Urological diseases produce symptoms which can include:
1. Flank pain with or without fever and/ vomiting
2. Bleeding in urine
3. Burning sensation during urination
4. Straining for passing urine, poor flow of urine
5. Leakage of urine
6. Sudden inability to pass urine at all/ reduced urine output
7. Testicular pain
8. Testicular enlargement
9. Poor erections
10. Male infertility
Certain symptoms can indicate serious urological problem and need investigations to rule out serious conditions like cancer:
1. Bleeding in urine
2. Flank pain with fever/repeated vomiting
3. Reduced urine output
4. Sudden sever testicular pain
5. Testicular enlargement
1. Severe flank pain with or without high grade fever
2. Reduced urine output
3. Inability to pass urine for hours
4. Sudden testicular pain
What are symptoms of kidney stones?
Stones that lodge in the tube that carries urine from the kidneys to the bladder (ureter) results in severe pain that begins in the loin and lower back and radiates to the groin or front of the lower abdomen. Stones can also produce blood in the urine (hematuria), increased frequency of urination, nausea and vomiting, fever etc. Stones can also be silent.
Which tests are used in diagnosis of stones?
Ultrasound can detect a dilated (swollen)) upper urinary tract and kidney caused by a stone lodged in the ureter, but usually cannot detect small stones, especially those located outside the kidney (in the ureter). It is the preferred imaging method for kidney stone patients who are pregnant.
2. Intravenous Pyelogram (IVP)
This test involves taking a series of x-rays after injecting a contrast agent (dye) into a vein. Most kidney stones can be precisely located using this procedure.
3. Computerized tomography (CT Scan)
It can detect nearly all stones and can be done quickly. CT scan can also help identify other conditions (e.g., ruptured appendix, bowel obstruction) that cause symptoms similar to kidney stones. The drawback is that is somewhat expensive.
How are kidney stones treated?
1. Treating kidney stone disease depends on the size, position and number of stones in urinary system, patient age, associated medical conditions (e.g. antiplatelet medication), occupation of the patient etc.
2. The majority of small stones (< 4 mm stones) that are not causing infection, blockage or symptoms do not need any active treatment in general.
3. Pain that occurs when small stones come down into the ureter can usually be treated with alpha-blockers and analgesia.
4. Certain types of stones, such as those made of uric acid, can be treated with medical therapy but majority of the stones are composed of calcium and are not responsive to medicine.
Indications for surgical treatment of stones include:
1. Presence of infection
2. Presence of kidney failure
3. Persistent colic with no advancement of the stone
Extracorporeal Shock wave lithotripsy uses shock waves to break stone into small fragments that can be more easily flushed out of the urinary tract and pass out from the body. After identification of the position of the stone with X-ray or ultrasound, shockwaves are applied to fragment the stones. This procedure takes about 45 minutes to 1 hour, and is often done as an Outpatient Procedure. It can be repeated and may have to be repeated for larger or harder stones. It however is not suitable for > 2cm sized stones.
1. Ureteroscopy – Involves the use of a scope that can be inserted up the urethra, through the bladder and into the ureter without an incision. Stones are fragmented using Holmium laser.
2. Open Surgery – Pyelolithotomy/ Ureterolithotomy refers to the open surgical removal of a stone from the kidney/ureter. These techniques are rarely used now a days.
3. Percutaneous surgery (PCNL) – Under anesthesia a nephroscope is passed through an incision made in the flank area to locate and remove the stone after breaking it(fragmentation)
A small flexible scope is passed from urethra into kidney. It is used for small renal stones. It does not require kidney puncture, hence there is no risk of bleeding and can be used in patients in whom PCNL cannot be done. Drawback is it cannot be used in very large stones.
Bladder infection (called cystitis) is by far the most common UTI. Infection of the urethra is called urethritis. Kidney infection (called pyelonephritis) requires urgent treatment and can lead to reduced kidney function and possibly even death in untreated, severe cases.
What are symptoms of urinary tract infections?
Symptoms of UTI in adults include the following:
Back pain, blood in the urine, cloudy urine, frequent need to urinate, painful urination (dysuria), fever
What complications can occur due to pyelonephritis?
Pyelonephritis, can lead to sepsis, renal abscess formation and renal failure.
How is kidney infection treated?
1. Antibiotics; Treatment of underlying source of infection if any
2. Rarely drainage or abscess or removal of kidney if emphysematous pyelonephritis.
What is prostatitis?
Prostatitis is an inflammation of the prostate gland. Symptoms will be somewhat similar to bladder infections.
There are 2 kinds of prostatitis:
1. Acute prostatitis
2. Chronic prostatitis.
Both are caused by an infection of the prostate. Some kinds of prostatitis may be a result of the muscles of the pelvis or the bladder not working correctly.
How is prostatitis treated?
The treatment is based on the cause: Antibiotics are used to treat prostatitis that is caused by an infection. Rarely abscesses develop that require treatment. Painkillers are used in chronic prostatitis.
What is epididymo-orchitis?
1. Epididymitis means inflammation of the epididymis.
2. Orchitis :means inflammation of a testis (testicle).
As the epididymis and testis lie next to each other, it is often difficult to tell if the epididymis, the testis, or both are inflamed. Therefore the term epididymo-orchitis is often used. Most cases are due to bacterial infection secondary to pre-existing uroloigcal problem(e.g. prostate enlargement) or sexual transmitted infection in young age.
Mumps ( viral infection usually in childhood) infection in boys can rarely cause epididymo-orchitis. This cause is now uncommon since the MMR (measles, mumps and rubella) immunization is now routinely given to children.
How is epididymo-orchitis diagnosed?
The affected epididymis and testis swell rapidly, and the scrotum becomes enlarged, tender, and red. It can be very painful Diagnosis can be confirmed by ultrasound of scrotum, urine testing for infection. Later investigations can be done to find any pre-existing abnormality.
How is epididymo-orchitis treated?
A course of antibiotics is usually advised as soon as epididymo-orchitis is diagnosed. These normally work well. Pain usually eases within a few days, but swelling may take a week or so to go down. Supporting underwear and painkillers will ease the pain.
What complications can be produced by epidymo-orchitis?
Most people recover fully and complications are uncommon. Possible complications include:
1. An abscess develops in the scrotum. This may need a small operation to drain the pus.
2. Reduced fertility in the affected testis.
3. An ongoing (chronic) inflammation occasionally develops. Rarely, serious damage to the testis may occur and result in gangrene (dead tissue) in the testis that needs to be surgically removed.
The ureter is a long thin tubular structure 10-12 inches long which carries urine produced in the kidney to the bladder. The urine is transported by a process called peristalsis. The ureter actively propels urine from the kidney down into the bladder.
Ureteropelvic junction obstruction is a condition where blockage occurs at the junction where the ureter attaches to the kidney. This results in decreased flow of urine down the ureter and an increase of fluid pressure inside the kidney. This can result in kidney damage.
What are symptoms produced by PUJO?
Ureteral obstruction can cause flank pain on the effected side sometimes with vomiting or rarely with urinary infection. Investigations
Ultrasound can show kidney swelling (called hydronephrosis). Intravenous pyelography (IVP), CT scan and renal scan can be used later for diagnosis.
What is treatment of PUJO?
The traditional treatment for ureteropelvic junction obstruction has been open surgery (open pyeloplasty) to cut out the area of narrowing and re-connect the ureter to the kidney.
What are the newer treatment options for PUJO?
Newer treatment include endopyelotomy, endopyeloplasty etc. Which were developed but were found to be not as effective as open pyeloplasty
Laparoscopic pyeloplasty was developed in order to give the same high success rate obtained with open pyeloplasty while decreasing the morbidity. The internal procedure is performed in the same manner as the open surgery without the need for a large incision. Postoperative pain is less, recuperation is significantly quicker and scarring is minimal when compared with open surgery. The procedure requires general anesthesia and hospitalization (usually 2 nights). An internal stent is also needed for four weeks. Success with this procedure is the same as open surgery (>90%)
Prostate is a gland which sits below urinary bladder. Normally it is small in size. In old age it enlarges in size (called benign prostatic hyperplasia-BPH) and may cause problems is urination.
Pushing or straining to begin urination, weak urinary stream, frequent urination, urgency (sudden urgent need to urinate),night time frequent urination, incontinence ( leakage of urine) and blood in the urine. Some other urethral or bladder problems can also cause similar symptoms. It needs evaluation to differentiate these different conditions.
In severe cases of BPH, acute urinary retention (sudden complete inability to urinate) can result.
Commonly done tests done in BPH include:
1. Ultrasound: Of kidney, prostate and bladder.
2. PSA: It is a blood test is done to differentiate between BPH and prostate cancer. The decision to do PSA is to be individualized as per patient profile.
3. Uroflowmetry: It measures how quickly the urine is flowing. Given image is of a uroflowmetry machine.
4. Sometimes specialized test called urodynamics is done to test power( contractility) of urinary bladder.
How is prostate enlargement treated?
Several treatments are available. Choice of treatment options will depend on age of patient, severity of BPH and general well being of patient.
1. Watchful waiting: Have regular checkups and be ready to start treatment as soon as you need it.
2. Medication:The alpha-blockers work by relaxing the prostate to keep it from blocking the bladder opening. It may cause some amount of giddiness especially if one gets up suddenly from a lying to a standing position. Symptoms usually reappear when the medication is stopped. The 5-alpha reductase inhibitors are used to shrink the prostate.
3. Prostate surgery: When medicine do not work or when associated with certain features (e.g. inability to pass urine at all) there is no alternative to prostate surgery. Mostly it is done by endoscopic methods (called TURP).
What is TURP?
Minimally invasive BPH treatments are used to remove prostate endoscopically. The gold standard surgery for BPH is TURP or transurethral resection of prostate. In TURP, the surgeon inserts a thin telescopic tube up the urethra and cuts away pieces of the prostate to create wide channel which improves the urine flow.
Usually performed when the prostate is too large to be removed endoscopically. Now a days this methods is rarely used for removal of prostate.
What is bipolar TURP?
It is a recent advancement in treatment of BPH.
The limitation of TURP in treatment of large prostate is fluid absorption and consequence side effects. This is overcome when bipolar TURP is used. It is special equipment where there are no side effects of fluid absorption. This allows
1. Treatment of large glands with endoscopic method.
2. Follow the conventional gold standard TURP
3. No additional cost
4. Reduces the side effects
Other new options include laser prostatectomy, green light laser prostatectomy etc.
A stricture occurs when a part of urethra becomes narrowed. There is usually some scar tissue around the affected part of urethra that causes the narrowing. The length of strictures varies from less than 1 cm to the full length of the urethra.
What is the treatment for urethral stricture?
Treatment is usually advised to improve the flow rate of urine, to ease symptoms and to prevent possible complications. Treatment advised by urologist depends on factors such as the site and length of your stricture, also your age and general well-being.
What is urethral dilatation?
This is usually done by passing a thin plastic rod (boogie) into the urethra. Rods of increasing thickness are gently inserted to gradually dilate the narrowed stricture. However, a stricture often tends gradually to narrow again after each dilation. Therefore, a repeat dilation is commonly needed every so often when symptoms recur. Some people are given a self-lubricating tube (catheter) which they insert themselves regularly to keep a stricture dilated.
What is endoscopic cutting of stricture called?
In visual internal urethrotomy (VIU) procedure, a thin telescope is passed into the urethra to see exactly where the stricture is. A tiny knife is then passed down the telescope to cut along the stricture. This widens the narrowed stricture. You will get relief of symptoms from this procedure. However, like dilation, the stricture may re-form and the procedure may have to be repeated from time to time in some cases.
Generally, the shorter the stricture, the greater the chance of a cure with this procedure. Recently laser has been used to cut the stricture similar to knife (laser VIU).
What surgery are done for stricture urethra?
A corrective operation which is called a urethroplasty is performed if the above procedures do not work or stricture is long one. Various techniques are used. For example, a short stricture can be cut out and the two ends of the healthy urethra stitched together.
If the stricture is longer, buccal mucosal graft urethroplasty is advisable. A graft is usually used from the inside of cheek to form the new section of urethra. Urologist will advise which operation is best for the length and site of stricture. As a rule, there is a high success rate in curing symptoms with these operations.
Due to the deep location of the kidneys, there may not be any symptoms until the cancer has grown quite large. The most common symptom is blood in the urine (hematuria). Other symptoms of kidney cancer may include: a lump in the kidney area, recurrent fever, rapid weight loss, lingering dull ache or pain in the side, abdomen or lower back
How are renal cancers diagnosed?
Small and early stage renal cell carcinomas are commonly diagnosed incidentally by routine ultrasound and CT scans done for other unrelated symptoms and health problems. Larger renal cell carcinomas usually present with symptoms. CT scan of is used to know spread of the cancer. In patients with poorly functioning kidney or has allergies to contrast (dye), MRI is done instead.
What is treatment of kidney cancers?
Kidney cancers do not respond to radiotherapy or chemotherapy.
What are types of removal of kidney for kidney cancer?
1. Depending on extend of disease whole kidney with cancer (called radical nephrectomy) or part of kidney (called partial nephrectomy) is done for kidney cancers.
2. Open radical nephrectomy has the standard treatment over last many decades. Laparoscopic radical nephrectomy is developed since last 25 yr to reduce pain and side effects due to large incision in open surgery.
What is partial nephrectomy?
How is prostate cancer (CaP) diagnosed and what are treatment options?
Symptoms due to CaP are often indistinguishable symptoms produced by prostate enlargement. In advanced stages of CaP, it can be suspected by rectal examination.
How CaP diagnosis can be confirmed?
Prostate Specific Antigen PSA test can help in suspecting between CaP and benign prostatic enlargement. Diagnosis requires prostate biopsy (done through rectum)
Staging (knowing extent of spread of cancer) of prostate cancer requires CT scan, MRI of pelvis, bone scan
How is prostate cancer in early stages treated?
Prostate cancer is usually slow growing disease. Early stage CaP has multiple options of management. Watch and watch approach (no treatment), active surveillance, radical prostatectomy, radical radiotherapy(with or without hormonal therapy) are all accepted methods of treatment. This is a difficult decision and it depends on the detailed information of prostate biopsy, patient age, fitness level of patient etc. Each treatment options has pros and cons. You can discuss these options with urologoist who can give use advice as to which option may be best for you.
How is advanced and metastatic (widespread) prostate cancer treated?
Though called advanced, the CaP at this stage can be kept under control for a reasonable period of time (in many years) by hormonal therapy and /or radiotherapy/chemotherapy.
Primary symptom of bladder cancer is blood in the urine (hematuria). Hematuria is usually painless. Other symptoms may include urinary frequency, urgency, passage of blood clots etc.
What are tests done in bladder cancer?
1. Urinalysis (to detect or confirm microscopic hematuria)
2. Urine culture (to rule out Urinary Tract Infection)
3. Urine cytology (to detect cancer cells by examining cells flushed from the bladder during urination)
Cystoscopy is an internal examination of urethra and bladder. The cystoscope is an instrument like a telescope, which is inserted through the urethra in to the bladder. It allows the doctor to view the inside lining of the urethra and bladder and take pieces of bladder cancer for biopsy and diagnosis.
CT scan or MRI can be used to gain detailed information about spread of bladder cancer in the body.
What is the treatment of superficial (not involving bladder too deeply) bladder cancer?
Using a specialized telescopic instrument, the bladder tumor can be scraped and removed through the urethra. There is no operation or scar in the abdomen. This operation is called TURBT. The resected tumor is then sent to the lab for microscopic study to confirm the nature and stage of cancer.
Certain therapies that can used to prevent reappearance of bladder cancer after resection include BCG therapy or intravesical mitomycin treatment.
What is invasive bladder cancer and how it is treated?
1. Invasive tumor that has invaded the bladder muscle. Treatment involves removal of entire bladder and reconstruction. (cystectomy)Types of bladder reconstruction include ileal conduit, and neobladder.
2. Radical cystectomy with formation of ileal conduit is the gold standard treatment. The benefits of removing the bladder are to control disease, eradicate symptoms associated with bladder cancer and long-term survival. For advanced bladder cancer that has spread radiation and chemotherapy are treatment options