Urological Conditions

Lower urinary tract symptoms (LUTS) are a very frequent issue for both men and women and unfortunately become more common with age. In men the most likely cause is developing obstruction thanks to non-cancerous growth of the prostate gland (BPH), however, the symptoms may also relate to problems with bladder function and this too may affect women.

Therefore, typically, LUTS are described as being either

Filling or storage symptoms, which include

  • Increased frequency in the need to urinate
  • Increased urgency in the need to urinate even leading to incontinence
  • Having to urinate possibly several times at night

Voiding or obstructive symptoms, including

  • Poor urinary stream
  • Difficulty initiating the flow of urine
  • The sensation of poor bladder emptying
  • Needing to strain to pass urine

All these symptoms are very common and are actually very unlikely to relate to prostate cancer.

A useful tool in assessing the severity of LUTS in men is the International Prostate Symptom Score (IPSS)

International Prostate Symptom Score (IPSS)

The IPSS is an eight question, (7 symptom and 1 quality of life) questionnaire used to derive a score (0-35) and determine the management of Benign Prostatic Hyperplasia (BPH). You can determine your IPSS by visiting http://www.usrf.org/questionnaires/AUA_SymptomScore.html

Typically a score of 0-7 indicates mild symptoms, 8-19 moderate symptoms and 20-35 severe symptoms. Higher scores indicate more severe symptoms. Scores less than seven are considered mild and generally do not warrant treatment. Regardless of your score, if your symptoms are bothersome, you should consult with your doctor.

What if your PSA is raised?

PSA is not a diagnostic test, it is rather an indicator that there is a risk of prostate cancer. If raised, there are a number of routes which our consultants may follow. Read more about them under the prostate cancer diagnosis section.

Applicable Treatments:

Life Style Measures
Medication
TURP
TURiS
Greenlight Lazer PVP
Urolift

The term Benign Prostatic Hyperplasia (BPH) relates to an enlarged prostate which is not cancerous, but which may cause bothersome problems with the waterworks or lower urinary tract symptoms (LUTS) thanks to the resultant obstruction to the flow of urine out of the bladder. It is a very common problem in men, the growth in the prostate probably starting in middle age. It may result in bothersome symptoms in approximately 50 percent of men between the ages of 51 and 60 and up to 90 percent of men over the age of 80. 

Typical symptoms include;
  • Difficulty in passing water,
  • Having to go to the toilet frequently or urgently,
  • Having to get up several times during the night,
  • Dribbling at the end of urinary flow and sometimes incontinence.

The symptoms can impact on quality of life causing embarrassment, tiredness and limitations to the activities one can undertake. Furthermore, it may also result in the sudden and often painful inability to pass urine (acute urinary retention) leading to emergency hospital attendance and the siting of a drainage tube down the water pipe (urethra) into the bladder (a catheter). It is worth noting that this is a much more common disease than prostate cancer which is often symptom free in its early stages.

Information on treatment for LUTS and BPH can be found in the Treatments section or by clicking the links below. 

Applicable Treatments: 

Life Style Measures
Medication
TURP
TURiS
Greenlight Laser PVP
Urolift
Rezum
Aquablation

What is Cancer?

Your body is made up of millions of cells which continuously renew themselves to replace old or damaged tissue. When the renewal process gets out of control whereby more cells grow than die they begin to form growths or tumours.

These tumours can either be benign (non cancerous) or malignant which are cancerous and can invade and damage healthy tissue.

Sometimes cancer cells can break away from the original site and settle in other parts of the body causing further damage. When this happens the cancers that have spread are called 'metastases', 'mets' or 'secondaries'.


About Prostate Cancer

The cause of prostate cancer is unknown, although it is more common in some ethnic groups than others and diet may be involved. There is some evidence that it runs in families. You have a slightly higher chance of developing it if you have a father or brother with prostate cancer. The more aggressive the cancer is, the greater the threat it poses to your life-expectancy.

Prostate cancer can present with a whole range of diverse symptoms, not all related to the waterworks. Men’s concerns, however, regarding the presence of this tumour are mostly raised if they start to develop bothersome urinary symptoms (link to LUTS above)Investigations into these symptoms will include examination of the prostate gland as well as measurement of PSA. Should you have concerns regarding prostate cancer for other reasons, it is perfectly reasonable to ask your doctor for a PSA (link to: What is PSA? In FAQ’s)

Diagnosing prostate cancer

Prostate cancer is a very common condition. It can be found in 50% of men in their 50s and almost all men by the time they reach their 9th decade. However, most men who get prostate cancer will be unaware of it and live a normal, full, healthy life.  A significant proportion, 14-17% of all men, will develop symptoms and some will unfortunately die due to the disease. Currently prostate cancer is the most common cause of cancer death in men, killing over 10,000 men in England and Wales each year. It is therefore important to correctly identify whether a man has prostate cancer, but perhaps more importantly to identify men with prostate cancer that matters. This is done by prostate scans (MRI scans) and by taking small pieces from the prostate (a prostate biopsy).

At Urology Partners we are at the forefront of developing better ways to diagnose and correctly categorise prostate cancer. We were the first surgeons to describe the template prostate biopsy (Bott 2003 British Journal of Urology), a tool now used around the world, which allows a more thorough prostate examination. We use state of the art MRI scans (3T-multiparametric MRI) to reduce the need for unnecessary biopsies and also enable us to target suspicious areas in the prostate. We are also now able to fuse together the MRI scan pictures with the pictures we obtain at the time of the biopsy (Fusion targeted prostate biopsies) to increase the accuracy of the biopsy. The first step in the diagnosis of prostate cancer is a blood test called the PSA. This test is not specific to prostate cancer but is specific to any process going on in the prostate. This means that a raised PSA blood test does not necessarily mean you have prostate cancer but it does mean further investigation is required.

At Urology Partners we first assess you by asking questions about your waterworks, whether anyone in the family has prostate problems and about your general health. We will then examine you and perform a digital rectal examination. We will discuss with you the next step which may be an MRI scan of your prostate.   

Stages of prostate cancer

When Prostate cancer is diagnosed it can be described as 'early', locally advanced or 'late'. It starts with changes in the cells of the prostate. The cells form a lump which may eventually be felt in a physical examination. When prostate biopsies are taken they are examined by a pathologist who will report the grade of cancer present in the cells. The Gleason system is used to grade prostate cancer and describe how aggressive the cancer is.

A Gleason score of 2 - 4 is least aggressive, a score of 5 - 7 is moderately aggressive and a score of 8 - 10 is the most aggressive.


Further Information on Diagnostics:

3T mpMRI
Transperineal Template Biopsy

Prostate cancer can also be described by stage. The stage is determined by a combination of rectal examination, symptoms and/or imaging (such as MRI and bone scan). Stage 1 describes early prostate cancer which can only be seen under a microscope. Stage 2 is early prostate cancer which can be felt on examination. Stage 3 refers to locally advanced prostate cancer which may cause urinary problems and stage 4 is late prostate cancer probably with metastases (spread to other areas of the body). Unfortunately, it is only when it has advanced that most men will get symptoms which lead them to see a doctor. So about half of the men diagnosed with prostate cancer will already have it in an advanced or late stage. However, even when prostate cancer has reached this stage it may still be possible to slow down its growth.

Applicable Treatments:

Active Surveillance
HIFU

Brachytherapy
Cryotherapy
Prostatectomy 
Radiotherapy 

This is a common condition affecting young and middle aged men. It is often neglected and overlooked as a potential diagnosis, particularly as it can present with a wide range of symptoms ranging from vague aches and pains to a serious acute infection.

Prostatitis literally translated means inflammation of the prostate gland but it describes a spectrum of symptoms. In the majority of cases it is not caused by bacterial infection but a small proportion of men will develop an acute severe infection with a fever and pain and may require a period of time in Hospital. Symptoms of chronic prostatitis often develop slowly and are less severe. It is not always possible to cure prostatitis but it will often settle on it’s own after a period of time. Nevertheless, review by a Urologist is recommended if the symptoms are in any way troublesome.

There are 4 categories of prostatitis which are listed below:

Acute bacterial prostatitis (uncommon - type I)

This tends to declare itself quite quickly with a fever and flu-like symptoms with pain in the genital area including penis and lower back. It can also cause troublesome urinary symptoms and pain with ejaculation. This is a serious condition requiring prompt review by a Doctor.

 

Chronic bacterial prostatitis (type II)

The symptoms and signs with this type of problem tend to come on gradually and are less severe and often intermittent. The symptoms may respond to a prolonged course of antibiotic treatment. Symptoms include troublesome urinary symptoms including a burning pain when urinating. Discomfort in the prostate and genital area as well as the lower back and abdomen is possible. It can be more difficult to pass water and ejaculation can be painful and there can be blood present. Bladder infections and cystitis can also develop.

 

Chronic prostatitis and chronic pelvic pain syndrome the most common – type III)

This is by far and away the most common type and tends to cause similar symptoms to type II. It would be very uncommon to have a fever or have any bacteria detected in the urine or ejaculatory fluid although there may be signs of inflammation (some types do show inflammation and others don’t).

Inflammatory prostatitis without symptoms 

This isn’t important really as it doesn’t require treatment


There is a lot that we don’t understand with regards to both bacterial and non-bacterial prostatitis. Chronic bacterial infection may follow an acute prostate infection or instrumentation such as catheterisaton. It may also develop following infections elsewhere in the urinary tract or other parts of the body.

 

The possible risk factors or triggers for non-bacterial chronic prostatitis are listed below:

  1. Infections may be caused by an agent that we are currently unable to detect
  2. Heavy lifting particularly with a full bladder may cause reflux of urine inside the prostate
  3. Occupations where somebody is exposed to strong vibrations such as truck driving has been considered
  4. Physical exercise such as running or cycling are thought to irritate the prostate gland
  5. Pelvic muscle spasm or uncoordinated voiding with resulting high pressures inside the prostate
  6. Reduced frequency of ejaculation – there is no real evidence to support this but it is widely held belief amongst Urologists.
  7. Structural abnormalities of the renal tract (congenital or acquired). One such example is a urethral stricture (scarring), which results in a poor flow. For some men this gives rise to inflammation of the prostate.

A patient information download sheet can be found in the Info Sheets section.

Applicable Treatments:

Diagnosis and Treatment for Prostatitis

Blood in the urine

It is never normal to see blood in the urine. If an infection is excluded, urgent arrangements should be made for review and investigation by a urologist. Investigations into the cause of blood in the urine (haematuria) include a telescopic examination of the bladder (cystoscopy) and an ultrasound scan of the kidneys. Further X-ray tests (IVU) and urine tests may also be necessary.

Your doctor may also suggest referral to a specialist for these investigations if ‘invisible’ blood is found on repeated urine testing at the surgery.

Bladder Stones

Bladder stones form when urine is retained in the bladder after having finished passing urine.  Crystals are formed from chemicals in the urine and the crystals grow to form stones. 

Symptoms

Bladder stones may cause no symptoms, but they can cause blood in the urine, infections, pain passing urine and the desire to pass urine frequently. 

Applicable Treatments:

Bladder Stones Treatments




What is cancer?

Your body is made up of tiny 'building blocks' called cells that repair and reproduce themselves in a controlled manner when other cells become damaged or die. If for some reason the cells divide and reproduce in an uncontrolled manner, resulting in more cells being made than are dying, they form into lumps. It is these lumps that are called tumours.

Tumours can be benign or malignant. Benign tumours grow but do not spread and therefore cause little trouble to the individual. Malignant tumours (or cancerous tumours) grow but also spread, often invading the surrounding tissues or structures. Sometimes cancer cells can break away from the original site and settle in other parts of the body where they may cause further damage. If this happens, the cancerous tumours that then develop are called 'secondaries' or 'metastases'.


Causes of bladder cancer

The causes of bladder cancer are not yet well understood by medical scientists. Studies have shown that cigarette smoking is a potential cause and others have noted a higher incidence in people who work in heavy industries such as chemical, printing and rubber. There is some evidence to suggest that bladder cancer is up to three times more common in men than women and that it is very rare before the age of 50. Although it does not affect the UK, in parts of the world where bilharzia is common (a chronic parasitic bladder infection that lives in water), the incidence of bladder cancer is higher.

Therefore, people from the UK who have travelled to these areas and swam in rivers where bilharzia is present may be at a greater risk of developing bladder cancer.

Other hereditary, environmental and genetic factors have also been linked to the occurrence of bladder cancer. However, no conclusive information is available. Repeated urinary tract infections and bladder or kidney stones (which can cause infection) have also been linked to bladder cancer. Similarly, the risk is increased by previous radiotherapy to the pelvic area for treating another kind of cancer and treatment with the chemotherapy drug cyclophosphamide. Ultimately, research into the causes of bladder cancer is ongoing and more will be known as new results are published.

When diagnosed with bladder cancer it may be frustrating not to be able to isolate a cause for your condition. Your GP and the staff here at LUA will be able to discuss these worries and feelings further with you which you may find helpful.

Most bladder cancers are superficial and therefore only affect the lining of the bladder wall. However, if not diagnosed, or left untreated, they can grow and spread deeper into the muscle layer of the bladder wall.
 

Bladder Cancer Symptoms

The most common symptoms include:

Haematuria (Blood in the urine) - this will usually happen suddenly and painlessly and may come and go. Sometimes you can not see the blood in your urine but it can be picked up on a routine urine test.

Bladder changes - bladder irritation may cause a feeling of burning when you void or a feeling of wanting to void often and/or urgently. These symptoms are more common with a normal infection but, if they do not settle after treatment with antibiotics, further tests may be needed. More common bladder problems such as infection or stones may cause the above symptoms and most people won't have bladder cancer.

Applicable Treatments:

Bladder Cancer Treatments
Bladder Biopsy
Blue light cystoscopy
TURBT

Stones in the urinary tract are common, between 8-15% of people will get a stone in their lifetime.  They can occur at any point along the urinary tract, but they are most commonly found in the kidney, ureter and bladder.  Bladder stones will be discussed separately under Bladder Stones.

Stones are formed in the kidney.  From the kidney they may gradually grow and then move from the kidney into the ureter (pipe connecting the kidney to the bladder).  

Incidence

Stones affect about three in twenty men and one in twenty women in the UK.  They most commonly occur between the ages of 20 and 50, but can occur at any age.  Once someone has had a stone there is a 50% chance they will form a further stone within five-ten years.  

How do stones form?

The kidneys’ function is to filter the blood and remove unwanted chemicals. These chemicals are passed out in the urine, and some are able to form crystals. The crystals grow to become stones.  Crystals, and indeed stones, form more readily when the urine is very concentrated (golden in colour). 

Symptoms of stones

Small stones in the kidney may give rise to no symptoms at all.  However, kidney stones may grow up to several centimetres in size and give rise most commonly to pain, recurrent urine infections and blood in the urine. 

If a kidney stone drops out of the kidney into the ureter pipe this can block the kidney.  As urine continues to be made by the kidney, but the pipe is blocked, the kidney is stretched and this causes excruciating pain.  Women say this pain can be even worse than the pain of labour.  This pain is called renal colic.  It is often associated with a feeling of nausea and vomiting and sometimes also with an increasing need to pass urine.  Blood may also be seen in the urine and it is something the doctor will check for before making a diagnosis of renal colic.  Occasionally a stone may block the ureter in the presence of a urine infection.  In these cases a patient may feel hot, sweaty and have the chills or shake.  This requires emergency treatment to unblock the kidney to stop the bugs (infection) in the urine escaping into the bloodstream.  

Diagnosing stones

The diagnosis of stones is normally made based on the symptoms outlined above.  To confirm the presence of a stone, urine is taken to look for blood and to exclude a urine infection.  At Urology Partners we will arrange a CT scan, this looks along the length of the urinary system at 1mm intervals so is incredibly accurate at detecting stones. This will identify the site and size of the stone, which dictates how the stone is then treated.  

Stone Prevention

Stones are more likely to form when the urine is concentrated.  It is therefore advisable to try and drink plenty of water to avoid stone formation.  It is advised that you try and pass 2½ - 3 litres of urine per day.  This should keep the urine clear rather than golden.  

Even though most stones are made of calcium, patients are not advised to reduce the amount of calcium in their diet. It has been shown that low calcium diets are associated with higher rates of stone formation and therefore dairy products, e.g. milk, cheese and yoghurt, which are rich in calcium, should be taken normally. 

A high salt intake may be associated with stone formation.  It is therefore advisable not to add salt to your food excessively.  A diet low in animal protein (meat) and rich in fibre may also prevent stone formation. 

Finally, a chemical called citrate naturally prevents stone formation in the urine. You can increase the amount of citrate in the urine by having a glass of fresh orange juice or freshly squeezed lemon juice each day. 

Investigating stone formers

Most patients if they have a single stone episode only require a simple blood test to check the calciumandurate in the blood.  However, if the stones have come back, there is more than one stone, there is a family history of stone formation or an underlying medical condition that predisposes to stone formation, then a more extensive investigation called a 24 hour metabolic stone screen will be arranged.  This involves collecting urine over a 24 hour period and then the chemicals within the urine can be measured to see if there is an underlying cause for the stone formation.   

Applicable Treatments: 

Medical
Surgical

Kidney cancer is one of the few cancers increasing with incidence in the modern era. More common in men than women, this increase has been linked to aspects of modern society, including obesity and poorly controlled hypertension, as well as to smoking.

The mainstay of treatment for localized kidney cancers is surgical removal and in the vast majority of cases this should involve minimally invasive approaches i.e key hole or laparoscopic surgery or now robotic assisted surgery using the Da Vinci Robot System, rather than open surgery that can result in larger, painful and occasionally disfiguring wounds.

Recent times have seen an increase in small (less than 4cm) incidentally discovered tumours thanks to the greater number of scans (ultrasound or CT) performed for other reasons. The aim of surgery should be to remove the tumour with minimum impact upon overall kidney function. This is known as nephron sparing surgery, the nephron being the functioning unit of the kidney. Most often this means a partial nephrectomy (excision of only the tumour mass) although there are other ablative options to kill the tumour e.g cryoablation or freezing of the tumour.

Applicable Treatments:

Nephrectomy
Cryoablation

Loss of desire? Difficulties gaining or maintaining an erection? These common problems can be effectively treated.

Although often a difficult topic for men and women to discuss, problems in the area of sexual function are very common in our society and perhaps unsurprisingly are more of an issue the older we get. Such difficulties can relate purely to a loss of interest and desire in sex, i.e. loss of libido.

This may be linked to a decline in production of the male hormone (testosterone) with increasing age. This association has been referred to as the ‘male menopause’ or andropause, although its more accurate label is probably ‘Testosterone Deficiency Syndrome’ (TDS). In such cases, carefully managed testosterone replacement can be extremely effective.

Impotence or erectile dysfunction, i.e. the inability to gain or maintain an erection sufficient for sexual intercourse, is a very common problem in men. It is estimated that over 50% of men aged 40 to 70 years have erectile difficulties.

There are numerous approaches in treating this distressing problem. However, effective treatment requires a more holistic approach than simply prescribing tablets, for erectile difficulties are often multi-factorial.

Urology Partners believe that problems of this nature should be approached as part of a global assessment of male health and through this approach provide the most appropriate and effective treatment regime for each individual.

 

Applicable Treatments:

Other Urological Treatments and Procedures