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The Kidney 
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Infection (Pyelonephritis) is usually associated with high fever, chills ,‘kidney’ pains (loin /flank pain) with/without bladder symptoms .Treatment is with Intravenous antibiotics after necessary tests.Can result in serious complications if neglected / inadequately assessed and treated.
Stones
Although the cause of kidney stones are not always clear they usually present with what is commonly known as ‘renal colic’ where patient experiences excruciating loin pains which gradually radiates to groin requiring immediate treatment to ease pain. Urgent urine testing and scans / X-rays are required to confirm diagnosis and to plan treatment. If kidney is obstructed with or without the complication of infection removal of obstruction is the main objective. Stones from ureter can be removed endoscopically using a Ureteroscope (instrument to visualise the ureter, the tube draining urine from kidney to bladder) or through a direct approach to the kidney if stone is large and lodged in the main funnel shaped drainage tube , the renal pelvis and its branches .The procedure is PCNL (PerCutaneous NephroLithotomy) Stones sometimes are amenable to ‘shock wave’ treatment applied externally from a shock wave generating machine , ESWL (Extra Corporeal ShockWave Lithotripsy) . Temporary relief of blockage is effectively done by inserting a hollow plastic tube coiled at its ends called a Stent endoscopically through the bladder. Testing 24 hrs urine collection and blood tests can sometimes give a clue to the cause and assist in modifying diet to prevent recurrence .Large fluid intake is also normally recommended to prevent recurrence.
Kidney Cancer
Cancer arising from the kidney cells,Renal Cell Carcinoma are quite often detected during investigations for other unrelated conditions but can present with blood in urine, loin pain and swelling in kidney area also.Once detected on ultrasound scan or kidney X-ray (IVU, IntraVenous Urogram) further tests like CT scan and MRI are done for staging the cancer .Surgery in its early stages offers best outcome, carried out through open surgery or Laparoscopically (‘key hole surgery’)
Cancer of Lining of the Kidney Pelvis and Ureter is a different type of cancer , TCC (Transitional Cell Carcinoma) which is similar to and even co-exist with bladder cancer as the lining is the same. Treatment is by surgery and may involve complete removal of kidney,ureter and a cuff of bladder where ureter opens into it (Nephro-ureterectomy).
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| Kidney conditions: |
Haematuria (blood in the urine)*
Stones
Cancer
Cysts
Infection
Renal Colic |
NOTE: Those concerns marked in red require urgent attention |
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The Ureter
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The ureters are fibromuscular tubes that convey the urine from the renal pelvis to the bladder. Each ureter is approximately 16 inches long and the one leading from the right kidney is slightly shorter than the left. The ureters consist of mucosal, muscular, and fibrous layers. The area where the ureters enter the bladder is called the trigone. Valves in this region prevent the reflux (i.e., backing up) of urine into the kidneys. <top>
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Ureter Conditions: |
Haematuria (blood in the urine)
Obstruction |
NOTE: Those concerns marked in red require urgent attention |
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The Bladder
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The urinary bladder is a hollow, muscular organ that stores urine. It is located behind the pubic bone and sits within and is protected by the pelvis. The bladder is held in place by ligaments (bands of tough, fiberlike tissue) that connect it to the pelvis and to other organs. The narrow, internal opening of the urethra within the bladder is called the bladder neck. Muscles in the bladder neck called sphincters tighten around the urethra to prevent urine from leaking.
Bladder Cancer
Cancer promoting pollutants like smoking, certain chemicals ,chronic infection and certain ‘worms’ in certain parts of the world can be responsible in many cases of bladder cancer but at times no cause is identifiable .Investigations are the same as for haematuria (blood in urine) .Scans and special X-rays ,Cystoscopy (camera examination of bladder)and Cytology (inspection of urine for malignant cells) and further tests if proven to be cancer for determining the true extent of cancer (Staging). Treatment depends on the type of cancer , the extent of the disease, patient related factors etc. Simple endoscopic procedures to complete removal of bladder with or without ‘new bladder reconstruction’, Radiation treatment , Chemotherapy etc are the options offered after careful consideration of all factors related to the cancer and the patient by the MDT (Multi-Disciplinary Team of specialists). Some bladder cancers may require treatment of the bladder lining with instillations of Chemotherapy drugs or other agents after endoscopic treatment .
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| Bladder Conditions: |
Haematuria (blood in the urine)
Cancer
Infection
Cystitis
Stones
Incontinence
Overactive
Dysfunction
Diverticulum |
NOTE: Those concerns marked in red require urgent attention |
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The Prostate
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A small gland,size and shape of a chestnut which surrounds the urethral tube at its exit from the bladder tend to be be the site for three common problems affecting men: Inflammation (Prostatitis), Non-cancerous enlargement (BPH – Benign Prostatic Hyperplasia) and Prostate Cancer.It produces a little secretion which is a nutrient for sperms and helps keep semen liquid.
Prostatitis is inflammation of prostate gland and tend to affect relatively young and middle aged men with varying symptoms, often requiring treatment with antibiotics. Ache /pain in the testicles, in the area between testicles and back passage, lower back ,lower part of abdomen are the common symptoms, but in an acute form it can be incapacitating with high fever and general feeling of being very ill and needing hospital admission for treatment with strong antibiotics.
BPH (Non-cancerous swelling) affects the inner part of the prostate gland close to the urethral tube and tend to squeeze it restricting the flow of urine ,often being interrupted (‘stop – start’) and resulting in incomplete emptying of bladder .Often these patients have to get up several times to pass urine interfering with their quality of life.If left untreated it may progress with worsening symptoms sometimes resulting in complete stoppage (Urine Retention) needing urgent catheter drainage of the bladder .Early stages can be successfully treated with various medications after prostate examination and necessary tests. As prostate cancer patients also have similar symptoms blood test for Prostate Specific Antigen (PSA) is included in the initial work up with Flow measurement and Ultrasound scan. If obstruction is severe and or complicated with kidney function impairment endoscopic surgery to widen the outlet (TURP- TransUrethral Resection of Prostate or BNI – Bladder Neck Incision) will be required.
Prostate Cancer : Although the cause of prostate cancer is not well understood it is certainly the most common male cancer and results in significant mortality if left untreated. If detected in its early stages it is potentially curable.As prostate cancer has no specific symptoms in its early stages the detection is only possible by prostate examination through the back passage (DRE – Digital Rectal Examination) and blood tests (PSA – Prostate Specific Antigen) and confirmation of suspicion by prostate biopsy (TRUS – TransRectal UltraSound guided biopsy) Pathologist examines cores of prostate tissue samples to determine if there is cancer and if so its grade (Gleason Grade - which often predicts aggressiveness). Extent of the cancer is determined by Scans (Staging by CT, MRI, Bone Scan) before deciding on treatment strategy (after joint consultation, MDT – Multi-Disciplinary Team). Treatment options, Surgery (Radical Prostatectomy – total removal of prostate and the attached seminal vesicles), Radiation, Hormone Manipulaion and Chemotherapy (depending on the stage of the cancer and other relevant patient related factors). Regular follow up with PSA tests will be necessary.
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Prostate Conditions: |
Enlargement
BPH
Cancer
Prostatitis
Obstruction
Retention
Inability to pass urine
Haematuria (blood in the urine)
Haemospermia (bood in the semen) |
NOTE: Those concerns marked in red require urgent attention |
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The Urethra
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Stricture or narrowing : Although there are many causes,usually occurs as a result of inflammation or trauma. Urine flow is restricted needing straining and at times comes out as a ‘spray’. Urinary infections are a common complication. Usually treated by stretching the scarred segment using metal dilators (dilatation), by slitting it to widen the lumen (Optical Urethrotomy) or by reconstructing the urethral tube (Urethroplasty) if very badly scarred.
‘Wart’ ‘Papilloma’ (Condyloma) is a soft friable growth appearing at the opening of urethra (meatus) which tends to bleed easily and stains clothes and needs to be treated after confirmation by the urologist. Usually requires electrocoagulation or Laser treatment.<top>
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| Urethral Conditions: |
Stricture (Narrowing)
Blood at the opening
Warts (Papilloma) |
NOTE: Those concerns marked in red require urgent attention |
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The Testicle (Scrotum)
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Swollen testicle or feeling of a lump on self examination always needs careful evaluation to rule out any underlying serious problem. Fluid collection in a sac surrounding testis (Hydrocele) Cysts and abnormally dilated veins draining testicles (Varicocele) are some of the common benign conditions. Twisting of testis on its cord (Torsion) and inflammation of epididymis/testis (Epididymitis/orchitis) are two very painful conditions at times difficult to differentiate need urgent attention. Testicular cancer often present as painless lumps sometimes with ache and heaviness in testicles. All testicular lumps need investigating. <top>
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Testcular Swellings: |
Swollen testicle
Cancer
Infection (inflammation)
Epididymitis
Torsion (Twisting)
Varicocele
Hydrocele |
NOTE: Those concerns marked in red require urgent attention |
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The Foreskin/Penis
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A commonly seen problem is inability to retract a tight foreskin (Phimosis) which can be as a result of infections and can result in retention of secretions, pain during sex and complications of varying severity. Forceful retraction of a tight foreskin can result in the complication of paraphimosis (tight foreskin stuck behind glans causing painful swelling) requiring urgent attention.
Surgical correction is by a minor procedure, Circumcision (removal of excess foreskin ) usually done under general anaesthesia as a day case.
Erection Problems
Erectile dysfunction affects 5-25 % of men between 40 -65. There is increasing evidence that ED is a vascular disorder in the majority of cases. Detailed history, examination and tests are required before reaching a diagnosis and planning the most appropriate treatment as psychological, organic or combined causes may be responsible for the ED. Common non-surgical treatment options are oral medications to improve blood flow to the penis. These drugs are used with great caution as they can interact with some medications used for anginal pain causing serious consequences. Injection treatment and vacuum devices are also used with success in appropriate cases. Surgery is reserved for patients with surgically correctable disorders. ED is certainly a treatable disorder in most instances. <top>
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Foreskin Conditions: |
Phimosis (Tight Foreskin)
Paraphimosis
Lumps
Adhesions
Hard Lumps
Peyronies Disease
Erection Problems
Impotence
Priapism (Persistent Erection) |
NOTE: Those concerns marked in red require urgent attention |
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Vasectomy
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An effective minor procedure for permanent male contraception carried out under local or general anaesthesia as a day case. Small segments of vas (tube which transports semen from testis to the urethra) are removed and cut ends tied/sealed. Two negative semen tests are required before declaring ‘sterile’.
Vasectomy Reversal carried out using fine sutures and magnification (Microsurgery) Success depends on many factors including interval between vasectomy and reversal. <top>
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Vasectomy: |
Vasectomy
Reversal of Vasectomy |
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Cystoscopy
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Inspection of bladder and urethra using either a rigid or flexible narrow calibre telescope. Done under general anaesthesia or local anaesthesia as a day case.
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Prostate Biopsy
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Like the prostate examination an ultrasound probe is introduced into the backpassage to visualise prostate and a biopsy needle is advanced into different areas of the prostate to take representative samples for pathologist to examine under the microscope. This is done with local anaesthesia and antibiotic cover. Potential risks after biopsy are blood in urine,blood in the backpassage or blood in semen. Usually not a painful procedure.
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Circumcision for Adults and Children
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The procedure is the same for both children and adults and involves surgical removal of tight foreskin covering the glans penis. Difficulty in retracting the foreskin with or without pain or discomfort may result in poor hygiene, infections, scarring, painful intercourse and may result in complications.
This is a day case procedure done under anaesthesia. Time to return to normal activities is rapid in uncomplicated cases. There will be some soreness and increased sensitivity at the beginning
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Vasectomy/Vasectomy Reversal
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An effective minor procedure for permanent male contraception carried out under local or general anaesthesia as a day case. Small segments of vas (tube which transports semen from testis to the urethra) are removed and cut ends tied/sealed. Two negative semen tests are required before declaring ‘sterile’.
Vasectomy Reversal carried out using fine sutures and magnification (Microsurgery) Success depends on many factors including interval between vasectomy and reversal. <top>
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Urethral Dilatation/Optical Urethrotomy
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When the urethral tube is narrowed reducing stream with or without complete bladder emptying from scarring or other causes its lumen is widened by passing metal 'rods' of gradually increasing sizes usually under anaesthesia.
Extreme scarring with only a 'pin hole' opening of the urethral tube may require slitting of the scar tissue endoscopically (Optical Urethrotomy) instead of the dilatation method. After the widening has been achieved a catheter tube is left in for few days for healing to take place and to prevent premature sticking to the edges of the slit.
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TransUrethral Resection of the Prostate (TURP)
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This purely endoscopic procedure (without the need for Open Cut Operation) is carried out to improve flow of urine by coring out the obstructing prostate tissue using an instrument called resectoscope. It has a telescope and an electrically operated loop to scoop out prostate tissue. Normally a catheter tube is left in until the urine becomes clear which normally takes a day or two. There may be some blood in the urine from time to time until the healing is complete inside. 'Prostate chips' removed at operation are examined by the pathologist.
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Radical Prostatectomy
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Complete removal of cancer bearing prostate and the seminal vesicles attached to it. This is offered to patients with no obvious cancer spread outside the gland. This is done through the abdomen (Rectropubic Prostatectomy), through the perineum (the space between the back passage and the testicles) with no visible cut to the abdomen (Radical Perineal Prostatectomy) or through the abdomen using laparoscopy instruments passed through few small skin incisions endoscopically (Laparoscopic Radical Prostatectomy). Lymph glands draining the prostate may also need to be removed in certain circumstances.
Main potential complications are poor urinary control and erection problems
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Kidney Stone Removal - PerCutaneous NephroLithotomy (PCNL/PNL) |
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Removal of kidney stones through a 'key hole' approach without the need for an open abdominal operation. Access to the kidney with the stone is achieved through a small opening in the back and the stone is removed with or without fragmenting and with rapid return to normal activities in uncomplicated cases. |
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