The branch of medicine that is concerned with the conditions affecting the kidneys, ureters, bladder and urethra, otherwise clubbed under the urinary tract in both males and females is known as Urology. Other organs such as penis, testes, scrotum, prostate, etc., in relevance to males only and disorders related to them also fall under the purview of urology.
What is Urology?
The Greek word ‘ο?ρον ouron’ implies to ‘urine’ and ‘λογ?α -logia’ means the ‘study of’ which combined together refers to urology that is also known as genitourinary surgery. This is a discipline in medicine that concentrates on the medical conditions and surgical operations of the female and male urinary tract system and reproductive organs in the males.
There is a close connection between the reproductive organs and the urinary tract, thus, also establishing a link between conditions that affect one or the other. Therefore, a substantial domain of the disorders that are treated and managed under urology falls under genitourinary disorders. A combination of non-surgical or medical treatments with surgical methods are typically used in treating urological conditions.
Urology – Sub specialties
Urology can be further broken down in multiple sub-specialities including:
• Endourology: It is a specialty under urology that is concerned with the urinary tract’s close manipulation. Recently, this sub-discipline has expanded its purview to include all minimally invasive urologic surgical procedures. In comparison to general open surgery, endourology is a procedure that uses tiny cameras and instruments that are inserted via the urinary tract. Lately, the cornerstone of endourology has been Transurethral surgery. However, additions of laparoscopy and robotics has led to further sub-division of this specialty branch of urology.
• Laparoscopy: This branch of urology is still evolving but has been able to replace some open surgical procedures in recent times. The most advanced form of laparoscopic surgery is performed with the help of robotics typically for prostate, kidney, and ureter.
• Urologic oncology: Dealing primarily with malignant genitourinary conditions, for example, cancer of the prostate, adrenal glands, bladder, kidneys, ureters, testicles, and penis, skin and subcutaneous tissue and muscle and fascia of those areas, urologic oncology is a form of surgical therapy that is managed by a specialist urologist or oncologist via using minimally invasive techniques such as laparoscopy or endourology, robotic-assisted surgery.
• Neurourology: This branch of urology is concerned with nervous system control of the genitourinary system and any related disorders leading to abnormal urination. Stroke, multiple sclerosis, Parkinson's disease, and spinal cord injury are neurological conditions that may have a disruptive effect on the lower urinary tract leading to conditions such as urinary incontinence, detrusor overactivity, urinary retention, and detrusor sphincter dyssynergia. Less marked neurological abnormalities can cause urological disorders as well. A key diagnostic role in neurourology is played by urodynamic studies.
• Paediatric urology: All urologic disorders that concern children and dealt by the paediatric urology sub-specialty. Common conditions under paediatric urology are cryptorchidism, or undescended testes, congenital abnormalities of the genitourinary tract, enuresis, underdeveloped genitalia which are caused owing to belated development or overdue puberty, time and again an endocrinological problem, and vesicoureteral reflux.
• Andrology: Concentrating on the male reproductive system, andrology covers anomalies in the connective tissues pertaining to the genitalia, as well as changes in the volume of cells, such as in genital hypertrophy or macrogenitosomia. As male sexuality is fundamentally regulated by hormones, the sub-division of andrology intersects with endocrinology at particular junctures. There are several conditions that are required the intervention of andrology including:
Common treatment methods for these disorders can be male-specific medical and surgical procedures include vasectomy, vasovasostomy, orchidopexy and circumcision.
• Reconstructive urology: This is an extremely specialised branch of urology that focusses on the restoration of structural and functional defects in the genitourinary tract. Procedures involving the prostate comprise of both partial of full hysterectomies, trauma diseases caused as a result of auto accidents, gunshot wounds, industrial accidents, straddle injuries, etc., in addition to obstructions, blockages such as urethral strictures. Reconstructive surgery may also be required occasionally by reason of childbirth. Examples of reconstructive surgery also include urinary bladder, ureters (the tubes that lead from the kidneys to the urinary bladder) and genitalia.
• Female urology: A sub-specialty of urology that concentrates on the overactive bladder, pelvic organ prolapse, and urinary incontinence. In order to accurately diagnose female urological conditions, experts need to have a through knowledge of the female pelvic floor together with intimate understanding of the physiology and pathology. A medical or surgical interventional may be the solution to the condition. The cause of the condition has to be determined first before proceeding towards treatment.
Symptoms of Urological Conditions
Urological diseases and injuries have different signs and symptoms. The common ones are:
• If you find it hard to pass urine
• If you notice an abnormal volume of urine, either too much or too small
• If you have pain in the lower back
• If you experience pain in the lower part of the abdomen
• If you have fever that is persistent for some time
• If you see that you are passing off blood during urination that could indicate towards hematuria
• If you experience pain during urination
• If you have a frequent urge to pass urine
• If you feel that you are not fully emptying the bladder
• If you are overtaken by a feeling of nausea and vomiting
• If you observe the colour your of urine changing and
• If you notice smell from your urine
• If you have an enlarged prostate
• If there is urine leakage
• If you experience loss of bladder control pointing towards incontinence
Causes of Urological Conditions
Here are some of the most common causes of urology problems:
• Infection: More common in women, urinary tract infections of UTIs occur as a result of harmful microorganisms, typically bacteria that enters the body via the anus. In due course of time, the bacteria attacks the urethra and as a result, urination becomes painful. The treatment of the condition is simple, although if left unmanaged, the condition has the potential to cause severe complications that may develop into septic shock, resulting in organ failure, possibly death.
• Obstruction: Stones in the kidney may obstruct the flow of urine to the bladder. These blockages may also occur in the prostate and vas deferens.
• Lifestyle reasons: In recent times, one of the biggest threats resulting in chronic kidney disease is due to obesity. Other factors that associated with chronic kidney disease are high blood pressure and diabetes.
• Genetics: Amongst hereditary conditions, polycystic kidney disease is a common occurrence, distinguished by the development of multiple fluid-filled sacs in the kidneys which able to grow large and multiply. Severe bleeding with pain whilst urinating can be a side effect when these sacs break. Kidney damage in the long run is a probability and they also promote elevated blood pressure.
• Medications: Specific medications increase urine production which is due course of time may lead to excessive urination or incontinence. Certain medicines can cause severe harm to the kidneys in the long run.
• Food: Caffeine and alcohol intake in significantly large quantities can be harmful to the kidney by acting as diuretics.
• Congenital: Micropenis and chordee, are amongst male abnormalities affecting the male genitalia.
• Physiological: Poor or slow sperm production, ejaculation issues, and hormonal imbalances can lead to male infertility conditions.
• Unidentified Causes: A few of the urological conditions do not really have a specific cause such as interstitial cystitis or painful bladder syndrome. Several factors, for example, an autoimmune disease, heredity, genetic defect, and infection have been cited by researchers as possible causes.
Conditions that may be experienced by a male or a female for which you may need to consult with a urologist are:
• Benign prostatic hyperplasia
• Urinary Tract Infections (UTIs)
• Kidney and Ureteral Stones
• Prostate cancer
• Bladder cancer
• Lower urinary tract symptoms
• Overactive bladder
• Neurogenic bladder dysfunction
• Urethral stricture
• Undescended testicle or cryptorchidism
• Male infertility
• Stress incontinence
• Peyronie's disease
• Chronic prostatitis or chronic pelvic pain syndrome
• Bladder outlet obstruction
• Bladder exstrophy
• Renal colic
• Renal cell carcinoma
• Obstructive uropathy
• Testicular torsion
• Fournier gangrene
• Urinary Incontinence
Urologists recommend the following diagnostic tests in order to determine the urological condition in a patient:
• A Physical Examination: Initial consultation with your specialist will involve answering a series of questions about your current health condition, medical history of you and your family and if you are on any medications. This will be followed by a physical examination where the doctor will check your kidneys, ureters, and bladder to see if there is presence of any urinary tract issue. Subsequently, the doctor will also examine your penis and testis if the erectile dysfunction or any other related symptoms are causing the condition. A digital rectal exam or DRE may also be included in the physical examination that evaluates the prostate gland.
Blood Tests: A number of blood tests may be recommended to check the overall condition of urinary system. The common ones include:
Urine Tests: To determine an accurate diagnosis, your urologist may prescribe the following urine analysis tests including:
Imaging tests: These include the following:
X-rays may be used to look at diagnosing conditions of the urinary tract including:
Biopsy: This test can check for cancer and other disorders.
Cystoscopy: This screening is slightly more invasive and requires administering of local anaesthesia over the urethra before performing it. This process can help in identifying tumours and other abnormalities of the bladder wall.
Semen Analysis or Seminogram: This test is generally ordered in cases where male infertility is suspected. The collected sample is checked under laboratory conditions to determine the presence of sperm – its motility and quality.
The diagnosis is the main criteria that determine the type of treatment applicable. In the majority of cases, it may involve a combination of medicines and surgery.
Types of medications include:
• Antibiotics that may be prescribed in case of infections
• Hormone treatment may be recommended for prostate cancer cases
• Phosphodiesterase 5 (PDE5) inhibitors will be ordered for erectile dysfunction, such as Cialis, or tadalafil
• Drugs may be suggested that act on the smooth muscle of the bladder to minimise urinary incontinence
• Chemotherapy drugs for cancer cases
Types of Surgical therapy that may be proposed are:
• An open surgery
• A laparoscopic, or minimally invasive "keyhole" surgery
• A laser therapy to treat BPH, cancer, and kidney stones
A surgery may be performed by a urologist in order to:
• In cases of cancer, a tumour or the entire bladder, prostate, or other parts, may have to be removed
• In cases involving trauma, repairs have to be carried out repairs
• In cases of urethral dilation, surgical operation relieves strictures in the urethra, that has been caused by the scar tissue
• In cases such as sling procedure, it relieves stress incontinence
• In cases involving kidney stones, surgery helps to break up or remove them from the kidney
• It helps in removing part of a kidney
• It helps in kidney transplantation
• Circumcisions is a procedure that removes the skin from the tip of penis which may be done for cultural, religious, or medical reasons
• Vasectomy surgical procedure which is a permanent type of male contraception
About the Department
The Department of Urology at Fortis Hospitals in Chennai is steadfast in delivering excellence, empathetic care and treatment of urinary related disorders. We endeavour to accomplish the extraordinary degree of quality in patient care, that has merited us with our exceptional standing in this part of the country.
Having several specialists in urological disorders on board, the department of Urology at Fortis, Chennai, offers its patients, the knowledge and expertise that is not easily available elsewhere in other healthcare establishments in the city. A determined and skilled group, our urologists work with a collaborative approach and determine and diagnose patients with utmost accuracy. This is a tremendous source of comfort and confidence for all patients who choose to partner with Fortis, Chennai.
Every specialist in the department of Urology at Fortis is highly respected in their domain of medical expertise. With a combination of outstanding qualifications, recommendations and experience along with top-notch clinical and surgical skills, is what brings the department to the forefront amongst all other divisions in the hospital. Keeping up research in the field, our experts bring forward modern methods of diagnostic screenings and treatment modules that offers renewed hope to many of our critical patients.
Conveniently located in Chennai. Fortis Hospitals has the ability to offer the care that our patients need, close to home. Our support staff is polite, friendly and are always there to answer any questions that our patients may have. Our staff is dedicated to make the patient visit to the hospital as convenient and comfortable through continued efforts in 100% patient service.