FAQ

Urology is a specialty in medicine that deals with diseases of the male and female urinary tract (kidneys, ureters, bladder and urethra). It also deals with the male organs (penis, testes, scrotum, prostate, male reproductive organs) as well as certain conditions in the female organs (incontinence, prolapse).

Urologist is a doctor dealing with issues related to diseases of the male and female urinary tract (kidneys, ureters, bladder and urethra) as well as with the male organs (penis, testes, scrotum, prostate, male reproductive organs) as well as certain conditions in the female organs (incontinence, prolapse).
Urologists deal with issues not only directly related to urology as a surgical specialty, but are trained with wisdom in internal medicine, pediatrics, gynecology and other parts of health care as they encounter a wide range of clinical problems. Although they are trained surgeons, they are also specialized in the field of genitourinary medicine, in male sexual health, involved as primary doctors in urology cancers as in the field of Uro-oncology, and are also involved with urological conditions affecting women due to the unique anatomy of the female urinary tract and reproductive system, what is known as the field of Female Urology and Functional Urology.

The various fields in Urology include Endourology dealing with urinary tract stones and various endoscopic procedures, Urologic Oncology (urological cancers), Reconstructive Urology, Male Sexual Health with Andrology and Male Infertility, Female Urology, Urodynamics and Neurourology (nervous system control disorders of the genitourinary organs), Pediatric Urology, and Vascular Access surgery in Renal (Kidney) Failure with Transplantation.

Besides 4 years of medical school, urologists have at least 4 years of general surgical training followed by 6 more years of special training in Urology focused on the urinary tract and male reproductive system.
Now in Malaysia there is currently a move to try training medical doctors in Urology with direct admission to a 6 year urological training program.

1. Endourology – dealing with urinary tract stones and various endoscopic urology procedures like ureteric strictures, ureteropelvic junction (UPJ) obstruction
2. Urologic Oncology (urological cancers) – dealing with surgery in Kidney cancer, Ureteric cancer, Bladder cancer, Prostate cancer, Penile cancer and Testicular cancer
3. Reconstructive Urology – reconstructing the urinary system as in bladder cancers by reconstructing the intestine to form a bladder or a diversion conduit, enlarging the bladder in spinal injury patients by augmentation cystoplasty by using the intestines to enlarge the bladder, reconstructing the penis after amputation, reconstructing various grafts during reconstruction of urethra, scrotum and penis
4. Male Sexual Health with Andrology and Male Infertility –  dealing with male sexual problems and sexual dysfunction, low testosterone issues
5. Female Urology – involved with urological conditions affecting women due to the unique anatomy of the female urinary tract and reproductive system – including urinary incontinence, overactive bladder, urinary bladder prolapse treatments
6. Urodynamics and Neurourology – dealing with nervous system control disorders of the genitourinary organs and spinal problems affecting the bladder and kidneys
7. Pediatric Urology –  dealing with urinary problems in children 
8. Vascular Access surgery in Renal (Kidney) Failure with Transplantation – deals with constructing arterio-venous fistulas and vascular access for hemodialysis, peritoneal dialysis, as well as involved in renal (kidney) transplantation.

The most common urinary disorders are BPH (“prostate enlargement with obstruction”), Overactive Bladder and urinary stones

Kidney Cancer

The first sign of kidney cancer is blood in the urine (hematuria). In later stages there may be swelling at the kidney area and kidney pain

No.
Kidney cancer may be suggested from a urine test which shows blood in the urine, and sometimes pus cells in the urine. But absence of blood in the urine sample does not mean cancer is absent. And repeating a urine test until there is no more blood does not mean the cancer has disappeared or is absent.
Kidney cancer can be screened with a ultrasound of the kidney, and confirmed with CT scan.
The final diagnosis of confirmation is sending the kidney or part of the kidney involved with tumor as a whole for pathological confirmation.
Needle biopsies are usually not done as the sample may not be representative, unless in small renal tumors subjected to observation and active surveillance.

The ones most likely to get kidneys cancers and who are at higher risks for this are older age groups, smoking, obesity, high blood pressure, those undergoing long-term treatment for kidney failure, certain inherited cancer syndromes and family history of kidney cancer.

The best treatment for kidney cancer is removal of the kidney or part of the kidney involved with the cancer, when the disease is still early and localized to the kidney

Kidney cancer is diagnosed with urine test for blood, ultrasound of the kidneys and CT scan.

For localized kidney cancer, the best treatment is removal of the kidney or part of the kidney involved with cancer, when the disease is still early and localized to the kidney.
For advanced kidney cancer, there are various targeted therapies both alone or in combination depending on the stage and aggressiveness of the cancer, and depending on any earlier treatment given. At times the kidney cancer will be removed before these therapies are given, what is known as cytoreductive nephrectomy.

Prostate Cancer

In early stages, there are no sign and symptoms of prostate cancer. Hence the argument for prostate cancer screening consisting of a prostate examination and a PSA blood test as a tumor marker.
In later stages, there may be blood in the urine and difficulty in passing urine.
In very late stages, there may be bony pain and back ache.

It is not clear what causes prostate cancer. Prostate cancer starts when cells in the prostate become abnormal due to mutations in the abnormal cells’ DNA that causes the cells to grow and divide more rapidly and out of control compared to what normal cells do. The abnormal cells continue living and dividing, when other cells usually die to be replaced. The accumulating abnormal cells forms the tumor that can grow to invade nearby tissue. Some abnormal cells can also break off and spread (metastasize) to other parts of the body.

There are many latest treatment for prostate cancer that have been approved since the past 3-5 years.
They include androgen biosynthesis inhibitors like abiraterone acetate, antiandrogens like enzalutamide, apalutamide and darolutamide; LHRH antagonists like Degarelix, PARP inhibitors like olaparib and rucaparib, amongst others.
The drugs have very specific approved indications based on the various stages of the disease.

Bladder Cancer

The symptoms of bladder cancer in a female is no different from that in males.
They include hematuria (blood in the urine), and various irritative urinary symptoms which include urgency and urinary frequency.

Bladder cancer may be suspected if there is blood in the urine. Urine cytology may also detect bladder cancer, but there may be false negative results.
There are various urine tests for tumor markers in bladder cancers, but although they may find some bladder cancers early, but they can miss bladder cancers as well due to false negative results.
And in some cases, the test result might be abnormal even in people who do not have cancer, giving a false positive result.
Currently, the urine tests for tumor markers in bladder cancers are used mainly to look for bladder cancer in people who have signs or symptoms of it, or to watch for signs that the cancer has come back (recurred) in people who have had a bladder cancer removed. They are currently not standard investigations for detection of bladder cancers in general.

The main symptom of urinary tract cancer is hematuria (blood in the urine). Anyone who has even a single episode of hematuria should see a urologist within 2 weeks of the episode to have a full evaluation. Repeating a urine test over and over again until it becomes clear, or taking antibiotics to treat a suspected infection-related hematuria, will not make the cancer disappear.
Even if the blood in your urine goes away, you should still meet the urologist for a proper assessment as the blood passage may be intermittent, and the next episode of blood in the urine may occur very much later when the bladder cancer has already been in an advanced stage.

• Painful urination
• Pelvic pain
• Back pain
• Having to urinate more than usual
• Feeling the urge to urinate even if the bladder is not full
• Lower back pain on one side
• Weak urine stream
• Fatigue and weakness
• Loss of appetite and weight

In clinical practice, the most common risk factor for bladder cancer is smoking.
Other causes include exposure to chemicals used in dye factories, latex (especially for rubber tappers), leather, textiles, printing, plastics, paints and other chemical industries.

The color of your urine may be dark or red in color if you have bladder cancer.
However even if the color of your urine is normal, you may still have an undetected bladder cancer.

Yes. Bladder cancer can spread fast if left untreated, especially the more aggressive ones. Bladder cancers should not be kept waiting too long for surgery, and should preferably be done within one month of diagnosis.

URINARY STONES:

Kidney stones

Bladder stones

Ureteric stones

Treatment for bladder stones is removal of the stones by endoscopic technique, unless the stones are very small less when a trial of observation is allowed for it to pass through naturally.

There is no best treatment for kidney stones.

The best treatment / preventive strategy against formation of kidney stones is to keep yourself hydrated and drink at least 2.5-3 liters water a day, and substitute more water after an exercise or whenever you are dehydrated.

During acute pain due to stones, take some pain relievers. Passing a small stone can cause some discomfort.

There are various options for definitive kidney stone treatment depending on the size and location of the stone, as well as the body characteristics and the medical conditions the patients have.

The treatment option may vary from observation for small kidney stones, ESWL (Extracorporeal Shockwave Lithotripsy – where sound energy waves are transmitted to the kidney to break the stones in to small pieces non-invasively) therapy, PCNL (Puncturing the kidney and removing the stones), and Retrograde Endourological approaches (where a scope with a small camera is inserted through the urinary passage under anesthesia to break and remove the kidney stones).

The main cause of kidney stones is concentrated / supersaturated urine.

Kidney stones form when your urine contains more crystal-forming substances — such as calcium, oxalate and uric acid — than the fluid in your urine can dilute. At the same time, your urine may lack substances that prevent crystals from sticking together, creating an ideal environment for kidney stones to form

Common symptoms of kidney stones is called renal colic or ureteric colic, and include a sharp, cramping pain in the back and side. This feeling often moves to the lower abdomen or groin. The pain often starts suddenly and comes in waves.

Foods that may cause kidney stones include foodstuff containing oxalates and uric acid.

Avoid stone-forming foods: Beets, chocolate, spinach, rhubarb, tea, and most nuts are rich in oxalate, which can contribute to kidney stones.

If you suffer from stones, your doctor may advise you to avoid these foods or to consume them in smaller amounts.

Citrate has been shown to reduce the aggregation of crystals during stone formation in supersaturated urine. Citrate is found in citrous fruits – lemon, lime, orange etc.

Citrate, a salt in citric acid, binds to calcium and helps block stone formation. Studies have shown that drinking ½ cup of lemon juice concentrate diluted in water each day, or the juice of two lemons, can increase urine citrate and likely reduce kidney stone risk.

Limit your intake of animal protein.

Eat less salt, added sugar, and products containing high fructose corn syrup.

Avoid foods and drinks high in oxalates and phosphates.

Avoid eating or drinking anything which dehydrates you, such as alcohol.

No. There are no pills to dissolve kidney stones. Herbal medications packed in capsules are commonly being marketed to dissolve stones. This has not been conclusively proven to dissolve stones.

Pure uric acid stones are the only type of kidney stones that can sometimes be dissolved with the help of medication. Alkaline citrate salts or sodium bicarbonate are considered for this purpose, and sometimes allopurinol.

The best treatment / preventive strategy against formation of kidney stones is to keep yourself hydrated and drink at least 2.5-3 liters water a day, and substitute more water after an exercise or whenever you are dehydrated.

Half of people who have had a kidney stone will develop another one. A key way to reduce the risk of forming stones is to drink extra water. This dilutes the substances in urine that lead to stones. To prevent repeat stones, try to drink at least 2.5-3 liters (about ten 10-ounce glasses) of liquid a day.

Urinary incontinence and Overactive Bladder

Urinary incontinence is the involuntary leakage of urine. It means a person urinates when they do not want to. Control over the urinary sphincter is either lost or weakened. Urinary incontinence is a common problem that affects many people.

Most people urinate between six and eight times a day. But if you’re drinking plenty, it’s not abnormal to go as many as 10 times a day. You may also pee more often if you’re taking certain medications, like diuretics for high blood pressure.

If you pee more than 8 times a day and feel it is bothersome, you will need to consult a urologist for an assessment.

You should not get up from bed to pee in the night. If you do pee in the night, you need to see a urologist, even more so if it is bothersome, it causes lethargy and you feel you have not had enough sleep  as a result of this.

For people over the age of 70, over two-thirds of men and women over 70 urinate at least once per night, and up to 60 percent go twice or more each night. In a nutshell, studies shows that it is very common for most people to wake up once a night, and it becomes more common as you get older.

Getting up in the night may disturb your REM (rapid eye movement) sleep, and can even result in slipping down in the toilet and sustaining a fracture of the hip.

There are many causes for getting up at night to pee. It is known as nocturia.

The common causes include drinking too much water before you sleep, taking certain diuretic medications in the late evenings, BPH (“prostate enlargement”), Overactive Bladder and Diabetes.

At times one may get up at night due to sleep fragmentation, obstructive sleep apnoea and restless leg syndrome.

Urinary incontinence is usually caused by problems with the muscles and nerves that help the bladder hold or pass urine.

Certain health events unique to women, such as pregnancy, childbirth, and menopause, can cause problems with these muscles and nerves.

Other causes of urinary incontinence include: Overweight, prostate enlargement, overactive bladder amongst others.

Types of urinary incontinence include:

• Stress incontinence. Urine leaks when you exert pressure on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy.
• Urge incontinence. You have to rush to the toilet to pass urine due to severe urge, and the urine leaks before you can reach the toilet.
• Overflow incontinence. The urine leaks because your bladder is too full due to an obstruction like BPH (“prostate enlargement”), and the urine overflows as the bladder is too distended to hold anymore urine.
• Functional incontinence. There is nothing wrong with the bladder, but due to one or more physical or mental reasons you are unable to get to a bathroom in time. For example osteoarthritis of the knee or old age and you are not able to walk fast enough to reach the toilet. The loss of urine can vary, from small leakages to full emptying of the bladder.
• Mixed incontinence. A combination of any of the above causes which leads to leakage of urine.

Dehydration from not drinking enough liquid can cause your urine to become very concentrated. This collection of concentrated salts can irritate your bladder and make incontinence worse. Bladder irritation from drinking carbonated drinks, artificial sweeteners, tea and coffee (with or without caffeine).

The treatment of urinary incontinence should be directed to the cause of the incontinence.

In stress incontinence, it will require pelvic physiotherapy and medications, failing which sling operations may be necessary

In urge incontinence, one may require anticholinergics. These medications can calm an overactive bladder and may be helpful for urge incontinence. Examples include oxybutynin (Ditropan XL), tolterodine (Detrol), darifenacin (Enablex), fesoterodine (Toviaz), solifenacin (Vesicare) and trospium (Sanctura). Mirabegron (Myrbetriq) is a newer medication that acts through the beta-adrenergic receptors. It is a selective beta 3-adrenoceptor agonist.

In overflow incontinence, you may require treatment directed to bladder obstruction.

In functional incontinence, you may require bladder training, pelvic floor muscle exercises, and improving your functional status which includes modifying transient causes for the incontinence (e.g., fecal impaction), and reducing environmental barriers to toileting or providing sufficient toileting assistance to avoid incontinence episodes.

If left untreated, urinary incontinence can cause loss of activities such as exercising and social interactions. Personal problems may ensue, including embarrassment, self-consciousness, depression / anxiety, and sexual problems. Skin problems such as rashes, infections, and sores may occur. Sleep loss and feeling tired may be a result of incontinence as well.

There is no doubt that going to the bathroom after holding it for a long time is an enjoyable relief, but for some women it offers something even more pleasurable. They’re called “peegasms,” a kind of full-body orgasmic feeling that some say they experience if they’ve been waiting a long time to go to the bathroom.

You should not hold your pee for longer than is necessary as it can cause urinary tract infection as well as causing a back-pressure of urine to your kidneys causing the kidneys to progressively get swollen.

Contact your doctor as soon as possible if you have frequent urination more than 8 times a day, especially if it has become bothersome, along with any of these signs or symptoms: blood in your urine, red or dark brown urine and painful urination.

Much like tomatoes and citrus fruits, cranberries can potentially irritate your bladder and cause urge incontinence. You might be tempted to try cranberry juice for relief, but it may worsen your symptoms. If you are going to take in fluids, water is your best bet.

Drinking too much fluid during the evening can cause you to urinate more often during the night. Caffeine and alcohol after dinner can also lead to this problem. Other common causes of urination at night include: Infection of the bladder or urinary tract, overactive bladder, BPH (“prostate enlargement”), urinary stones especially at or near the bladder, and obstructive sleep apnoea.