What are urologists and what do they do?
A Urologist is a physician trained to treat problems of the female urinary system and male genitourinary tract. Urologists treat problems ranging from cancers of the urinary tract to kidney stones to issues with continence and bladder function. Some urologists specialize in treating fertility issues children, and people with specific urology diseases.
Why do people need to see a urologist?
There are a variety of illnesses which commonly affects our patients, to name a few:
End-Stage Renal Disease
Hemolytic Uremic Syndrome
Urinary Tract Infections
One symptom that would clearly prompt someone to see an urologist is blood in the urine. The most common reason our patients seeks the consultation with our urologists are due to Kidney Stones.
Symptoms of Kidney Stones
The most common symptoms for kidney stones are blood in the urine or pain in the flank, abdomen, groin, penis, vaginal, or even legs. This is quite often associated with nausea and vomiting. Patients may experience blood in their urine either seen microscopically or seen visually with the naked eye. Cloudy, foul smelling urine, fever, or chills may be a sign of serious infection which is usually dealt with on an emergency basis. Some kidney stones are called are called silent stones because there are no symptoms involved.
Causes and Risk Factors:
Some people are more likely to develop stones than others. A few of the factors includes:
• Age- more common during middle age
• Sex- twice as common in men than women
• Activity level- stones are more common in patients with a sedentary life style or in patients who lose excess fluid due to sweating, diarrhea, etc.
• Climate- stones are more common in hot climates during the summer months.
• Certain stones are associated with a family history of stones.
Urine testing – the physician will examine a urine specimen looking for blood, infection, and crystals.
X-rays- different stones are diagnosis with different types of x-rays.
• KUB – this is a plain x-ray of the abdomen. KUB stands for kidney, ureter, and bladder. Stones that are seen on KUB are known as radio opaque stones (calcium, oxylate, struvite). Stones that are not visibile on KUB are known as radiolucent ( uric acid stones, some cystine stones) they are best diagnosed with CT scan or ultrasound
• CT scan –computerized tomography is now the most commonly used test for diagnosis of kidney stones.
• Ultrasound – kidneys are examined with sound waves
• Stones – are often visualized with other tests such as MRI scans however; these are not cost effective and typically are not used in diagnosis of stones.
• Patients are usually questioned about their diet, medication, lifestyle and family medical history.
Types of Stones:
• Calcium oxylate – the most common type of stone, this is usually visualized on plan KUB.
• Uric acid- these stones are radiolucent (not visualized on KUB and are often treated by a alkalinizing the urine causing them to dissolve).
• Struvite Stones – these stones are also known as infection stones or magnesium, ammonium phosphate stones – associated with recurrent infection.
• Cystine stones – these stones are usually present during childhood and are a result of a genetic defect.
Treatment of Stones:
• Conservative therapy- many stones can pass on their own. Patients are given pain medication and typically a medication which will dilate the urinary tract. They are asked to drink plenty of water and to strain their urine. Most stones will pass spontaneously if given time.
• Lithotripsy – this is the main stay of treatment. Patients are sedated and shock waves are passed through the body to break a large stone up into smaller pieces. This is general successful 80 – 85% of the time depending on the type of stone. The procedure lasts approximately 40 minutes. Patients are typically treated on an out-patient basis. Some patients are not suitable candidates due to the size of the stones, location, and number of stones, height, and weight, pregnancy status of the patient or overall medical status such as severe heart problems.
• Ureteroscopy- a lighted tube is passed up the urethra through the bladder, up the ureter to the stone; the stone is visualized and is removed with a basket. Many times a laser is used to break a large stone into smaller pieces.
• Percutaneous stone removal- a tube is placed through the patient’s side directly into the kidney. This tract is gently dilated and a lighted tube is passed through the patient’s side and under direct vision the surgeon can remove stones with a grasper or break a large stone into small pieces using an ultrasonic wand or laser.
• Open surgery- rarely used however in some circumstances it is a procedure of last resort in extremely large stones.
Prevention of Kidney Stones:
• Water, water, water- drinking water keeps urine diluted therefore decreasing the chance of stone formation. . Many stones form in hot environment as a result of dehydration due to sweating. We should drink 10 -12 glasses of liquid each day with at least half of this intake being water. Don’t forget to drink one large glass of water at bedtime.
• Sodium (salt) – salt intake should be kept to a minimum as this may contribute to stone formation.
• Fiber and Fat- a low fat, high fiber diet is recommended. Foods to avoid include: iced tea, chocolate, greens, berries, nuts, asparagus, anchovies, organ meats (liver, kidney, brains), meat extract (broth, consume, and gravy).
• Remember excessive quantities of any food types are bad. Moderation is typically acceptable. Restriction of dairy products is not generally recommended due the risk of osteoporosis.
Answers to Common Questions
Please explain, briefly, the controversy over PSA testing for prostate cancer.
PSA screening is a blood test used to screen men for prostate cancer. There is some controversy about PSA screening especially as men become older because prostate cancer is often a slow growing disease and some of the men who are found to have the disease may not require treatment. The American Urological Association recommends that all men over 40 years old with a life expectancy of at least 10 years be screened. This seems like a reasonable way to handle this issue.
Tell us about advances in treating men’s sexual health since the advent of Viagra.
Since Viagra was introduced men’s sexual health has advanced significantly. Several additional drugs have been introduced but more importantly it has become something that more men are feeling comfortable talking to their doctor about.
What are recent major advances in the diagnosis and treatment of kidney stones?
Kidney stones are a common problem and over the last 10 years or so the diagnosis of them has been revolutionized through the use of a non-contrast CT done in manner to detect stones. The treatment of stones has also advanced with improvements in the instruments used to remove them. There has also been increased understanding of what causes stone formation and a push to try to help people who have had a stone to try to prevent future stones.
Even though there are urological conditions that respond well and quickly to treatment, why do you think many people hesitate to seek help from a urologist?
People may fail to seek treatment of urological conditions for many reasons. One of these is that many people feel some embarrassment about issues of the genitourinary system and may delay treatment because of this. There may also be a lack of awareness that some changes such as symptoms from an enlarging prostate in men or incontinence in women are now much more treatable than in the past and may delay treatment because they feel that this is a normal part of aging and that they just need to put up with it.
What can you do to maintain a healthy urinary system?
To maintain urological health is the same as maintaining a healthy body. In general people should try to maintain a healthy diet, drink plenty of fluids and empty their bladders on a regular basis.