Urology is that discipline in medical science that deals with all diseases affecting our urinary system from kidney to the urethra (urine passage). Diseases of the kidney that dictate medical line of management like kidney failure is managed by a different subdivision of medicine called nephrology.
Encountered solely in males, the prostate gland under the influence of male hormone (Testosterone) starts growing slowly but steadily and projects towards the urethra. When enlarged sufficient enough to obstruct the outflow of urine from the bladder it manifests as frequency, urgency, nocturnal frequency (nocturia), hesitancy, thinning of urine stream or straining in various proportions. Occasionally the patient may not be able to pass urine at all (urinary retention) and a tube (catheter) may need be passed to tackle the situation. All patients with prostatic symptoms undergo a battery of blood and urine tests as well as ultrasound, following which the plan of action is determined. The available options are medicines or endoscopic surgery (TURP). Uncommonly these symptoms may also be secondary to prostate malignancy so these symptoms should never be neglected and the patient should seek consultation at the earliest.
The entire urinary tract is capable of harbouring stones and hence these problems are very commonly encountered. The most common types of stones are calcium stones however uric acid stones are also commonly met with. In contrast to calcium stones, uric acid stones are usually not seen in conventional x-ray but detectable in CT scan. The commonest symptoms with stone disease is back pain or pain radiating down from back towards the thighs and genitalia, bloody urine, fever. Rarely stones are silent and large stones may occasionally present late with complete obstruction to kidney. Patients with stone diseases are subjected to blood and urine assays, ultrasound and special xray(KUB). Available options are medicines, breaking the stone with shock waves from outside (ESWL), breaking the stone from below endoscopically (URS) or keyhole from back (PCNL). Dietary adjustments are usually advised in uric acid stones. High water intake is also beneficial and occasionally small stones may escape with urine after abundant water intake.
Urinary incontinence means involuntary (unintentional) leakage of urine. This affects both male and female population in varied proportions. The various subcategories of incontinence are: urge incontinence (associated with urgency, the need to rush to the restroom immediately as you feel the sensation to pass urine and urine leaks prior to actual act of voiding), stress incontinence (urine leaks involuntarily when you cough, sneeze, bend or with minimal straining) or overflow incontinence (involuntary leakage of urine at resting position without any sensation or straining attempts). Whereas overflow incontinence is commonly attributed to the urinary bladder outlet pathologies and more precisely prostatic enlargement, stress incontinence is due to descent of the bladder neck beyond the boundaries of the pelvic floor. Urge incontinence in contrast may be secondary to a variety of pathologies involving bladder (men or women) or prostate (men) as well as neurological problems affecting the bladder. The treatment for incontinence also varies as to the etiology. All patients undergo detailed examination and evaluation of blood and urine profiles and ultrasound. Further evaluation is conducted as suggested by the preliminary results. The commonest treatment offered for stress incontinence is tape suspension of the descended bladder neck (TVT, transvaginal tape; TOT, transobturator tape; TVT-O, transvaginal tape-obturator). These are usually short duration procedures under short anaesthetic. If there is associated cystocele or rectocele this is corrected simultaneously. Overflow incontinence secondary to prostatic or bladder neck pathologies require endoscopic surgeries (TURP, transurethral resection of prostate or BNI, bladder neck incision). Other pathologies are managed in respective lines.
The commonest cause of pelviureteric obstruction is abnormal development of the pelviureteric junction to the extent that it fails to open and allow passage of urine in a coordinated fashion from the kidney to the ureter (the tube conveying urine from kidney to urinary bladder). This is acquired congenitally. Rarely this may be encountered due to external compression. The patient may be totally asymptomatic and the diagnosis may come up as a surprise due to evaluation of other problems. Alternatively the patient may present with back pain, recurrent urinary infection, bloody urine or stone disease. Patients with these symptoms usually undergo some blood and urine examinations followed by ultrasound assessment. Thereafter IVP (intravenous pyelography) or CT urography and renal scan is ordered to assess the status of the kidney and confirm its salvagability. We routinely undertake laparoscopic correction of this problem- a procedure called laparoscopic pyeloplasty. This is done by creating 3 or 4 holes in the abdomen. The abnormal area is removed and the two sides are rejoined. The procedure lasts for about 2 hours. A plastic tube called stent is placed across the repair that is removed by a small endoscopic procedure after 6 weeks from the major surgery. Usually after the procedure the patient is re-evaluated every 3 months and some tests are carried out. At 6 months (or 1 year) from the procedure a repeat IVP, CT urogram or renal scan is conducted to assess the status of the repair.
A kidney tumor may be completely without symptoms or may cause back pain or bleeding during urination. Uncommonly one may complain of loss of weight or swelling of feet if the tumor is spreading to the major vein of the body. Usually few blood tests will be evaluated at the beginning following which a CT scan or MRI scan will be advised. After seeing these reports a decision is taken for the definite surgery. If the tumor is small in comparison to the whole kidney, only part of the kidney will be removed (partial nephrectomy) or if it is large, the whole kidney can be removed. On most occasions these can be done by keyhole technique (laparoscopy). Every patient with kidney tumor needs regular follow-up 3 monthly for the first 2 years followed by 6 monthly for next 2 years and yearly thereafter. During follow-up some blood tests and imaging studies are carried out.
The procedure by which kidney from a healthy individual is taken out and placed into another individual. The persons receiving the kidney are usually suffering from kidney failure and may or may not be on regular dialysis. The patients are selected after thorough checkup with multiple experts including nephrologists. In this centre since last 10 years all kidneys have been retrieved by keyhole technique. The kidney receiver undergoes an open surgery whereby the kidney is joined to his blood vessels to ensure blood flow and thereby production of urine. The kidney donors usually recover very well due to the keyhole technique and resume normal work within 2 weeks from the surgery. There is no restriction to work after kidney donation. But the donor should immediately report to a medical facility if experiencing any problem any time after the transplant. The kidney receivers are usually on some medicines to help his body accept the new kidney (immunosuppressants).The entire procedure is very safe. Kidney donation is a noble act and gives a new life to the receiver. There is high demand for kidney transplantation in present era as the number of patients with kidney failure and in need for transplantation is very high. Kidneys can also be obtained from cadavers (brain dead but heart beating patients) and is actively practiced in most western countries. Most centres in India are severely lagging behind in this aspect.
A tumor in urinary bladder may present with bleeding with urination, burning sensation during urination, frequency of urination or rarely may be completely asymptomatic. Few blood tests, ultrasound, CT scan or MRI is carried out for identification of these but small tumors may be missed in these investigations. Cystoscopy (examination of the bladder with an endoscope, carried out in operation theatre under anaesthesia) is the only reliable method for confirming the diagnosis. At the same time these tumors can be resected through the same route (TURBT). Further treatment depends on histopathological impression. The subject needs to be on regular follow-up on a 3 monthly schedule for the first 2 years. After this period the frequency of visits may be reduced to 6 monthly for the next 2 years following which yearly visits may be acceptable. At each visit apart from blood investigations, a cystoscopy will also be carried out.