The urinary tract system comprises the kidneys, little tubes that run down to the bladder called ureters. Urine is then stored in the bladder and passed out through the urethra. Urinary tract infections can occur in men & women for a variety of reasons and become apparent usually because of discomfort or pain with passing urine, increased frequency of passing urine and sometimes an unpleasant odour. At other times a urinary tract infection may exist without any symptoms at all. The most common way of diagnosing a urinary tract infection would be from assessment of symptoms that may be present as well as assessment of the urine through a pathology lab. When a diagnosis is confirmed, antibiotics usually help resolve the infection. If there are associated problems that lead to urinary tract infections, they would often be assessed by a urologist.
Blood in the urine should always be taken seriously while sometimes bleeding in the urinary tract may be due to a non-serious condition, at other times it may suggest physical problems with the urinary tract, including stones as well as cancers of the kidney, bladder or prostate gland. The kidneys can form growths on them, they can include fluid filled structures called cysts, which are usually not serious, although sometimes kidney cysts are serious and will require either repeated observation with imaging or surgery. In addition, solid tumours of the kidney are quite often cancerous and require surgery. Surgery can involve removing only part of the kidney (partial nephrectomy) or the whole kidney. Most kidney surgery is now performed with telescopic techniques.
The prostate gland is a structure that sits below the bladder, in the middle, and is responsible for some of the reduction of seminal fluid. When the prostate enlarges it can affect the function of the bladder, commonly referred to as bladder outlet obstruction, and at other times the prostate gland can become cancerous. This is called prostate cancer. A PSA blood test and digital rectal examination are used to assess the risk for prostate cancer and these can be undertaken by your general practitioner. If there is concern about your risk, you may be referred to a urologist for a prostate biopsy where small amounts of tissue from the prostate are taken to be looked at under a microscope for clarification. Prostate cancer can be managed in a variety of ways and these are detailed in “Prostate Cancer – Your Guide to the Disease, Treatment Options and Outcomes”.
Bladder cancer is a less commonly known cancer. It most often becomes apparent when blood is passed in the urine. Sometimes it shows up on imaging studies, including ultrasound or CT scan, and often needs diagnostic testing, which is known as a cystoscopy, where a telescope is passed into the bladder to visually examine the bladder. Most bladder cancer can be treated by endoscopic techniques. When advanced, however, the bladder would need to be removed. This is referred to as cystectomy.
There are a variety of scrotal conditions that can cause swelling and/or pain. The most common are benign fluid collections within the scrotal cavity near the testicle. These include epididymal cysts and hydroceles. More importantly in younger men, sometimes relatively painless swellings can occur that can be hard and these may be testes cancer. If there is any doubt, clinical examination by your GP should be performed and most often an ultrasound of the scrotum can be very helpful. If there remains doubt, a referral to a urologist is often required.
Stone disease most commonly presents as an unexpected and sudden onset of pain that can range from back pain and radiate all the way to the front. In men it can radiate to the tip of the penis or the testicle, and with women, to the labia. Stone disease, when severe, usually results in a visit to the Emergency Department for pain relief and subsequent management following imaging studies, most commonly CT scan. Most stones can be treated with telescopic techniques and there are also a variety of non-invasive techniques that can be used.
Urinary incontinence is common in some groups of men and women. There are a variety of conservative measures that can help, including bladder training and pelvic floor exercises. When these are no longer effective, a variety of slings can be placed, most commonly as day surgery, to limit the amount of leakage, and when severe, artificial urinary sphincters can be placed into the lower urinary tract to control leakage. Sometimes leakage is managed by a urinary diversion, most commonly in the form of a urethral catheter placed in the bladder.
As men age, erectile failure becomes more common. Initially the erections become softer and less reliable and ultimately erectile failure becomes evident. It is important that your GP assesses you for any risk that may predispose you to erectile failure. Most commonly men are trialed on medicines that are currently in three forms, including Viagra, Levitra and Cialis. When these are no longer effective, penile injection therapy can be undertaken and if that fails, penile implant surgery can be considered.
An overactive bladder is one that wants to go all the time. This is most evident in frequency of passing urine as well as a strong urge. Overactive bladders need to be assessed by a urological service. Most commonly the treatment involves conservative measures involving bladder training, pelvic floor exercises and the use of drugs, use of medications that can settle down bladder contractions and sensations. Sometimes further investigations including urodynamic studies or cystoscopy may be required.