Urology

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Urological Cancers

Urological cancers are the abnormal proliferation of the cells in the urological parts of the body, they include:

  • Bladder Cancer: Bladder cancer is the most common type of cancer, it is when the atypical cells in the urinary bladder proliferate at an abnormal rate, which then can spread to distant organs and can cause death.
  • Prostate Cancer: Prostate cancer occurs in a man’s prostate gland that produces the seminal fluid, and it is when there is an abnormal cell proliferation. Many prostate cancers grow slowly and are confined to the prostate gland, where they may not cause serious harm.
  • Kidney Cancer: Kidney cancer is cancer that begins in the kidneys, it develops due to the uncontrolled proliferation because of the mutation of kidney cells. It may lead to the invasion of the metastatic sites and stopping their functionality.
  • Adrenal Gland Cancer: Adrenal cancer is a cancer that begins in one or both of the small, triangular glands (adrenal glands) located in the upper part of the kidneys. A surrenal tumor is a caused by the formation of a mass of atypical uncontrolled cells in the adrenal gland. The tumor can be either benign or malignant.
  • Penile Cancer: Penile cancer is a type of cancer that starts from the penile skin and can spread to other layers of the penis. Not being circumcised and having poor hygienic conditions can be the cause of this type of cancer.
  • Testicular Cancer: Testicular cancer is a disease in young men and is most common between the ages of 25-45. It develops because of uncontrolled proliferation of atypical cells in the testicle, and it can spread to other organs through the lymph and blood. Cancer in one testicle, puts the other in a higher risk than normal.

Treatments vary based on the type of cancer and its advancement, they be treated with medicine, cryotherapy, thermotherapy, ultrasonic treatments, or certain surgeries by removing part of the tumor or all of it. 

Stone Diseases

Stone disease occurs when chemicals in your urine become concentrated and forms crystals in your urinary tract. There are multiple types as explained below:

  1. Kidney Stone:

Kidney stones are small, hard deposits of mineral and acid salts on the inner surfaces of kidneys (the collecting system of the kidneys). Kidney stones occur due to disruptions in the minerals and acid salts. Having a kidney stone is normal and it is usually excreted with the urine, but sometimes the buildup stays in the kidney, and it keeps growing till it forms kidney stones.

  1. Ureteral Stone:

Usually, stones do not form in the ureter but rather move from the kidney to the ureter. If the stone remains in the ureter for a while, its size increases. They hinder the flow of urine which in result enlarges the upper part of the ureter and the kidney. Infections develop and unbearable pain is experienced. 

  1. Bladder Stone:

Because of changes in the composition of the stabilized materials, bladder stones are formed. Also because of the stones transferred from the kidney and the ureter.  Infections, fever, chills due to prostate and kidney inflammation, and bleeding in the urine are all symptoms of bladder stones.

After the diagnosis and the detection of the stone, the size, number, and underlying diseases of the stone should be determined which leads to finding a treatment. Hydration and increasing the fluid intake, use of certain medications, surgical treatment or shock wave lithotripsy (ESWL), ureterorenoscopy (URS) treatment, or laparoscopic treatments. Stones can also be broken by laser by entering the urethra with a cystoscope with a camera. Wig cystolithotomy (PSL) can also be performed as well as open surgeries regarding large stones.

Other Diseases

  1. Reconstructive Urology:
  1. Bladder Enlargement:

The bladder enlargement is crucial to make the patient’s life tolerable by the evacuation and protection of the kidneys. The goal of this is reduce the intra-bladder pressure, protect the kidneys, and increase the capacity. The surgery takes from 3 to 5 hours. Some complications may involve clotting from the leg to any part of the body, lung infection, intestinal leakage, and kidney infection if it is still at the beginning. However, if it is in the later period kidney and urinary tract infections can occur. The patient will have protected and functional kidneys after the expansion, as well as getting rid or decreasing urinary incontinence, needing to urinate more often along with other factors.

  1. Uterine Prolapse:

Uterine prolapse is when the uterus is displaced into the vaginal canal, it happens when the pelvic floor muscles and the ligaments that hold the uterus in its place are weakened due to multiple factors such as giving various births, being overweight, and having chronic lung diseases. It is usually seen in postmenopausal women. Treatment can sometimes require either vaginal or abdominal (open, laparoscopic, or robot-assisted laparoscopic method) surgeries to be performed.

  1. Female Urology:
  1. Cystocele:

Cystocele is when the existing wall between the bladder and vagina grows weak, which results in the sagging or dropping of the bladder onto the vagina. Many factors contribute to the treatment like age, the degree of illness, and comorbidities. Diets, certain exercises, and anticholinergic drugs can all be used to treat mild cases. If the patient is not responsive to the pervious treatment, then they must undergo surgery.

  1. Overactive Bladder:

Having to urinate more than usual and the impossibility of delaying it are symptoms of an overactive bladder. Urinating more than 8 times a day would be considered having an overactive bladder. After the problem is identified, treatments can vary among different cases, some lifestyle changes can be recommended, medication can be prescribed especially muscarinic receptor antagonists or drugs with anticholinergic effects, and a Botox injection into the bladder.

  1. Interstitial Cystitis:

Interstitial cystitis is a chronic condition causing bladder pressure, bladder pain and sometimes pelvic pain. It is a rare disease, and it is more common in women than men. There is no final treatment for this disease but there are alternatives, and they all depend on how far the disease has advanced and how much the patient can take. Treatments such as:

  • A change in lifestyle. 
  • Physical therapy.
  • Cystoscopy.
  • Intra-bladder Botox application and sacral neuromodulation. 
  • Cyclosporine A treatment.
  • Removal of bladder.
  1. Total Organ Prolapse (TOP):

Total or pelvic organ prolapse is the displacement of the bladder, uterus, or intestines out of the vagina. Some of the symptoms are vaginal pain, difficulties in draining urine and in bowl movement, and difficulty in sexual intercourse. Although almost 40% show little to no symptoms. 

For the treatment, exercise can be recommended in the first stages, placing a pessary ring (in case of wanting children in the near future), and as a last resort when medications do not work surgical treatment is performed. It is in two ways either vaginal and abdominal approaches (open, laparoscopic, or robot-assisted laparoscopic methods), The operation is called sacrocolpopexy and its success rate is very high, it lies between 90% and 95%. 

  1. Urological Infections:
  1. Urinary Tract Infections:

Urinary tract infection is an inflammatory disease in where bacteria invade and grows in the urinary tract, it includes the kidneys, ureteral tubes, urinary bladder, prostate, and external urinary tract. This illness usually happens because of microbial agents that enter the urinary tract and some of the time from diseases that develop in the urinary tract. 

Treatment differs based on the degree of sickness, only antibiotics can be enough to treat simple infections as well as increase in fluid intake and urinating frequently. In complicated cases it differs based on the underlying cause, in congenital urinary tract diseases surgery is required and pyelonephritis may require hospitalization and hospital treatment.

  1. Sexually Transmitted Diseases (STDs):

Sexually transmitted diseases are diseases that occur by sexual contact that is unprotected and there are various diseases that are listed below:

  • Chlamydia.
  • HIV/AIDS.
  • Hepatitis B & C.
  • Genital Herpes.
  • Syphilis.
  • Trichomoniasis.
  • Genital Wart (HPV)
  • Gonorrhea.

Treatment can include drugs such as Ceftriaxone, macrolide antibiotics and azithromycin in some diseases and AIDS and hepatitis should be followed very closely. If not treated, prostatitis (prostate gland inflammation), aortitis, heart diseases, joint diseases affect the brain itself and may cause unalterable consequences. 

  1. Urethra Stenosis:

Urethral stenosis is the narrowing of the urethra, the urethra is 20-25 cm long in adult males and 3-5 cm in females. Since men are long, strictures are most common in men. It can happen because of urological infections, catheter insertion, traffic accidents, Endoscopic surgical procedures used in urology, and other causes can also be involved. 

In case of complete obstruction, the narrow part should be removed surgically, and urethra is to be connected end to end 

Andrology

Andrology is the study of functions and diseases related to males especially of the reproductive organs. Some of the diseases that we face are:

  1. Varicocele: 

A varicocele is the abnormal dilation of the internal veins that drain the dirty blood of the testicle in men. It is the most common cause of infertility. 

  1. Male Infertility:

Male infertility refers to when a man is unable to reproduce and have a child with his female partner. Infertility in men occurs because of a blockage in the sperm ducts. If there is disease in the eggs, there is a problem in sperm production. If there is inflammation in the sperm tract and there are sequelae, even if the sperm is produced in the egg, it will not be transported.

  1. Men’s Health:

depending on age, some negative changes are observed in organs such as prostate, urinary bladder, penis, testis. These changes occur because of the decrease in the hormonal values ​​that provide the formation and maintenance of male characters such as testosterone hormone. Men’s health covers Late-onset hypogonadism (IH-Andropause) diagnosis and treatment, prostate disease diagnosis and treatment, male infertility, and sexual dysfunctions (erectile dysfunction, premature ejaculation, late ejaculation).

  1. Penile Prosthesis:

When a patient becomes unable to provide erection although he has gone through all kinds of medical treatment, doctors resort to penile prosthesis. It is a medical device which is surgically planted into the penis into the tunica albuginea layer, and it is made of silicon like substances.it restores the rigidity of the penis.

  1. Sexual Problems and Diseases:
  1. Erection Problem:

Also known as erectile dysfunction is the consistent inability to achieve an erection adequate for satisfactory sexual intercourse. Some of the causes of erection problems are diabetes, hypertension, high cholesterol, smoking, and many more. Any disturbance in the nervous, hormonal, vascular structures lead to this problem. Depression, bipolar disorder, schizophrenia, and some drugs used may also be the cause of erectile dysfunction. 

  1. Premature Ejaculation:

Premature ejaculation is a sexual dysfunction where a man ejaculates sooner than expected. Infections affecting the prostate, diseases affecting the spinal cord and brain, psychogenic events, hormonal disorders, metabolic disorders can all lead to premature ejaculation disorders.

Treatments to these illnesses can include microsurgical varicocele, shrinking the veins with some substances, surgery, treating infections, treatments for sexual intercourse problems, hormone treatments and medications, and assisted reproductive technology (ART). As well as, lifestyle and diet changes, the use of drugs that are phosphodiesterase type-5 inhibitors can be applied when it comes to sexual problems and diseases. Papaverine/regitin and prostavasin mixture treatment is given to the patients if the drugs do not work. There is also behavioral therapy, local anesthetic creams, and using antidepressants (Dapoxetine).

Pediatric Urology

Pediatric urology is a surgical subspecialty of medicine that deals with children’s genitourinary system disorders. 

  1. Hypospadias:

Hypospadias is a congenital defect in which the urethral meatus opens in the ventral side of the penis. It can be very close to the normal external urine hole at the head of the penis, as well as at the junction of the bags and the penis, or even in the bag. There may be penile curvature with hypospadias. Usually to treat hypospadias, doctors need to replace the external urinary exit hole through surgery. For a less traumatic experience, the surgery is preferred to be performed on males under 2 years old.

  1. Epispadias and Bladder Exstrophy:

Epispadias is a malformation of the penis in which the urethra ends in an opening on the upper aspect of the penis instead of the normal penile tip. Bladder exstrophy is an abnormality of the formation of bladder and the boney pelvis. Full abdominal ultrasonography is used to see if there are additional urinary tract abnormalities.

The only way to treat these anomalies is through surgery.

  1. Vesicoureteral Reflux (VUR):

VUR is when the urine flows from the bladder back up to the ureters. It happens because of congenital damage of the ureteral tubes at the entrance to the bladder or because of the increased bladder pressure as a result of obstruction of the lower urinary tract.

Void cystourethrography (VCUG) test is performed to diagnose VUR. Antibiotics are given after detection of VUR. However, if they do not work, surgical treatment is needed. 

  1. Ureteropelvic Stenosis (UP Stenosis):

Ureteropelvic Stenosis is the narrowing of the ureteral tubes at the renal outlet. It is more common in boys than girls. When the ureteropelvic stenosis junction is not developed in the correct way or is insufficient in the womb, the renal vessels crossing the UP region, or the UP region coming out of the renal pelvis outside the normal results in stenosis in the UP region. The treatment for such a case is surgery, either a laparoscopic or an open surgery. 

  1. Nocturnal Urinary Incontinence:

Nocturnal enuresis is an involuntary urination that happens at night when sleeping, at an age where a person should be able to control their bladder. It usually seen in people over 5 years old. Nocturnal enuresis can be hereditary if both the parents had it before. Sleep disorders, a late developed nervous system, and psychogenic factors can all cause it.

To treat it the following methods are used:

  • Behavioral treatment.
  • Desmopressin tablets or sprays.
  • Alarm therapy.
  • Imipramine (tofranil).
  1. Urinary Incontinence in Children:

Urinary incontinence is the loss of bladder control during the day and night in children over 5 years old. This problem has various causes such as anxiety, overactive bladder, and structural problems in the urinary tract. A determination of the type and cause of the illness is necessary to find treatment to urinary incontinence in children. As the type varies so would its treatment; pelvic floor exercises, anticholinergic drugs, and bladder expansion surgeries can all be used to treat urinary incontinence.

All of the personnel I came in contact with, went above and beyond to help me with my medical problems. I am now enjoying a more active lifestyle and no longer feel the discomfort in chest.
Betty Ballesteros Rendon— Urologist

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