Urology Problems and Treatments

Benign prostatic hyperplasia is also known as benign prostatic hypertrophy. It is a condition characterised by the enlargement of the prostate gland, which may slow or obstruct urine flow.

BPH commonly occurs in older men, and most men have no symptoms. However, common symptoms include:

• Increased frequency of urination, especially at night
• The need to urinate frequently
• Dribbling or leaking of urine
• Weak stream of urine

Kidney stones are solid pebble-like material that can form in one or both kidneys and most commonly affect adults between the ages of 30 and 60.

Mineral and salt deposits that form inside your kidneys can harden and become kidney stones. This usually happens when your urine is overly concentrated, leading to the crystallisation of these mineral and salt deposits. Passing a stone can be painful, but kidney stones typically do not cause harm when discovered early.

Kidney stones of small size are unlikely to cause significant symptoms. They may pass out gently and undetected when you urinate.

Large kidney stones can cause symptoms such as:

• Sharp pain in the lower, back and side of the abdomen or groin 
• Pain during urination
• Frequent urination
• Cloudy or foul-smelling urine
• Blood in urine

Urinary tract infections (UTIs) are common infections that occur when bacteria, typically from the skin or rectum, infect the urinary tract via the urethra.

UTIs can affect any part of the urinary tract, which includes the kidneys (pyelonephritis), bladder (cystitis) and urethra (urethritis). However, bladder infections are the most common type.

Women are more likely to have a urinary tract infection compared to men as their urethra is shorter and closer to the rectum.

Symptoms of UTIs include:

Lower UTIs (bladder and urethra)

• Increased frequency of urination
• Strong urge to urinate despite having an empty bladder
• Foul-smelling urine
• Burning sensation or pain during urination
• Cloudy appearance of urine
• Blood in the urine
• Lethargy and tiredness 
• Lower abdomen pain 

Upper UTI (kidneys and ureters)

• Symptoms mentioned above
• Fever (38^oC or above)
• Chills and rigor
• Nausea and vomiting 
• Lower back pain or pain in the sides of your back
• Restlessness

Problems with erections are relatively common, especially among men over 40. It is often nothing to worry about. However, you should consult your doctor if it persists, as it may indicate a more severe condition. Learn more about erectile dysfunction and premature ejaculation.

Urinary incontinence is the involuntary leakage of urine and is a common problem. When and how this occurs depends on the type of urine incontinence a person has. Talk to your doctor if you have urine incontinence.

Prostate cancer is the growth of abnormal cells that originates in the prostate gland, which is part of the male reproductive system.

Early prostate cancers are usually asymptomatic and are known as silent killers. As it is more likely to affect older men above 50, all men aged 50 and above are encouraged to undergo prostate cancer screening.

Patients with advanced prostate cancer would have the following symptoms: 

• Difficulty in passing urine
• Urinary hesitancy
• Frequent urination
• Blood in the urine
• Blood in semen
• Bone pain
• Erectile dysfunction
• Loss of weight
• Tiredness

Bladder cancer is the most common cancer involving the urinary system. In this condition, an abnormal growth of tissue in the bladder lining can spread to the bladder muscle. 

Symptoms may include:

• Blood in the urine (haematuria)
• The need to urinate frequently
• Pain during urination
• Burning sensation when passing urine
• Feeling the urge to urinate even if the bladder is not full
• Fatigue and weakness
• Weight loss

Wait and observe if symptoms are less severe. If treatment is needed, it depends on the patient’s age, severity of BPH, and general health.

Treatment options include:

• Medications
• Laser vaporisation for patients with smaller prostate glands
• Surgical treatment to remove the parts of the swollen prostate that are pressing against the urethra

Treatment depends on the type of stone and the cause.

For small kidney stones, treatment goal is to help you pass the stones without further invasive treatment. Treatment options include:

• Drink water
• Pain relief or medication (alpha blocker) to relax the muscles in your ureter

For larger kidney stones or stones that cause symptoms, treatment options include:

• Extracorporeal shock wave lithotripsy (ESWL): A 40-50 minutes procedure that uses sound waves to break up the stones into tiny pieces which then pass in your urine.
• Surgery (percutaneous nephrolithotomy): To remove large stones in the kidney, using small instruments inserted through a small incision in your back.
• Using a scope passed through your ureter and bladder to remove stones trapped in the ureter or kidney.

Treatment options include:

• Urinalysis: To test for signs of infection in the urine
• Antibiotics: The length of treatment is dependent upon the severity of symptoms. A three-day course of antibiotics is usually sufficient in eliminating the infection for urinary tract infection in patients who are otherwise healthy. If the infection has spread to the kidneys, a longer course of antibiotics may be necessary.
• Other methods which may be used in conjunction with antibiotic treatment to relieve pain, such as:
• Consumption of probiotics
• Pain medications
• Increase fluid intake
• Apply heat
• Avoid substances that irritate the bladder, such as coffee and spicy foods

Treatment depends on the cause and general health of the patients. There are different treatment options available:

• Oral medication: Effective in about 80% of patients but it may not be suitable for everybody as the medication can interact with some prescription medications which the patient may be taking.
• Injection therapy: If oral medications are unsuccessful, injection therapy can be performed by using a specific drug that can be self-injected by the patient into the shaft of the penis to achieve an erection.
• External suction device: The device is used to pull blood into the penis to achieve and maintain an erection for intercourse.
• Penile implant surgery: Involves placing a prosthetic device for some patients to artificially create an erection.

Treatment depends on the type, severity, and the cause.

Acute urinary incontinence caused by kidney stone, infections or medication side effects often clears out when the root-cause problem is treated.

Other urinary incontinence treatment options include:  

• Conservative management such as Biofeedback, electrical stimulation, and simple Kegel exercise 
• Continence devices such buking substances (collagen or artificial substance) and pessary (semi-rigid ring) to help reposition and stabilise the bladder and urethra
• Surgical treatment such as insertion of thin tube into the bladder (catheterisation) for those whose bladder fails to empty completely, placement of a pubo-vaginal sling (“hammock”) beneath the bladder to provide support, placement of an artificial sphincter to prevent urine leakage or sutures to stabilise the bladder
• Medication

Subject to patient’s conditions, a combination of these therapies may be needed, and treatment is tailored to meet individual needs.