- General urology
Special emphasis on repeated cystitis. Patients who have presented more than 3 infections in a year, need accurate evaluation of a urologist to rule out problems that judtify the repetition, as well as to treat acute episodes, and evaluate a possible treatment prevention.
This condition frequently affects sexually active women between 20 and 50, but can also occur in non-sexually active girls. Older adults also are at high risk for developing cystitis, with a much higher incidence in younger people. Cystitis is rare in men. Over 90% of cases of cystitis are caused by E. coli, a bacterium found in the intestine and colon.
Clinic: Pressure in the lower pelvis, painful urination, urgency to urinate, cloudy urine, urine odor.
Acute prostatitis is a type of common bacterial infection that is easily diagnosed and usually responds well to antibiotic treatment. The clinical picture is characterized by sudden onset with high fever, shaking chills, malaise, back pain and severe micturition that can reach acute urinary retention.
The infection quickly improves with antibiotics.
Once an acute episode occurs, it is important to check out any reason that would justify their cause. The characteristics of the prostate and the proper functioning of the urinary bladder must be checked.
Benign prostatic hyperplasia (BPH) is an overgrowth in the size of the prostate gland. It is very common in men from 60 years. It may cause urinary symptoms as: difficulty in urination, feeling of incomplete emptying, weak urinary stream, postvoid dribbling, increased frequency of urination, need to get up at night to urinate, urinary urgency. It may lead to complications, especially if left untreated, as increased risk of urinary tract infections, bladder stones, urinary retention (inability to urinate, requiring immediate catheterization, and renal failure.
Diagnosis is needed with good medical history, a rectal examination (palpation of the prostate through the rectum), determination of prostate specific antigen in serum (PSA), and ultrasounds.
After diagnosis is established, depending on the needs of the patient there are different treatments:
- 5a-reductase inhibitors
Indicated when drug treatment is not enough, symptoms significantly affect the quality of life, or when complications appear:
- Transurethral rediv of prostate (TURP): removal of part of the prostate through the urethra.
- Retropubic adenomectomy: by an incision in the lower abdomen or perineum.
- Prostate Laser Enucleation. This technique performs the same surgical proceeding that the open retropubic adenomectomy but without skin incision. The use of laser allows us to perform surgery of large prostates through the urethra.It achieves similar result as open technique, but with less blood loss, decreased transfusion requirements and a faster postoperative period.
- Prostate Laser Vaporization: It is equivalent to TURP. It allows transurethral vaporization of prostate tissue with laser. It reduces the risk of blood loss, postoperative transfusions and allow faster recovery.
For optimal diagnosis and monitoring of BPH, we have a BPH Unit to perform the most specific tests for diagnosis and follow-up of BPH, including uroflowmetry and IPSS (International Prostate Symptom Score).
Vasectomy consists on ligation and div of the deferent ducts, resulting in permanent sterilization.
It is performed under local anesthesia, with a small incision in the scrotum. The sperm ducts are cut and tied after removing a segment so that both ends of each tube are knotted apart. After 2-3 months of the procedure, a semen analysis should be done to confirm the absence of sperm in semen.
Importantly, the following points:
- There is no “reversible vasectomy,” Vasectomy is done to be irreversible. If, in the future, we want to restore fertility, vasovasostomy should be performed, or a testicular biopsy for sperm aspiration and artificial insemination.
- Vasectomy involves no sexual or hormonal change.
- After a vasectomy ejaculation is not lost.
Phimosis is an abnormality of the penile skin (foreskin) that alters the mechanics of this organ. Prevents complete retraction of the foreskin to leave the glans uncovered. Contrary to what many people think, it is not exclusively of childhood; it may occur at any age. If not treated, it may involve difficult erection, discomfort during sexual intercourse. Left to their natural evolution over the years can lead to obstructive renal failure by not allowing the bladder to empty, or trigger cancer of the penis.
The solution consists on performing a circumcision.
It is the medical discipline responsible for the treatment of the male reproductive system.
Formerly called impotence, it is a situation of inadequate erection with sexual stimulation, allowing the introduction of the penis into the vagina.
There are several causes:
- Organic causes
- Vascular (lack of blood supply)
- Hormonal (lack of testosterone)
- Neurological (nerve condition)
- Psychological problems, thoughts of fear
- Mixed causes.
- Treatment may vary depending on severity. From changes in lifestyle to oral drug therapy (oral PDF- 5 inhibitors) or intracavernosal therapy, injected into the penis.
- Constricting ring is placed at the base of the penis
- Vacuum devices
- Surgery: Last resort, involves the implantation of a penile prosthesis, the most desirable are hydraulic, which have a mechanism that allows the reversibility of the erect penis.
Testosterone deficiency syndromes
Fertility in Men
Studied by semen analysis to evaluate the degree of male infertility and appropriate treatment.
In vasectomized patients, we perform vasovasostomy.
Part of urology in charge of diagnosis and treatment of cancer in the urinary tract.
Includes several types of malignant tumors that are located in the urinary bladder.
We distinguish superficial bladder cancer from invasive cancer. When cancer remains superficial, is more often associated with a good prognosis, while the invasive bladder cancer is much more severe and requires aggressive treatment. The treatment of bladder cancer is based on extension. It ussually requires transurethral rediv of the bladder and intravesical chemotherapy or immunotherapy if superficial. In invasive cancers, radical cystectomy (bladder removal) may be required, with subsequent urine derivation, either an ileal conduit (Bricker) which involves carrying a bag attached to the abdomen, or a neobladder using intestine, in this case the urine goes out through the urethra.
The most common symptom is hematuria (blood in the urine), voiding symptoms (itching or burning sensation during urination). Ultrasound, cystoscopy and cytology may be used for diagnosis.
It develops most often in men over fifty years. Most cases are diagnosed through physical examination or analysis, such as PSA (prostate specific antigen). Suspected prostate cancer is confirmed by extracting a sample of the prostate (prostate biopsy). Sometimes it is necessary to perform multiple biopsies over time in a single patient to exclude or comfirm prostate cancer. Urologia Girona have studied the role of less invasive techniques in the diagnosis of prostate cancer such as functional MRI.
Treatment of prostate cancer is highly individualized, and many factors are taken into account to decide the final treatment: age, life expectancy, patient preferences regarding side effects associated with each treatment, stage and grade of cancer.
- Treatment may vary from a watchful waiting to radical treatment with surgery or radiation therapy.
- Regarding surgery for prostate cancer, we perform several techniques:
Retropubic radical prostatectomy: Open surgery with an incision in the lower addomen
Laparoscopic radical prostatectomy: Surgery without incision
Side Effects may include urinary incontinence, erectile dysfunction.
- Other techniques: HIFU, cryotherapy, are not accepted as first-line treatment for the international urological associations
- Hormonal treatment is for patients who are not candidates for radical treatment
The treatment of choice is radical surgery. Depending on the size of the tumour and location, surgery may be performed totally (nephrectomy, consisting on the removal of the whole kidney) or partially (tumorectomy, or removal of the tumour, leaving the rest of the kidney). Both techniques may be performed open or laparospically.
There are other second-line treatments to be considered, but less effective.
It is the most common malignant tumour among young people aged fifteen to forty years. Removal of the testicle is often sufficient to cure the patient (orchiectomy). This disease has a fairly high cure rate, of around 90%. Depending on the stage of the disease, chemotherapy, radiotherapy or lymphadenectomy may be needed.
Nephrolithiasis is a common disease consisting on the formation of stones due to crystallization and precipitation of compounds in the urine. It may cause a renal colic. There are different composition: calcium oxalate, uric acid, struvite, cystine.
The stones need treatment to cure the discomfort and prevent further complications:
- Medical treatment to help deliver the stone
- Ureteroscopy with laser lithotripsy: (endoscopic access to the ureter for breaking and removing the stone.
- Extracorporeal shock wave lithotripsy : series of pulses transmitted to the skin to reach the stone and break it. The fragments are then ejected.
- Open surgery
- Percutaneous surgery
Part of Urology dedicated to regain good function of the excretory system and male reproductive
Part of urology dedicated to correct all the abnormalities of the urethra, or the tube that is responsible for taking out the urine and semen to the outside from the organs where they produce The main urethral pathology is Urethral strictures, ie light thinning of the urethra that may result from multiple causes. Treatment is mainly surgical:
Internal urethrotomy, ie : cold cut of the urethra at the level of the narrow canal through the same urethra. The relapse is very common, requiring open surgery most of the times.
Urethroplasty Open surgery of the urethra that often require grafts (tissue from other parts of the body). In Urologia Girona we have been using oral grafts for this type of surgery with good results.
Urinary incontinence can be of three types:
For the correct diagnosis must be an adequate history and performing a good physical examination and a urodynamic study.
Stress is a loss of urine that occurs when performing an exercise, coughing, laughing or sneezing. It is a common problem in women and can be treated by surgical or nonsurgical methods.
Nonsurgical: Pelvic floor rehabilitation
Surgical: urethral slings
Urgent: It needs medical treatment with anticholinergic drugs mainly.
Mixed: When you match symptoms of urgency and effort.