Not many people want to think or talk about urology problems, but the fact is that most of us will have an infection or issue that requires medical treatment at some point in our lives.
Not many people want to think or talk about urology problems, but the fact is that most of us will have an infection or issue that requires medical treatment at some point in our lives. And the older we get, the more likely we are to experience issues. While kidney stones, urinary tract infections, and urological cancers occur in both men and women, urologists also treat conditions that only affect the male reproductive tract, including the penis, testes, and prostate. Since June is Men's Health Awareness month, it’s the perfect time to take a closer look at men’s urology issues.
Urinary problems in men include incontinence, frequent and/or painful urination, difficulty urinating, and leakage. These issues may be due to a variety of causes such as BPH, infection, kidney stones, diabetes, or Parkinson’s. A variety of treatments may be prescribed, including diet changes, medication, pelvic floor exercises, or prostate surgery. Urinary Incontinence.
Sexual health concerns such as erectile dysfunction (ED) or premature ejaculation may require the expertise of a urologist. ED drugs are very effective and sometimes help with premature ejaculation.
Benign prostate hyperplasia (BPH) affects 50% of men over 50, a percentage that increases with age. BPH happens when an enlarged prostate puts pressure on the urethra, leading to urinary urgency, frequent urination, and leakage. Medication is used for moderate symptoms. If the problem is severe, a wide variety of minimally invasive procedures may be used to remove excess tissue.
Peyronie's disease is a curvature of the penis that occurs during an erection. Caused by an accumulation of plaque-like scar tissue, the curvature can be as slight as 10 degrees or so severe that the penis takes on a "U" shape. Peyronie's frequently resolves itself over several months but if there are no changes with time and nonsurgical therapies, medication or surgery may be needed to remove the plaque and correct the curvature.
Inguinal hernia, located in the groin area, is most common in men. Hernias happen when part of an organ, usually the intestines, protrudes though a weakness in the abdominal wall. An inguinal hernia must be repaired through surgery to prevent incarceration, a dangerous condition in which the intestines become trapped or obstructed by the hernia.
Kidney stones
Kidney stones are formed when mineral deposits build up on the inner lining of the kidneys. Small stones may pass through the urinary tract unnoticed but larger ones cause extreme pain and can grow too large for the body to excrete. Left untreated, kidney stones may become lodged in the ureter, the tube that connects the kidney and bladder, and block the flow of urine. For smaller stones, physicians often prescribe pain medication and drinking plenty of liquids to help flush out the stones. Bigger stones may be broken up into smaller ones through shock wave therapy (lithotripsy) so that the fragments can be excreted. There are also minimally invasive surgical procedures to remove larger stones. Kidney stones.
Urinary tract infections (UTI), also called cystitis, can occur in the bladder, kidneys, or urethra. Symptoms include a persistent urge to urinate, trouble urinating, burning or tingling during urination, a low-grade fever, cloudy urine with an unusual odor, or blood in the urine. UTIs are treated with antibiotics.
Infertility in couples breaks down statistically by thirds. One third of the time, the problem is traced to the man, one third of the time to the woman, and one third of the time there are issues with both partners. Drugs can help with low sperm production, hormone imbalances, infections, and low testosterone levels. If the infertility is due to blockages in the vas deferens, the tubes through which sperm passes, these can be surgically repaired.
Vasectomy is a safe, permanent form of surgical contraception for men. The procedure, which takes about 15 minutes, can be performed in the office with local anesthesia. Surgical reversal is usually effective but needs to be performed within ten years of the initial procedure as scar tissue continues to form over time. After a reversal, most men have an 80-90% chance of achieving pregnancy if their partner does not have any fertility issues.
Testicular issues are part of a urologist’s expertise. A variety of infections, from mumps to UTIs and STI’s, can cause scrotal pain and swelling. Varicoceles, enlarged veins in the scrotum, are treated surgically. Hydrocele, buildup of fluid around the scrotum, is treated surgically if it does not resolve on its own.
Urological cancers in men include kidney, bladder, prostate, adrenal, and testicular cancers. While these cancers may be diagnosed by a urologist or a man’s primary care physician, they are treated by urologic oncologists who are specially trained in treating cancers of the male reproductive system.
- Prostate cancer, if diagnosed early, has a range of treatment options depending on the patient’s age, health and personal preferences. Treatment may include radiation therapy, surgical removal of the prostate (prostatectomy) or, if the cancer is more advanced, hormone therapy to cut off the body’s supply of testosterone. If a cancer is slow growing, a man may have the option of "active surveillance." Treatment is delayed but will require regular PSA tests, usually every three months, digital rectal exams every 6 months to a year, and a yearly biopsy. If there is no change, active surveillance can continue indefinitely.
- Bladder cancer treatment depends on the type and stage of the tumor. Traditional or robotic surgery may be performed to remove all or part of the bladder. Sometimes surgery is combined with intravesical therapy, which uses a catheter to introduce chemotherapy or immunotherapy drugs directly into the bladder. Radiation may be used either before surgery, to shrink the tumor, or after surgery, to remove any remaining cancer cells.
- Kidney cancer is primarily treated surgically. A radical nephrectomy is an open or minimally invasive procedure which removes the kidney and surrounding tissue, often including the adrenal gland and nearby lymph nodes. A partial nephrectomy removes just the tumor plus a small amount of surrounding healthy kidney tissue at its margins. Advanced kidney cancer is resistant to most chemotherapy drugs but may respond to immunotherapy, the use of drugs to stimulate the body's own immune response.
- Testicular cancer is a rare form of cancer that affects boys and young adult men. Treatment is surgical removal of the affected testicle and any affected nearby lymph nodes. In some cases, surgery is supplemented with radiation and chemotherapy.
This article appeared in the June 2024 edition of the HealthPerks newsletter.
