Urology is the surgical specialty that essentially focuses on the disorders or diseases associated with the urinary tracts of males and females, and the male reproductive system. Medical professionals who specialise in this field are called Urologists and are trained to effectively diagnose, treat, and manage patients suffering from related disorders. The various organs covered by urology include – kidneys, ureters, urinary bladder, urethra, and male reproductive organs namely – the, epididymis, vas deferens, seminal vesicles, prostate and penis.

Urology involves the management of problems such as urinary tract stones, infections and benign prostatic enlargement, as well as complicated surgical problems such as the surgical management of different types of cancers and correction of congenital defects. Moreover, it is closely related to other medical fields including Oncology, Nephrology, Gynaecology, Gastroenterology, and Endocrinology. It is a discipline that combines the study of different organs and physiological systems, comprising different sub-fields.

You may consult a urologist if you face issues such as:

   Painful urination, straining or difficulty in passing urine, poor flow, frequency or urgency and incomplete voiding

   Abdominal pain radiating to the groin with or without nausea or fever

   Blood in the urine or Hematuria, which could be an early sign of a bladder or kidney cancer

   Urinary tract infection, kidney stones and bladder infections

   An increase in PSA levels or a change in PSA, the most sensitive indicator of prostate cancer

   Any defect or abnormality of the kidney revealed by an X-ray

   A testicular mass or continuous pain in scrotum

   Male infertility problems such as low sperm count and sperm abnormalities

   Erectile dysfunction or ejaculatory problems

Factors that could increase the potential risk of developing kidney stones include:

   Dehydration

   People who live in regions that have predominantly warm climates and those prone to excessive sweating

   Consuming food rich in high protein, sodium and sugar

   Obesity

   Gastric bypass surgery, inflammatory bowel disease or chronic diarrhoea can bring about changes in the digestive process, which could in turn affect the assimilation of calcium and water

   Other medical conditions such as Renal tubular acidosis, Cystinuria, and Hyperparathyroidism

   High uric acid levels

   Recurrent Urinary tract infections

   Family history of stones

   Men are more vulnerable to developing kidney stones when compared to women

   Certain medications

Adequate hydration does have a role in preventing stones; however, many patients, especially the elderly, land up with increased urinary frequency, urgency, nighttime frequency, incontinence, disturbed sleep, and daytime sleepiness, resulting in falls.

Water requirements are based on ambient temperature and activity level.

To maintain good hydration status: Heed your thirst and check your urine colour.

Foods containing seeds like tomato, guava, and lady finger need not be avoided by patients with kidney stones as they do not increase the potential for stone formation.

Their diet needs to be altered depending on the type of kidney stone.

Severe restriction of calcium in the diet in fact increases the recurrence rate of urolithiasis by increasing the oxalate absorption from the intestine.

Calcium should be consumed in moderation and should not be restricted.

It is worse than water.

Beer or alcohol may produce more urine through a diuretic effect, but this can also be achieved by the consumption of other oral fluids or water.

Excess beer intake increases the risk of oxalate renal calculi by increasing oxalate and urate content in urine.

Blood in urine, also known as Hematuria, is in fact a symptom and not a particular condition. Cases of hematuria should be precisely evaluated by the doctor to determine or rule out an underlying cause. Blood in urine can usually come from the kidneys, ureters, bladder or urethra

Some of the possible causes of blood in urine include:

• Infections or stones in the bladder or kidney
• Benign prostatic hyperplasia or enlarged prostate
• Prostate cancer
• Tumour in the bladder, kidney, or ureter
• Injury to the kidney due to an accident or sports
• Vigorous exercise
• Consuming blood thinners like Aspirin, Clopidogrel and the like
• Certain kidney diseases such as glomerulonephritis or inflammation that occur in the kidneys’ filtering system

Dysuria refers to pain, discomfort, or burning sensation when urinating. This symptom is more common in women than in men. However, it is commoner in older men than the young ones.

Some of the common causes of painful urination are:

• Urinary tract infections (UTI) caused due to several factors such as diabetes, advanced age, enlarged prostate, kidney stones, pregnancy and having a urinary catheter in place.
• Vaginal infection
• Sexually transmitted infections such as Genital herpes, Chlamydia and Gonorrhea

Some of the things you can do to reduce urinary frequency are:

• Bladder retraining, or in other words, training your bladder to hold urine for a longer time and urinate less frequently over a period of about 12 weeks
• Kegel exercises to help strengthen the pelvic muscles around the bladder and urethra so as to increase bladder control and to minimize urinary urgency and frequency
• Not consuming foods that upset your bladder or act as diuretics such as caffeine, alcohol, carbonated drinks, chocolate, artificial sweeteners, or spicy food
• Consuming abundant high-fibre food, as constipation may worsen symptoms associated with an overactive bladder syndrome
• Drinking adequate water to prevent constipation and over-concentration of urine
• Avoiding too much water, just before bedtime, as it can cause night-time urination
• Keeping  blood sugar levels under control if diabetes has been diagnosed as the cause

More often than not, patients have already taken multiple courses of antibiotics without a documented urine report suggestive of a urine infection and have been labelled as having a recurrent UTI with no obvious symptomatic relief.

Thorough history, clinical examination, and evaluation are paramount for proper diagnosis and treatment.

SWL is used to treat calculi up to 1.5 cm, preferably in the upper or middle calyx.

ESWL breaks the stone into large fragments, which may sometimes block the ureter, or some of these fragments may remain in the kidney as residual fragments necessitating another procedure.

Also, it is not ideal for very hard stones, lower calyceal stones, or obese patients.

The hardness of water does alter the urinary salt parameters but has not been found to increase the risk of stone formation or recurrence.

Barley water is no different from regular plain water.

The key is to prevent supersaturation of urine.

80% of the urinary stones are composed of calcium oxalate or calcium phosphate, for which there are no medicines available that can dissolve the stones.

The most common procedures performed by urologists in an office include:

• Cystoscopy or visual scope inspection of the urethra, bladder and prostate in men
• Removal of stents
• Dilatation of the Urethra
• Urodynamic studies

Common procedures performed in an operation room setting include:

• Robotic or Laparoscopic removal of the kidney, prostate, bladder or testis owing to cancer
• Transurethral surgeries for benign prostate hypertrophy and bladder tumours using lasers
• Endoscopic removal of the kidney, ureteral or bladder stones using lasers
• Kidney transplant
• Robotic and Laparoscopic reconstructive surgeries like Pyeloplasty or Reimplant
• Urethral stricture surgeries
• Vasectomy, Penile implants or Incontinence surgeries

The size of the prostate does not affect the severity of the symptoms.

Men with mild enlargement can experience extreme symptoms, and vice versa.

Many patients with CKD feel well with proper therapy and may discontinue prescribed medications and dietary restrictions.

Discontinuation of therapy in CKD can be dangerous.

Rapid worsening of kidney function may lead to end-stage renal disease, requiring earlier initiation of dialysis or kidney transplantation.

Prostatomegaly is age-related, and all enlarged prostates do not need therapy if asymptomatic, and there is no evidence of any bladder outlet obstruction or associated complications.

PSA screening is important, but it should not be prescribed without understanding its implications.

According to the American Urology Association, screening has the greatest benefit for men between the ages of 55 and 69 years of age.

Men at increased risk of prostate cancer, such as Africans, Americans, and those with a family history, will benefit from screening at an earlier age.

Risks outweigh the benefits for men with a life expectancy of 10 years, which include unnecessary anxiety, biopsies, and complications of treatment.

Shared decision-making is the key.

PSA is a glycoprotein produced by the prostate gland in small quantities.

It is not prostate cancer-specific. PSA may be elevated in malignancy, urinary tract infection, acute prostatitis, urinary retention, benign enlargement of the prostate, ageing, prostatic massage or biopsy, and post-ejaculation.

Millions of prostate biopsies are performed every year, the incidence of seeding is virtually non-existent, and there is no potential risk of spread.

It is assumed that the bladder loses its tone after it has been catheterized, and the intention of clamping the catheter is to maintain bladder tone and capacity.

There is no evidence, however, that the cyclical bladder filling produced by intermittent clamping has any effect on bladder capacity or tone except in defunctionalized bladders.

Clamping may exacerbate involuntary detrusor contractions, which may be interpreted as a normal bladder sensation.

Pericatheter leak is a common problem and occurs in 40–70% of catheterized patients. Inserting a bigger catheter may, in fact, worsen the pericatheter leak.

The usual cause is detrusor contractions, which may be caused by irritation of the bladder by the catheter balloon, debris, stones within the bladder, or infection.

Reduce the catheter balloon capacity by partly deflating the balloon, and treat constipation if present. Treating the underlying cause is important.

The addition of anticholinergic medication may help.