Common urological clinical conditions

Listed by Urological Organ:

• Kidney

  Kidneys

  The function of the kidneys is to filter the blood and remove toxins and salts via the urine.

  Cysts

  Most kidney, or renal, cysts are found incidentally. Whilst the majority are not cancerous, review of your imaging (ultrasound, CT) with your urologist may be required to discuss the type of cyst present. Occasionally, non-cancerous cysts can grow to large sizes and become symptomatic requiring treatment.

  Stones (calculi)

  Kidney stones can cause loin (back) pain, be the source of recurrent urinary tract infections, but are often also found incidentally. If the stone falls into the ureter, the pain may radiate down into the groin and cause blood to be seen in the urine (haematuria). Some patients are prone to form recurrent urinary tract stones. Kidney stones may be seen on plain XR, ultrasound or CT. Management should be discussed with your urologist and options include observation, extra-corporeal sound wave lithotripsy (ESWL), flexible pyeloscopy and laser, and percutaneous nephrolithotomy (PCNL).

  Masses

  Many solid masses in the kidney are found incidentally, though patients may present with loin (back) pain, or less commonly blood in the urine (haematuria) or systemic symptoms (fever, poor appetite, general malaise). The majority of solid renal masses are cancerous though with smaller renal masses (<3.5cm), approximately 20% will not be cancerous. A renal biopsy may be required to assist with the diagnosis. If the mass is thought to be cancerous, “staging” investigations such as a chest XR, CT and bone scan will be performed to look for spread. For kidney cancer that has not spread, surgery to remove the mass (partial nephrectomy) or the whole kidney (radical nephrectomy) may be required. Alternative management strategies, which are less commonly utilized, include observation, or radio frequency ablation.

• Ureters

  Ureters

  These are thin tubes that carry the urine from the kidneys to the bladder.

  Obstruction

  If the ureters are blocked in any way, distension may be seen radiologically and described as hydro-ureter, or hydro-nephrosis. Symptoms may include loin or groin pain, but often patients are asymptomatic. Long-term obstruction may cause damage to the kidney. There are many causes of obstruction and these will be investigated by your urologist. Investigations may include a CT with contrast, retrograde pyelogram and other specialized tests.

  Stones

  Unlike renal stones which are often painless, ureteric stones often cause pain which may radiate from the back down into the groin. Blood may be seen in the urine (haematuria). Some patients are prone to form recurrent urinary tract stones. Ureteric stones may be seen on plain XR, ultrasound or CT. Management should be discussed with your urologist but depends on the size and location of the stone. Options most commonly include observation (allowing spontaneous passage of the stone), extra-corporeal sound wave lithotripsy (ESWL), and ureteroscopy and laser. A temporary internal ureteric stent may be used to bypass the blockage.

• Bladder

  Bladder

  The bladder functions to store and expel (void) urine from the body. Difficulties in urination can manifest in many ways. Bringing a diary of fluid intake (type, amount, and time) and urine output to your consultation will be extremely helpful.

  Difficulties storing urine

  This manifests clinically with increased urinary frequency (day), urgency and nocturia (waking at night to urinate). Caffeine containing drinks can irritate the bladder and cause these symptoms.
  Urological causes that will be considered include bladder infection, stones, and masses (cancer).
  Overactivity can also occur secondarily to obstruction.
  Neurological conditions such as stroke, Parkinson’s Disease, multiple sclerosis, among others can also manifest with these symptoms.

  Difficulties emptying urine/Urinary obstruction

  Symptoms include difficulty initiating voiding, straining to void, decreased flow, dribbling, and needing to void again soon after the initial void.
  The majority of causes for these symptoms are related to obstruction of the bladder. In men, the most common cause is benign prostatic hypertrophy (non-cancerous enlargement of the prostate).
  Urethral stricture, narrowing or scarring of the tube taking urine out of the bladder can also manifest with these symptoms.

  Urinary retention means unable to pass urine. This can often be uncomfortable and painful if the bladder is very full. Commonly, this occurs after recent surgery but can also arise with worsening bladder obstruction. If present for a prolonged period, kidney damage, recurrent urinary tract infections or bladder stones may occur. A urethral catheter is required to empty the bladder and allow recovery. Further investigations, may be required.

  Urinary incontinence means leakage of urine. Broadly speaking, incontinence is associated with either urinary urgency (unable to defer urination) or with increased abdominal pressure (leaking with coughing, straining, bending over). Previous natural child birth, trauma or surgery, radiotherapy, and prolonged obstruction are among many different causes of incontinence that will be investigated by your urologist.

  Haematuria

  Blood in the urine can of concern when seen. It may also be microscopic (found on dipstix test). Causes include urinary tract infection, stones and cancer arising from the lining of urinary tract. Urine cytology is performed to look for infection or abnormal cells. Ultrasound or CT may show stones, bladder thickening or a mass. Cystoscopy is nearly always recommended to investigate for bladder cancer.

  There are many different causes for these symptoms and investigations may include urine tests, urinary flow rate and bladder ultrasound, urethrogram, cystoscopy and urodynamics.

• Prostate

  Prostate

  Present only in men, the prostate secretes fluid for the ejaculate. As men get older, it often enlarges.

  Benign prostatic hypertrophy:

  This is non-cancerous enlargement of the prostate. As the prostate enlarges, it can compress on the urethra (link to anatomy picture), causing urinary obstruction and in some cases, recurrent urinary tract infections, haematuria, bladder stones, and urinary retention. Symptoms are usually evaluated using a standardized questionnaire. Investigations for other causes of bladder outlet obstruction are performed. Ultrasound may show bladder thickening. Treatment may involve observation, medication to relax or shrink the prostate, or surgery to remove part of the prostate.

  Prostate cancer

  In most cases, prostate cancer does not cause symptoms as it is detected early. Testing of PSA requires a discussion with your family doctor or your urologist to help you understand what an elevated result means. There are many causes of an elevated PSA, one of which is prostate cancer. Your urologist may recommend a biopsy of your prostate or regular monitoring of your PSA. If prostate cancer is found on biopsy, you may be suitable for active surveillance as many prostate cancers are thought to be indolent and not aggressive. Surgery offered by our urologists includes open, laparoscopic and robotic-assisted radical prostatectomy. What is involved with each of these procedures will be discussed further with your urologist, if required. We also work closely with our pathology, radiology, radiation and medical oncology colleagues to offer a multidisciplinary service with our cancer care.

• Testis and Scrotum

  Testis and Scrotum

  Scrotal swelling is often painless but may be uncomfortable or even painful. You may already have had urine tests and an ultrasound performed as investigations prior to seeing your urologist. Infection of the epididymis and testis usually responds to antibiotics.

  Collection of fluid around the testis (hydrocoele) can be monitored or surgically repaired. Testicular masses need to be investigated further for cancer. A varicocoele (dilation of veins in the scrotum) may require further investigation but is generally monitored unless fertility is an issue.