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Urology is a part of health care that deals with diseases of the male and female urinary tract (kidneys, ureters, bladder and urethra). It also deals with the male organs that are able to make babies (penis, testes, scrotum, prostate, etc.). Since health problems in these body parts can happen to everyone, urologic health is important.
Urology is known as a surgical specialty. Besides surgery, a urologist is a doctor with wisdom of internal medicine, pediatrics, gynecology and other parts of health care. This is because a urologist encounters a wide range of clinical problems. The scope of urology is big and the American Urological Association has named seven subspecialty parts.
Prostate cancer is cancer of the prostate gland. It is the third-leading cause of cancer death for men in the United States. About 1 in 7 men will be diagnosed with it in their lifetime. About 1 in 39 men will die from it. Growths in the prostate can be benign (not cancer) or malignant (cancer).
• Are rarely a threat to life
• Don’t invade the tissues around them
• Don’t spread to other parts of the body
• Can be removed and can grow back very slowly (however, it doesn’t usually grow back)
• May sometimes be a threat to life
• Can invade nearby organs and tissues (such as the bladder or rectum)
• Can spread to other parts of the body
• Often can be removed but sometimes grow back
Prostate cancer cells can spread by breaking away from a prostate tumor. They can travel through blood vessels or lymph vessels to reach other parts of the body. After spreading, cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues. When prostate cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary (original) tumor. For example, if prostate cancer spreads to the bones, the cancer cells in the bones are actually prostate cancer cells. The disease is metastatic prostate cancer, not bone cancer. For that reason, it’s treated as prostate cancer, not bone cancer.
To understand prostate cancer, it helps to know how the prostate normally works.
The prostate is part of the male reproductive system. It is about the size of a walnut and weighs about an ounce. The prostate is below the bladder and in front of the rectum. The prostate goes all the way around a tube called the urethra. The urethra carries urine from the bladder out through the penis. The main job of the prostate is to make fluid for semen. During ejaculation, sperm made in the testicles moves to the urethra. At the same time, fluid from the prostate and the seminal vesicles also moves into the urethra. This mixture—semen—goes through the urethra and out of the penis.
In its early stages, prostate cancer often has no symptoms. When symptoms do occur, they can be like those of an enlarged prostate or BPH. Thus, it is vital to talk to your health care provider when you have urinary symptoms. Later symptoms include:
He don’t know exactly why and how prostate cancer starts. Autopsy studies show that one in every three men over age 50 have signs of prostate cancer. Up to 80% had small, low grade tumors. A study of organ donors found prostate cancer in 1 in 3 men age 60–69 and in 46% of men over age 70.
What causes prostate cancer is still unknown. Research hopes to find the answer soon. Modern theory is that many things can raise a man’s risk for prostate cancer.
As men age, their risk of prostate cancer goes up. The American Cancer Society says prostate cancer causes about 10% of cancer–related deaths in men 60 to 79 years old. It causes nearly 25% of cancer deaths in men over age 80. It is rarely found in men younger than 40.
African–Americans are in the highest risk group. There are more than 200 cases per 100,000 black men. White and Asian men have about half as many cases as African-Americans. African–American men tend to be diagnosed when the disease is more advanced. They are more likely to die of prostate cancer than white or Asian men.
Men with a family history of prostate cancer also face higher risk. The more close relatives (father, son, brother) diagnosed with prostate cancer, the higher your risk. The age when a close relative was diagnosed can also raise your risk. If you have a family history, you are 2 to 11 times more at–risk than men with no family history.
If your father, brother or other close relative had prostate cancer, you are at higher risk. This is true if two or more close relatives had prostate cancer. It is also true if a close relative was diagnosed before age 55.
Studies show prostate cancer risk may double for heavy smokers. Within 10 years of quitting smoking, your risk goes down to that of a non–smoker the same age.
Prostate cancer numbers and deaths vary around the world. Numbers are low but rising in Asian countries. Numbers are medium in Central America and Western Africa. They are higher in North America and Northern Europe. The higher rates may be due to better screening, heredity, diet and environment.
The differences may also be linked to soy proteins in the diet. In some Asian countries, soy intake in tofu, soy milk, and miso is up to 90 times higher than in the U.S. Prostate cancer numbers and deaths are much lower in those countries. A study of more than 40 nations found soy, per calorie, to be the most protective dietary factor. This may be linked to chemicals in soy. They may act as weak estrogens. Estrogens are female hormones. They slow down prostate cancer growth. Some experts think high intake of green tea in Asia may also have an effect. But, there are no clear answers yet.
Diet and lifestyle may affect the risk of prostate cancer. It isn’t clear exactly how. The risk may be higher for those who eat more calories, fat and refined sugar and not enough fruits, vegetables and exercise. Obesity is linked to increased risk for death from prostate cancer. One way to avoid death from prostate cancer is to lose weight, and keep it off.
There is no known way to prevent prostate cancer. But if you do things that are heart healthy, you will also keep your prostate healthy. Eating right, exercising, watching your weight, and not smoking can improve your health and help avoid prostate cancer.
There is still debate on how to prevent prostate cancer. Some health care providers believe drugs like finasteride (Proscar) and dutasteride (Avodart) can prevent it. Others believe they only slow progress. In studies, men taking these drugs were less likely to be diagnosed with prostate cancer. It is not known if the drugs slow the cancer and lower the death risk.
eciding what treatment you should get can be complex. It depends on the stage and grade of the cancer. It also depends on your age and health. When thinking about which treatment to choose, you should consider side effects, long–term effects and outcomes of each. No one treatment is perfect for every man.
Some cancers grow so slowly that treatment may not be needed. But some grow fast and are life–threatening. Your health care provider will review your PSA level, T stage, Gleason score, and biopsy results. The results from these test will help your health care provider predict the likelihood of your cancer progressing or coming back. With all of this information you and your health care provider should decide the best treatment option for you. To help you make the best decision visit Michigan Cancer Consortium to review their materials on how to choose the best treatment for you.
is a part of health care that deals with a lot of different body parts. This includes body parts that form the Urinary System and Male Reproductive System. If you have a problem with a body part in these two systems, you may need to see a urologist.
Many of your body parts work with each other to form the Urinary System. Urine is taken out of the body if these parts work with each other in the right order. This allows normal urination to happen. For both men and women, the main parts of the system are Kidneys, Ureters, Bladder and Urethra. Urine is produced in the kidneys. It flows through tubes called ureters, and into the bladder. Urine leaves the body through the urethra.
The kidneys are fist-size organs that make urine. They are found on both sides of the spine behind the liver, stomach, pancreas and bowels. Healthy kidneys work like clockwork to turn extra water and waste into urine.
Urine flows out of the kidneys and into the ureters. Ureters are thin tubes of muscle that connect the kidneys to the bladder. Ureters carry urine from the kidneys to the bladder.
The bladder is a hollow, balloon-shaped organ. It is mostly made of muscle. It stores urine until you are ready to go to the bathroom to release it. The bladder helps you urinate. The brain tells it to tighten and force the urine out.
Urine leaves the body through a hollow tube connected to the bladder. This tube is called a urethra.
Many body parts work with each other to form the Male Reproductive System. The purpose is for each part to work in the right order so a male can have sex. During sex, you may be able to fertilize a woman’s ovum (egg) and make a baby. Not all men are able to have sex, even if their Male Reproductive System works right.
The testicles (also known as testes) are two golf ball size glands held in a sac (scrotum) below the penis. The testicles have a firm, slightly spongy feel. At the top and outside edge is a rubbery, tube-like structure called the epididymis. The firmness of the teste should be the same throughout. The size of the testicles should be about the same.
The testicles make male hormones. The most common hormone is testosterone, which controls the sex drive (libido). It also triggers the development of male traits, such as facial hair. The testicles also make sperm, the male reproductive cells, which travel through a group of tube-like structures to the epididymis. Sperm cells are then carried from the testicles by the vas deferens to the seminal vesicles, where they are mixed with fluid from the prostate gland.
The prostate is a walnut-shaped gland inside the male body. The prostate sits under the bladder and in front of the rectum. The prostate’s main job is to help make fluid for semen to help protect and energize the sperm as they travel to the female egg.
During ejaculation the sperm cells, seminal vesicle fluid and prostate fluid enter the urethra (the tube in the penis through which urine and seminal fluid leave the body).
The penis carries sperm out of the body. There are three tubes inside the penis. One is called the urethra. It is hollow and carries urine from the bladder through the penis to the outside. The other two tubes are called the corpora cavernosa. These are spongy tubes that are soft until filled with blood during an erection. The three tubes are wrapped together by a very tough fibrous sheath called the tunica albuginea.
During sex, the stiffness of the penis makes it hard enough to be inserted into the woman’s vagina. In this case, the urethra acts as a tube for semen to be ejaculated into the vagina. When you ejaculate, seminal fluid and seminal vesicles mix with sperm to form semen. The semen travels through the urethra and comes out the end of your penis.
Urine contains many dissolved minerals and salts. When your urine has high levels of these minerals and salts, you can form stones. Kidney stones can start small but can grow larger in size, even filling the inner hollow structures of the kidney. Some stones stay in the kidney, and do not cause any problems. Sometimes, the kidney stone can travel down the ureter, the tube between the kidney and the bladder. If the stone reaches the bladder, it can be passed out of the body in urine. If the stone becomes lodged in the ureter, it blocks the urine flow from that kidney and causes pain
The kidneys are fist-size organs that handle the body’s fluid and chemical levels. Most people have two kidneys, one on each side of the spine behind the liver, stomach, pancreas and intestines. Healthy kidneys clean waste from the blood and remove it in the urine. They control the levels of sodium, potassium and calcium in the blood.
The kidneys, ureters and bladder are part of your urinary tract. The urinary tract makes, transports, and stores urine in the body. The kidneys make urine from water and your body’s waste. The urine then travels down the ureters into the bladder, where it is stored. Urine leaves your body through the urethra.
Kidney stones form in the kidney. Some stones move from the kidney into the ureter. The ureters are tubes leading from the kidneys to the bladder. If a stone leaves the kidney and gets stuck in the ureter, it is called a ureteral stone.
Kidney stones come in many different types and colors. How you treat them and stop new stones from forming depends on what type of stone you have.
Calcium stones are the most common type of kidney stone. There are two types of calcium stones: calcium oxalate and calcium phosphate. Calcium oxalate is by far the most common type of calcium stone. Some people have too much calcium in their urine, raising their risk of calcium stones. Even with normal amounts of calcium in the urine, calcium stones may form for other reasons.
Uric acid is a waste product that comes from chemical changes in the body. Uric acid crystals do not dissolve well in acidic urine and instead will form a uric acid stone. Having acidic urine may come from:
Struvite stones are not a common type of stone. These stones are related to chronic urinary tract infections (UTIs). Some bacteria make the urine less acidic and more basic or alkaline. Magnesium ammonium phosphate (struvite) stones form in alkaline urine. These stones are often large, with branches, and they often grow very fast.
People who get chronic UTIs, such as those with long-term tubes in their kidneys or bladders, or people with poor bladder emptying due to neurologic disorders (paralysis, multiple sclerosis, and spina bifida) are at the highest risk for developing these stones.
Cystine is an amino acid that is in certain foods; it is one of the building blocks of protein. Cystinuria (too much cystine in the urine) is a rare, inherited metabolic disorder. It is when the kidneys do not reabsorb cystine from the urine. When high amounts of cystine are in the urine, it causes stones to form. Cystine stones often start to form in childhood.
Stones in the kidney often do not cause any signs and can go undiagnosed. When a stone leaves the kidney, it travels to the bladder through the ureter. Often the stone can become lodged in the ureter. When the stone blocks the flow of urine out of the kidney, it can cause the kidney to swell (hydronephrosis), often causing a lot of pain.
Common symptoms of kidney stones are:
A sharp, cramping pain in the back and side, often moving to the lower abdomen or groin. Some women say the pain is worse than childbirth labor pains. The pain often starts suddenly and comes in waves. It can come and go as the body tries to get rid of the stone.
A feeling of intense need to urinate.
Urinating more often or a burning feeling during urination.
Urine that is dark or red due to blood. Sometimes urine has only small amounts of red blood cells that can’t be seen with the naked eye.
Nausea and vomiting.
For men, you may feel pain at the tip of t
Causes of stone
A major risk factor for kidney stones is constant low urine volume. Low urine volume may come from dehydration (loss of body fluids) from hard exercise, working or living in a hot place, or not drinking enough fluids. When urine volume is low, urine is concentrated and dark in color. Concentrated urine means there is less fluid to keep salts dissolved. Increasing fluid intake will dilute the salts in your urine. By doing this, you may reduce your risk of stones forming.
Adults who form stones should drink enough fluid to make at least 2.5 liters (⅔ gallon) of urine every day. On average, this will take about 3 liters (100 ounces) of fluid intake per day. While water is likely the best fluid to drink, what matters most is getting enough fluid.
Diet can also affect the chance of forming a stone. One of the more common causes of calcium kidney stones is high levels of calcium in the urine. High urine calcium levels may be due to the way your body handles calcium. It is not always due to how much calcium you eat. Lowering the amount of calcium in your diet rarely stops stones from forming. Studies have shown that restricting dietary calcium can be bad for bone health and may increase kidney stone risk. Health care providers usually do not tell people to limit dietary calcium in order to lower urine calcium. But calcium intake should not be too high.
Instead of lowering dietary calcium intake, your health care provider may try to reduce your urine calcium level by decreasing your sodium (salt) intake. Too much salt in the diet is a risk factor for calcium stones. This is because too much salt is passing into the urine, keeping calcium from being reabsorbed from the urine and into the blood. Reducing salt in the diet lowers urine calcium, making it less likely for calcium stones to form.
Because oxalate is a component of the most common type of kidney stone (calcium oxalate), eating foods rich in oxalate can raise your risk of forming these stones.
A diet high in animal protein, such as beef, fish, chicken and pork, can raise the acid levels in the body and in the urine. High acid levels make it easier for calcium oxalate and uric acid stones to form. The breakdown of meat into uric acid also raises the chance that both calcium and uric acid stones will form.
Certain bowel conditions that cause diarrhea (such as Crohn’s Disease or ulcerative colitis) or surgeries (such as gastric bypass surgery) can raise the risk of forming calcium oxalate kidney stones. Diarrhea may result in loss of large amounts of fluid from the body, lowering urine volume. Your body may also absorb excessive oxalate from the intestine, resulting in more oxalate in your urine. Both low urine volume and high levels of urine oxalate can help to cause calcium oxalate kidney stone formation.
Obesity is a risk factor for stones. Obesity may change the acid levels in the urine, leading to stone formation.
Certain bowel conditions that cause diarrhea (such as Crohn’s Disease or ulcerative colitis) or surgeries (such as gastric bypass surgery) can raise the risk of forming calcium oxalate kidney stones. Diarrhea may result in loss of large amounts of fluid from the body, lowering urine volume. Your body may also absorb excessive oxalate from the intestine, resulting in more oxalate in your urine. Both low urine volume and high levels of urine oxalate can help to cause calcium oxalate kidney stone formation.
Some medical conditions have an increased risk of kidney stones. Abnormal growth of one or more of the parathyroid glands, which control calcium metabolism, can cause high calcium levels in the blood and urine. This can lead to kidney stones. Another condition called distal renal tubular acidosis, in which there is acid build-up in the body, can raise the risk of calcium phosphate kidney stones.
Some rare, inherited disorders can also make certain types of stones more likely. Examples include cystinuria, which is too much of the amino acid cystine in the urine, and primary hyperoxaluria, in which the liver makes too much oxalate.
Some medications, and calcium and vitamin C supplements, may increase your risk of forming stones. Be sure to tell your health care provider all the medications and supplements you take, as these could affect your risk of stone formation. Do not stop taking any of these unless your health care provider tells you to do so.
The chance of having kidney stones is much higher if you have a family history of stones, such as a parent or sibling.
Stones in the kidney often do not cause any signs and can go undiagnosed. When a stone leaves the kidney, it travels to the bladder through the ureter. Often the stone can become lodged in the ureter. When the stone blocks the flow of urine out of the kidney, it can cause the kidney to swell (hydronephrosis), often causing a lot of pain.
Common symptoms of kidney stones are:
“Silent” kidney stones, those that cause no symptoms, are often found when an X-ray is taken during a health exam. Other people have their stones diagnosed when sudden pain occurs while the stone is passing, and medical attention is needed.
When a person has blood in the urine (hematuria) or sudden abdominal or side pain, tests like an ultrasound or a CT scan may diagnose a stone. These imaging tests tell the health care provider how big the stone is and where it is located.
A CT scan is often used in the ER when a stone is suspected. It is used because it can make a quick and exact diagnosis.
Treatment depends on the type of stone, how bad it is and the length of time you have had symptoms. There are different treatments to choose from. It is important to talk to your health care provider about what is best for you.
Often you can simply wait for the stone to pass. Smaller stones are more likely than larger stones to pass on their own.
Waiting up to four to six weeks for the stone to pass is safe as long as the pain is bearable, there are no signs of infection, the kidney is not completely blocked and the stone is small enough that it is likely to pass. While waiting for the stone to pass, you should drink normal amounts of water. You may need pain medication when there is discomfort.
Certain medications have been shown to improve the chance that a stone will pass. The most common medication prescribed for this reason is tamsulosin. Tamsulosin (Flomax) relaxes the ureter, making it easier for the stone to pass. You may also need pain and anti-nausea medicine as you wait to pass the stone.
Kidney stones should be removed by surgery if they cause repeated infections in the urine or because they are blocking the flow of urine from the kidney. Today, surgery usually involves small or no incisions (cuts), minor pain and minimal time off work.
Surgeries to remove stones in the kidneys or ureters are:
Shock Wave Lithotripsy (SWL) is used to treat stones in the kidney and ureter. Shock waves are focused on the stone using X-rays or ultrasound to pinpoint the stone. Repeated firing of shock waves on the stone usually causes the stone to break into small pieces. These smaller pieces of stones pass out in the urine over a few weeks.
Because of possible discomfort caused by the shock waves and the need to control breathing during the procedure, some form of anesthesia is often needed. SWL does not work well on hard stones, such as cystine, some types of calcium oxalate and calcium phosphate stones, or very large stones.
With SWL, you may go home the same day as the procedure. You may be able to resume normal activities in two to three days. You may also be given a strainer to collect the stone pieces as they pass. These pieces will be sent to the laboratory to be tested.
Although SWL is widely used and considered very safe, it can still cause side effects. You may have blood in your urine for a few days after treatment. Most stone pieces pass painlessly. Larger pieces may get stuck in the ureter, causing pain and needing other removal procedures.
Percutaneous Lithotripsy (PCNL) is the best treatment for large stones in the kidney. General anesthesia is needed to do a PCNL. PCNL involves making a half-inch incision (cut) in the back or side, just large enough to allow a rigid telescope (nephroscope) to be passed into the hollow center part of the kidney where the stone is located.
An instrument passed through the nephroscope breaks up the stone and suctions out the pieces. The ability to suction pieces makes PCNL the best treatment choice for large stones.
After the PCNL, a tube is usually left in the kidney to drain urine into a bag outside of the body. This will allow for drainage of urine and stop any bleeding. The tube is left in overnight or for a few days. You may have to stay in the hospital overnight after this operation.
Your urologist may choose to do X-rays while you are still in the hospital to see if any stone pieces remain. If there are any, your urologist may want to look back into the kidney with a telescope again to remove them. You can begin normal activities after about one-to-two weeks.
Other kidney surgery is rarely used to remove stones. Open, laparoscopic or robotic surgery may be used only if all other less invasive procedures fail.
Part of preventing stones is finding out why you get them. Your health care provider will perform tests to find out what is causing this. After finding out why you get stones, your health care provider will give you tips to help stop them from coming back. Some of the tests he or she may do are listed below.
Your health care provider will ask questions about your personal and family medical history. He or she may ask if:
Knowing your eating habits is also helpful. You may be eating foods that are known to raise the risk of stones. You may also be eating too few foods that protect against stones or not drinking enough fluids.
Understanding your medical, family and dietary history helps your health care provider find out how likely you are to form more stones.
After taking a complete history and doing a physical exam, your health care provider may take blood and urine samples for testing. Blood tests can help find if a medical problem is causing your stones. Your urine can be tested to see if you have a urinary tract infection or crystals that are typical of different stone types. If you are at high risk for getting stones in the future, a 24-hour urine collection can be done. This test will reveal the levels of different stone-forming substances in your urine. The results of this test can help your health care provider recommend make specific diet and medications to prevent future stones.
When a health care provider sees you for the first time and you have had stones before, he or she may want to see recent X-rays or order a new X-ray. They will do this to see if there are any stones in your urinary tract. Imaging tests may be repeated over time to check for stone growth. You may also need this test if you are having pain, hematuria (blood in your urine) or recurrent infections.
If you pass a stone or a stone is removed by surgery, your health care provider will want to test it. Testing the stone will determine what type of stone it is. This information helps your health care provider decide the best way to prevent future stones.
During routine visits to your health care provider, you are often asked to give a urine sample for testing. Many tests are done routinely, like checking for sugar (diabetes), bacteria (infection) and blood. Blood in the urine that you do not see is called “microscopic hematuria.” This blood is only visible under a microscope. There are many causes and most are not serious, but may call for care by your health care provider.
When blood is found in the urine, health care providers want to make sure there is not a serious health issue involved such as a tumor in the kidney or bladder. Urological cancers are rarely the cause of blood in the urine. Only about 2 or 3 of every 100 people with microscopic hematuria are found to have cancer.
When you actually see blood in the urine, it is called “gross hematuria.” This is much more likely to be tied to a cancer or other health issue that needs medical care.
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