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Urology (from Greek οὖρον - oûron, "urine" and -λογία, -logia "study of") is the branch of medicine that focuses on the 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).
As a medical discipline that involves the care of many organs and physiological systems, urology can be broken down into several subdisciplines.
Endourology is the branch of urology that deals with the closed manipulation of the urinary tract. It has lately grown to include all urologic minimally invasive surgical procedures. As opposed to open surgery, endourology is performed using small cameras and instruments inserted into the urinary tract. Transurethral surgery has been the cornerstone of endourology. Most of the urinary tract can be reached via the urethra, enabling prostate surgery, surgery of tumors of the urothelium, stone surgery, and simple urethral and ureteral procedures. Recently, the addition of laparoscopy and robotics has further subdivided this branch of urology.
Laparoscopy is a rapidly evolving branch of urology and has replaced some open surgical procedures. Robot-assisted surgery of the prostate, kidney, and ureter has been expanding this field.
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 treatment of genitourinary cancer is managed by either a urologist or an oncologist, depending on the treatment type (surgical or medical). Most urologic oncologists in western countries use minimally invasive techniques (laparoscopy or endourology, robotic-assisted surgery) to manage urologic cancers amenable to surgical management.
Neurourology concerns nervous system control of the genitourinary system, and of conditions causing abnormal urination. Neurological diseases and disorders such as a stroke, 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. Urodynamic studies play an important diagnostic role in neurourology. Therapy for nervous system disorders includes clean intermittent self-catheterization of the bladder, anticholinergic drugs, injection of Botulinum toxin into the bladder wall and advanced and less commonly used therapies such as sacral neuromodulation. Less marked neurological abnormalities can cause urological disorders as well—for example, abnormalities of the sensory nervous system are thought by many researchers to play a role in disorders of painful or frequent urination (e.g. painful bladder syndrome also known as interstitial cystitis).
Pediatric urology concerns urologic disorders in children. Such disorders include cryptorchidism (undescended testes), congenital abnormalities of the genitourinary tract, enuresis, underdeveloped genitalia (due to delayed growth or delayed puberty, often an endocrinological problem), and vesicoureteral reflux.
Andrology focuses on the male reproductive system. It 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 is a highly specialized field of urology that restores both structure and function to the genitourinary tract. Prostate procedures, full or partial hysterectomies, trauma (auto accidents, gunshot wounds, industrial accidents, straddle injuries, etc.), disease, obstructions, blockages (e.g., urethral strictures), and occasionally, childbirth, can necessitate require reconstructive surgery. The urinary bladder, ureters (the tubes that lead from the kidneys to the urinary bladder) and genitalia are other examples of reconstructive urology.
Urogynecology is a branch dealing 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.
Benign prostatic hyperplasia (BPH) is a common urological condition caused by the non-cancerous enlargement of the prostate gland as men get older. As the prostate enlarges, it can squeeze down on the urethra. The symptoms associated with BPH are known as lower urinary tract symptoms. This can cause men to have trouble urinating and leads to symptoms of BPH. The symptoms associated with BPH are known as lower urinary tract symptoms (LUTS)
As a man ages, his prostate may become larger and start to cause urinary symptoms and other problems. But what are some of those problems? How will a man know if he has an enlarged prostate (also known as BPH)? When should a man see his doctor? What kinds of tests will my doctor perform? The following guide should help answer your questions and help you make an informed decision about what your next steps should be.
The prostate is part of the male reproductive system; it is about the size and shape of a walnut normally and weighs about an ounce. It is located below the bladder and in front of the rectum, and surrounds the urethra, the tube-like structure that carries urine from the bladder out through the penis. The main function of the prostate is to produce fluid for the semen.
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Risk factors for developing BPH include:
Since the prostate is just below the bladder, its enlargement can result in symptoms that irritate or obstruct the bladder. Common symptoms are:
In extreme cases, a man might not be able to urinate at all, which is an emergency that requires prompt attention.
In order to help assess the severity of such symptoms, the American Urological Association (AUA) BPH Symptom Score Index was developed. This diagnostic system includes a series of questions that ask how often the urinary symptoms identified above occur and the amount of bother from these symptoms. This helps measure how severe the BPH is — ranging from mild to severe.
When a doctor evaluates someone for possible BPH, the evaluation will typically consist of a thorough medical history, an examination of the urinary sediment (urinalysis) a physical examination (including a digital rectal exam or DRE), and use of the AUA BPH Symptom Score Index. In addition, the doctor will generally do a urine test called a urinalysis. There are a series of other studies that may or may not be offered to a patient being evaluated for BPH depending on the patient’s current medical condition. These include:
A man should see a doctor if he is bothered by any of the symptoms mentioned previously. In addition, he should see a doctor immediately if he has blood in the urine, pain with urination, burning with urination or is unable to urinate.
This treatment option is good for patients who have mild symptoms of BPH or have moderate to severe symptoms but are not bothered by their symptoms. Patients suffering from kidney problems as a result of BPH, urinary retention (suddenly being unable to urinate), or frequent urine infections, and urinary incontinence are not good candidates for this treatment option.
During watchful waiting, a patient is closely monitored by his physician but he does not receive any active treatment. Many patients’ symptoms can be controlled and/or managed by changing their current medications and diet. Patients will be examined yearly, and findings from the tests will be used to determine if additional treatment is needed in order to control a patient’s BPH.
The risk of watchful waiting may be that the patient’s symptoms cannot be reduced after active treatment is started.
Alpha blockers: These drugs, originally used to treat high blood pressure, work by relaxing the smooth muscle of the prostate and bladder to improve urine flow and reduce bladder outlet obstruction. Although alpha blockers may relieve the symptoms of BPH, they usually do not reduce the size of the prostate. They are usually taken orally; once or twice a day and work almost immediately. Commonly prescribed alpha blockers include:
All of these drugs have the same equal level of effectiveness and side effects. Side effects can include headaches, dizziness, light-headiness, fatigue and ejaculatory dysfunction. These medications are beneficial for patients who have bothersome to moderate severe BPH.
Patients who are undergoing cataract surgery may be advised by their physician against taking this medication until after their surgery.
5-alpha-reductase inhibitors: Finasteride and dutasteride are oral medications used to treat BPH. In select men, finasteride and dutasteride can relieve BPH symptoms, increase urinary flow rate and actually shrink the prostate though it must be used indefinitely to prevent symptoms. Studies suggest that these medications may be best suited for men with relatively large prostate glands. These drugs reduce the risk of BPH complications such as acute urinary retention (suddenly being unable to urinate) and the eventual need for BPH surgery. Side effects generally are sexually related and include: erectile dysfunction decreased libido and reduced semen released during ejaculation.
Finasteride should not be used if men do not have prostate enlargement. Finasertide has been shown to cause more adverse effects in the beginning of its use; however, over a period of time the side effects between finasteride and dutasteride become equal.
Combination Therapy: The use of both alpha blockers and 5-alpha-reductase inhibitors have shown to be superior to single drug therapies in men with larger prostates. The combination approach prevents the progression of disease and improves bothersome symptoms. However, this improved benefit may be associated with more side effects (possible side effects from both medications).
Anticholinergics: Another medical therapy that is an appropriate and effective treatment alternative for the management of symptoms related to BPH.
Complementary and Alternative Medicines/Phytotherapies: These compounds, also know as herbal therapies, are very popular self treatment remedies. Currently there is no dietary supplement, complementary alternative medicine or therapy that is recommended for the management of BPH. Furthermore, the quality and purity of these over-the-counter supplements are not rigorously monitored, adding further uncertainty about the value and safety of these products.
Saw palmetto one of the more popular dietary supplements used by men has been shown to provide no benefit over a placebo for the treatment of BPH conditions and LUTS.
Since the advent of medical therapy for symptomatic BPH with 5-alpha reductase inhibitors and alpha-adrenergic blockers, the need for immediate surgical intervention in symptomatic prostatic obstruction has been reduced substantially. However, alpha-blockers do not modify prostate growth, and even the use of prostatic growth inhibitors such as finasteride or dutasteride often fails to prevent the recurrent LUTS of BPH and urinary retention. In the past, these patients would almost certainly have undergone more invasive treatment earlier in the disease process.
There are many surgical procedures to treat BPH. Surgery is the most invasive approach and is typically reserved for patients suffering from moderate-to-severe BPH related LUTS or complications which arise from BPH (e.g. urinary retention, progressive LUTS, recurrent urine infection). It is generally reserved for patients who have not been able to successfully treat the condition with other treatment options or for those who present with moderate to severe BPH. The following are the generally accepted surgical treatment options:
Has excellent outcomes and is the gold standard. All treatment options are generally compared to this approach. It is not safer with bipolar TURP meaning less risk of water intoxication leading to low sodium levels.
Before deciding if any of these treatment options are best make sure to discuss with your physician the following:
The following are things a patient should consider before deciding on a particular option:
Aging, sickness, or injury can lead to problems in the urinary system. With age, certain changes in the kidneys’ structure may cause them to lose some of their ability to remove wastes from the blood. In addition, the ability of the kidneys to filter blood entirely may be weakened by poor health or injury.
Muscles in your bladder and urethra may be inclined to lessen in strength. Increased urinary infections may occur because the bladder muscles do not tighten enough to completely empty your bladder. Diminished strength in the sphincter and pelvis muscles will in some cases lead to incontinence.
Yes. Certain foods, also known as bladder irritants, can contribute to urinary frequency, urgency, and discomfort. Below is a list of irritants, eliminate the foods that make your symptoms worse for 10 -14 days. Once you are feeling better, you can begin to add foods back into your diet, one at a time. If your symptoms return, you should avoid that food. Be sure to drink plenty of water
If incidents of incontinence are isolated, medical attention may not be required. However, if incontinence is recurrent or affects your quality of life, discuss symptoms with your doctor.
As the bladder muscle ages this may lead to decreased ability to store urine and elevated overactive bladder symptoms. With blood vessel disease, there is a risk of increased overactive bladder. Good overall health — including no smoking, moderate blood pressure and a healthful weight — can help limit symptoms of overactive bladder.
Smoking is the leading cause of bladder cancer; therefore, if your smoke, stop. A special type of chemotherapy medication called mitomycin can prevent the recurrence of bladder cancer if it is instilled immediately following bladder tumor resection. Another type of immune therapy uses specially treated tuberculosis bacteria called BCG that is instilled into the bladder to prevent bladder cancer recurrence. BCG is instilled into the bladder as an office procedure once the bladder has healed.
Although controversial and not proven, natural measures may decrease the risk of developing bladder cancer
Bedwetting or nocturnal enuresis is a common problem in children.
The bladder is a hollow organ, which stores urine produced...
Benign prostatic hyperplasia (BPH) is a common condition in aging men...
Erectile Dysfunction is the persistent inability to achieve and maintain...
The kidneys play an important role in eliminating waste products...
Scrotal pain is any discomfort of the scrotum or its contents...
Robotically-assisted surgery was developed to overcome...
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