Urology

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• Urology (also known as the study of genitourinary surgery) is the branch of medicine that focuses on surgical and medical diseases of the male and female urinary tract system and the male reproductive organs.
• The organs under the domain of urology include the kidneys, adrenal glands, ureters, urinary bladder, urethra, and the male reproductive organs (testes, epididymis, vas deferens, seminal vesicles, prostate, and penis).

What Are Urologic Diseases?

• The term “urologic diseases” describes a wide variety of conditions, all related to the filtering and carrying of urine out of the body.
• These diseases can affect men, women, and children of all ages.
• These diseases affect very specific parts of the body.
• In females, they involve the urinary tract.
• In males, they affect the urinary tract or the reproductive organs.

Some other common urological conditions include:

• Prostate cancer.
• Bladder cancer.
• Bladder prolapse.
• Hematuria (blood in the urine)
• Erectile dysfunction (ED)
• Interstitial cystitis (also called painful bladder syndrome)
• Overactive bladder.
• Prostatitis (swelling of the prostate gland)

Benign Prostatic Hyperplasia (BPH)

• Benign prostatic hyperplasia (BPH) is an enlarged prostate. It is an increase in the size of the prostate gland.
• BPH is very common in older men. It is not directly connected to prostate cancer.
• Men with BPH may experience a frequent urge to urinate. They may also have a weak stream of urine when they do go and a feeling that the bladder is not empty after urination.
• Your doctor may choose to just monitor this condition or prescribe medications such as alpha-blockers for treatment. Severe cases can be treated with surgery.

Urinary Incontinence

Urinary incontinence is a loss of bladder control. It results in the unwanted leakage of urine. According to the AUAF( Foundation of The American Urological Association), more than 15 million people in the United States have incontinence.

The most common causes include:

• Diabetes,  Pregnancy or childbirth, Overactive bladder, Enlarged prostate, Weak bladder muscles, Weak sphincter muscles (muscles supporting the urethra),  Urinary tract infections, Diseases including Parkinson’s and multiple sclerosis, Injury to the spinal cord, Severe constipation.
• In some cases, lifestyle changes such as controlling fluid intake can be enough to address the problem. If these approaches prove ineffective, your doctor may suggest surgery to correct the underlying cause.

Urinary Tract Infections (UTIs)

• UTIs are the result of pathogenic bacteria(specially E.coli) or viruses that invade the urinary tract and cause infection. They are much more common in women, although men can get them too.
• According to the AUAF, roughly 40 percent of females and 12 percent of males will have a UTI that causes noticeable symptoms at some point in their lives.
• A burning sensation during urination is one of the symptoms of a UTI. Others include a frequent urge to urinate and the feeling that the bladder is not completely empty after urinating.
• Antibiotics can usually clear up most UTIs within five to seven days.

Kidney and Urethral Stones

• Stones develop in the kidneys when there are crystals in the urine. Ureteral stones are ones that move from the kidney into the ureter.
• These stones can block urine flow and cause a considerable amount of pain..
• Medical or surgical procedures may be needed in some instances, to remove large stones. Extracorporeal shock wave lithotripsy (ESWL) is one of the most commonly used techniques. The procedure involves using sound waves to break stones into smaller pieces so that they can more easily exit the body.

Some Important Terms

• Endo-Urology: Endourology is the branch of urology that deals with minimally invasive surgical procedures. As opposed to open surgery, endourology is performed using small cameras and instruments inserted into the urinary tract.
• Urologic-Oncology: Urologic oncology concerns the surgical treatment of malignant genitourinary diseases such as cancer of the prostate, adrenal glands, bladder, kidneys, ureters, testicles and penis. The medical treatment of advanced genitourinary cancer is managed by either a Urologist or an Oncologist depending on the cancer.
• Neuro-Urology: Neurourology concerns the control of the genitourinary system by the nervous system and of conditions causing abnormal urination. Neurological diseases and disorders such as multiple sclerosis, Parkinson’s disease and spinal cord injury can disrupt the lower urinary tract and result in conditions such as urinary incontinence, detrusor overactivity, urinary retention and detrusor sphincter dyssynergia.
• Pediatric-Urology: Concerns urologic disorders in children. Such disorders include cryptorchism (undescended testes), congenital abnormalities of the genito-urinary tract, enuresis, underdeveloped genitalia (due to delayed growth or delayed puberty, often an endocrinological problem) and vesicoureteral reflux.
• Andrology: is mainly concerned with male infertility, erectile dysfunction and ejaculatory disorders. Since male sexuality is largely controlled by hormones, andrology overlaps with endocrinology. Surgery in this field includes fertilization procedures, vasectomy reversals and the implantation of penile prostheses. Vasectomies may also be included here although most urologists perform this procedure.
• Reconstructive Urology: reestablishes functionality of the genito-urinary tract. Strictures of the urethra or the ureter often require reconstructive surgery. Another frequent procedure is the reconstruction of the urinary bladder from small bowel in conjunction with cancer surgery. Cosmetic surgery such as penis enlargement is rarely done in urology.
• Female Urology: is a branch that deals with overactive bladder, pelvic organ prolapse, and urinary incontinence. Thorough knowledge of the female pelvic floor together with urodynamic skills are necessary to diagnose and treat these disorders. Depending on the cause of the individual problem a medical or surgical treatment can be the solution.

Common Procedures

• Trans-Urethral Needle Ablasion of the Prostate
• Cystoscopy with Retrograde Pyelogram
• Prostatectomy
• Trans-Urethral Resection of Prostate
• Circumcision
• Ureterorenoscopy for ureteric stones
• PCNL(Percutaneous Nephrolithotomy)
• Cystolitholapexy for bladder  stones
• ESWL for renal stones
• Urethroplasty for stricture
• VVF/UVF repair
• Nephrectomies
• Pyeloplasty
• Hypospadias repair

Trans-Urethral Needle Ablasion of the Prostate

Transurethral needle ablation (TUNA) of the prostate is a procedure used to treat benign prostatic hyperplasia (BPH). It is performed by placing interstitial radiofrequency (RF) needles through the urethra and into the lateral lobes of the prostate, causing heat-induced coagulation necrosis. The tissue is heated to 110°C at an RF power of 456 kHz for approximately 3 minutes per lesion. A coagulation defect is created.

Cystoscopy with Retrograde Pyelogram

Cystoscopy with retrograde is a procedure where provider will examine the bladder with a lighted telescope. The cystoscope is placed into the bladder and a small tube is inserted into the opening of the ureter. Contrast is then injected into the small tube and fluoroscopy is done evaluating images of the ureter and kidney. A sample of fluid may be taken during this procedure or a ureteral stent may be placed.

Prostatectomy

• Is a medical term for the surgical removal of all or part of the prostate gland. This operation is done for benign conditions that cause urinary retention, as well as for prostate cancer and other cancers of the pelvis.
• There are two main types of prostatectomies. A simple prostatectomy (also known as a subtotal prostatectomy) is when only part of the prostate is removed. Simple prostatectomies are typically only done for benign conditions. A radical prostatectomy, the removal of the entire prostate gland, the seminal vesicles and the vas deferens, is performed for malignant cancer.

Ureteroscopy for Ureteral Stones

• Ureteroscopy is an examination of the upper urinary tract, usually performed with a ureteroscope that is passed through the urethra and the bladder, and then directly into the ureter; usually the lower 2/3 of the ureter is accessible by this procedure. The procedure is useful in the diagnosis and treatment of disorders such as kidney stones. Smaller stones in the bladder or lower ureter can be removed in one piece, while bigger ones are usually broken before removal during ureteroscopy.
• The examination may be performed with either a flexible or a rigid fibre optic device while the patient is under a general anesthetic. The patient is usually free to go home after the examination.

Percutaneous Nephrolithotomy (PCNL)

Percutaneous Nephrolithotomy (PCNL) is a minimally-invasive procedure to remove stones from the kidney by a small puncture wound (up to about 1 cm) through the skin. It is most suitable to remove stones of more than 2 cm in size and which are present near the pelvic region. It is usually done under general anesthesia or spinal anesthesia.

Extracorporeal Shock Wave Lithotripsy (ESWL)

• Extracorporeal shock wave lithotripsy (ESWL) is a non-invasive treatment of kidney stones[1] (urinary calculosis) and biliary calculi (stones in the gallbladder or in the liver) using an acoustic pulse. It is also reported to be used for salivary stones.[2] and pancreatic stones.
• Means-Extracorporeal shock wave lithotripsy (ESWL) uses shock waves to break a kidney stone into small pieces. These pieces can more easily move through the urinary tract and pass from the body.
• For this procedure you lie on a water-filled cushion. X-rays or ultrasound tests are used to locate the stone. High-energy sound waves pass through your body without injuring it and break the stone into small pieces.

Vesicovaginal fistula (VVF)

• VVF: is an abnormal fistulous tract extending between the bladder (or vesico) and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault.
• Cause: caused by childbirth (in which case it is known as an obstetric fistula), when a prolonged labor presses the unborn child tightly against the pelvis, cutting off blood flow to the vesicovaginal wall. The affected tissue may necrotize (die), leaving a hole.
• Procedure: Surgical management of VVF can be performed through various approaches namely vaginal or abdominal. The abdominal approach can be performed with open or laparoscopic approach.

• Pyeloplasty is the surgical reconstruction or revision of the renal pelvis to drain and decompress the kidney. Most commonly it is performed to treat an uretero-pelvic junction obstruction if residual renal function is adequate.

• A pyeloplasty can either be done by the robotic, open, or laparoscopic route.

Diagnostic Tests

• Cystoscopy and Ureteroscopy
• Medical Tests for Prostate Problems
• Imaging of the Urinary Tract
• Urodynamic Testing