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Introduction:
Urological surgery was one of the last surgical disciplines to become recognised
as a separate specialty from general surgery in terms of training and practice.
Urological disorders account for about one third of all surgical admissions to
hospital. Such disorders are common in the community, and though few are life
threatening, many may have a profound effect on the quality of life.
Philosophy of urology
There is an ever increasing preference for both diagnosis and treatment to be
minimally invasive. Investigations are becoming more sophisticated, and the
equivalent of a diagnostic laparotomy is needed very rarely, if at all.
Ultrasonography and computed tomography have replaced many of the more invasive
investigations, such as intravenous urography, angiography, and lymphography.
Urodynamic disorders
Problems of bladder outflow obstruction secondary to benign prostatic
hypertrophy constitute about a third of urological practice. Other urodynamic
disorders occur in patients with neurological disorders of many kinds. The
management of patients with urinary incontinence is also included under this
heading.
Oncology
Bladder tumours and prostate cancer are the two commonest malignant diseases
presenting to urologists. Most urology departments run a haematuria service as
many studies confirm the importance of investigating haematuria urgently.
Prostate cancer is now being diagnosed at an earlier stage and more often since
the advent of prostatic specific antigen and transrectal, ultrasound guided
biopsies of the prostate. All urologists can treat patients with a bladder
tumour or prostate cancer, but more complex and advanced disease requiring
major surgery is best dealt with by a cancer centre.
Stone disease
The prevalence of stone disease in the United Kingdom (3%) is much lower than in
many other developed and developing countries. The need for expensive, high
technology equipment dictates that patients who need intervention for their
stones are best treated in stone centres, of which there should be one or two
per health region.
Reconstruction
Reconstructive urological procedures include surgery for congenital
malformations, though many of these are best treated by paediatric rather than
adult urologists. Complex urethral strictures need special expertise. There is
an increasing tendency to avoid urinary diversion in favour of a reconstructive
procedure--to provide a continent neobladder--in patients who have had a
cystectomy or who have intractable incontinence secondary to bladder neuropathy
or congenital malformation. Such procedures are usually carried out by those
who specialise in reconstructive urology.
Urinary Incontinence:
Incontinence is any involuntary loss of urine. It affects approximately two
million Americans and accounts for billions of health care dollars spent
annually. Incontinence affects both men and women. It is not a normal part of
aging. It is a sign of an underlying condition.
Causes of Urinary Incontinence
Incontinence has many causes. It can be the result of trauma, surgery,
childbirth or hormonal loss post-menopause. It can be related to diseases such
as diabetes, stroke, multiple sclerosis or spinal cord injury.
Types of Incontinence
The two most common types of incontinence are called stress and urge. Stress
incontinence is loss of urine when a person coughs, laughs or sneezes or with
activity such as walking, running or lifting. Urge incontinence is when urine
starts to flow before the person has time to get to a restroom. A person can
have both stress and urge incontinence. This is referred to as mixed
incontinence.
Other types of incontinence include overflow incontinence. This is when the
bladder never empties properly and continuously drips urine. Functional
incontinence is when a person can not reach a restroom in time due to physical
limitations.
Diagnoses of Urinary Incontinence
Your doctor or health care provider will want to take a complete history and
perform a physical examination. Sometimes, additional tests are needed to
determine the type of incontinence. These include blood and urine tests as well
as X-Ray studies of the urinary tract. The urologist may wish to look inside
the bladder using a cystoscope. A special test called urodynamics can evaluate
the function of the bladder.
Treatments
There are many treatment options available to help people with urinary
incontinence. Management options include pads, diapers, external or internal
catheters and clamps. Behavioral treatment options include dietary
modifications, timed voiding and pelvic floor retraining. Pelvic floor
exercises (also known as Kegel exercises) can help to strengthen the muscles
that support the bladder and prevent urine leakage.
Drug therapy is most effective for urge incontinence. A variety
of agents are available to help relax the bladder and prevent the involuntary
contractions that cause urine leakage. Some people may benefit from electrical
stimulation therapy combined with Kegel Exercises. With electrical stimulation
therapy, a small current is passed along the muscle paths leading to the
bladder to help reset the nerve pathways to function properly.
There are also many surgical options for treating incontinence. Collagen
injections can be placed at the opening of the bladder to help tighten the
closure of the bladder. For women, urethral slings or supports can be placed.
Bladder suspension surgery can benefit women who also have bladder prolapse
(dropped bladder). Men with incontinence can also have urethral slings. The
artificial urinary sphincter involves surgical placement of a cuff around the
urethra that can be inflated or deflated by the person based on their urge to
urinate.
Female UrologyThe subspecialty of female urology is concerned with the diagnosis and treatment
of those urinary tract disorders most prevalent in females. These include
urinary incontinence and pelvic floor prolapse, voiding dysfunction, recurrent
urinary tract infection, urethral syndrome and interstitial cystitis. Expert
evaluation of these conditions includes a complete history and physical exam.
Urodynamics (bladder function test) and imaging studies may be required to
fully evaluate the urinary tracts. Additional bladder studies such as
cystoscopy may be necessary. The Department of Urology at Stony Brook offers a
comprehensive evaluation and treatment plan for these female urologic
disorders.
IncontinenceIncontinence is an involuntary loss of urine. It is further defined by type as
either stress (leakage with straining, coughing, sneezing), urge, mixed,
overflow, functional or reflex incontinence. Treatment is dependent on the type
of incontinence. Current therapies include dietary changes, scheduled voiding,
bladder retraining, pelvic muscle exercises, biofeedback, electrical
stimulation therapy, medication, collagen implants and minimally invasive
surgery.
Voiding Dysfunction Voiding dysfunction can take many forms. The main symptoms are urinary
frequency, urgency, painful urination and/or incomplete bladder emptying.
Treatment is aimed at decreasing or eliminating symptoms. Treatment may involve
medications or pelvic
floor relaxation exercises.
Urinary Tract Infection (UTI)A recurrent urinary tract infection (UTI) may be generally defined as three or
more infections within one year. This may be idiopathic (no obvious cause or
related to a urologic disorder such as stones, tumor, reflux (urine flows
backwards toward the kidney) or ineffective bladder emptying. Treatment is
aimed at identifying the cause and/or proper antibiotic therapy to break the
cycle of recurrent infection.
Urethral SyndromeUrethral syndrome is a condition involving pain at the urethra that can occur
during urination or without regard to urination. Treatment may consist of oral
medication or local estrogen replacement therapy. Urethral syndrome may exist
as a component of interstitial cystitis.
Interstitial Cystitis (IC)Interstitial cystitis (IC) is a urologic syndrome characterized by excessive
urinary urgency, frequency, nocturia (nighttime urination) and pain in the
lower abdomen and/or perineum. It can occur at any age, however, the median age
at diagnosis is between 42 and 46 years. The cause of IC is unclear. It is
believed to be related to irregularities in the bladder lining and/or an
allergic/immune response. IC can severely affect an individual's quality of
life. Promising developments in the treatment of IC include medications, such
as Elmiron, which works to restore the normal function of the bladder lining.
Other drugs with calming effects on the bladder may also be helpful. Bladder
instillations with dimethyl sulfoxide (DMSO) have achieved variable success.
Hydrodistention of the bladder under anesthesia is a common therapeutic and
diagnostic procedure. In the most severe cases, surgery including denervation,
urinary diversion and augmentation cytoplasty may be performed. All of these
evaluation and treatment options are available at the Urology Department of
Stony
Brook.
References:
http://bmj.bmjjournals.com
http://www.hsc.stonybrook.edu
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