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Urology Treatment

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). The urinary and reproductive tracts are closely linked, and disorders of one often affect the other.
A urologist is a physician who specializes in diseases of the urinary tract and the male reproductive system. This can include diseases affecting the bladder, urethra, ureters, kidneys, and adrenal glands, along with the epididymis, penis, prostate, seminal vesicles and testes specifically in men.
Urology is commonly regarded as a surgical specialty. There are a wide variety of different procedures that urologists carry out, such is the scope of urology as a field.

The American Urological Association (AUA) have identified seven subspecialties that comprise the field of urology:

  • Calculi : the management of stones that form within the kidneys and move into the ureters.
  • Female urology : pelvic outlet relaxation disorders and urinary incontinence.
  • Male infertility : primarily surgical correction of acquired and congenital obstructions within the male genitals.
  • Neurourology : includes erectile dysfunction and impotence, urodynamic evaluation of patients and voiding disorders.
  • Pediatric urology : treatment of urological problems within children that are too complex for non-specialized pediatricians or urologists.
  • Renal transplantation : kidney transplants may be required following kidney failure.
  • Urologic oncology : treatment of cancers such as bladder cancer and prostate cancer.

Urology is a constantly changing specialty, primarily due to advances made to technology. Refinements to endoscopic procedures and the utilization of the surgical microscope have greatly increased urologists’ options. Laparoscopic surgery and chemotherapy are altering how treatment is administered, and laser therapy promises to become an important part of future urologic practice.

Urological Treatments

Kidney Stones

Kidney stones (renal lithiasis, nephrolithiasis) are hard deposits made of minerals and salts that form inside your kidneys.

Kidney stones have many causes and can affect any part of your urinary tract — from your kidneys to your bladder. Often, stones form when the urine becomes concentrated, allowing minerals to crystallize and stick together.

Passing kidney stones can be quite painful, but the stones usually cause no permanent damage if they're recognized in a timely fashion. Depending on your situation, you may need nothing more than to take pain medication and drink lots of water to pass a kidney stone. In other instances — for example, if stones become lodged in the urinary tract, are associated with a urinary infection or cause complications — surgery may be needed.

Percutaneous NephroLithotomy (PCNL)

Percutaneous NephroLithotomy (PCNL) is the preferred technique for treating larger kidney stones (over 2cm in diameter) located within the kidney. It involves keyhole surgery that is performed through a 1cm incision in the skin (see diagram). A mini-PERC is similar in approach, but represents a refinement in the technique due to having smaller cameras, better stone lasers and specialized tools. The incision that is made in the skin is much smaller and allows for quicker patient recovery and results in a safer procedure.

Ureteral Stones

Ureteral stones are rocklike accumulations that form from naturally occurring mineral salts in the urine. Most stones form in the kidney and migrate into the kidney tubes or ureters. The typical patient with urinary stones is a 40- to 50-year-old white man with a family history of urinary stones.

Urinary stones can be round or irregular, relatively smooth, or have jagged edges or projections. The color of urinary stones varies according to their chemical composition. Stones can remain in the kidneys for years without causing problems.

Prostate Stones

Prostate Stones in the prostate are very common. They appear to be calcified proteinaceous bodies called corpora amylacea. In some men, infected prostate stones may cause recurrent urinary tract infections (UTIs) and make it hard to cure bacterial prostatitis. The stones may have to be removed with surgery before UTIs or chronic prostatitis can be resolved.

BPH (Benign Prostatic Hyperplasia)

It’s a natural part of aging, but at some point, it can lead to a condition called BPH, or benign prostatic hyperplasia. Your prostate surrounds part of your urethra, the tube that carries urine and semen out of your penis. When you have BPH, your prostate is larger than usual, which squeezes the urethra. This can cause a weak stream when you pee and cause you to wake up a lot at night to go to the bathroom.

BPH isn’t prostate cancer and doesn’t make you more likely to get it. It’s a common condition, especially in older men, and there are a lot of treatments for it, from lifestyle changes to surgery. Your doctor can help you choose the best care based on your age, health, and how the condition affects you.

During transurethral resection of the prostate (TURP), an instrument is inserted up the urethra to remove the section of the prostate that is blocking urine flow. TURP usually requires a stay in the hospital. It is done using a general or spinal anesthetic.

Bladder Cancer

The wall of the bladder is lined with cells called transitional cells and squamous cells. More than 90 percent of bladder cancers begin in the transitional cells. This type of bladder cancer is called transitional cell carcinoma. About 8 percent of bladder cancer patients have squamous cell carcinomas.
Cancer only in cells in the lining of the bladder is called superficial bladder cancer. This type of bladder cancer often comes back after treatment, but it does not tend to progress. If the tumor recurs, the disease often recurs as another superficial cancer in the bladder. Cancer that begins as a superficial tumor may grow through the lining and into the muscular wall of the bladder. This is known as invasive cancer. Invasive cancer may extend through the bladder wall. It may grow into a nearby organ such as the uterus or vagina in women or the prostate gland in men. It also may spread to other parts of the body.

Erectile Dysfunction

Erectile dysfunction (ED), also known as impotence, is a common condition affecting an estimated 150 million men worldwide. ED is defined as a man's inability to achieve and maintain an erection that is sufficient for satisfactory sexual intercourse. The ability to have an erection requires the normal, integrative functions of the nerves, blood vessels, muscles and brain.
ED may result from a variety of factors or a combination of factors. These may include psychological, neurological, hormonal and vascular disorders. Certain drugs and chronic diseases, as well as the natural aging process, also may contribute to ED.

Peyronie's Disease

Peyronie's disease is a disorder affecting about three percent of men middle-age and older. The condition is caused by the formation of dense, fibrous scar tissue, or plaque, in the penis' tunica albuginea, the sheath that surrounds the erectile tissue.
The cause of Peyronie's disease is not completely known. However, factors such as genetics and trauma to the penis, which can occur due to injury or invasive penile procedures, may contribute to the disease.

Genitourinary Tract Injuries

About 10 percent of all injuries seen in the emergency room involve the genitourinary tract, including the kidneys, bladder, genitals, ureters and urethra.

At UCSF Medical Center, we use advanced reconstructive surgical techniques to correct a variety of injuries and abnormalities to the male genitourinary tract. We specialize in the management and treatment of the following:

Urethral strictures and obstructions, which cause voiding problems related to the normal passage of urine and semen. Our patients have a high success of voiding normally after urethral reconstructive surgery.
Genital reconstruction for patients who have suffered a traumatic genital injury or have genital skin loss due to infection or other causes.
Management of traumatic injuries to the kidney, ureter, bladder, scrotum/testicles and penis.

Priapism

Priapism is an uncommon condition that causes a prolonged and often painful erection, which occurs without sexual stimulation. In a third of the cases, the cause is unknown. The remaining cases are caused by an associated condition, including sickle cell disease, pelvic tumors, pelvic infections, leukemia, genital trauma or spinal cord trauma, and medications or recreational drugs.

Testicular Cancer

When detected early, testicular cancer is highly treatable and usually curable, which is why early diagnosis and treatment are so important for men of all ages. Adolescent boys and young men should be particularly aware of the signs and symptoms of the disease and perform regular testicular self-exams.
Testicular cancer is a disease in which cells become malignant, meaning cancerous, in one or both of the testicles. Testicular cancer can be broadly classified into two types: seminoma and nonseminoma. Seminomas make up about 40 percent of all testicular cancers. Nonseminomas are a group of cancers that include choriocarcinoma, embryonal carcinoma, teratoma and yolk sac tumors. A testicular cancer may have a combination of both types.