NEW GROWTHS

A neoplasm is an abnormal or new growth of tissues. This may be benign, which means that there is an abnormal growth pattern and on the other hand, malignant which is characterized by an uncontrolled cell division with the ability of these cells to invade other tissues, either by direct growth into nearby tissue (invasion) or by spread of cells to other sites (metastasis).




Tumors may arise from most of the organs of the genito-urinary tract namely:

*kidneys
*ureters
*bladder
*adrenal glands
*penis
*testis
*prostate




Any cancer, for that matter, warrants the appropriate and immediate attention for the benefit of every patient. The earlier the cancer is dectected, the better is the success rate of cure and survival of the patient.
Urologists recommend annual check-ups especially for those with family histories of cancer.

BETTER BE SAFE!

What are Sexually Transmitted Diseases?

Sexually transmitted diseases (STD) are diseases that are acquired through sexual activity. They include chlamydia, gonorrhea, genital herpes, HIV/AIDS, and syphilis. There are many serious health problems associated with STDs.

Complications of STD infection include:

* pelvic inflammatory disease (PID)
* inflammation of the cervix (cervicitis) in women
* inflammation of the urethra (urethritis)
* inflammation of the prostate (prostatitis) in men
* fertility and reproductive system problems in both sexes.




STDs can be spread by other means than sexual activity, such as contact with body fluids from an infected person, and can be passed from a mother to her newborn baby.

Symptoms of an STD:

* Burning sensation urinating
* Sores, bumps, rashes, or blisters in the genital or anal area
* Abnormal discharge from the vagina or penis
* Itching, pain, or discharge in the anal area
* Redness or swelling in the genital area
* Pain in the pelvic or abdominal area
* Pain, soreness, irritation, or other discomfort during intercourse, or bleeding
after intercourse
* Recurring yeast infections

Remember that many people with STDs may not experience symptoms.

Treatment

Viral STDs, such as genital herpes (HSV), human papillomavirus virus (HPV), and human immunodeficiency virus (HIV), cannot be cured, but symptoms can be managed with medication.

Bacterial STDs, such as gonorrhea and chlamydia, can be cured with antibiotics.

Fungal (e.g., vaginal yeast infection) and parasitic (e.g., trichomoniasis) diseases can be cured with antifungal and antihelminthic agents, respectively.

Early diagnosis and treatment increase the chances for cure.

Lowering Your Risk of STD Infection


* The risk for transmission is dramatically reduced with the use of condoms and other safer sex practices.

* Avoid contact with body fluids and tissues, such as vaginal fluids, semen, and any open sores

If you suspect you have an STD, see your urologist immediately.

SHOOTING BLANKS?

Infertility is the inability to conceive after at least one year of unprotected intercourse. Since most people are able to conceive within this time, physicians recommend that couples unable to do so be assessed for fertility problems (OB-GYN for females; Urologist for males).

In men, hormone disorders, illness, reproductive anatomy trauma and obstruction, and sexual dysfunction can temporarily or permanently affect sperm and prevent conception. Some disorders become more difficult to treat the longer they persist without treatment.

Infertility can result from a condition that is present at birth (congenital) or can develop later (acquired).

Listed below are common causes of infertility:

* Chemotherapy
* Defect or obstruction in the reproductive system (e.g., cryptorchidism, anorchia)
* Disease (e.g., cystic fibrosis, sickle cell anemia, sexually transmitted disease
[STD])
* Hormone dysfunction (caused by disorder in the hypothalamic-pituitary-gonadal
axis)
* Infection (e.g., prostatitis, epididymitis, orchitis)
* Injury (e.g., testicular trauma)
* Medications (e.g., to treat high blood pressure, arthritis)
* Metabolic disorders such as hemochromatosis (affects how the body uses and stores iron)
* Retrograde ejaculation (i.e., condition in which semen flows backwards into the
bladder during ejaculation)
* Systemic disease (e.g., high fever, infection, kidney disease)
* Testicular cancer
* Varicocele

A thorough examination and a review of the man's medical and surgical history are necessary, because chronic disease, pelvic injury, childhood illness, abdominal or reproductive organ surgery, recreational drug use, and medications can affect fertility. Physical examination may detect testicular irregularities (e.g., varicocele, absence of vas deferens, tumor), evidence of hormonal disorders (e.g., underdeveloped reproductive organs, enlarged breast tissue), or evidence of testosterone deficiency.

A semen analysis is done to examine the entire ejaculate, because seminal fluid can affect sperm function and movement. Generally, three semen samples are taken at different times to account for variables such as temperature and error.

Treatment options include the following:

* assisted reproduction
* medical treatment
* surgery

LOW BATT?

Erectile dysfunction (ED) is the inability of a man to achieve or maintain an erection sufficient for satisfactory sexual performance. Most men experience this at some point in their lives, usually by age 40, and are not psychologically affected by it. This results from decrease in the blood flow in the penis thereby causing lesser penile stiffness.

There are many underlying physical and psychological causes of erectile dysfunction. Reduced blood flow to the penis and nerve damage are the most common physical causes.



Listed below are conditions commonly associated with ED:
* Vascular disease
* Diabetes
* Drugs
* Hormone disorders
* Neurologic conditions
* Pelvic trauma, surgery, radiation therapy
* Peyronie's disease
* Venous leak
* Psychological conditions

Whether the cause of impotence is physiological or psychological, both the patient and his partner often experience a range of intense feelings and emotions. Any of these feelings can lead to a sense of hopelessness and lower self-esteem.

Of course, feelings of sexual insecurity can reinforce any performance anxiety a man experiences and create a vicious cycle of repeated failures and increasingly negative feelings.

Treatment options include counseling, behaviour and lifestyle changes, oral medications, penile injections and the placement of penile prostheses.

The goal of treatment:

FOR CHILDREN

Pediatric urology involves the diagnosis and treatment of congenital(inborn) or acquired urological conditions in children (newborns to early adult age). The most common condition is urinary tract infection (UTI).







These are some commonly encountered conditions that warrant a pediatric urologic consult, evaluation and management.



- undescended testis (testis is not in the scrotum)


- vesicoureteral reflux (back up of urine from the bladder to the ureters and/or kidney)


- urinary tract obstruction (UPJ stenosis)





- hypospadias (abnormally located opening of the penis)


- hydrocoele (enlargement of the scrotum caused by a fluid filled sac)


- recurrent UTI especially in males
- bladder control problems such as bedwetting
- phimosis (very tight foreskin of the penis)
- antenatal hydronephrosis (distention of the kidneys of the fetus noted during
prenatal ultrasound of the mother)
- tumors of the urinary tract in children (kidney or bladder tumors most common)
- hernia

The best time to bring the child for consult with a urologist for the above conditions is between the age of 6 mos to 12 mos. The earlier the condition is diagnosed, evaluated, treated and corrected, the better are the treatment success rates. Most pediatric conditions require surgery to correct the problem.

KEYHOLE UROLOGIC SURGERY (LAPAROSCOPY)

Laparoscopy was first performed in 1901 by Kellig to view the abdomen of a dog. A century later, it has gained popularity and widespread use in multiple specialties. Dr Clayman of UCLA-Irvine was the first urologist to perform laparoscopic procedures during the early 90's. Presently, laparoscopy is slowly being included in the urologist's armamentarium.

Laparoscopic urology is a technique in performing major urologic surgery through several tiny (0.5cm to 1.0cm) incisions, instead of the long incisions, that have been traditionally used. Laparoscopy uses a camera that is inserted inside the abdomen through one of the small incisions so that organs can be visualized using a telescope, and manipulated with long thin instruments likewise inserted into the abdomen through small incisions.

Although in essence this technique employs keyhole surgery, the view obtained is much better than looking through a keyhole. Modern camera equipment produces a wide, bright, clear, magnified view of the operation.

Additionally, though using only small incisions, laparoscopic surgery requires general anesthesia like open surgery.

Many documented advantages have been demonstrated compared with the traditional open surgery.

* Because of the small wound size, this technique produces much less pain thus requiring less pain medications
* Less blood loss
* Shorter hospital stay
* Favorable cosmetic result with smaller scars
* Recovery time greatly reduced resulting to earlier return to work and normal daily activities

Whatever is the goal of open surgery can also be achieved using laparoscopic surgery

The are several urologic procedures being done laparoscopically namely:

* Laparoscopic lymph node dissection
* Laparoscopic adrenalectomy
* Laparoscopic cyst unroofing/decortication
* Laparoscopic nephrectomy
* Laparoscopic partial nephrectomy
* Laparoscopic nephroureterectomy
* Laparoscopic radical nephrectomy
* Laparoscopic donor nephrectomy
* Laparoscopic pyeloplasty
* Laparoscopic radical prostatectomy


The estimated complication rate of laparoscopic urologic surgery is less than 5%. The most common risks include bleeding, infection, and injury to adjacent organs such as liver, bowel, spleen, pancreas and vascular structures. These complications do also happen with open surgery.

Conversion to open surgery after initial attempts of laparoscopy are sometimes necessary to safely complete the procedure but is never considered a failure of surgery.

Although laparoscopic surgery is easier on the patient than open surgery, it is technically more difficult to perform than that of equivalent traditional open surgery that it sometimes takes longer time to perform.


In the Philippines, the National Kidney and Transplant Institute is the pioneer institution where this procedure is commonly performed and has the largest experience with this technique.

Laparoscopic milestones in the National Kidney and Transplant Institute

2001 first laparoscopic pelvic lymph node dissection.
first laparoscopic hand-assisted nephrectomy

2002 first laparoscopic adrenalectomy
first full laparoscopic nephrectomy

2003 first full laparoscopic radical nephrectomy

2004 first laparoscopic donor nephrectomy
first laparoscopic radical prostatectomy

2005 first laparoscopic orchiectomy for undescended abdominal testis
2007 first laparoscopic partial nephrectomy

Laparoscopic procedures for urology is gaining popularity in our country. IT IS NOTEWORTHY TO KNOW THAT THE EXPERTISE IN LAPAROSCOPIC UROLOGY IS ALREADY AVAILABLE IN DAVAO CITY AND SOME INSTITUTIONS HERE IN THE CITY ALREADY HAVE LAPAROSCOPIC INSTRUMENTS.


LAPAROSCOPIC DONOR NEPHRECTOMY (NKTI)

FOR MEN AGED 40 YEARS OLD AND ABOVE

Prostate gland and urinary problems

The prostate gland is a male reproductive organ. Many men experience urinary changes as they age, which may be caused by inflammation or enlargement of the prostate gland. An enlarged prostate gland, however, does not always cause urinary problems. Troublesome urinary symptoms are rarely symptoms of prostate cancer.

The prostate gland is about the size of a walnut and is found at the base of the bladder. A thin tube that allows the passage of urine out of the penis (urethra) runs through the prostate gland. Fluid produced by this gland helps to nourish and support sperm, which come from the seminal vesicles via the ejaculatory ducts into the urethra.




How the prostate gland develops

The prostate undergoes two main growth spurts. The first is triggered by sex hormones made by the testicles during puberty. This prompts the gland to reach an average weight of 20g. The second growth spurt begins when men are in their 40s.

Urinary changes are common as men age

Many men experience urinary symptoms as they age, which may be caused by inflammation of the prostate gland (prostatitis). In the older male, symptoms may be the result of a blockage in the tubes due to a benign (non-cancerous) enlargement of the prostate gland (benign prostatic hyperplasia). The most common symptom is difficulty emptying your bladder.

Urinary symptoms may become sufficiently difficult that they require treatment.

Common urinary symptoms associated with aging

Not all urinary symptoms are due to changes to the prostate. Also, some men have enlarged prostates and yet experience few, if any, symptoms.

Urinary symptoms commonly experienced include:

* The need to urinate frequently during the night
* Urinating more often during the day
* Urinary urgency – the urge to urinate can be so strong and sudden that the toilet may not be reached in time
* The urine stream is slow to start
* Urine dribbling some time after finishing urination
* A sensation that the bladder isn’t fully emptied after urination
* Lack of force to the urine flow, which makes directing the stream difficult
* The sensation of needing to go again soon after urinating.




Although these symptoms often do not need treatment, you should see your doctor if they are particularly difficult as they can be successfully treated.

Symptoms that should be followed up

See your urologist if you have the following symptoms:

* Inability to urinate
* Painful urination
* Any blood in the urine at all
* Any discharge from the penis
* Continuous or severe urinary incontinence (you can’t hold your urine).

Inflammation of the prostate

Bacteria sometimes cause prostatitis (inflammation of the prostate). More commonly, however, the underlying cause is uncertain. If the following symptoms are present, you should consult your urologist promptly:

* Fever
* Low back pain
* Pain in the groin
* Urgent and frequent urination.

Antibiotic treatment is essential for acute bacterial prostatitis. Admission to hospital is often necessary and, as with chronic prostatitis, specific antibacterial drugs are required for a long time.

Enlargement of the prostate
Benign prostatic hyperplasia (BPH) causes enlargement of the prostate, which may cause troublesome symptoms. BPH is more common as men get older.

The prostate gland goes around the urethra, so men may have problems urinating if the enlarged gland restricts the flow of urine. If the flow stops completely, a catheter is required to empty the bladder. It is rare for this form of acute urinary retention to cause kidney damage.



An enlarged prostate doesn’t always cause urinary problems. Studies indicate that the size of a man’s prostate gland has little influence on the type or severity of his urination problems. BPH is just one possible cause of urinary symptoms.


Diagnosis
If you are troubled by urination problems, you should see a urologist – no matter what your age. If your doctor agrees that your symptoms need further evaluation and treatment, you may need to undergo a few tests. These may include:

* Physical examination – including digital rectal examination (DRE) to check the size and shape of the prostate gland.
* A urine check – to ensure the prostate is not infected.
* An ultrasound examination – to assess if the bladder is emptying completely and to examine the appearances of your kidneys.


Digital Rectal Exam(DRE)

Treatment

If your urinary problems are caused by infection or enlargement of the prostate gland, treatment options include:

* For prostatitis – a prolonged course of antibacterial drugs. Because infection is difficult to eradicate, they will need to be taken for many weeks.

* For obstruction caused by an enlarged prostate

a) Medical treatment: medications to relax the muscles of the urethra to facilitate passage of urine

b) Surgical treatment: Transurethral incision of the prostate (TUIP), Transurethral resection of the prostate (TURP), open prostatectomy (for very large prostate glands)


TRANSURETHRAL RESECTION OF THE PROSTATE (TURP)


OPEN PROSTATECTOMY

Things to remember

* The prostate gland is a male reproductive organ that contributes fluids to nourish sperm cells in the ejaculate.
* Many men experience urinary changes as they age. In many cases, these changes do not need specific treatment.
* When urinary changes cause problems, they can be treated successfully by lifestyle changes, medication, surgery or both.
* For problems such as blood in the urine, pain on urination, inability to urinate or uncontrollable urine flow, you should see your urologist promptly.