Incontinence
Urinary incontinence is defined as the inability to control the bladder. It can be mild, resulting in leakage when you laugh, exercise or cough, to severe, resulting in the sudden incontrollable urge to urinate and inability to control it until you reach a toilet. To determine more about your case of incontinence, it is likely that your doctor will perform a test. This may include a urinalysis, ultrasound, cystoscopy or urodynamics study. Treatment for your incontinence will depend on the severity of the case.
Risk factors
Past surgeries (prostatectomy, hysterectomy), childbirth history, diet, obesity, smoking, caffeine, some medications.
Cystoscopy
This is a simple, in-office procedure that allows your doctor to see the inside of the bladder and urethra. The physician will use a small lens equipped with fiber-optic lighting, called a cystoscope, to perform the procedure. Sometimes, the physician will also perform a biopsy, inserting a small tool through the urethra and into the bladder to collect a tissue sample for testing.
Urodynamics study
Your physician may want to schedule an urodynamics study with you to help evaluate your bladders ability to store and empty (void) urine. The urodynamics study consists of three parts:
Uroflow
To measure the volume and speed of urine your void from your bladder.
Cystometrogram (CMG)
Filling of your bladder with sterile water to determine how efficiently your sphincter muscle is working to either hold urine or allow it to pass.
Pressure flow
After the filling of bladder, you will be asked to urinate with pressure sensors in place.
You will be asked to perform some preparation prior to your visit. A urine sample will need to be dropped off one week before your visit to test for infection. Other preparation includes:
Interstitial cystitis (IC) is most often characterized by frequent urination, urgency and pain in the pelvic or suprapubic area. Some people experience only pain or pressure and discomfort. The symptoms of IC are often similar to that of a urinary tract infection but the patient’s urine is usually free of bacteria. In order to diagnose IC, your doctor may do a cystoscopy, a simple in-office procedure. You may also be asked to keep a diary of your voiding.
Once diagnosed, there are treatments available. Oral medications may be prescribed to relieve pain or reduce urgency and frequency symptoms. Other treatments include bladder distention using a cystoscope or instilling medication directly into the bladder via the urethra. Bladder instillations are simple, in-office procedures usually performed by a member of the medical staff on a weekly basis, usually for 6 to 8 weeks. Treatment of IC depends on the severity of the symptoms.
Most often, urinary tract infections are caused by an infection in the lower part of the urinary tract, namely the urethra and bladder, but urinary tract infections (UTIs) can affect any organ in the urinary system. More often, UTIs occur in women and are characterized by frustrating pain and/or itching in the bladder and urethra. Although bothersome, a UTI does not become immediately dangerous unless it spreads to the kidneys. Symptoms include burning during urination, frequency, urgency, strong smelling urine, flank pain and/or a fever. If your physician suspects a UTI, they will take a culture of your urine to test it. Most often, infections are treated with a simple dose of antibiotics. In rare circumstances, more intensive treatments are required. Untreated urinary tract infections can be dangerous as they can cause acute or chronic kidney infections or irreversible damage to the kidneys.
Risk factors: Being female, sexual activity, post-menopause, dealing with kidney stones, having a catheter.
Vaginal prolapse occurs when the pelvic organs (rectum, intestines and vagina) are no longer held in place by the muscles and ligaments supporting them, resulting in their collapse into the vagina. As many as 34 million women are affected by this problem. Prolapse can be caused by weakening of the muscles due to childbirth, surgeries and obesity. Often patients suffering from vaginal prolapse also show signs of bowel dysfunction or bladder over-activity.
Physicians treat this condition a number of ways depending on severity. Sometimes patients can perform physical therapy to help the problem, but often physicians must place a device in the vagina to support the weakened muscles.
Circumcision is a simple procedure performed in-office to remove the foreskin from the head of the penis. Pain and recovery time are minimal, as is risk of infection. Studies show that circumcision decreases the risk of UTIs in men and sexually transmitted diseases (including HIV). Most often, circumcision is performed on infants but can also be performed at later stages in life. Circumcision is a not a required procedure but should be a decision made after weighing in medical and societal circumstances.
Erectile dysfunction is defined by the inability to attain an erection when aroused by sexual intercourse. Often, ED is a result of obesity, high blood pressure, age, smoking, prostate conditions or diabetes. Physicians often treat ED with prescription medications such as Cialis or Viagra. In some cases, patients can elect to have a penile prosthesis put in place.
In some cases, the testicles will not descend into the scrotum after a child is born. This can be dangerous for the health of the testicle because the temperature of the body is warmer than the scrotum and the testes need to be kept at a cooler temperature to remain healthy. Often the testicle will descend on its own over the first year after birth, but sometimes a surgery is required to bring it down and reduce the risk of damage to the testicle.
Orchiopexy
During orchiopexy, the physician will make a small incision in the scrotum, groin or abdomen, depending on the location of the undescended testicle, and it is pulled back down and fixed to the scrotum. Most often this is a simple, outpatient procedure.
Vasectomy is a simple, in-office procedure that provides men with a safe, highly effective, permanent form of birth control. During the procedure, your physician will simply cut and seal the tubes that carry sperm to the semen. Most men experience few to no side effects after surgery. It is important that before the surgery is performed, the patient understands that he will no longer be able to father children. There are vasectomy reversal surgery options; however, these are not guaranteed to restore fertility.
For more information on vasectomy surgery, please read our postoperative guidelines.
Bladder stones are small, rock-like deposits that form in your bladder. When urine becomes too concentrated, minerals will build up and form a stone. Bladder stones may pass with urination, but often they will need to be removed by your physician.
Aside from treating kidney cancers, urologists primarily diagnose and treat problems associated with kidney stones.
Kidney stones are small, rock-like pieces (usually of calcium or acid salts) that form in the kidney. Although kidney stones can be caused by many things, they are often caused when urine is highly concentrated, allowing the minerals to crystallize and clump together. Often, patients feel no discomfort with kidney stones until they move into the ureter. As a stone moves into the ureter, it can be painful and cause blood in the urine, nausea and vomiting. Often with smaller stones, the stone will move down the ureter and be passed from the body with urination. Doctors often advise patients to increase water intake when attempting to pass a stone (2 to 3 liters per day).
Risk factors: Certain diets, obesity, genetics, and digestive issues or surgeries.
Though bladder cancer often affects those over 50, it can occur at any age. With regular checkups, bladder cancer is often diagnosed while it is at an early stage and still treatable. Symptoms of bladder cancer include, but are not limited to: pelvic pain, urinary frequency and varying amounts of blood in the urine. Unlike many cancers, the rate of recurrence in bladder cancer is high. Thus, after being treated for the cancer, your doctor will likely require regular screenings of the bladder for the first four years following surgery.
Cystoscopy
This is a simple, in-office procedure that allows your doctor to see the inside of the bladder and urethra. The physician will use a small lens equipped with fiber-optic lighting, called a cystoscope, to perform the procedure. Sometimes, the physician will also perform a biopsy, inserting a small tool through the urethra and into the bladder to collect a tissue sample for testing.
Transurethral resection of the bladder tumor
During this procedure, a cystoscopy is performed and a probe is passed through the cystoscope to remove the tumors. This probe is sometimes fit with a high-energy laser that works to burn away cancer cells. This surgery is most often performed under general anesthesia and may result in pain or bleeding for a few days following surgery.
Radical cystectomy
This surgery involves the removal of the entire bladder as well as the affected lymph nodes and surrounding tissue. In women, a radical cystectomy often involves the removal of the uterus, part of the vagina, as well as the ovaries. In men, radical cystectomy often involves the removal of the prostate and seminal vessels.
To allow for urination following surgery, your doctor will chose one of three methods that suits your healthcare needs and situation. The first, the ileal conduit, involves creating a small conduit that leads to a stoma in your abdomen. A tube is then attached to the stoma and drains urine from the body to a bag that is worn at your abdomen. The second option is the creation of a small reservoir inside of your body using a section of intestine. This procedure is called cutaneous continent urinary diversion. The third option is the creation of a “neobladder,” a piece of intestine used to create a new bladder. The neobladder is connected to the urethra, and allows you to urinate in much the same way you did prior to your cystectomy.
Immunotherapy
This form of treatment for bladder cancer uses your body’s immune system to help fight the cancer. Most often, biological therapy is administered through the urethra and up into the bladder — a process known as intravesical therapy. This form of therapy works along side treatments with biological therapy drugs.
BCG
TICE® BCG is a bacterial preparation of a strain called Bacillus Calmette-Guerin, or BCG. BCG contains live bacteria that have been found to be helpful in the treatment of bladder cancers. BCG is instilled directly into the bladder so the bacteria will come in contact with the tumor cells. BCG may be an effective way to treat bladder cancers if done correctly. Your physician will ask you to schedule weekly visits for a certain period of time and provide you with specific instructions which must be followed closely in order for BCG to work.
Learn more about cancer care at the Salem Health Cancer Center.
Kidney cancers, most commonly caused by a renal cell carcinoma, rarely show symptoms in the early stages. Often, diagnosis occurs while a physician is testing for other conditions by abdominal ultrasound or a CT scan. Although less common, transitional cell carcinomas (also affecting the ureters or bladder) begin as kidney cancers.
If kidney cancer is suspected, physicians look for trace amounts of blood in the urine sample, or in more extreme cases, large amounts of blood.
Nephrectomy
A radical nephrectomy involves the removal of the affected kidney and any affected tissue or lymph nodes at the site. This procedure is done as an open procedure with a large incision or as a laparoscopic procedure in which the physician inserts a camera and surgical tools through a few small holes to remove the kidney.
Partial nephrectomy
This surgery involves the partial removal of the kidney. During surgery, the tumor, as well as a buffer of surrounding healthy tissue, is removed. This surgery can be performed with a larger, open incision or laparoscopically. This surgical option is often used for smaller tumors or in patients who have just one kidney. Your physician will determine the best method of treatment for you.
Cryoablation
During this procedure, your doctor will insert a needle into the tumor in your kidney. This needle will release a gas that will freeze the cancer cells of the tumor.
Learn more about cancer care at the Salem Health Cancer Center.
Prostate cancer is one of the most common cancers diagnosed in men over 50. The prostate is a small, semen-producing gland, about the size of a golf ball, located between the bladder and rectum. If diagnosed early and before it has spread beyond the prostate gland, prostate cancer can be successfully treated. Unfortunately, some prostate cancers are aggressive and can spread quickly, rapidly becoming much harder to treat. Because of this risk, it is important than men undergo regular screenings (the rectal exam and blood test known as a PSA test) to check the health of the prostate.
If your doctor has reason to suspect a cancer in the prostate, he/she may perform a prostate biopsy to remove a piece of prostate tissue to test for cancer. This is a simple procedure that is performed by inserting a thin needle into the prostate to remove the tissue sample.
Risk factors: Obesity, age, smoking, family history and ethnicity.
Radical prostatectomy
This surgery is the removal of the entire prostate as well as surrounding lymph nodes and tissue. This surgery can be performed as an open surgery with an incision made in the lower abdominal wall or through an incision made in the perineal wall (the area between the scrotum and anus). This procedure can also be performed robotically.
Transurethral resection of the prostate (TURP)
This procedure removes tissue from the prostate by inserting a resectoscope (a cutting tool attached to a lighted tube) through the urethra. This procedure is often performed to decrease pain or discomfort before more aggressive cancer treatment is performed.
Radiation and hormone therapy may also be performed.
Learn more about cancer care at the Salem Health Cancer Center.
Although testicular cancer is one of the rarer forms of cancer in men, it is the most common cancer in men ages 15 to 34. Testicular cancer is highly treatable, even if it has moved beyond the testicle, but it is important to perform regular self checks and see your doctor for an annual physical to ensure early detection.
If cancer is suspected after examination, your doctor will order a blood test and it is possible he/she will decide that the removal of the testicle is the best form of action.
Radical inguinal orchiectomy
During this procedure your doctor will remove the affected testicle through an incision in the groin. Your doctor may also decide that the lymph nodes and tissue in the surrounding area must be removed as well. Often this is the only surgery necessary in cases of testicular cancer and your doctor will then closely monitor your progress during frequent follow-up visits, CT scans and blood tests over the following two to three years.
In some cases, doctors will require the patient to undergo further treatment in the form of radiation therapy or chemotherapy.
Learn more about cancer care at the Salem Health Cancer Center.