Urology

Benign Prostatic Hyperplasia
Benign prostatic hyperplasia (BPH) is a histopathological diagnosis characterized by epithelial cell & smooth muscle cell proliferation in the transition zone of the prostate leading to a non-malignant enlargement of the gland, which may result in lower urinary tract symptoms, including voiding and storage symptoms.
It is commonly called enlarged prostate.
Etiology is unknown but due to its similarity to the embryonic morphogenesis of the prostate has led to the hypothesis that BPH may be the result of "reawakening" in adulthood of embryonic induction processes.
Bladder Cancer

Bladder cancer is a heterogenous neoplasm that ranges from non-life-threatening, low-grade, superficial papillary lesions to high-grade invasive tumors that often metastasizes at the presentation.

It is the most common cancer involving the urinary system and it is the 11th most commonly diagnosed in the world.

Microscopic or gross painless hematuria is the most common presenting complaint.

Chronic Pelvic Pain
Chronic pelvic pain (CPP) is a persistent, distressing, & severe pain of >6 month duration.
It occurs intermittently, cyclically, or situationally.
Localized to the pelvis, anterior abdominal wall at or below the umbilicus, the lumbosacral back, or the buttocks.
It is severe enough to cause functional disability or need medical care.
In women, CPP is not restricted to intercourse or menstruation & is not associated w/ pregnancy.
It is a symptom w/ a number of contributory factors & not a diagnosis; pathophysiology is complex & not well understood.
It is assumed that in the development of chronic pain, the nervous system is affected among others by inflammatory & chemical mediators & hormones.
A complex problem that is both multifactorial & multidimensional
Erectile Dysfunction

Erectile dysfunction is the inability to attain and maintain an erection enough to have satisfactory sexual performance for ≥3 months.

It is when the patient complains of partial erection that could not attain vaginal penetration.

Complete loss of penile rigidity is uncommon.

Initial penile erections can penetrate but early detumescence occurs without ejaculation.

Gonorrhea - Uncomplicated Anogenital Infection
Gonorrhea is a sexually or vertically transmitted infection secondary to gram-negative diplococcus Neisseria gonorrhoeae.
It is one of the most common bacterial sexually transmitted infections that may cause pelvic inflammatory disease leading to infertility or ectopic pregnancy.
Most of the infected females are asymptomatic but may present with increased or altered vaginal discharge, dysuria, urethral discharge, abnormal vaginal bleeding, vulval itching or burning, dyspareunia, conjunctivitis and proctitis.
Herpes Simplex Virus Infection
Primary herpes simplex virus (HSV) infection is first infection with either herpes simplex virus-1 (HSV-1) or herpes simplex virus-2 (HSV-2) in individuals who do not have antibodies to either HSV-1 or HSV-2.
First episode-non primary infection is infection with either HSV-1 or HSV-2 in individuals who have previously existing antibodies against HSV-1 or HSV-2 respectively.
Recurrent HSV infection results from reactivation of latent virus. It is usually brought about by triggering factors eg UV light, immunosuppression.
Orolabial HSV disease is mostly caused by HSV-1 that occurs most commonly in children <5 years of age. It is transmitted through close contact with individuals who have active viral shedding.
Genital HSV disease is caused by HSV-2 that is the usual cause of herpes genitalis. It typically occurs in adults and transmitted through sexual contact.
Hypogonadism in Males - Late-Onset
Late onset hypogonadism is defined as clinical and biochemical syndrome characterized by older age, set of typical symptoms, and deficiency in serum testosterone levels.
The quality of life may be decreased and multiple organ systems may be adversely affected.
Prior to the start of testosterone substitution, there should be confirmation of low serum testosterone and a confirmation of need based on clinical findings.
Only if the potential benefit exceeds the risk, then replacement testosterone should be started.
Male Infertility

Infertility is the inability to conceive despite regular unprotected sexual intercourse for one year.

Male infertility as the sole cause accounts for 20% & 30-40% as a contributory factor to infertility in couples.

Causes include: hypothalamic pituitary disease, primary testicular disease, disorders of sperm transport, genetic disorders, idiopathic infertility, infections, immune system disorders, iatrogenic causes, and chronic illness.

Overactive Bladder

Overactive bladder or non-neurogenic overactive bladder is a syndrome characterized by urinary urgency, frequency, nocturia and urgency incontinence.
It is not a disease but a symptom complex that generally is not a life-threatening condition. It is also known as bladder spasms.
Urgency is the complaint of sudden, compelling desire to pass urine that is difficult to deny. It is considered a hallmark symptom of overactive bladder.
Frequency is usually micturition of >7 episodes during waking hours.
Nocturia is the interruption of sleep one or more times because of the need to void.
Urgency incontinence is the involuntary leakage of urine associated with a sudden compelling desire to void.

Penile Cancer

Penile cancer is a rare type of malignant growth that occurs on the skin or tissues of the penis.

It often presents as a palpable visible penile lesion w/ signs that may include pain, bleeding, discharge or a foul odor.

The lesion may be fungating, nodular or ulcerative and may be concealed by phimosis.


Premature Ejaculation
Premature ejaculation is a male sexual dysfunction characterized by short, easily stimulated ejaculation that occurs always or nearly always before or within one minute of vaginal penetration.
It is involuntarily controlled and causes negative personal consequences like distress, frustration and avoidance of sexual intimacy.
Exact etiology and risk factors are unknown.
Prostate Cancer

Prostate cancer is the cancer that occurs in the male's prostate.

It is the most common cancer in men >50 years of age.

Signs and symptoms include weak urinary stream, polyuria, nocturia, hematuria, erectile dysfunction, pelvic pain, back pain, chest pain, lower extremity weakness or numbness and loss of bowel or bladder control.

Prostatitis

Prostatitis is the inflammation of the prostate that may be caused by infection, chronic pelvic pain syndrome or asymptomatic prostate inflammation.

Prominent features are genitourinary, pelvic or rectal pain and lower urinary tract symptoms, eg urinary frequency, urgency, hesitancy, weak stream and straining on urination, dysuria, pain that increased with urination.

Renal Cancer

Renal cancer is the disease in which certain tissues of the kidney starts to grow uncontrollably and form a tumor.

It is also called as renal adenocarcinoma or hypernephroma.

Classic triad of symptoms are flank pain, palpable abdominal mass and gross hematuria.

Testicular Cancer

Testicular cancer is a rare neoplasm that arises from the testis. It commonly presents as a painless testicular mass.

It has high prevalence in young and middle-aged men in the age of 15-40 years old.

It is a highly treatable disease with a high cure rate.

Testicular primary germ cell tumors coming from the malignant transformation of primordial germ cells make up 95% of all testicular cancer.

 

Urinary Incontinence
Urinary incontinence is the complaint of involuntary urine leakage.
Stress urinary incontinence is the involuntary urine leakage on effort or exertion or when coughing or sneezing.
Urge urinary incontinence is the one associated with or immediately preceded by urgency.
Mixed urinary incontinence is the involuntary urine leakage associated with both urgency and with exertion, effort, coughing or sneezing.
Urinary Tract Infection - Complicated
Urinary tract infection (UTI) is complicated if the UTI is associated with factors that increases colonization and decreases therapy efficacy. Factors may include one or all of the following: Structural or functional abnormalities of the genitourinary tract; presence of an underlying disease that interferes with host defense mechanisms or the patient being immunocompromised; and being infected by a multi-drug resistant bacteria.
Principles of therapy includes effective antimicrobial antimicrobial therapy, optimal management of the underlying abnormalities or other diseases & adequate life-supporting measures.
Urinary Tract Infection - Uncomplicated
Acute uncomplicated urinary tract infection (UTI) is one of the most common bacterial infections in adults that may involve the lower or upper urinary tract or both.
Acute cystitis is an infection limited to the lower urinary tract while acute pyelonephritis is an infection that involves the upper urinary tract (renal parenchyma & pelvicaliceal system) that usually has significant bacteriuria.
Recurrent UTI is characterized by 2 episodes of uncomplicated UTI in the last 6 months or ≥3 episodes with positive cultures in the last 12 months in patients with no structural or functional abnormalities.
Urolithiasis

Urolithiasis is the formation of urinary stones in the kidney, bladder and/or urethra.

The hallmark of obstruction in the ureter and renal pelvis is the sudden onset of excruciating, intermittent pain that radiates from the flank to the groin or to the genital area and inner thigh.

It is a painful urologic disorder that occurs in 12% of the global population and has a high recurrence rate among male patients.

Lower urinary tract symptoms that are associated with urolithiasis are urgency, frequency, urge incontinence and dysuria.