is your bladder? Bladder is about average 10 ounces, 300 CC. Math is very clear. What comes in, goes out. If you're drinking 120 ounces, divided by 10 ounces, then you're going to go to the bathroom 12 times, which is 12 times, every hour during the daytime. If you want to take that chance, go ahead. That is important to think about. The other thing is actually extra fluids, I tell people, think about this, you are making your kidneys, your heart, your liver working extra because if I drink a lot of fluids, what's going to happen? My kidneys have to deal with this extra fluid, my heart have to deal with extra fluid. I am putting more stress on my heart, and on my kidneys, and my rest of body functions. Is it worth it? You make that the judgment. You have to have a balance between what your body needs and how is it going to affect your body function. Usually 60, 70 ounces, you will be going to the bathroom about six times a day, allows your body to get a balance and happy medium.

Chrissy Billau:

In terms of talking about frequency of urination. If we start drinking more water, we should be peeing six times a day?

Dr. Ahmed El-Zawahry:

For every 10 ounces, about one time.

Chrissy Billau:

Okay.

Dr. Ahmed El-Zawahry:

If you think about it, hundred ounces, it will be about 10 times to the bathroom.

Chrissy Billau:

Okay.

Dr. Ahmed El-Zawahry:

I have a lot of people come and say, okay, I'm going to the bathroom so frequent what's going on? Okay, how much you drink? Oh, I'm having my glass all the time. That's expected. It's not a problem if you are willing to go to the bathroom all the time, good luck, but if you are not having a problem with that, that's fine. In general, your body will tell you. If you are thirsty, then you need to go drink. The issue comes with, usually older generation, so if someone's 65, 70, 80, their thermostat that tells them that you need to go drink is not working properly, not as sensitive, and they forget to drink a lot of times. This is when we have to stress, you need to make sure that you are getting the 60 ounces or 50 ounces of fluid in your body to make sure that you are in the right environment.

Chrissy Billau:

What should the color of urine be and should it have a smell?

Dr. Ahmed El-Zawahry:

That's two questions.

Chrissy Billau:

That's two questions. We can start with the first one. What should the color of urine be?

Dr. Ahmed El-Zawahry:

Okay. The color of urine, you are a woman, so it's a gold color. Once it is gold color, you are in the right range. We call it amber yellow. From that color to lighter color, that's when you are in a good hydration status. If it is darker than that, then you are behind in your liquid, unless you are taking some vitamins or some food that makes your urine dark. Of course, you don't look in your urine one time and you say, oh my goodness, my urine is dark, I'm going to die. No, it is the whole day. In the morning it's going to be more concentrated, darker, because you're not drinking when you are asleep. It's going to expect a little bit darker in the morning. The rest of the day, it should be more of the amber yellow. If you are looking at the range of the colors, it could be from dark brown to all the way... When I say dark brown, dark like darker yellow, let me say, it's better color, dark yellow to water like. If you are behind in your fluid, it's going to be dark yellow, if you are super hydrated, it's going to be water.

Chrissy Billau:

Okay. Clear is super hydrated?

Dr. Ahmed El-Zawahry:

Yes.

Chrissy Billau:

Okay. But that won't happen in the morning. What about for men?

Dr. Ahmed El-Zawahry:

Same thing, men and women.

Chrissy Billau:

Okay.

Dr. Ahmed El-Zawahry:

Some people say, okay, I'm exercising a lot, I'm doing this, or I am working in the heat. Do I need to drink more liquid? Yes. Your body usually is going to tell you, but if you are feeling, maybe I am behind, take a look at your urine. If your urine is darker color, then just one or two glasses is going to be more than enough. You may need more because if you are, like in the military, they are exercising in the heat, they're carrying heavy weight, they can drink one or two gallons of liquid and it's not sufficient. Right?

Chrissy Billau:

Yep.

Dr. Ahmed El-Zawahry:

You have to be gauging it depending on the activities, how much. Here is your kidney functions going to tell you whenever your kidney is having the notion, you are super dehydrated, your urine is going to be smaller amount and very dark in color. This is a very, very sensitive thermostat in our body. In this case, if you drink more liquids, it's going to adjust that color.

Chrissy Billau:

When it comes to frequency of urination, I know we talked about this with kidney stones, but for frequency of urination, do other drinks besides water have an impact on kidney health and frequency of urination?

Dr. Ahmed El-Zawahry:

Yes. Yes. That's a very smart question, because probably you're drinking coffee and you go to the bathroom a lot. Some of the drinks, especially black drinks, drinks like Gatorade, they have electrolytes, so when you drink these, you are going to have more frequency. If you look into the coffee, it's going to have a lot of impact because it has caffeine, caffeine is like a water pill. If you drink this and you are hydrated, you are going to be in the bathroom every 15, 20 minutes for maybe hour or two hours. If you are not hydrated well and I'm behind, then you're going to be fine, it's not going to affect you so much. One day you may go to the bathroom so frequent because I drink coffee and I'm hydrated, another day drink the same amount of coffee, but you're not going to the bathroom a lot. This is where it is coming in play, the amount of liquid that is in your body.

Dr. Ahmed El-Zawahry:

Another thing that you brought it up to me now is the food that you are eating. Food is going to have some metabolites and some of the food can have some irritating effect on the bladder. If you are eating something like spicy food, some food that has a lot of fried food, tomato sauce, some people have more sensitivity to these than other people, so this can make someone go to the bathroom more frequent than usual. In the day that they're eating this food, they feel like I'm going to the bathroom, more frequent, what's going on? This is what's going on. Another thing is a lot of younger adults, they exercise and they go and drink tons of protein drinks. This also can cause the same effect on the bladder, because protein drinks has amino acids. Amino acids going to make your urine acidic, and your bladder doesn't like that acidity for a long time, so this can create some sort of frequency going to the bathroom.

Dr. Ahmed El-Zawahry:

Smell, that's another question. The smell of urine if you are holding urine for a long time is going to have an old urine smell, some ammonia in there. Urine smell is actually very characteristic for different disease, so if someone has diabetes, that's not controlled, you can have some smell in the urine. If you have someone who's diabetic and you smell, it's an apple kind of smell, that can be because his diabetes is not controlled and can be causing this smell. Asparagus can cause some smell in the urine. It depends on also usually you wouldn't tell if I eat this food, my urine smells funny. Your body metabolize food different than my body, than other people body, so some food you might metabolize and you have certain smell to it, and you can immediately recognize, you can say, oh, whenever I go to this restaurant or I go to make this kind of food, I'm going to have that funny smell in my urine. This can be happening from different people, but the urine should be not really strong smell most of the time.

Chrissy Billau:

Okay. Now, switching gears, I want to ask you, as a urologist, at what age should men start getting screened for prostate cancer?

Dr. Ahmed El-Zawahry:

AUA guidelines, American Urological Association and ASCO American Society of Cancer, they actually commend starting screening at age of 54. Until the age of 54 and some and 59. 54, whenever someone is younger, family has history of prostate cancer. If someone come and his brother or his father had prostate cancer at the age of 50 or 60, we cheat a little bit and go little bit lower, if no other family history, then it depends on the association you are following the recommendation, between 54 to 59.

Dr. Ahmed El-Zawahry:

We usually recommend until the age of 74. The reason for this is prostate cancer, although we say it's cancer, but there are some grids of prostate cancer is not lethal. Some people can have the prostate cancer for 10 years, 12 years, and it's not causing damage or problems, even if we don't treat it. This is why we have to think about as, whenever we have evaluation and assessment, are we doing good or harm? It will be harm whenever we have people with lower grade cancer, lower risk cancer, and we treat them. Whenever we have someone of 75 and 76 and we screen them, then we're not going to give them so much benefits from treatment, because a lot of times the treatment, versus no treatment, it's not going to make a huge difference until almost 10 years after the start of treatment.

Chrissy Billau:

Wow, so you live with it.

Dr. Ahmed El-Zawahry:

You live with it. This is why they say at age of 74 or 75, if you live another 10 years, depending on of course, what is the average age of the country? Most of the people are going to be 85 or 86. A lot of people would be dying, if they die, with diseases other than prostate cancer. They don't die because of the prostate cancer, but they die with prostate cancer.

Chrissy Billau:

Well, let's talk about urinary tract infections. What are they? What's the risk of getting one? And what can you do to protect yourself from getting a UTI?

Dr. Ahmed El-Zawahry:

That's very important question. Urinary tract infections, or UTI, are very common in women. It's almost 70% of women are going to report in the lifetime that they have UTI. That's one important factor to recognize. In men, it's a completely different story. If a man come with UTI, I think completely different than if a woman come with UTI. Men comes with UTI, this mean that there is a problem, that I need to address. It's either prostate, stone, something not working right. In women, it is very common to have that. It's not bias against women, but it is, because women have, their anatomy is little different. Women have a short urethra, it's about one and a half inch and this makes it easy for infection to climb and cause problem, bacteria. In men, they have natural barriers, long urethra, prostates, so it helps to protect, to some extent, against infections.

Dr. Ahmed El-Zawahry:

That's one thing. The other factor that we have to think about is, what kind of infection we're talking about. There is kidneys, ureters, bladder, prostate, urethra, all of these are different anatomies. Whenever we say UTI, it's a generic term, but most of women, and most of the physician, means bladder infection, which is completely different than kidney infection. Whenever we talk about bladder infection, it is symptoms can be urgency, frequency, but the most important is burning. A lot of times women can say, oh, I have frequency, well, you drink coffee, so you're going to have frequency and it's going to have symptoms like infection, but it's not an infection, so we have to be careful with that.

Dr. Ahmed El-Zawahry:

This is the symptoms of infection, how to protect, important, enough liquid drinking. If someone is drinking very low volume, then it's not good, we have to make sure that we are drinking. Think about it is, we are flushing our system, and usually you don't want to hold urine for three hours or four hours. This is very common in some teachers, nurses, physicians, they tend to hold urine, and this can put them at higher risk. Usually we recommend to drink enough liquids that makes you go to the bathroom every two or three hours. There are other factors, of course, if the woman is menopausal or post-menopausal, versus pre-menopausal, this is completely different category. In post-menopausal, they have some hormonal imbalance or changes that we need to address, and this can cause weakening of the immune system, of the bladder.

Dr. Ahmed El-Zawahry:

In premenopausal, it's mostly related to the holding urine or sexual activities. Having sex is going to increase the risks of contamination, the woman shouldn't blame her partner, it's own bacteria, it's just changing the normal from being a nice, quiet, friendly bacteria, to being more infectious bacteria. Usually we recommend the hygiene, which really science did not prove it's working 100%, but I usually say, why not? Going to the bathroom afterwards, making sure you're not using so much of a spermicide creams or something like that, which is creams that they use for contraception in the past. We don't have those too much now, but these are the things that can increase the risks of infections.

Chrissy Billau:

Do bidet's cause any issues?

Dr. Ahmed El-Zawahry:

The bidet is actually very good.

Chrissy Billau:

They're good? Okay.

Dr. Ahmed El-Zawahry:

Yes. I recommend them. When you think about this, is actually, it's healthy. I heard one show one time and they were talking about the bidet, and they were saying, okay, if you have a peach and the peach has some mud or dust, would you wipe it or would you wash it? Washing it is going to clean it much more. Actually, some women, especially when you start getting like above 35, your skin in the perineal area is very sensitive, very delicate, it's like a baby's skin. If you get some of that toilet paper on that baby skin, it's going to be a little harsh. I usually recommend, in my clinics, I'm usually uro-gynecology too, so I'm doing female urology. I recommend usually doing like a wet wipe. The bidet idea is not really acceptable so much, but the wipes are more soft and has good clean, but it's also very delicate on the delicate tissue, so it protects the skin.

Chrissy Billau:

Well, piggybacking on all the popular Google searches, I want to ask you Dr. El-Zawahry, what is the most common question you get from patients? And what is your answer?

Dr. Ahmed El-Zawahry:

Oh my goodness, that is tricky question. It's usually actually, believe it or not, about the fluid.

Chrissy Billau:

Really?

Dr. Ahmed El-Zawahry:

Yes, because they come and they have a lot of frequency and they come and say, okay, I'm drinking this amount of liquids and I'm going to the bathroom, so why am I going so much?

Chrissy Billau:

Something's wrong.

Dr. Ahmed El-Zawahry:

Something is wrong. They always concerned like, am I doing something wrong? Yes, you're drinking so much. When you drink so much, it's going to cause that much of a situation with going to the bathroom a lot. The other thing that also, waking up at night, we didn't mention that. When someone wakes up at night so many times we said, what comes in, goes out. Whenever someone drinks a glass of liquid within one hour of bedtime, guess what? They're going to wake up to go to the bathroom. People come and they like to have a glass of beer, some wine, some drink, and then they come and say, I'm waking up two or three times what's going on. Yes, because you have these fluids and they are going to cause you to wake up at night that much.

Dr. Ahmed El-Zawahry:

You have to be careful with the fluid intake. It's not a disease, it's not a problem, but you pay the price. You can adjust your life based on that. Some people like to drink the fluids and I tell them, that's fine, but if you are complaining about that, don't do it whenever you are going to travel, for example. I had a patient one time was like, his wife actually told me, every hour, we stop to go to the bathroom. It's like the trip that should be six hours, it's about 10 hours, so do something for him. I was like, how much are you drinking? Whenever he's driving, he has coffee, and he drinks coffee, a cup, after cup, after cup. They stop, they go to the bathroom, get more coffee. Here's the answer to the problem, so it's just have some link between what you're doing and what the price you're going to pay.

Chrissy Billau:

Well, let's talk about some elements of your practice. What have you been working on lately that we can talk about?

Dr. Ahmed El-Zawahry:

I do general urology and I do more of subspecialty, which is a female urology, uro-gynecology and reconstruction of men. What is this? This basically work with people who has frequency, we call it voiding dysfunction, but whenever you think about avoiding dysfunction, what does this mean? It's if someone has frequency, if someone has urgency, if someone is waking up at night to go to the bathroom a lot, if someone has a urinary incontinence, leakage, if someone has difficulty with peeing, if the woman has a prolapse, if pain in the pelvic area, men with large prostate, obstruction in the urethra, stones, bladder dysfunction, bladder problems. All of these are things that comes into my specialty, or subspecialty, recurrent urinary tract infections, slings or meshes that we put for women for prolapse, all of these can funnel into my subspecialty.

Chrissy Billau:

Okay. What is one thing you'd like to tell your patients, and the listeners of our podcast, relevant to your specialty that they need to know?

Dr. Ahmed El-Zawahry:

You need to be healthy. Common sense is important, and if you follow common sense, you're going to live well. Basically like what we talked about, fluid intake, don't overeat something that is going to be something you do every day, you need to alternate, avoid holding urine for a long time. All these things are the healthy habits that we need to adapt to avoid having problems. Constipation is a big player, and constipation causes problems with pelvic floor issues. Pelvic floor is the muscles that control our pelvis, and when you are having constipation, or hold urine, or do some tricky stuff with your pelvic muscles, your muscles are not going to be dealing with you nice, they're going to give you a hard time and this hard time causes problem. I usually tell people, you have to use common sense and don't do crazy stuff that can cause problems. Drinking fluids so much and holding urine, that can cause problems, constipation can cause problems. These are the things that we have to be careful about.

Chrissy Billau:

Listen to your body.

Dr. Ahmed El-Zawahry:

Listen, I like that word.

Chrissy Billau:

It's great when it tells you got to go, you got to go. Everything else.

Dr. Ahmed El-Zawahry:

Yes. Yes. This is very important. Yes. Listen to your body is very nice. Some people come and say, I'm listening to my body, but they're doing crazy stuff too. You have to listen to your body, that's normal.

Chrissy Billau:

And be honest with yourself.

Dr. Ahmed El-Zawahry:

Yes, yes, exactly.

Chrissy Billau:

The second glass of wine at night.

Dr. Ahmed El-Zawahry:

No, but you know, when someone comes... Something very important, when you say listen to your body. Whenever we are born, when you have kids, they are always having a bowel movement, three or four times, it's like, you feel like I'm paying all these diapers for my kids all the time, but this is a normal thing. As we grow, our system change little bit and you have a bowel movement once or twice a day, comes the problem when you are a teenager, I don't want to waste my time in the bathroom.

Chrissy Billau:

Well, you don't want to go at school, right?

Dr. Ahmed El-Zawahry:

Yes. Yes. All of this happen and what ends up with is your body starts changing, your biologic clock starts to change. Now you have a bowel movement every week and you say, my body is doing this, no, you ruined your thermostat, you changed your body biologic clock. The normal has to be coming back. I usually tell people, you have to re-institute the normal. If you're having constipation every week, then you start having some fibers, some food that helps you to have a bowel movement every day or every other day. Training your body, listen to your body, so train your body. I tell my patients, don't let your colon control you, you control your colon. You have to go to the bathroom every day or every other day, almost the same time, in the morning, and this will help your gut to go back to normal. It is important for me, although I'm urology, but believe it or not, constipation affects us in a very bad way. You can have the infections, you can have retention of urine, you can have difficulty voiding. If your bladder is weak, constipation can make it even weaker. You can have a lot of price to pay for constipation that's not treated.

Chrissy Billau:

This has been an awesome conversation and I've learned so much.

Dr. Ahmed El-Zawahry:

I'm glad you did.

Chrissy Billau:

I'm so excited about this. But how can people schedule an appointment with you?

Dr. Ahmed El-Zawahry:

I work with UTMC, University of Toledo Medical Center. Anytime they can call us and I am happy to see them and I have wonderful partners who can see people as well.

Chrissy Billau:

Well, thank you, Dr. El-Zawahry. That's all for this episode of Prescribed Listening from the University of Toledo Medical Center. Subscribe to hear more on your favorite podcast platform and join us next week for another episode where we tackle more of the top Googled health questions.