Urological diseases of the upper urinary tract involve kidney and ureter diseases such as stones, drainage abnormalities and cancer. These can cause pain in the flank, abdomen or groin; blood in the urine or repeated urinary infections. Drainage obstruction can occur due to the narrowing of the ureter at any level and often results in the dilatation of the kidney drainage system requiring surgical correction.
Lower urinary tract consists of the urinary bladder, urethra (water pipe) and associated genital organs. In men; there is the prostate, ejaculatory system, the testis and the penis. In women, the urethra is much shorter just above the vagina with the uterus and cervix having an indirect role on the urinary tract.
Kidney & Ureteric Stones
Stone disease is increasing in incidence. In the Bristol area, approximately 1300 patients are admitted as an emergency with severe pain or kidney obstruction from stone disease. It is an increasingly common problem.
Patients often report inadequate water intake, increasing meat intake and oxalate containing diet. An association with metabolic syndrome (term describing disease cluster of obesity, type 2 diabetes, abnormal cholesterol parameters and high blood pressure) has been described.
Diagnosis is with kidney ultrasound, with confirmation of the stone size and kidney structure mapped out with a CT scan. Treatment is required if the stone(s) is causing symptoms or obstructing the kidney drainage if it has dropped into the ureter (or is at risk of obstructing). Some professions such as pilots, Bus and HGV drivers need to be stone free. Treatment options include shock wave lithotripsy, ureteroscopy or percutaneous nephrolithotomy. See the Procedures page for more information.
Kidney and Ureteric Cancer
Cancers of the Kidney are often diagnosed incidentally (when having an ultrasound or CT scan for other abdominal symptoms), but can also present with blood in the urine or pain. Cancers of the Ureter are rare cancers and are often diagnosed during investigations for blood in the urine. There are often non-cancerous causes for blood in the urine.
Urinary Flow / Prostate Problems
The prostate gland is situated at the base of the water pipe in men and poses one of life’s challenges to men over 50 years.
It can be ‘normally’ enlarged causing obstruction to the calibre of the water pipe (urethra) and can lead to incomplete urinary bladder and urinary flow symptoms such as reduced flow strength and increased frequency. Even Barack Obama has alluded to getting up at night in his 2016 White House Correspondents’ address. As with most married men, it is often the ‘cavalry’ who quintessentially nudge their partners forward. Prostate obstruction to the urinary bladder outflow results in compensatory bladder muscle development of the urinary bladder wall which subsequently contracts often and in-appropriately resulting in urinary bladder over activity.
Raised PSA and Prostate Biopsies
The prostate could also be ‘abnormally’ enlarged from prostate cancer. This requires a back passage examination (spare a thought for how I earn my living!), a blood test called PSA (prostate specific antigen) and sometimes a prostate biopsy.
Often the prostate cancer is a slow growing relatively quiescent disease but it is important to rule out the aggressive variant of the disease.
Investigating for prostate cancer with a blood test is one of the biggest controversies in men’s health with the ‘For’ campaign suggesting it saves lives by identifying patients with the aggressive disease early and initiating radical treatment early whereas the ‘Against’ camp suggesting that a lot of patients with minute cancer amounts go on to have radical treatment when this small amount of cancer may not ever metamorphose into problematic disease in the lifetime. There are also other reasons why the PSA maybe high such as ejaculations, cycling, prostate inflammation or urinary infections.
Blood in the Urine
Is this the ‘red- flag sign of imminent danger? Blood in urine can be visible to the eye or picked up on urine tests. Diagnostic rates of malignancy range from 5% to 19%. Most people have a benign (non-cancerous) explanation for this symptom. The Urologist would opine on the appropriate investigations which often includes a clinical evaluation, ultrasound or CT scan and a telescopic examination of the bladder.
Urinary Tract Infections (UTIs)
Urinary tract infections are debilitating. Symptoms include, burning feeling on passing urine, lower abdominal or back pain, fever and chills and blood in the urine on testing or rarely visible blood in the urine.
In women, these could be due to hormonal changes, life style pressures or bladder abnormalities. In men, the bladder may not be emptying adequately due to the outflow narrowing. Stones in the kidney or kidney drainage problems can also cause infections.
Life style advice and sometimes a period of preventive antibiotics maybe needed to overcome water infections following normal infections.
Urinary Bladder Dysfunction (including frequency, urgency, incontinence)
The urinary bladder is an intriguing organ which could be obstructed from the prostate enlargement or cervical abnormalities or overactive due to the irritation of the bladder muscle (detrusor).
The pelvis has a hammock of muscles which keep the the downward tubes (urinary and bowel) under control and tight. Wear and tear of time and relaxation of the muscle tone leads to the control loss. Investigating this system is like an Engine ‘MOT’ with the Urologist deciphering the appropriate culprit organ before initiating medical, behavioural or surgical treatment.
Penile & Scrotal
Epididymal cyst removal