Urology

Üroloji

Urology is a surgical medical science that covers male and female urinary tracts and the male reproductive organs, and deals with diseases of these systems. In short, any disease related to the following limbs is included in interests of urology. 

Areas of Interest of Urology

Pediatric Urology

Undescended Testes

It is the absence of one or both testes from the scrotum. It can improve within the first 10-12 months after birth. Otherwise, it should be definitely treated without delay. Treatment is usually to bring the testis into the scrotum and fix it there.

If undescended testis is left untreated, it may cause important problems such as infertility, testicular cancer. Furthermore, undescended testes are usually accompanied by hernia. During surgery, hernia is also repaired.

Hydrocele (Water Hernia)

It is caused by the fact that abdominal membrane connection between abdominal cavity and testicle is left open after birth. It manifests itself by occasional or permanent accumulation of fluid around one or both testicle(s).

After the diagnosis, disappearance of swelling and self- healing are usually expected until the end of the first year after birth. If it doesn’t heal, the problem is resolved by a small operation.

Foreskin Problems

Foreskin may appear as if it tightly sticks to the penis head immediately below. This situation is normal and there is no need to remedy it. However, sometimes the hole at the end of the skin is excessively narrow and this may prevent urinating comfortably. Sometimes, germs under the narrow foreskin multiply and cause inflammation and discharge.
All these cases should be evaluated by an urologist and immediately treated, then the child should be circumcised, if necessary.

Hypospadias

It is a defect in which urethra opens to any point below the tip of the penis, instead of opening at the tip of the penis. It is seen in one every 300 male children. It has mild and severe degrees. In severe cases, serious problems may occur such as that the patient cannot urinate forward and in a smooth way, an erect penis remains bent, semen cannot be ejaculated to the desired location.

The only treatment of hypospadias is a meticulous surgery performed by experienced hands. During surgery, incomplete urinary tract is completed by using body tissues. The best time for surgery is between the ages of 1-2 years.

Voiding Disorders

Voiding Disorders are common in childhood but often neglected, and noticed in case of serious problems. These disorders appearing with various symptoms from incontinence during day or night to voiding in a difficult and troubled manner and from holding urine for a long time to frequent visits to the toilette require meticulous and thorough urological research .    

If voiding disorders are disregarded and ignored, they may cause dangerous consequences, such as serious kidney inflammation, organ loss, and even kidney failure.

Andrology (Sexual Dysfunction Diagnosis and Treatment)

Andrology is a medical branch that studies male and female sexual health and male infertility.  Its areas of interest can be listed as follows:

  • Erectile Dysfunction in Men 

Erectile dysfunction is defined as the inability to reach a stiffness level that can provide a successful sexual intercourse or the inability to maintain this stiffness level as much as required.  It seems to be more common in men over the age of 40.  Other sexual functions of men experiencing erectile dysfunction are often normal. 

Erectile dysfunction can only be diagnosed by a doctor after the examination.  It is often diagnosed by information given by the patient and physical examination. Some simple tests which help making a diagnosis may be required. 

Selection of treatment depends on whether the cause is physical or psychological.  If the problem is psychological, psychologists who specialize in sex therapy should be consulted.  

There are 4 main treatment methods used for erectile dysfunction due to physical causes: 

    • The drugs used orally
    • The vacuum apparatus 
    • Injection into the penis: Vasodilating drugs are injected using a fine needle. These drugs act by loosening the tissues of the penis and blood vessels.
    • Penile prosthesis:  Penile prosthesis consists of two synthetic cylinders surgically placed into the penis.  The prosthesis does not affect urination and sexual functions such as ejaculation, orgasm. 

These treatment methods do not eliminate the cause. However, they help one achieve the erection level that will provide sexual contact.  

    • Penile structure disorders(curvature , etc.)
    • Sexual aversion
  • Female sexual dysfunction (reluctance, pain syndromes, disorders of arousal, etc.)

Sexual dysfunction may occur as a result of a variety of organic and psychological causes. Its incidence in women is at the level of 40%. Sexual dysfunction in women is classified as follows:

    • Sexual desire disorders (disgust, etc.)

It can be seen as lack of / absence of sexual desire, and even as an aversion to sexuality. It may occur as a result of organic and psychological causes. 

    • Arousal Disorders

In women experiencing arousal disorder, arousal enough to take pleasure during foreplay and sexual intercourse does not occur.  Its causes may include systemic diseases (such as diabetes), hormonal problems, menopause, medication use, nerve injuries that can occur as a result surgical procedures. 

    • Painful Sexual Intercourse (Dyspareunia )

Defined as ” dyspareunia ” in medical language, it means feeling pain during sexual intercourse.  Dyspareunia of 30% develops in women after surgical intervention in genitals and medical problems of reproductive organs are detected in 40% of women admitted to the clinic with this complaint. 

    • Vaginismus

Vaginismus involves involuntary contraction of 1/3rds of the outer potion of the vagina during sexual intercourse, preventing introduction of the penis. It may be caused by trauma, rape and surgeries one underwent in the past. Apart from this, it may also occur as a result of tissues that have formed in the area opening during childbirth and being stitched afterwards, inflammatory diseases related to sexual organs and sexual glands and vaginal changes during menopause.
Vaginismus often emerges due to psychological reasons or conditions of being brought up.  It requires medical treatment, psychotherapy and sex therapy. 

In the case of sexual dysfunction, first the grounds are established and a treatment method that will eliminate the grounds is applied. 

It involves a range of treatments from medication or therapies with devices such as vacuum to psychotherapy. Studies on new treatment methods still continue.

  • Male infertility ( infertility )

Infertility is generally defined as failure to fulfill reproductive function. 

Male infertility is dependent on many factors. Abnormalities in sperm production, clogged sperm ducts, presence of antibodies against sperm, testicular trauma, hormonal disorders, anatomical problems, varicocele, past illnesses, infections and certain medications can lead to infertility. In addition, smoking and alcohol use, the rise in testicular temperature (for reasons including high fever, wearing tight pants, etc.), external causes such as being overweight and excessive exercise may also cause this condition.

For diagnosing infertility, first of all, patient’s medical history and habits (smoking, etc.) are evaluated.  Then a physical examination is conducted. Diagnostic is supported by tests, including semen analysis, urine analysis, hormone analysis.  

Treatment is usually conducted by aiming at the source of the problem. Infections and hormonal disorders are treated by administering medication.

If it is found what causes narrowing in the part of sperm ducts opening to prostate, it is cut open by endoscopic method. Regions of clogging in other levels are found and removed under a microscope.

Auxiliary reproduction techniques are used for pregnancy. IVF is the most common method of auxiliary reproduction techniques. 

Urological Oncology

Prostate Cancer

Although the exact cause of prostate cancer, which is only seen in men, is unknown, age, race and genetic factors have been found to play an important role.  Among these factors, age stands out as the most important factor.  The incidence of prostate shows a significant increase at and over the age of 50.

In some patients, prostate cancer shows no symptoms. Some patients may experience symptoms such as frequent, strong, painful urination, blood and inflammation in the urine, and urinating in droplets. However, these symptoms are not only symptoms of prostate so an expert should be consulted to be sure.

The prostate makes very slow progress and it can be treated with medication or by surgery. 

Bladder Cancer

Bladder (urinary bladder) is our organ that ensures accumulation and discharge of urine and bladder cancer is defined as uncontrolled proliferation of the cells forming the bladder. Full recovery is usually possible by early diagnosis and treatment in the case of bladder cancers.   In general, it is often seen between the ages of 50 and 70 and it is three times more common in men than women. Incidence of this disease is higher in smokers and workers in paint, chemical and rubber industry.  It mostly manifests itself by blood in the urine. However, blood in urine is not a symptom only specific to bladder cancer.

Definitive treatment plan of bladder cancer is arranged according to the depth of spread of the cancer and degree of aggressiveness of cancer cells.

The first procedure to be basically performed when bladder cancer is detected is to endoscopically remove the tumoral mass as much as possible under operating theater conditions. After this surgery, accurate diagnosis of bladder cancer and its then current stage will be determined as a result of pathological examination of parts removed.  

Kidney Cancer

Kidney cancer usually occurs between 50 and 70 years of age. It is 2-3 times more common in men than women. The cause of kidney cancer is not fully known yet.  However, factors including smoking, genetic factors, hypertension, obesity, occupational risk factors (steel industry, petroleum, cadmium, lead industry employees) and exposure to radiation increase the risk. 

Kidney cancers don’t show symptoms at the beginning. However, as the tumor progresses, symptoms such as blood in urine, pain, loss of appetite, weight loss, recurrent fever, high blood pressure and anemia occur.

Surgery is the main treatment for renal tumors. Radiotherapy may be applied to support surgery.

Testis Cancers

It is the most common form of cancer in young men between the ages of 19 and 44.   It accounts for 1% of all cancers in men.  Its incidence in Caucasian men is higher than that in other races. 

Its most common symptoms include pain, mass or growth in any of the testicles. In testicular cancer, chemotherapy can be performed after surgery by urologists.

Female Urology – Urogynecology

  • Unintentional Urinary Incontinence

Bladder (urinary bladder) has two important functions. One is to store urine and the other is to discharge urine. Urinary incontinence occurs in the event of urine storage dysfunction.  This may not always originate from the bladder. Different types of urinary incontinence are caused by clogging in last part of urinary tract, urinary tract infections, and damaged urinary retention mechanism. 

Incontinence is a quite common disorder appearing especially in women during laughing, coughing and lifting heavy objects.  This situation typically occurs in multiparous women or women who have difficulty in giving birth or as a result of relaxation of the muscles in the lower part of the abdomen for various reasons. Excess weight also negatively contributes to this situation.

Urinary incontinence is a symptom, rather than a disease. Although it isn’t usually associated with a dangerous condition, it adversely affects a person’s life.

Its causes are identified and first exercises or drug therapy is/are applied. Nowadays, there are quite effective drugs against this problem. Dose and duration of drug treatment varies from patient to patient. However, stress-related urinary incontinence does not respond to drug therapy.

  • Overactive Bladder  

It is a condition that significantly disrupts the quality of life.   Individuals go to the toilet so frequently that their daily lives are affected and in advanced cases, incontinence occurs as a result of sudden need to urinate.  Research has reported that 60% of women between ages of 20 and 70 may suffer from this condition in a certain period of their lives or permanently. 

  • Pelvic organ prolapses

Bladder, uterus, rectum and bowel prolapses can create serious problems both anatomically and in everyday life. This condition can be treated nonsurgically in the early stages by strengthening the pelvic floor muscles as well as exercise and biofeedback therapy, while it is also possible to save women from this problem by extremely simple surgical interventions in advanced stages of the condition.  

Kidney Diseases.

  • Nephritis

Inflammatory diseases of the kidney are called nephritis. This disease is one of the most important causes of kidney failure.  It is divided into 2 as non- microbial and microbial nephritis. 

    • Microbial nephritis (pyelonephritis)

It is also called as upper urinary tract infection.  It is a disease mostly caused by bacteria and it shows a sudden onset. Viruses or fungi can rarely be the cause. 

The final diagnosis is made by urine culture.  In patients with recurrent pyelonephritis, presence of an abnormality in the urinary tract should be investigated.

Recovery is achieved by antibiotic treatment.  In case of an abscess, surgical intervention may be rarely needed. The kidney can be treated permanently and without damage to the kidney using a correct treatment.   If it is not treated or in advanced cases, it may cause loss of the patient due to transfer of germs into the patient’s blood.

    • Non- microbial Nephritis

It is a condition where inflammation occurs in glomerulus (the filter through which the blood coming to the kidney is filtered) or tubule (long, partly curved pipes in which the filtered blood is transformed into urine).   

In case of rapid progress of the condition, chronic renal failure occurs and the patient may need dialysis. Each patient is treated differently.  Type of treatment is determined according to renal biopsy.

  • Kidney Stones

If inflammation of the urinary tract in a person results in a blockage, the substances in there precipitate and form kidney stones in our body. As a result, kidney stones cause severe pain and bleeding in our kidneys. Sometimes blood in urine has also been observed in this disease.

The majority of the stones up to 5 mm can be removed by drug therapy and intake of plenty of liquids.  As the size of the stone increases, it is less likely to drop it without intervention.

ESWL ( Extracorporeal shock wave crushing ) is the most commonly used method in treatment of kidney stones. The shock waves generated outside the body are focused on the stone and the stone is crushed into small pieces during treatment. Then these pieces are expected to be discharged along with the urine.

Percutaneous nephrolithotripsy (PNL) is a current endoscopic surgery method applied when the stone inside the kidney is larger than 2 cm or couldn’t be crushed by  ESWL. Under general anesthesia, the kidney is entered by a tract created from an incision of 1 cm in the lumbar region and the stones are removed in the same way as a whole or by crushing them.

Another surgical treatment method is ureteroscopy. In this method, ureter is entered by urethroscope and the stones are crushed using laser. Advantage of ureteroscopy is that urethroscopes are flexible and thus even enter small pockets in the kidneys.

  • Uremia

Harmful substances carried to the kidneys by blood and excreted in the urine are called urea. Uremia is the illness occurring when urea is not excreted into the urine and is retained in the body. This illness results from failure of the kidney to adequately filter urea. The patient suffers from permanent headache, blurred vision, hiccups, a need for sleeping during the day, and insomnia during the night. It is a disease that should be treated immediately.

  • Kidney Cancer

Kidney cancer usually occurs between 50-70 years of age. It is 2-3 times more common in men than women. The cause of kidney cancer is not fully known yet.  However, factors including smoking, genetic factors, hypertension, obesity, occupational risk factors (steel industry, petroleum, cadmium, lead industry employees) and exposure to radiation increases such risk. 

Kidney cancers initially do not show any symptoms. However, as the tumor progresses, symptoms such as blood in urine, pain, loss of appetite, weight loss, recurrent fever, high blood pressure and anemia develop.

Surgery is the main treatment for renal tumors. Radiotherapy can be applied to support surgery.

  • Renal Failure:  

It is divided into 2 groups as chronic and acute renal failure.  This illness is a result of failure of kidneys in a person to fully perform their duties. Diagnosis of renal failure can be made by measuring urea and creatine levels in the blood.

The main functions of the kidneys are ensuring water, salt, calcium balance in the body, excretion of harmful substances and drugs from the body via urine and contributing to hormone, glucose metabolisms.  In renal failure, these functions deteriorate. Kidney failure may develop in two ways, which are sudden (acute) or insidious (chronic).

Diagnostic Methods Used in Urology

  • IVP

A contrast medium injected intravenously is retained by the kidneys and in x-ray graphs taken at 5-10-15-20 minutes, kidneys and urinary tract are displayed. 

  • Ultrasonography

Ultrasound uses sound waves to view internal organs of the body.  Frequency of the sound waves used is so high that a human ear cannot hear. The amount of sound reflected by each tissue will be different so the image perceived will be different. Thus, tissues and organs will be seen on the screen of ultrasound device. By this method, different images can be detected for tissues like a cyst or tumor.

  • Ultrasound-guided multiple prostate biopsy 

It must be carried out in the diagnosis of prostate cancer.  Accompanied by ultrasound, this procedure is based on obtaining tissue samples from suspected area.

  • Computed tomography

It is a special imaging technique that gives a cross-sectional image of the tissues and organs of the body using x-rays.  In comparison to ordinary plain radiographs, CT provides more detailed information about head injuries, brain tumors and other brain disorders. Bone, soft tissues and blood vessels can also be displayed by CT.

  • MR

MR i.e. Magnetic Resonance Imaging is a painless diagnostic technique which doesn’t utilize rays that may cause harm, such as x-rays, in other words, which doesn’t involve radiation. Giving successful results especially in the display of soft-tissues, MR involves creation of an image by means of radiofrequency waves in a strong magnetic field.   Due to its success in the case of soft tissues, cancerous areas which can not be identified in other diagnostic methods can be detected. 

  • Scintigraphy

It is a technique based on giving radioisotopes intravenously and imaging that such isotopes are retained and excreted by kidneys. It is a very useful method in the diagnosis of tumors.

  • Endoscopic Examinations
    • Cystoscopy:  It is an examination method carried out by entering urinary bladder via external urinary tract under local or general anesthesia. Its advantage is that it allows direct observation of bladder and external urinary tract. Where necessary, it is also possible to make some limited interventions with this tool.
    • RGP: During cystoscopy, a thin catheter is placed in the kidneys to inject contrast, and intra-renal channels, kidney pool and internal urinary tract can be evaluated.   This examination is called retrograde pyelography. It is a method by which we mostly evaluate kidneys and renal tracts which show failure or which cannot be fully evaluated by other methods.
    • Ureteroscopy: It is a much thinner and longer tool with respect to cystoscope. It is used to examine internal urinary tract, which is much above the bladder.
  • Urodynamic Studies

It is a test that helps us evaluate bladder pressures and voiding. The simplest of these is uroflowmetry. It allows us to easily assess voiding flow rate under outpatient clinic conditions. 

  • Spermogramms

It is a procedure that shows an individual’s ability to inseminate. It is performed by examining semen obtained after ejaculation of the male.

  • VSG

It is a procedure that shows male genitalia tracts. Under local anesthesia, semen cord is found manually inside the scrotum and semen tracts are made visible by administering a contrast medium.

Treatment Methods Used in Urology

Robotic Surgery

Robotic Surgical System consists of an ergonomically designed surgeon’s console where the surgeon sits while operating, with handles controlled by the surgeon using his fingers and feet-controlled pedals, and a unit bearing robotic arms, and optical systems providing 3D images by instruments with mobility up to 540o.  During long surgeries, the surgeon works in an ergonomic position by sitting so he can concentrate on the operation for a long time as well as tiredness-induced hand vibrations are filtered by the robot so success of the operation increases.

In the case of robot -assisted surgeries, faster recovery is achieved and sexual functions especially in the case of prostate cancer are affected less.

The operation is performed with the help of advanced optical systems so it provides a much more detailed visible area compared to open surgery. In addition, because of the advantage of magnification up to 12 times of the operated area, it causes less tissue trauma, resulting in faster recovery and better oncological outcomes after the surgery. After the surgery, less pain and faster recovery of the patient imply a short period of hospitalization.

ESWL (Extracorporeal shock wave lithotripsy)

It is an extremely easy and comfortable treatment. Stones are crushed using sound waves and excreted from the body via urinary tract. Usually by this method, stones smaller than 2.5 cm in diameter are treated with a success rate of 85-90%. 

Kidney Transplant

Kidney transplantation is the organ transplant of a kidney into a patient whose kidneys fail to perform its functions well enough to continue his life and activities.

The process of dialysis is a process negatively affecting patients’ lives both mentally and physically. Before the transplant, an individual lives a dialysis-dependent life, whereas after the transplant, the individual becomes independent. People who have undergone kidney transplant regain their strength, and their social and physical activities improve.

Transplantation from relatives or non-related people with compatible tissue can be performed. It is a procedure with a fairly high success rate.

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