Urology

What is urology?

Urology is a surgical discipline that deals with conditions affecting the kidneys, ureter, bladder and urethra in both sexes – so women shouldn’t shy away from visiting the urologist. 

Urology is also better known as the speciality that deals with the male sex organs, like the prostate. 

Urology follow-up extends from initial diagnosis to final check-up, so that the patient enjoys end-to-end care from the same doctor, with the convenience of attending the same facility from start to finish of their treatment.

The most common urological conditions are prostate cancer and urinary infections. 

Prostate cancer

Definition

Prostate cancer is the most common cancer in men over 50. It generally develops slowly and only becomes metastatic after several years of progression, meaning that age at the time of diagnosis is of key importance. Cancer is the uncontrolled growth of cells that invade the surrounding tissues. These cells can also spread to other organs, creating metastases. 

Prostate cancer generally starts in the outer part of the prostate gland, which is why abnormalities can be felt from inside the rectum. If left untreated, prostate cancer can cause swelling in the legs as a result of obstructed lymphatic drainage. It can also cause bone pain, kidney failure and ultimately death.

Symptoms

• Frequent need to urinate
• Weak urine flow
• Pain during urination
• Difficulty urinating
• Blood in urine
• Erectile dysfunction
• Incontinence

Investigations

The only way of establishing a formal diagnosis is to take a tissue sample (biopsy). MRI (magnetic resonance imaging) is crucial for identifying the suspect area of the prostate more accurately. Using the images and biopsy, we can grade the tumour, i.e. establish how aggressive it is (assigning it a Gleason score), and this allows us to suggest appropriate treatment.

Diagnosis

There are two distinct categories of prostate cancer:

• Localised and locally advanced cancer, which can be cured
•  Metastatic cancer, where cells have already spread to other organs

Nowadays, thanks to screening, most newly-diagnosed cancers are at the localised stage and are therefore curable.

Treatment

Active surveillance
This approach is suitable for tumours that are not too aggressive (with a Gleason score of less than 7), non-palpable and have a low PSA level (less than 10). These criteria are regularly reassessed.

Advantage of this approach: No immediate treatment
Disadvantage of this approach: The patient has to live with an untreated cancer, which may progress rapidly.

Surgery
Radical prostatectomy is a surgical procedure to completely remove the prostate gland, capsule and seminal vesicles. This entails reconnecting the bladder to the urinary canal (a procedure known as vesicourethral anastomosis). The lymph nodes will also be removed. Our clinics offer the robot-assisted technique using the da Vinci Surgical System, which increases visibility for the surgeon and improves their accuracy. 

Radiotherapy
This approach is recommended for men over 70 but it may also be indicated for younger men who have contraindications for surgery. Radiotherapy uses beams to destroy cancer cells. It may be internal (brachytherapy, also known as curietherapy) or external (conformational radiotherapy). 

High-intensity focused ultrasound treatment (HiFU) 
This treatment is ideal for small, non-aggressive tumours. The Focal One device concentrates ultrasound on the diseased area of the prostate and gradually removes it without the need for surgery. Treatment follows the principle of active surveillance by means of MRI scans and measurement of PSA levels. 

The best treatment option depends on a number of factors and the decision is based on careful consideration by the patient and care providers. Factors to be evaluated include the stage (T) and the grade (Gleason score) of the tumour. 
The patient’s general health and history, the available methods and the doctors’ experience, and lastly, how the patient themselves feels about the different approaches will be factors that will help make choosing the treatment as comfortable as possible.

Care

At Swiss Medical Network, we offer the latest treatments, including robotic surgery using the da Vinci robot. Prostatectomy performed with this robot has become the reference surgical technique. 
High-quality dissection of the prostate is essential and the robotic technique provides better visibility (3D) and improved accuracy (tremor reduction, precise micro-movements and elimination of the lever effect that can be present with a standard instrument introduced into the abdominal cavity).

Main benefits for the patient

• ​Increased safety
• Accuracy of dissection
• Small incision
• Combined benefits of minimally invasive surgery:
• Reduced bleeding
• Reduced rate of infection
• Reduced pain
• Shorter stay in hospital and period of convalescence

Urinary infections

Definition

There are three different types of urinary infection:

• The most common infection, known as 'Cystitis', is caused by Escherichia coli bacteria generally present in the intestines. They travel up the urethra via gut and faecal flora and multiply in the urinary tract. Cystitis causes a urinary tract infection and is often accompanied by urethritis (inflammation of the urethra). 
• Infectious urethritis, an infection of the urethra, is most often a sexually transmitted disease (STD). 

• Pyelonephritis is a more serious condition and an inflammation of the kidney tissue. In addition to the standard symptoms of cystitis, it involves a very high fever and sharp pains in the lower back.

Symptoms

• Pain or burning during urination
• Frequent need to urinate
• Constant urge to urinate 
• Cloudy or strong-smelling urine
• Occasional blood in urine
• Fever and chills (in the case of pyelonephritis)

Treatment

Urinary infections are generally treated with antibiotics. 

Care

Our doctors will ask you some questions to understand the extent of your difficulty passing urine and whether you have experienced this previously. They may also ask you to do a urine strip test that will show whether neutrophils and nitrites are present. Examination of the cells and bacteria in the urine will confirm the diagnosis.

Other condititons treated by the urologist

• Kidney stones
• Bladder, kidney and testicular cancers
• Female urinary incontinence and disorders
• Benign prostatic hyperplasia and male urinary disorders
• Male health issues and reproductive health
• Fertility

Urological conditions requiring emergency care

• Testicular torsion (twisted testicle): without timely surgical intervention freeing the testicle, torsion relief and orchiopexy, i.e. fixing it in the correct direction), the testis may die.
• Acute renal colic, which causes extremely intense pain. Women who have given birth report that the pain is as severe as labour. Renal colic is usually caused by kidney or ureteral stones. Alongside pain management, a ureteral stent (pigtail) may need to be inserted.
• Urosepsis (sepsis caused by an inflammation of the urinary tract). If this is associated with kidney congestion, a ureteral stent will need to be inserted immediately. 
• Visible blood in urine (macroscopic haematuria).
• Injuries to the genitals. In this case, a urologist is responsible for immediate and usually surgical treatment.