Common Urologic Conditions and Their Surgical Treatment Options

Introduction to Urologic Diseases

The urinary system plays a crucial role in regulating, managing and eliminating waste products through a complex network of organs and structures, including the kidneys, ureters, bladder and urethra. Various conditions affecting these components are commonly referred to as urologic conditions or urologic diseases. Regardless of age, gender or ethnicity, one can experience urologic diseases that directly affect the urinary tract and the urination process. Some of these urologic conditions are short-lived, while others may stay longer.

Common Urologic Conditions

The common urologic conditions affecting both men and women are:

1. Urinary tract infections

2. Kidney stones

3. Bladder control problems

4. Prostate problems

5. Kidney Cancer, Prostate cancer, Bladder cancer 

6. Blood in Urine

7. Kidney Failure

 Among these conditions, urinary tract infections occur frequently in women. However, an enlarged prostate is the most common urologic issue in males.

Kidney Stones

A kidney stone is a solid, pebble-like material that forms in one or both kidneys due to excessive mineral deposition in urine. They rarely cause permanent damage if treated properly and timely by a urology specialist.

Kidney stones often have no definite or single cause, although several factors may increase the risk of their formation. They are usually formed when urine contains an excess of crystal-forming substances like calcium, oxalate and uric acid in it. 

The risk factors that can lead to kidney stones are:

• Family history
• Obesity
• Dehydration
• Certain diets such as sodium-, sugar- or oxalate-rich foods

 Symptoms and diagnosis

The symptoms of kidney stone are:

• Severe pain in the back and lower abdomen
• Blood in the urine
• Fever and chills.
• Urine that smells bad or looks cloudy.

 For proper diagnosis, a urology specialist may recommend the following tests:

• Blood Testing: Blood tests diagnose excessive calcium or uric acid in the blood. It also aids in monitoring kidney health and provides information about other medical conditions.
• Urine Testing: The 24-hour urine collection test diagnoses the presence of excessive stone-forming minerals or inadequate stone-preventing substances in the urine.
• Imaging: Imaging tests like high-speed or dual-energy computerised tomography (CT) help to reveal the presence of kidney stones in the urinary tract. 
• Investigation Of Passed Stones: The kidney stones that are present in the urine are analysed in a lab to understand their composition.

 Surgical urological treatment options

• Extracorporeal Shock Wave Lithotripsy (ESWL)

  ESWL is a urological treatment recommended by urology specialists depending on the size and location of the stone. This technique employs sound vibrations to break stones into tiny fragments that can pass through urine.

• Ureteroscopy

  Ureteroscopy involves the examination of the upper urinary tract using a ureteroscope. The device is passed through the urethra and bladder, and then directly into the ureter to monitor kidney stones.

• Flexible Ureteroscopy (RIRS)

• Percutaneous Nephrolithotomy (PCNL)

  PCNL involves the surgical removal of kidney stones using a small telescope and other instruments. This urology surgery requires anaesthesia, and patients typically require one to two days of recovery time.

Benign Prostatic Hyperplasia (BPH)

BPH is a non-cancerous condition characterised by the enlargement of the prostate gland in men. It is more prevalent with increasing age and can lead to troublesome symptoms. The prevalence of BPH tends to rise after the age of 40, with estimates ranging from 8% to 60% among men aged 90 years and older.

The primary cause of BPH is an enlarged prostate gland that blocks the urethra which passes through it and aids in urine transportation from the bladder out of the penis. 

Risk factors associated with it are:

• Aging
• Family history
• Lifestyle
• Diabetes and heart disease

 Symptoms and diagnosis

The symptoms are:

• Frequent urge of urination
• Trouble starting to urinate
• Urinating more often at night
• Dribbling at the end of urination

 For proper identification of BPH, urology specialists recommend the following tests:

• Digital Rectal Exam: To examine a person's lower rectum and anus. This test helps to confirm the enlargement of the prostate gland. 
• Urine Test: The patient’s urine sample is tested for detecting other illnesses which can lead to similar symptoms like BPH. 
• Blood Test: This test examines the kidney problems that might cause BPH.

 Surgical urological treatment options

• Transurethral Resection Of The Prostate (TURP)

  TURP is a urological procedure that involves the insertion of a thin tool with a light in the urethra to remove a part of the prostate. This procedure provides quick relief and might need a catheter to drain the bladder for a short time.

• Laser Surgery (E.G., GreenLight Laser, Holmium Laser)

  A high-energy laser is used to destroy overgrown prostate tissue that blocks urine flow. In this procedure, either a green light laser causes photo-selective vaporisation of the prostate or a holmium laser abolishes overgrown prostate tissue.

• Transurethral Incision Of The Prostate (TUIP)

  TUIP is a urology surgery performed when there is a minimal enlargement of the prostate. The surgeon inserts a lighted scope into the urethra and makes small cuts in the prostate. This facilitates the passage of urine through the urethra.

• Transurethral Resection Of Prostate In Saline (TURIS)

• Prostate Urolift Technique

Urinary Incontinence

Urinary incontinence (UI) refers to the loss of bladder control with age. The severity ranges from minimal leakage of urine during sneezing or coughing to complete inability in controlling urination. Population studies from numerous countries have reported a prevalence rate of UI in the range of 25%-45% in the older population.

UI is caused by everyday habits, underlying medical conditions or physical problems. Certain drinks and foods that can lead to UI are:

• Alcohol
• Chocolate
• Caffeine
• Carbonated drinks
• Large dose of vitamin C

 However, persistent UI may also result from underlying physical health conditions like:

• Hormonal changes during pregnancy
• Childbirth
• Ageing and menopause
• Untreated prostate cancer

 Risk factors associated with UI are:

• Gender
• Age
• Smoking habits
• Obesity

 Symptoms and diagnosis

The symptoms are:

• Stress incontinence or urinating while experiencing pressure on the bladder
• Urge incontinence or urge to urinate frequently
• Overflow incontinence or frequent dribbling of urine
• Urinating during sleep

 UI diagnosis can be done by the following methods:

• Urinalysis
• Bladder diary
• Post-void residual measurement

 Surgical urological treatment options

• Sling Procedures (E.G., Tension-Free Vaginal Tape And Transobturator Tape)

  A synthetic mesh tape is used to create a pelvic sling that supports and stabilizes the urethra, preventing leakage during activities like coughing and sneezing.

• Artificial Urinary Sphincter (AUS) Implantation

  AUS implantation is used to treat stress urinary incontinence. A small fluid-filled ring is implanted around the bladder neck to shut the urinary sphincter until there is a need for urination.

Bladder Cancer

Bladder cancer originates in the urothelial cells of the bladder and is often non-muscle invasive. Early detection greatly increases the chances of successful treatment.

Bladder cancer results from DNA mutations in bladder cells, leading to abnormal cell growth and tumour formation with the potential for metastasis.

The risk factors of bladder cancer are:

• Smoking 
• Increasing age
• Being male
• Family history
• Exposure to carcinogens or other chemicals

 Symptoms and diagnosis

The symptoms include:

• Blood in urine or haematuria
• Frequent and painful urination
• Back pain

 Tests used to diagnose bladder cancer are:

• Cystoscopy
• Biopsy
• Urine cytology
• Imaging tests like computerised tomography urogram or retrograde pyelogram.

 Surgical urological treatment options

• Transurethral Resection Of Bladder Tumour (TURBT)

  TURBT is a urological procedure to remove early bladder cancers. Using an electric wire loop, the surgeon cuts or destroys cancer cells that are confined to the inner layers of the bladder.

• Radical Cystectomy (Robot Assisted / Laproscopic)

  Radical cystectomy is a surgery to remove the entire bladder, surrounding lymph nodes, and additional organs depending on the gender. In men, it usually involves removing the prostate and seminal vesicles, while in women, it includes the removal of the uterus, ovaries, and part of the vagina.

• Urinary Diversion Procedures

  Also referred to as neobladder reconstruction, a urinary diversion is a surgical procedure that creates a new way for urine to exit the body when the urine flow is blocked.

Common Urological Procedures

Common urological procedures are:

1. Nephrectomy or surgical removal of kidney

2. Pyeloplasty or surgical reconstruction of the renal pelvis

3. Ureteral reimplants

4. Ureteral stent placement

5. Robotic Radical Prostatectomy

6. Radical Cystectomy

Conclusion

People experience urological diseases at any point in their lifetime, irrespective of age, gender or ethnicity. However, the intensity often tends to increase with age and other health issues. Thus, proper diagnosis by consulting urology specialists is essential to ensure getting perfect treatment and curb further health disorders.

Frequently Asked Questions

1. Are there any preoperative preparations or guidelines to follow before undergoing urologic surgery?

Some guidelines that must be followed before urology surgery are:

• Maintaining a healthy weight

• Doing physical exercise regularly

• Limit smoking and alcohol

• Stop taking aspirin or other anti-platelet medications

2. What are female urological conditions?

Female urological conditions are urinary incontinence, overactive bladder and pelvic organ prolapse.

3. Do urologists treat both males and females?

A urologist is trained to diagnose and treat problems of the urinary tract in both men and women alike.

4. What is the recovery time for surgical treatment of urologic conditions?

Most patients recover fairly quickly within one week of the urology surgery, but the swelling or inflammation of the surgical area may take a few weeks to get better.

5. Are there any alternative treatment options to surgery for common urologic conditions?

Although surgery is the best option for the treatment of urological conditions, urology specialists may recommend fluid and diet management along with limiting alcohol consumption initially to regain control of the bladder. Regular physical exercise and losing weight are also recommended.