Adult Urology

Adrenal Cancer

Adrenal cancer is a rare disease that originates in the adrenal glands. The adrenal glands are located on top of the kidneys and consist of two parts that function separately: the outer layer (cortex) and the inner area (medulla). The cortex produces three major hormones. Adrenal tumors can increase hormone production called functioning tumors. Adrenal tumors that do not produce hormones are called nonfunctioning. Symptoms of adrenal cancer and treatment for this condition depend on whether the tumor is functioning or nonfunctioning and on which hormone is being overproduced.

Bedwetting

The best cure for bedwetting is time - time to let your child's body mature and develop. Most children eventually grow out of bedwetting. But the doctor may recommend some options to help your child become dry more quickly. Some of the solutions for bedwetting are the self-awakening routine, bedwetting alarms, medications, changes in your child's routine.

Benign prostatic hyperplasia (BHP; enlarged prostate)

As a man ages, it is common for the prostate to grow larger. This is known as BPH or benign prostatic hyperplasia. It often begins around age 50. This condition is not cancer. Because the prostate surrounds the urethra; BPH can cause problems with urination. Common symptoms of BPH are a slow or weak urine stream, a dribbling stream, or a stream that stops and starts, needing to push or strain to start urinating, feeling that your bladder isn't completely empty after urinating, needing to urinate often and frequently, feeling that you can not wait to urinate, urgency, waking up many times during the night needing to urinate which is known as nocturia.

Bladder Cancer

Bladder cancer accounts for approximately 90% of cancers of the urinary tract. The bladder is an organ located in the pelvic cavity that stores and discharges urine. Urine is produced by the kidneys, carried to the bladder by the ureters, and discharged from the bladder through the urethra. Bladder cancer usually originates in the bladder lining, which consists of a mucous layer of surface cells that expand and deflate smooth muscle and a fibrous layer. Tumors are categorized a low-stage or high-stage. A number of factors are believed to increase the risk of developing bladder cancer; cigarette smoking is by far the biggest single risk factor. Symptoms of bladder cancer can include blood in the urine, painful urination and increased frequency of urination. Most bladder cancers are diagnosed through the use of cystoscopy, a procedure in which the urologist views the inside of the bladder using a fiberoptic scope. Once a tumor has been found, it will usually be removed with a procedure called a Transurethral Resection of Bladder Tumor or TURBT.

Urinary Incontinence

Urinary incontinence is the inability to stop urine leakage. Incontinence can be so embarrassing that it interferes with living a normal, full life. But there are several ways to control it. There are different types of incontinence: urge also known as overactive bladder, stress, and overflow. You may have only one type or you may have urge incontinence along with one of the other types. All people with incontinence have bladder control problems. But each type of incontinence has its own pattern of signs and symptoms. Treatment options include certain medications, exercises and other therapy to help strengthen muscles, procedures to help stop leakage, or surgery. Incontinence may be controlled and in many cases, even cured.

Bladder control problems

In patients with an overactive bladder (OAB), the layered, smooth muscle that surrounds the bladder is known as a detrusor muscle contracts spastically, sometimes without a known cause, which results in sustained high bladder pressure and the urgent need to urinate. Normal, the detrusor muscle contracts and relaxes in response to the volume of the urine in the bladder and the initiation of urination.

Circumcision

Circumcision is a quick, simple procedure. It is most often done in the nursery before a baby boy goes home from the hospital. It can also be done later, but than it could be a little more complicated. There are a number of ways to do circumcision. A boy is born with a layer of skin that covers the rounded head or glans of the penis. This is called the foreskin. During circumcision, the foreskin is removed. This can make it easier to keep the penis clean. It may also help prevent urinary tract infections.

Erectile Dysfunction (impotence)

Erectile dysfunction is the inability of a man to achieve or maintain an erection sufficient for his sexual needs or the needs of his partner. Most men experience this at some point in their lives, usually by age 40, and are not psychologically affected by it. Some men, however, experience chronic, complete erectile dysfunction known as impotence and others, partial or brief erections. Frequent erectile dysfunction can cause emotional and relationship problems, and often leads to diminished self-esteem. Erectile dysfunction has many causes most of which are treatable, and is not an inevitable consequence of aging.

Hematuria

Hematuria is the presence of blood specifically red blood cells, in the urine. Whether the blood is visible only under a microscope or visible to the naked eye, hematuria is a sign that something is causing bleeding in the genitourinary tract: the kidneys, the tubes that carry urine from the kidneys to the bladder, the prostate gland in men, the bladder or the tube that carries urine from the bladder out of the body. Bleeding may happen once or it may be recurrent. It can indicate different problems in men and women. Causes of this condition range from non-life threatening to serious. Therefore, a physician should be consulted as soon as possible. There are two types of hematuria, microscopic and gross or macroscopic. In microscopic hematuria, the amount of blood in the urine is so small that it can be seen only under a microscope. A small number of people experience microscopic hematuria that has no discernible cause. These people normally excrete a higher number of red blood cells. In gross hematuria the urine is pink, red, or dark brown and may contain small blood clots. The amount of blood in the urine does not necessarily indicate the seriousness of the underlying problems. As little as 1 milliliter of blood will turn the urine red. Joggers' hematuria results from repeated jarring of the bladder during jogging or long-distance running. Reddish urine that is not caused by blood in the urine is called pseudohematuria. Excessive consumption of beets, berries or rhubarb; food coloring; and certain laxatives and pain medications can produce pink or reddish urine.

Interstitial Cystitis

Interstitial cystitis or IC is a chronic inflammatory condition of the bladder that causes frequent, urgent, and painful urination and pelvic discomfort. The natural lining of the bladder is protected from toxins in the urine by a layer of protein called glycoaminoglycan. In IC this protective layer has broken down, allowing toxins to irritate the bladder wall. The bladder then becomes inflamed and tender and does not store urine well. Unlike inflammation of the bladder caused by bacterial infection which is associated with urinary tract infections and usually treated with antibiotics, no infectious agent has been found in IC. Though not curable, IC is treatable and most patients find some relief with treatment and lifestyle changes.

Kidney Cancer

Several types of cancer can develop in the kidneys. Renal cell carcinoma known as RCC, is the most common form, which accounts for approximately 85% of all cases. In RCC, cancerous or malignant cells develop in the lining of the kidney's tubules and grow into a mass called a tumor. In most cases, a single tumor develops, although more than one tumor can develop within one or both kidneys. As with all cancers, early diagnosis of kidney cancer is important. The earlier the tumor is discovered, the better a patient's chances for survival. Tumors discovered at an early stage often respond well to treatment. Survival rates in such cases are high. Tumors that have grown large or spread or metastasized through the bloodstream or lymphatic system to other parts of the body are more difficult to treat and present an increased risk for mortality.

Kidney Stones

A kidney stone is simply a mineral deposit that forms in the urinary tract. Kidney stones develop when crystals, which are present in the urine, begin to stick together and gradually build up into a rock-like mass. Initially, kidney stones are quite small in size, but over time, as more and more crystals attach, they can grow quite large. The medical term for this condition is nephrolithiasis, or renal stone disease. The kidneys filter waste products from the blood and add them to the urine that the kidneys produce. When waste materials in the urine do not dissolve completely, crystals and kidney stones are likely to form. Small stones can cause some discomfort as they pass out of the body. Regardless of size, stones may pass out of the kidney, become lodged in the tube that carries urine from the kidney to the bladder and cause severe pain that begins in the low back and radiates to the side or groin. A lodged stone can block the flow of urine, causing pressure to build in the affected ureter and kidney. Increased pressure results in stretching and spasm, which cause severe pain. Kidney stones form when there is a high level of calcium, oxalate, or uric acid in the urine; a lack of citrate in the urine; or insufficient water in the kidneys to dissolve waste products. The kidneys must maintain an adequate amount of water in the body to remove waste products. If dehydration occurs, high levels of substances that do not dissolve completely may form crystals that slowly build up into kidney stones. Urine normally contains chemicals that prevent the formation of crystals. Low levels of these inhibitors can contribute to the formation of kidney stones.

Male Infertility

An urologist, who is an expert in male fertility problems, will begin your evaluation with a medical and sexual history. A physical examination will be performed to provide clues to a fertility problem and may be followed by blood tests and urinalysis. Semen analyses will also be performed to evaluate the quantity and quality of sperm. A medical history includes questions about childhood illness, diabetes, mumps in the testicles, previous injury or surgery including vasectomy, and the size of your immediate family. Infections along the reproductive tract can contribute to a male fertility problem as can any common infection that is apt to cause a fever, such as a flu or dental abscess. Sperm production may also be impaired by stress, exposure to toxic chemicals, general poor health, and the use of drugs, alcohol, or long-term medication. A sexual history includes questions about the frequency and timing of intercourse, and whether ejaculation occurs close to the cervix. A physical exam may reveal a variococele which is a varicose vein in the scrotum or undescended testicle which is a testicle in the abdomen. Hair distribution and the consistency of the testes and prostate gland may also indicate a hormone imbalance problem. Several tests are available to evaluate sperm production. A basic semen analysis includes a microscopic evaluation of the number, motility, and the shape of sperm. Generally, three separate samples are analyzed to obtain an average count. Other tests on the semen may be performed and a sample of tissue from the testicle may be taken for further assessments of fertility.

Peyronie's Disease

Peyronie's disease is characterized by the formation of hardened tissue in the penis that causes pain, curvature and distortion usually during erection. In Peyronie's disease, dense, fibrous scar tissue or plaque forms.

Prostate Cancer

The prostate is a small gland lying just below the bladder and in front of the rectum. The prostate wraps around the urethra, the tube that carries urine from the bladder. Your prostate produces some of your semen, the fluid that carries sperm. If cells in the prostate change abnormally, cancer may form. Prostate cancer often causes no symptoms unless the growth presses on the urethra. This is why screening tests are important. Adenocaricinoma of the prostate is the clinical term for a cancerous tumor on the prostate gland. As prostate cancer grows, it may spread to the interior of the gland, to tissues near the prostate, to sac-like structures attached to the prostate, and to distant parts of the body. Prostate cancer confined to the gland often is treated successfully. According to the American Cancer Society, ACS, prostate cancer is the most common type of cancer in men in the United States, other than skin cancer. The ACS estimates that about 230,900 new cases will be diagnosed on an annual basis and 29,900 men will die of the disease. Prostate cancer is the second leading cause of cancer death in men, exceeded only by lung cancer. Prostate cancer occurs in 1 out of 6 men. Reports of diagnosed cases have risen rapidly in recent years and mortality rates are declining, which may be due to increased screening. The risk for developing prostate cancer rises significantly with age, and 60% of newly diagnosed cases occur in men over the age of 70.

Prostatitis

Prostatitis is a term used to describe inflammatory conditions of the prostate gland. It is thought that most cases of prostates result from bacterial infection, but evidence of infection is not always found. An infected or inflamed prostate can cause painful urination and ejaculation, and if left untreated, serious complications. Prostatitis can affect men of any age and it is estimated that 50% of men experience the disorder during their lifetime. Prostatitis is the most common urological disorder in men over the age of 50 and the third most common disorder in men younger than 50.

Testicular Cancer

Testicular cancer develops in the testicles, which are the male reproductive glands. The testicles are located in the membranous pouch below the penis and are suspended from the body by the spermatic cord. They produce male reproductive cells called sperm and testosterone. Testicular Cancer is one of the most common cancers among men aged 20 to 34. It can occur as young as 15. The good news is that a simple three-minute examination every month can uncover signs of trouble. When detected early, testicular cancer is one of the most easily cured. The risk factors of having testicular cancer are undescended testicles in infants and young children, an identical twin with testicular cancer and a family history of testicular cancer. Be certain to tell your physician if you have any of these risk factors. Parents should have infants checked at birth for undescended testicles. The symptoms of testicular cancer may be symptom less in early stages. When symptoms do occur, they include: lump on the testicle, change in consistency of the testicle, enlargement of a testicle, enlargement of the male breasts and nipples, pain in the testicle, heavy sensation in the testicle or groin. Testicular cancer affects about 5,000 men a year and usually only one testicle is involved.

Testosterone Deficiency

Testosterone production declines naturally with age. Testosterone deficiency known as TD may result from disease or damage to the hypothalamus, pituitary gland, or testicles that inhibits hormone secretion and testosterone production, and is also known as hypogonadism. Depending on age, insufficient testosterone production can lead to abnormalities in muscle and bone development, underdeveloped genitalia, and diminished virility. Testosterone is the androgenic hormone primarily responsible for normal growth and development of male sex and reproductive organs, including the penis, testicles, scrotum, prostate, and seminal vesicles. It facilitates the development of secondary male sex characteristics such as musculature, bone mass, fat distribution, hair patterns, laryngeal enlargement, and vocal chord thickening. Additionally, normal testosterone levels maintain energy level, healthy mood, fertility, and sexual desire.

Undescended Testicle

The testicles are the male sex organs that produce sperm and the male hormones. They form near the kidneys. As the fetus grows in the mother's womb, the testicles move down through the groin into the scrotum. Normally they are in the scrotum before birth. Sometimes a testicle doesn't fully descend into the scrotum before birth. Instead, it stops somewhere along the normal pathway between the kidney and the scrotum. Or it may stray from this pathway. What causes this isn't known. An undescended testicle is most common in premature babies and most often only one testicle is affected. Treatment is important, because the testicle doesn't descend on its own, it should be treated. The longer a testicle remains outside the scrotum, the more likely it is that it will produce fewer sperm. An undescended testicle has a higher risk of cancer. This is true even after the testicle is brought down into the scrotum. Bringing the testicle down makes a problem easier to find. An undescended testicle can leave a small tear or hernia in the wall between the abdomen and the groin. The hernia needs to be treated to prevent future problems.

Urinary Tract Infections

The most common symptoms of urinary tract infection (UTI) include: sudden urge to urinate, need to urinate more often than usual, and an uncomfortable burning sensation, cramps or pain when urinating or immediately afterward. Urinary incontinence could also be a symptom, particularly in older women. The most common type of UTI affects the lower part of the urinary tract and is called UTI, bladder infection, acute cystitis, or “honeymoon cystitis.” In most cases, doctors can treat and cure UTIs quickly and easily. An untreated lower UTI however can become a serious condition involving the kidneys. In pregnant women, untreated UTIs can affect the pregnancy and might cause premature labor. In older women, UTIs can be more serious. They can cause kidney infection, which may lead to bacteria in the bloodstream. This is more difficult to treat. UTIs occur more frequently in women than in men. They are caused by bacteria normally found in and around the vagina and the lower bowel or the anus is very close to the opening of the urethra, the tube that carries urine from the bladder to the outside of the body. The closeness of these openings makes it relatively easy for bacteria from the vagina and anus to enter the urethra and travel the short distance to the bladder. Bacteria can be pushed into the urethra by the movement of the penis during sexual intercourse. You should see a doctor to get the right diagnosis and treatment for your condition. Several conditions, including sexually transmitted diseases (STDs), have similar symptoms, but require different treatments. Your doctor will usually diagnose UTI after asking questions about your symptoms. The doctor may also ask for a urine sample to test for an infection. If you get a positive result on one of the home tests that are available, you should seek medical advice as soon as possible. Your doctor will usually prescribe oral antibiotics for your UTI. In older women, UTIs are more likely to cause kidney infection. Therefore, women over 50 may need to take antibiotics for a longer time, or may need to be given antibiotics by injection.

Varicocele

A varicocele, is an enlarged vein in the scrotum usually found on the left side, may cause a pooling of blood and rise in temperature where sperm production occurs. Varicoceles are relatively common and do not always affect fertility; in fact, the relationship between a varicocele and sperm production remains uncertain. For some men, however surgical varicocele repair can raise sperm counts to fertile levels.

Penile Cancer

Scientist currently believe that penile tumors are caused by cancer-producing effect of secretions that become trapped within the foreskin if they are not washed away on a regular basis. It is not surprising, therefore, that this particular malignancy is extraordinarily common in South and Central America, as well as other Third world countries, where public health and personal hygiene often are lacking. Also, circumcision, a practice that could improve hygiene, is not regularly performed.

In the United States, penile cancer is a relatively unusual cancer, probably due to the country's superior sanitary and hygienic conditions along with commonly practiced circumcision. However, scientists are currently studying other causes of penile cancer, particularly the role of human papilloma virus (HPV), which already has strong links to cervical cancer. Antibodies to HPV - 16 a specific type of papilloma virus also implicated in cervical cancer, have been found in many patients with penile cancer.

Unfortunately, early diagnosis of penile cancer is often missed because it is so rare in the United States that general physicians and even urologists may only see two or three cancers in a practice lifetime. Also, patients are often reluctant or embarrassed to call attention to their genitalia and may be afraid of surgical procedures or treatment of the penis. But the earlier the diagnosis, the more effective the therapy and the better the chance for cure. If diagnosis is delayed and the disease progresses, therapy may be less successful and more disfiguring.

So, it is very critical that any skin erosion, ulcer, sore, irritation, discoloration that is noticed on the foreskin, the skin of the shaft of the penis or the surface of the head of the penis be brought to the attention of the physician by the patient and be promptly evaluated. Chances are good that most such lesions are linked to a bacterial or fungal infection or even an allergic reaction, all of which will respond readily to antibacterial or antifungal ointments and creams. But growths or areas that return or do not heal must be considered malignant until proven otherwise. The appropriate evaluation includes biopsy where the tissue is removed for examination under a microscope. If a precancerous or cancerous condition is found, prompt treatment and systematic, regular follow up are very important.

Early detection and identification of penile cancer are very valuable because the treatments that can provide successful outcome are indeed low risk. If the tumor appears on the skin surface, your urologist may be able to treat the problem with a topical cream that has minimal side effects. If the lesion is larger, but still limited to about pea-size, a small local excision or a type of surgery that continues to shave layers of abnormal tissue until normal tissue is reached which is known as Moh's surgery may be performed. With these procedures, there is essentially no loss of form or function to the penis. However, careful follow up is critical to identify early recurrence. In the removal of these small lesions, it is very unlikely that cancer has spread to lymph nodes and, therefore, removal of the lymph nodes is usually not necessary. With larger lesions, it is necessary to remove greater amounts of tissue and also to consider removal of the draining lymph nodes in the groin in order to achieve a cure. In these circumstances, a combination of surgery, radiation and chemotherapy may be necessary.

It is also important to note that external beam radiation is an alternative therapy, specifically for small lesions. Again, the critical importance of early detection not only ensures a better outcome for the treatment supplied but also provides more treatment options that can be applied. Your post-treatment experience will be directly tied to the stage of your cancer when it is diagnosed. Cure is almost certainly ensured when lesions are detected early. But it is less certain as the tumor becomes more advanced. Treatment is also increasingly more debilitating. Since your penis is readily accessible - you can visualize it easily and you touch it regularly during urination - you can help yourself greatly in detecting early disease by reporting any lesions that you see or feel.

While patients at greatest risk are those who are not circumcised, every man should be on the lookout for penile lesions as they need prompt attention. Until recently, the general consensus was that penile cancer was caused by chemical irritation and there was no concern about transmitting it. But recent data have implicated the HPV in both penile and cervical cancers. There appears to be increased incidence of these cancers in the spouses of people with this sexually transmitted disease. Thus, while penile cancer is not directly transmissible, if you or your partner has HPV, you need to use protection during intercourse, be aware of any lesions, and if you are the woman, have frequent cervical examinations. Not only are efforts to eliminate or minimize the infection important but so are discussions with an urologist or other specialist about its link to penile cancer.

If your cancer is detected early, the surgical procedures should not impact your ability to stand when you urinate. When the cancer is more advanced, the required surgical procedures may require you to urinate in the sitting position. Early detection and minimal surgical procedures should not interfere with normal sexual function. More extensive procedures might, however. This question creates much debate. Some experts believe that sexual sensation is diminished after circumcision, even though evidence points to a lower incidence of urinary tract infections and penile cancer in men who had had the procedure. Parents should discuss the risks and benefits of circumcision with the child's doctor.

There is now evidence that circumcision soon after birth the most reliable protection form subsequent penile malignancies. A procedure performed in young adults does not have nearly the protective effect as when it is done in infants. Population studies suggest, for instance, that the incidence of penile cancer is extraordinarily rare in Jewish males where circumcision at birth is an accepted ritual. More common in the Muslim population where circumcision at puberty is the established ritual. But it is not as common as in those individuals who have never been circumcised.