Dr. Edwin A. Smith, MD, FAAP

During a blepharoplasty, tiny incisions are made under local anesthesia, and any excess skin or underlying tissue is removed from the eyelids. The procedure takes between one and three hours, and patients may have bruising and swelling around their eyes for a few days afterwards. Icing the area may help.

The surgery is sometimes done along with other facial surgery as part of a facelift. Typically, a blepharoplasty is considered cosmetic. In severe cases, however, upper eyelids may droop so significantly that they make it hard to see. In these cases, blepharoplasty may be considered a necessary treatment.

Kidney stones can be smooth or jagged and are yellow to brown in color. They are mostly comprised of the minerals calcium, oxalate, and phosphorus. Examining the stones to see what they are made of can show what caused the stone to be formed in the first place. For example, a stone made of mostly calcium, which is the most common type, can happen any time the urine becomes too concentrated due to dehydration or a blockage in the kidney. A uric acid stone forms when acid levels in the urine get too high, usually due to excessive consumption of animal protein such as meat and fish. A struvite stone is a sign of certain infections, and a cystine stone can be due to a genetic disorder that raises the risk of kidney stones.

The most common symptom of kidney stones is pain, either in the back or lower abdomen, or severe pain when urinating. There may also be blood in the urine. Treatment for kidney stones depends on how large the stone is. Very small stones can pass out of the body on their own, and they do not require treatment other than drinking adequate water and taking pain killers. Larger stones need to be broken apart and removed. The main treatment options are:

• Shock wave lithotripsy, which uses sound wave vibrations to break apart the stone
• Percutaneous nephrolithotomy, or the use of a very tiny tool (like a wire inserted through the back) to break apart and remove the stone
• Ureteroscopy, a thin tube inserted through the urethra and bladder to the stone, where tiny tools can grasp the stone and remove

People who have had one kidney stone are at risk of developing another. To reduce this risk, patients are given instructions specific to the type of stone they developed. Generally the instructions will include drinking more water to dilute the urine, but it may also involve lowering sodium intake or eating less meat.

Urinary tract infections are extremely common: 12% of all men and 40-50% of all women will have a urinary tract infection during their lifetime. They are more common in women because women have shorter urethras, so bacteria have a shorter distance to travel from the outside of the body to the bladder and cause an infection. Some people also have urethras that are an unusual shape or have an obstruction in the urethra that makes getting a UTI more likely. Also, certain chronic illnesses like diabetes weaken the immune system, so any bacteria in the body are more likely to cause an infection.

A urinary tract infection can be diagnosed very quickly by a doctor. A sample of urine can be examined under a microscope for the presence of bacteria or white blood cells. There are also diagnostic strips that can be used to test a urine sample without the need for a microscope. Once a diagnosis is made, treatment is a course of oral antibiotics, and most patients feel better within just a few days. There are some things that patients can do themselves to help reduce the risk of getting a urinary tract infection in the future. Stay well hydrated, wipe from front to back after going to the bathroom, wear breathable cotton undergarments, and don't hold it in when patients feel the urge to go.