Urology is the specialty of medicine concerned with the study of the genito-urinary system along with the treatment of its associated problems and diseases. The organs covered by urology include the kidneys, ureters, urinary bladder, urethra, and the male reproductive organs (testes, epididymis, vas deferens, seminal vesicles, prostate and penis).
The function of the urinary system can be affected by ageing, hereditary factors, injury, infection, underlying illnesses, or hormonal imbalances that can lead to wide-ranging symptoms such as excessive urine production; prostate cancer restricted urinary flow, frequent, urgent or involuntary urination as well as pain.
Subfields of urology include urologic oncology, stone disease, voiding dysfunction, pediatric urology, sexual dysfunction and male infertility
The services/treatment offered are categorized under:
Benign Prostate Hyperplasia (BPH) is the enlargement of the prostate, frequently occurring in men over the age of 50. The enlargement can result in a gradual squeezing of the urethra, sometimes causing difficulty in urinating. Normally it is less than 20 grams. But it can enlarge up to 140 grams.
Many men may not have any symptoms of BPH. If you do have symptoms, they may include:
A weak urinary stream
Difficulty starting urination
Interrupted flow of urine.
Frequent urination
Urgency to pass urine
Frequently awakening at night to urinate
Sense of incomplete urination.
Blockage of the urethra from BPH may lead to repeated urinary tract infections, a sudden inability to urinate, or gradual bladder and/or kidney damage.
Treatment
TURP: Trans urethral resection of prostate remains a gold standard in the surgical treatment of prostate. Advantage of TURP are: no open surgery, safe to the patient, limited short hospital stay, sexual potency and continence maintained after surgery, and cost effective.
LASER assisted TURP. Traditional TURP done with LASER energy source. Very minimal blood loss.
Saline TURP. Plasma kinetic energy is used to do TURP.
Open prostatectomy only if the prostate is very big, more than 120 grams.
Prostate Cancer
Radical prostatectomy is gold standard for organ confined prostate cancer. Nerve sparing radical surgery is routine in our center. Continence is maintained in 95 to 98 % patients and potency in over 70 % patients.
Kidney Stones :
Kidney stones (calculi) are hardened mineral deposits that form in urine in the kidney. They originate as microscopic particles and develop into stones over time. Common kidney stones are,
Calcium Stones Approximately 85% of stones are composed predominantly of calcium compounds. Calcium stones are composed of calcium that is chemically bound to oxalate (calcium oxalate) or phosphate (calcium phosphate).
Struvite Stones This type of stone, also called an infection stone, develops when a urinary tract infection persists in the kidney.
Cystine Stones Cystine is an amino acid in protein that does not dissolve well. Some people inherit a rare, congenital (i.e., present at birth) condition that results in large amounts of cystine in the urine, called cystinuria
Uric Acid stones. Uric acid is the end product of protein. When excess of uric acid is secreted in the urine they form stones. They are associated with
non- vegetarian diet and some metabolic abnormalities.
Blockage of the urethra from BPH may lead to repeated urinary tract infections, a sudden inability to urinate, or gradual bladder and/or kidney damage.
RISK FACTORS
Several factors increase the risk for developing kidney stones, including inadequate fluid intake and dehydration, reduced urinary flow and volume, certain chemical levels in the urine that are too high (e.g., calcium, oxalate, uric acid) or too low (e.g., citrate), and several medical conditions, that blocks or reduces the flow of urine (e.g., urinary obstruction, genetic abnormality).
Treatment
If a kidney stone does not respond to medical treatment, surgery is considered. Urologists use several procedures to break up, remove the kidney stones.
Endoscopic treatment
Ureteroscopy This procedure can be used to remove or break up (fragment) stones located in the ureter. A long, thin telescope (ureteroscope) is inserted through the urethra and passed through the bladder to the stone. Once the stone is located, breaks the stone with a lithotriptor. The patient then passes the fragments. Ureteroscopy is performed under general or local anesthesia
Lithotripsy
It is a method of breaking of stones in kidney, ureter and in bladder.
A powerful Dornier Lithotriper which uses both X-Ray and ultrasound localization for real time image. This allows the stone to be seen at all times during treatment. With this machine the patient needs only a light sedative and the pain is minimal. The lithotripter generates shockwaves, which crush dense stones into sand like particles, which easily pass with urine.
Electrohydraulic lithotripsy (EHL) uses a flexible probe to break up stones with shock waves. The probe is positioned close to the stone through a ureteroscope. Small fragments can be passed by the patient or extracted.
Extracorporeal shock wave lithotripsy (ESWL) uses highly focused impulses projected from outside the body to pulverize kidney stones anywhere in the urinary system. The stone usually is reduced to sand-like granules that can be passed in the patient's urine. Large stones may require several ESWL treatments. This is a OPD procedure and patient can be attending to his day to day work.
Percutaneous Nephrostolithotomy (PCN)
Percutaneous (i.e., through the skin) removal of kidney stones (lithotomy). A needle is inserted in to the kidney under radiographic control and guide wire is passed in to the kidney. Through this tract Nephroscope is passed and stone is fragmented and extracted.. This procedure achieves a better stone-free outcome in the treatment of medium and large stones than shock wave lithrotripsy.
Open Surgery
This procedure requires anesthesia. An incision is made in the patient's back and the stone is extracted through an incision in the ureter or kidney or bladder. This is done only in large stones.
Uro-Oncology :
Radical Nephrectomy
A radical nephrectomy is a procedure to remove cancer in and around one of the kidneys. The surgeon removes the kidney, ureter (the tube connecting the kidney to the bladder), and surrounding connective tissue, lymph nodes, and adrenal gland. Depending on the reason for a nephrectomy, all or part of one kidney or both kidneys can be removed:
Radical Cystectomy
Radical cystectomy is considered to be the gold standard for treatment of muscle invasive bladder cancer.
A radical cystectomy is a surgical procedure for the treatment of bladder cancer. The surgery involves making an incision in the lower abdomen and removing the bilateral pelvic lymph nodes, bladder, and in men the prostate gland and seminal vesicles, and in women the uterus and ovaries if present. In some cases, the urethra is also removed. The purpose is to remove all of the bladder cancer.
After the removal of the bladder, the ureters (tubes that drain the kidneys) are re-routed into one of the possible sites:
Ileal Conduit- A small segment of small intestine (ileum) is separated from the rest of the bowel. The ureters are sewn to one end of this tube of ileum. The other end of the ileal conduit is sewn to the abdominal wall. The opening on the skin is called a urostomy (drains only urine, not stool). The patient has to wear an ostomy appliance (bag that holds the urine).
Indiana Pouch- A portion of small and large intestines are separated from the rest of the bowel. They are sewn together to form a large pouch. Ureters are sewn to this pouch and the opening is constructed from the pouch to the abdominal wall skin. The opening is small and requires no bag. A catheter is passed into the opening on the abdominal wall in order to empty the pouch when it is full of urine.
Neo-bladder- A portion of small and/or large intestines are separated from the rest of the bowel. They are sewn together to form a large pouch. The ureters are sewn to the pouch, and the pouch is sewn to the urethra.
The procedure to be undertaken depends on the patient may vary depending on age, overall health status, and extent of the cancer.
Radical Orchidectomy
Cancer of the testis usually affects young men and often appears as a painless swelling or lump in one of the 2 testicles. Biopsies are not performed when this cancer is suspected because there is a risk of cancer cells spreading to healthy tissue.
Radical orchidectomy is an effective treatment for this condition.
It is a straightforward procedure, carried out under general anaesthesia and takes about 30 minutes to perform. A small incision is made just above the groin on the side of the affected testicle. It involves complete removal of the testicle on that side.
Testicular cancer usually spreads via a very predictable route through the lymph nodes upwards to the lungs, and then outward to the liver, brain, and elsewhere. The affected lymph nodes are called the "retroperitoneal lymph nodes" and they are located behind all of the major organs in the belly, basically between the kidneys and along the vena cava and aorta.
An RPLND is an operation where the lymph nodes surrounding the aorta on the back wall of the abdomen (Para-aortic) are removed in order to:
Penile Amputation and Reconstruction
The exact cause of cancer of the penis is unknown. Some skin conditions that affect the penis can go on to develop into cancer if they are left untreated. If you notice white patches, red scaly patches, or red moist patches of skin on your penis, it is important to see your doctor so that you can get any treatment that you need.
Cancer of the penis is not infectious and cannot be passed on to other people. It is not caused by an inherited faulty gene and so other members of your family are not likely to develop it.
Inguinal Block Dissection
Inguinal block dissection is a necessary component in the treatment of certain cancers.
This inguinal block dissection is required when a person is diagnosed with a malignant condition and advised to have some of the lymph nodes removed from the groin. This is necessary for two reasons:
To control progression of the cancer in the groin.
To stage the disease accurately.
In doing this, appropriate advice and treatment can be given to the patient.
Urinary Diversion
Urinary diversion is a term used when the bladder is removed or the normal structures are being bypassed and an opening is made in the urinary system to divert urine. The flow of urine is diverted through an opening in the abdominal wall. Individuals who might require urinary diversion would be those whose bladders were non-functional or needed to be removed either because of cancer or injury.
Female Urology :
The subspecialty of female urology is concerned with the diagnosis and treatment of those urinary tract disorders most prevalent in females. These include:
Urinary Incontinence and Pelvic floor Prolapse
Voiding Dysfunction
Recurrent Urinary Tract Infection (UTI)
Urethral Syndrome
Interstitial Cystitis
Expert evaluation of these conditions includes a complete history and physical exam. Urodynamics (bladder function test) and imaging studies may be required to fully evaluate the urinary tracts. Additional bladder studies such, as cystoscopy may be necessary.
Urinary Incontinence
Incontinence is an involuntary loss of urine. It is further defined by type as either stress (leakage with straining, coughing, sneezing), urge, mixed, overflow, functional or reflex incontinence.
Treatment is dependent on the type of incontinence. Current therapies include dietary changes, scheduled voiding, bladder retraining, pelvic muscle exercises, biofeedback, electrical stimulation therapy, medication, collagen implants and minimally invasive surgery.
The tension-free vaginal tape (TVT) has become popular for the surgical treatment of urodynamic stress incontinence. The procedure includes insertion of polyester tape in the pelvic floor to support the urethra. This surgery is done through minimal incision.
Voiding Dysfunction
Voiding dysfunction can take many forms. The main symptoms are urinary frequency, urgency, painful urination and/or incomplete bladder emptying.
Treatment is aimed at decreasing or eliminating symptoms. Treatment may involve medications or pelvic floor relaxation exercises.
Recurrent Urinary Tract Infection (UTI)
A recurrent urinary tract infection (UTI) may be generally defined as three or more infections within one year. This may be idiopathic (no obvious cause or related to a urologic disorder such as stones, tumor, reflux (urine flows backwards toward the kidney) or ineffective bladder emptying.
Treatment is aimed at identifying the cause and/or proper antibiotic therapy to break the cycle of recurrent infection.
Urethral Syndrome
Urethral syndrome is a condition involving pain at the urethra that can occur during urination or without regard to urination.
Treatment may consist of oral medication or local estrogen replacement therapy. Urethral syndrome may exist as a component of interstitial cystitis.
Interstitial Cystitis (IC)
Interstitial cystitis (IC) is a urologic syndrome characterized by excessive urinary urgency, frequency, nocturia (nighttime urination) and pain in the lower abdomen and/or perineum. It can occur at any age, however, the median age at diagnosis is between 42 and 46 years. The cause of IC is unclear. It is believed to be related to irregularities in the bladder lining and/or an allergic/immune response. IC can severely affect an individual's quality of life.
Promising developments in the treatment of IC include medications. Hydrodistention of the bladder under anesthesia is a common therapeutic and diagnostic procedure. In the most severe cases, surgery including denervation, urinary diversion and augmentation cytoplasty may be performed.
Paediatric Urology :
Pyeloplasty
Due to the blockage in one of the child's ureters, urine cannot flow easily from the kidney into the bladder. The blockage is usually present from birth, but occasionally may appear later. If the tube remains blocked, the kidney could stop working.
A pyeloplasty is an operation to remove the blockage in the tube (ureter) leading from one of the kidneys to the bladder. The operation under general anaesthetic and generally needs a stay for three to four days in the hospital.
Orchidoplexy
In the time before a male baby is born, the growing testicles have to travel from just below the ribs at the back, to their proper place in the scrotum. Sometimes one or both testicles do not get down as far as they should. Most often they lodge in the groins. Sometimes they are higher. Then they are called undescended or maldescended testicles.
The testes may come down by themselves in the first three months following birth. If they do not, an operation, called an Orchidopexy is needed.
Posterior Urethral (PU) Valve Fulguration
Posterior urethral (PU) valves are most common cause of severe urethral obstruction in male infants and make up 80% of intrinsic urethral obstruction in children.
Usually, they are congenital and are produced by mucosal folds in post urethra possibly due to a malformation of the urethral crest. Urethral valves may rarely occur in girls and are believed to be due to the persistence of the cloacal membrane. Rarely too, valves may occur in the anterior urethra.
Ureter re-implantation
The ureters are two tubes which carry urine from the kidneys to the bladder. In some children, the ureters do not join the bladder in the correct place and this can cause a condition called vesicoureteral reflux (VUR). Normally, valves between the ureters and the bladder prevent urine 'backing up' and flowing towards the kidneys. If the ureters do not join the bladder in the correct place, these valves can fail, allowing urine to flow backwards from bladder to kidney. This can damage the kidney and eventually lead to kidney failure.
If the child suffers from this condition, he will have to undergo the operation under a general anaesthesia. The surgeon makes an incision (cut) in your child's lower abdomen (tummy) and disconnects the ureters. The surgeon then reattaches them to the bladder in the correct place. The end of the ureters joining the bladder is then surrounded by muscle, which strengthens the valves, reducing the chances of urine flowing back to the kidneys.
Augmentation Cystoplasty
Augmentation cystoplasty is a surgical procedure used in adults and children who lack adequate bladder capacity or detrusor compliance. Decreased bladder capacity or abnormal compliance may manifest as debilitating urgency, frequency, incontinence, recurrent urinary tract infections (UTIs), pyelonephritis, or progressive renal insufficiency.
Any patient with marked reduction in bladder capacity or compliance may be a candidate for augmentation cystoplasty. Augmentation cystoplasty is considered when a patient has symptoms so severe that, despite medical treatment, the person's lifestyle is limited or when a person has such high-pressure urinary storage that the upper urinary tracts are at risk. Both neuropathic and non-neuropathic causes for bladder dysfunction exist in pediatric and adult populations.
Impotence and Infertility :
Vericocele Ligation
Varicocele is defined as an abnormal dilatation of testicular veins in the pampiniformis plexus caused by venous reflux. There are a number of treatments avaiable to treat a varicocele. Treatment depends on symptoms and seriousness of the condition.
Surgery is recommended for men with a varcocele where pain, damage to the testicles, atrophy or where treatment is required for sterility. The procedure is surgical ligation (tying off) of the distended veins. This can be carried out under a general or local anesthesia. Keyhole surgery is sometimes available and results in a smaller scar.
Penial Prosthesis
ED is the loss of the ability to produce and maintain a functional erection caused by pathology of the nervous or vascular system or deformation of the penis. The surgical treatment of ED largely involves the placement of penile prosthesis.
Before 1960, urologic therapy for erectile dysfunction (ED) was rare. ED was branded a psychiatric disorder with little surgical role. More recently, insight has been gained into the pathophysiology of male sexual dysfunction, and both medical and surgical treatments of ED now are common.
Treatment
Medical therapy: Nonsurgical treatments for ED, such as vacuum devices, intraurethral alprostadil pellets (medicated urethral system for erection [MUSE]), oral sildenafil (Viagra), and intracavernosal prostaglandin injection, should be attempted prior to undertaking penile prosthesis implantation.
Surgical therapy: The criterion standard for erectile surgery is penile prosthesis implantation. However, in the rare patient whose discrete and focal arterial lesion can be identified on arteriography, then revascularization procedure(s) may be indicated.
The most fundamentally basic prosthesis is the semirigid rod prosthesis, which consists of 2 rodlike cylinders that are implanted in the corpora cavernosa.
Penile Curvature Correction
Penile curvature may be ventral, dorsal or lateral. Most of ventral curvatures are associated with hypospadias due to chordee or ventral dysplasia of cavernous bodies. The isolated anomaly is usually not recognized until later in childhood because the appearance of the penis is normal. The curvature is only observed during erections.
Vaso-vagal Reanastomosis
Vas ligation, vasotomy, and vasectomy are three operations to induce male sterility. Vasectomy is the most effective but least likely to be reversible. The operation can be performed in a polyclinic under local anesthesia and takes 15-30 minutes.
Several factors increase the risk for developing kidney stones, including inadequate fluid intake and dehydration, reduced urinary flow and volume, certain chemical levels in the urine that are too high (e.g., calcium, oxalate, uric acid) or too low (e.g., citrate), and several medical conditions, that blocks or reduces the flow of urine (e.g., urinary obstruction, genetic abnormality).
Cancer of the testis usually affects young men and often appears as a painless swelling or lump in one of the 2 testicles. Biopsies are not performed when this cancer is suspected because there is a risk of cancer cells spreading to healthy tissue.
Due to the blockage in one of the child's ureters, urine cannot flow easily from the kidney into the bladder. The blockage is usually present from birth, but occasionally may appear later. If the tube remains blocked, the kidney could stop working.