General Urology is a surgical subspecialty dedicated to the diagnosis and treatment of diseases related to the male and female genitourinary organs including the kidneys, adrenals, ureters, bladder, penis, testes, and prostate.
A Urologist is a physician who has completed a certified residency training program. A board certified Urologist has successfully completed oral and written exams conducted by the American Board of Urology. Urologists must repeat certification exams every 10 years. Urologists have specialized knowledge and skill with regard to problems of the male and female urinary tract and the male reproductive organs. Although Urology is classified as surgical subspecialty, the Urologist requires knowledge of internal medicine, pediatrics, gynecology, and other specialties.
Conditions treated by General Urologists include:
BPH is the non cancerous enlargement of the prostate. The prostate gland encircles the urethra in males and produces a fluid that makes up part of the semen. As the prostate enlarges, it can put pressure on the urethra causing a slowing of the urinary stream, hesitancy, frequency and dribbling. It can also cause urinary retention- the inability to urinate.
Complications from BPH may include urinary tract infections, weakening of the bladder muscle, hematuria (blood in the urine), renal failure, impaired sexual function and bladder stones.
The type and severity of symptoms experienced will vary from person to person and may change over time. For many men, BPH never progresses beyond a minor to moderate annoyance; for others, it may greatly impair their quality of life.
A diagnosis of BPH involves a physical exam, a digital rectal examination (DRE) and an evaluation of the patients symptoms. Laboratory tests may include:
Non- Laboratory tests may include:
Treatment decisions are based upon each patients condition. The pros and cons of each option are discussed in detail during treatment planning.
Examples include reducing fluid intake in the evening and eliminating bladder irritants from the diet.
In patients who have moderate symptoms, medications are used to control BPH.
Minimally invasive Therapies
Open prostatectomy is usually done in men who have a greatly enlarged prostate gland, bladder damage or other complicating factors, such as bladder stones.
A comprehensive program for the diagnosis, treatment and prevention of urinary stone disease is offered. The initial evaluation of a patient with stone disease is carefully performed to determine the number, size and location of the stone burden. Imaging studies are performed to demonstrate kidney function, the patient's anatomy and the CAT scan characteristics of the stone(s) degree of "hardness". The number, size, location and "hardness" of the stones provide vital information for planning the most efficient treatment strategy for each individual patient.
Today, there are many choices for removing urinary stones. We offer all the available options for treatment:
Emphasis is placed on a complete metabolic work up to identify the reasons for recurrent stone formation in each individual patient. The work up includes a review of the patient's past stone history, family history, with special attention paid to diet, eating habits and food preferences, physical activity and fluid intake.
One or two 24-hour urine collections are performed at home to assess the balance of stone promoters and stone inhibitors present in the patient's urine. Additional specific blood tests may be required to complete the metabolic evaluation.
Taken together, this information allows the generation of a specific plan for stone prevention for each individual patient. Dietary and fluid intake recommendations are made; if necessary medication
This is what occurs when urine needs to be temporarily diverted because of urinary obstruction and/or infection. This is usually performed by inserting a Ureteral stent or by performing a percutaneous nephrostomy which are described below.
What is a Ureteral Stent?
A stent is a narrow, hollow plastic tube that runs between the kidney and bladder, inside of the conduit that normally carries urine between those organs called the ureter. The stent functions to hold the ureter open and allow drainage of urine and allows the kidney to function properly.
Why are they used?
There are a variety of reasons why a stent has been placed. For patients undergoing stone surgery, the stent allows passage of residual fragments without blocking the ureter. Patients who have had ureteroscopy (a look up the ureter) have a stent placed to allow the ureter to remain open while the normal postoperative swelling of the ureter resolves. Patients who have had any form of surgery on the ureter have a stent placed to allow healing of the ureter in the proper open fashion.
The stent is held in place by its design, which incorporates "pig tail" spiraling where it is located in the kidney and bladder. Occasionally, a blue suture is attached to the end of the stent and comes out of the body through the urethra ( the urine tube leading from the bladder outside the body. If you have such a blue string present, under no circumstances pull on it, as it will cause the stent to become dislodged. Be especially careful when bathing, not to catch the string on the terry cloth towel.
Urine is diverted by placing a tube through the skin of the patient’s flank into the kidney. This is usually performed under local anesthesia and with sonographic or radiographic guidance.
What is permanent urinary diversion?
When the urinary bladder is removed (due to cancer, other medical condition, or because the organ no longer works), another method must be constructed for urine to exit the body. Urinary reconstruction and diversion is a surgical method to create a new way for urine to exit the body.
There are three main types of permanent urinary diversion surgeries:
For all of these procedures, a portion of the small and/or large intestine is disconnected from the gastrointestinal (fecal) stream and used for reconstruction.
ILEAL CONDUIT: This reconstruction includes removing an approximately 8 inch segment of small intestine, which will remain on its vascular stalk to insure a continuous blood supply. The gap in the remaining small intestines is reconnected, and one of the open ends of the removed 8 inch segment is closed. The ureter(s) will be connected to the free segment of intestine or "conduit" at the side of the closed end. Finally, the open end of the segment is connected to the skin as an opening, or stoma, at the lower aspect of the abdomen. Urine will continuously drain from the stoma, so it is necessary to wear an appliance to collect it. The appliance sac will need to be emptied manually approximately 3-4 times per day. At nighttime, individuals can connect their appliance sac to a larger collection bag, obviating the need to empty their urine during sleep. The urinary conduit is the simplest of the 3 reconstructions, and has the lowest rate of complications.
CATHETERIZABLE STOMA: A modification of the urinary conduit, the catheterizable stoma enables an individual to excrete urine from their stoma without the need for an external appliance. The stoma is modified into a one-way valve so that urine cannot leak out. Usually , a larger segment of large intestine is removed, and fashioned into a reservoir or "pouch" for holding approximately pint of urine. By inserting a rubber catheter into the stoma, urine is easily drained from the reservoir. This reconstruction requires individuals to have a level of dexterity and self-motivation to perform the catheterization several times each day. Unlike the urinary conduit, individuals cannot connect their stoma to a larger drainage sac at night, but rather must awaken at least once to empty their reservoir.
NEOBLADDER: The most technically complex reconstruction results in no external device but rather connects the intestinal reservoir to the urethra (the tube that exits urine naturally from the body). The neobladder is cosmetically attractive. This operation is far more complex for several reasons. First, the connection of the reservoir to the urethra is technically more difficult since it is deep within the pelvis. The complexity of this connection may lead to complications such as scarring leading to urinary retention; or internal leakage leading to urine collections that can become infected. Additionally, because the removal of the bladder includes part of the urinary sphincter responsible for continence, it is possible that there will be significant urinary leakage or frank incontinence. Also because the intestinal reservoir does not have the same innervation and musculature as does the bladder, the ability of the reservoir to contract and therefore excrete the urine is fairly limited. Because of this potential scenario, individuals must be motivated in and capable of performing self-catheterization through their native(original) urethra. Nevertheless, in most cases careful training and rehabilitation teach individuals to exert internal abdominal pressures in order to excrete urine. It should be noted that the extent of local bladder cancer may impact on the safety and efficacy of this reconstruction from a cancer-control standpoint.
Here is the internal view of a neobladder. Intestine has been made into a pouch and the ureters are connected to the top while the pouch itself is connected to the urethra is used to further decrease to the risk of stone formation.
By definition, urinary incontinence means involuntary leakage of urine. This can be a distressing problem that affects your quality of life. There are different kinds of urinary incontinence, including stress incontinence, urge incontinence, overflow incontinence, and mixed incontinence. Involuntary leakage of urine may occur due to a number of reasons including excessive production of urine, bladder irritation, neurologic or muscular disorders, or prostate problems in men. We are able to do various studies in the office to determine the cause of your incontinence.
Types of incontinence:
A number of studies can be done to better understand the type of incontinence you have and what may be causing it. These studies include:
There are different ways to treat urinary incontinence depending on the type and cause of leakage. The most conservative treatment is behavioral modification. Often decreasing the amount of fluid you are drinking may decrease the amount of leakage. Avoiding bladder irritants such as caffeine, alcohol, and spicy foods may help as well. Treating underlying medical problems such as diabetes or an enlarged prostate is also useful in treating incontinence.
Physical therapy can be helpful for those with stress incontinence. A licensed physical therapist can teach you the proper exercises to strengthen the pelvic floor muscles and thus eliminate or decrease the amount of leakage. Other options include injection of a bulking agent into the urethra or surgical placement of mesh (a “sling”) under the urethra to give you more support.
There are many medications available by prescription to help relax the bladder and eliminate urge incontinence. Injection of Botox into the bladder is another treatment option for urge incontinence. A bladder “pacemaker” device called Interstim™ can be implanted to help with urgency and urge incontinence as well.
You will need an appointment with one of our board certified urologists to further discuss the best treatment option for you.