Common urological conditions in men:

By: Dr Viola Morolo
Urologist

In Urology, the month of November is known as men’s health month ‘Movember’. It is aimed at raising awareness on men’s health specifically prostate cancer and testicular cancer. The ultimate goal of Movember is contribute to improving the quality of men’s life globally.

Many conditions will present in a similar manner with a few differences and therefore it is important to consult your health care professional to help you reach the correct diagnosis and treatment through shared decision making.

1. Urinary Tract Infection (UTI)- An infection, usually caused by bacteria, affecting any part of the urinary tract most commonly the bladder (cystitis). Urinary tract infections that affect the upper tract (kidneys) are serious and are known as pyelonephritis.   

• Symptoms: Frequent urination associated with pain or burning. Cloudy, offensive smelling urine.
• Diagnosis: Confirmed by laboratory urine testing that will culture the organism causing the infection and establish the antibiotic that will treat the infection.
• Treatment: This will depend on the cause of the infection. For bacterial infections, antibiotics according to the sensitivity results from the laboratory.

2.  Prostatitis – Inflammation with or without an infection of the prostate gland which may be asymptomatic.
3. Symptoms: Pain in the groin, painful urination, dribbling or hesitancy when urinating, frequent urination particularly at night, painful ejaculation, fever and chills.
4. Diagnosis: Inflammation and bacterial infection is confirmed by laboratory testing of urine.
5. Treatment: For bacterial infections, antibiotics according to the sensitivity results from the laboratory.
6.  Benign prostatic hyperplasia (BPH)-  A condition that causes the prostate to enlarge in size which then leads to your prostate squeezing against your urethra (water pipe) and thus resulting in difficulty urinating.

Symptoms: Slowness or dribbling when urinating, inability to completely empty your bladder and frequent urination especially at night.

Diagnosis: Digital rectal examination which will confirm a smooth prostate with no nodules. Prostate specific antigen (PSA) blood test will be performed to rule out cancer when necessary. 

Treatment: Aimed at alleviating the symptoms as there is no cure for BPH. Medical treatment includes medications that will either relax the muscles in your prostate, thus opening up your urethra, or decrease the production of the hormone that contributes to the growth of your prostate gland. Surgical treatment involves resecting the prostate to relieve the symptoms.

4. Prostate Cancer – Most common diagnosed cancer in men that is caused by abnormal prostate gland cells that can spread to other organs (bone, spine, lungs, liver).

• Risk factors: Age (risk of prostate cancer increase at the age of 55), male of African descent and family history (prostate and breast and colorectal cancer). Patients are encouraged to screen for prostate cancer especially those with risk factors and not wait for symptoms. Symptoms indicate advanced disease. 
• Screening: Includes both digital rectal examination and blood test for PSA.
• Diagnosis: Prostate biopsy.
• Treatment: May entail surgery, radiation therapy and medical treatment including chemotherapy.

5. Kidney Cancer – A condition caused by abnormal cells in the kidney can affect adults and children. Kidney cancers in adults differ from those in children.
6. Symptoms: Blood in urine, abdominal pain that may be associated with a mass that can be felt.
7. Diagnosis: CT scan with/without renal biopsy.
8. Treatment: May include surgical removal of the affected part of the kidney/the whole kidney. In selected cases other medical therapies are available.
9. Bladder Cancer – A condition caused by abnormal bladder cells. Bladder cancer usually involves cells that can also affect the upper tracts and cause cancer in the kidneys.
10. Risk factors: Smoking, exposure to hazards in the working environment (mines and factories), history of having been infected with bilharzia.
11. Symptoms: Blood in urine, frequency in urination.
12. Diagnosis: Bladder biopsy.
13. Treatment: May require resection of the tumour/s, chemotherapy, laser therapy, immunotherapy.

• Testicular Cancer – A rare cancer in the testicles, often presenting as a lump or swelling in the testicles, sometimes accompanied by discomfort in the scrotum.
• Risk factors: Age (19-35 years), undescended testes, previous cancer in other testis, family history of testicular cancer.
• Screening: Self-examination should be done at least once a month palpating for abnormal lumps on the testes.
• Symptoms: Painless testicular lump, swelling of scrotum, unintentional weight loss, pain in lower back (when advanced).
• Diagnosis: Ultrasound of scrotum and blood tests.
• Treatment: Options include surgical removal of testis, medical treatment (chemotherapy) and radiation.

8. Kidney Stones- A condition that is caused by hard deposits of minerals and salts that form inside the kidneys.
9. Symptoms: Severe sudden abdominal pain associated with nausea, vomiting and blood in the urine.
10. Diagnosis: CT scan.
11. Treatment: May include medication to facilitate stone passage and laser in the event that the stone is not passed.

• Incontinence –Involuntary leakage of urine, which can be associated with coughing, sneezing, jumping or a sudden intense urge to urinate.
• Treatment: May include pelvic floor physiotherapy, medication which will relax your bladder muscles, sling inserted in theatre to support the pelvic floor muscles.

1. Erectile Dysfunction (ED)- The inability to achieve or maintain an erection sufficient for sexual intercourse that can be caused by chronic conditions affecting the blood vessels (e.g. Diabetes, cardiovascular disease). It can result from psychological factors. Erectile dysfunction may be a sign of underlying cardiac condition that needs to be addressed.
2. Treatment: Options include medication, surgery including penile prosthesis. There is always a treatment option for return of erections.
3. Infertility – The inability to conceive a child after regular sexual encounters without the use of contraception with a partner for a year or more. In up to half of these couples, male infertility plays a role. Male infertility can be caused by low sperm production, abnormal sperm function or blockages that prevent the delivery of sperm. Illnesses, injuries, chronic health problems, lifestyle choices and other factors may contribute to male infertility.

The inability to conceive a child can be stressful and frustrating, but a number of treatments are available for male infertility

• Diagnosis: Semen analysis for men.
• Treatment: Depends on the cause, there is always a treatment option for a couple to acquire a child.

12. Peyronie’s disease –A condition in which fibrous scar tissue forms in the deeper tissues under the skin of the penis.
13. Symptoms: Abnormal bending of penis, shortening and pain during erections.
14. Treatment: May include manipulation techniques, medication or surgery.

Common urological procedures for adult men:

1. Vasectomy – A procedure to provide permanent contraception for men by removing a small section of the vas deferens (the tubes that carry sperm) on both sides. Important note: Completion of family needs to be confirmed prior to undergoing a vasectomy. Although vasectomy reversals are possible, vasectomy should be considered a permanent form of male contraception.
2. Circumcision- A procedure in which the skin covering the tip of the penis (foreskin) is removed surgically. 
3. Benefits of circumcision: Reduced risk of urinary tract infection especially in children with vesicoureteral reflux, decreases the risk of penile cancer (circumcision is also a treatment for penile cancer), treatment of foreskin abnormalities and decreases the risk of HIV infection by 59% (circumcision does not prevent HIV infection).

Common childhood urological conditions:

1. Undescended Testicles-A condition where one or both of the testicles fail to move into the scrotum before birth, which can increase the risk of infertility and testicular cancer if untreated.
2. Symptoms: Palpating only one or no testis in the scrotum.
3. Diagnosis: Examination under anaesthesia with/without laparoscopy.
4. Treatment: Usually requires surgery.
5. Urinary Tract Infection (UTI)- An infection of the urinary tract which is usually caused by bacteria. Urinary tract infection in children is a sign of an underlying disease.
6. Symptoms: Feeding problems in infants, fever, irritability,burning sensation during urination, frequent urination and abdominal pain.
7. Diagnosis: Laboratory testing of the urine. Further investigations are required to determine the cause, may include CT scan and other invasive tests.
8. Treatment: This will depend on the cause of the infection. For bacterial infections, antibiotics according to the sensitivity results from the laboratory.
9. Vesicoureteral Reflux (VUR) – A condition in which urine flows backward from the bladder into one or both the kidneys, increasing the risk of urinary tract infections and kidney damage.
10. Symptoms: Fever, strong urge to pee, needing to pee more often, burning sensation when peeing, pee that smells bad and abdominal pain.
11. Diagnosis: Requires an assessment by a Urologist who will determine the test to be conducted.
12. Treatment: May require surgery.

• Hydronephrosis-Dilation of the tubes that transport the urine from the kidney due to build-up of urine. This can occur when there is a blockage in the urinary tract that may lead to kidney damage if left untreated.
• Symptoms: Nausea and vomiting, pain in the back, abdomen and groin, decreased urine volume andblood in your pee.
• Diagnosis: Specialised tests as recommended by Urologist.
• Treatment: This will be determined by the cause.

• Nocturnal Enuresis (Bedwetting) –Involuntary peeing during sleep, common in children up to the age of 7. It can be related to developmental delays, small bladder capacity, or decreased arousal during sleep.
• Treatment: Treatment will depend on the cause and usually includes positive reinforcement and medication.
• Hypospadias – A congenital condition where the opening of the urethra is located on the underside of the penis rather that at the tip, often requiring surgical correction.
• Symptoms: Visible opening on the underside of penis instead of at the tip, abnormal downward curvature of penis and abnormal urinary stream.
• Treatment: In most casesrequires multiple surgeries.

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