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Patient information: UROLOGY

URO SPECIAL. Special pages for special problems. Information on frequent urological problems. Impotence - Interstitial Cystitis - Vasectomy Reversal   KIDNEY. An introduction about the location and form of the kidneys, and their function in daily human life. About what may go wrong and how to find out. And what can be done about it.   BLADDER. Where is it located and what is it for. Can it cause trouble; and if it does, what kind of trouble. Which examinations exist. Which kind of solutions are there when it does not function properly.   PROSTATE. An organ that, especially in the elderly, is quite often thought and talked about, although many do not know what it is for and/or where it can be found. How does one go about to find out whether the prostate does or does not do what it is intended to do, whether it is obstructing etc. How can problems be solved. Included is a questionnaire to get an estimate on the severity of urinating problems.   PENIS. An organ that, especially in the younger, is quite often thought and talked about, while most do know what it stands for and how it looks like. Many people, however, do not know how it (he) works and what can be done if it (he) does not work.   TESTICLE. Like the kidneys, the testicles are supplied in duplicate. They harbour two distinct functions. What can go wrong and how can we solve that. How can the testicles be tested.   UROLOGY. What kind of doctor is a urologist anyway, what does he/she do. Which part of the body 'belongs' to the 'urologic area'. Also the location of the small print. UROPANEL: questions to the urologists' panel.

Urology

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What is urology

MANNEKEN PISUrology is a medical specialty dealing with health problems in a broad area around the urinary system. This comprises a rather well-defined area of the human body, although there is some overlap between different medical specialties. Urologists concern themselves with:


  • Disorders of the urinary outlet of the kidney, such as obstructions of the ureter or stones, but also benign or malignant tumors and inborn disea ses.
    The kidneys themselves, concerning their function as a 'waste disposal unit', and the adrenals 'belong' to internal medicine or nephrology. The general surgeon performs operations concerning the adrenals. Kidney transplants are often performed by specialized surgical teams.

  • Disorders of the urinary bladder, like stones, tumors and inborn disorders. Incontinence in women is also part of urology, although some gynecologists deal with this kind of problems too.

  • Disorders of the urethra and prostate, like tumors, obstructions and infections.

  • Disorders of the penis, like impotence, tumors and inborn disorders.

  • Disorders of the testicle and connected structures, like infections and tumors, but also sterilizations. Male infertility also belongs to the domain of the urologist, although some clinics harbor specialists concerned with both male and female infertility.

 
Depending on the nature of the health problems there is cooperation with pediatric doctors, pediatric surgeons, neurologists and physiotherapists.

Urology has always had its own place within the medical profession. For centuries there has been a distinction between barbers/surgeons, for the cutting part of medicine, and the learned, university-educated, medical doctors, who used herbs and diets. Urologists come forth from the stonecutters, who used to travel around medieval Europe and practiced their skills on fairs, alongside the predecessors of dentists, and cured their, mostly male, patients of their bladder stones.

Bladder stones were then more frequent than now and often caused severe pain and infections; in certain patients they obstructed the bladder outlet, causing a sudden inability to pass urine. It often proved rather difficult to remove the stone in a painful operation (anaesthesia was still unknown) on a struggling patient, who had to be held still by four to five strong men. Often something went wrong, either because of insufficient knowledge of the anatomy or because of the speed of the operation. Many patients did not survive, became incontinent (they lost urine all day long) or developed a fistula (a hole next to the anus, from which urine dribbled out). These disadvantages did not keep a lot of patients to seek help to get rid of their pains, which were often unbearable. Because of the serious complications and the mortality rate of close to or even more than fifty percent, the life of the stonecutter was not always an easy one. For this reason, most of them used to travel around the country, settle down for a short while every now and then, do as many operations as they could, take the money and run. It is understandable, then, that their colleagues in the 'medical cutting profession', the surgeons, who also had a barbers shop (which normally was the more financially attractive part of their job), did not feel obliged to take over the work of the stonecutters - in times of trouble they did not want to have to leave their flourishing barbers shop.

The above mentioned early medical professions (general surgery, internal/general medicine, dentistry, urology) have been more or less independent from each other for a long time. Only in this century the number of medical specialties has grown considerably.
In the past centuries, urology has shown a tremendous development, partly because of the discovery of X-rays (making urinary stones visible) and because of the development of very small lenses, which made it possible to inspect the bladder, prostate and even the kidneys. The discovery and further development of anaesthesia and narcosis made it possible to perform more complicated operations, which take a long time and a quiet patient.

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What does a Urologist actually do?

  • Examination. A lot of people come to their doctor with urologic health problem. For example women with bladder infections or incontinence, or men with impotence or problems passing urine as well as boys having narrow foreskin or bedwetting. Most general practitio ners have a vast experience in frequent urological problems. In most cases it is best to go to the general practitioner first, more so because he/she often has a pretty good view on what is going on in the patients family; a lot of diseases, like impotence or bedwetting, can be caused or made worse by social of psychological problems, which may not become all that clear when visiting a (stranger-) urologist.
    If the disease shows to be difficult to treat, in case of a more complicated or less frequent urological problem or when an operation seems inevitable, the general practitioner can refer the patient to a urologist.
    A urologist is usually working from within a hospital. Often the patient will have a choice between several hospitals and/or several urologists, although most general practitioners deal with only one or two urologists, with whom he/she is familiar.
    After the first visit and physical examination, the urologist usually will plan additional examinations (blood/urine tests, X-rays, cystoscopy of the bladder) in order to find out what is wrong with the patient.

  • Treatment.After a diagnosis is reached, a treatment plan must be drawn. The urologist will then discuss the possibilities with the patient. Often, no treatment is necessary because the disease is minor and harmless or will be cured with time alone. Some people, especially men with prostate problems, seem to think that urologists start to think about an operation right after they have set foot in the urologic office; this is not the case. Nowadays, fortunately, there are simple solutions or medicines to cure many urologic disorders. Unfortunately, there are still diseases that can only be cured using the surgeons, i.e. urologists, knife. Again fortunately, the knife isn't the same as it used to be twenty years ago, so that in a lot of cases only a relatively small operation is necessary.

  • Prevention. A malignant tumor (cancer) can often be cured if it is discovered in an early stage of the disease. This holds true for cancer of kidney, bladder, prostate, penis and testicle. With some types of cancer it makes sense to try to detect them in their early stages, i.e. screening. Although it is often impossible to prevent cancer, in some cases it might be possible to find it in an early stage, when it is still curable. In several parts of the world doctors are trying to find out if such a screening is a realistic possibility. Because of the huge amount of money screening takes, it must also be a financial reality.
    Screening can also be useful for non-malignant diseases. Elsewhere on the Urology Page men can 'screen themselves' for urinary voiding problems using a questionnaire. Some men seem to think that passing urine takes more time when you're older and only visit their doctor when they don't pass urine at all anymore and they've already damaged their bladder and kidney by waiting. Another advantage of a visit to the doctor is that your doctor can perform a rectal exam to find out if there is prostatic cancer.

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The small print of the Urology page

  • Why this Urology Page? In the brief period of existence of Internet, especially the World Wide Web, the number of medical oriented Websites and News groups have grown at an enormous pace. There seems to be a craving for medical information on several different subjects. A number of patient groups have formed newsgroups to discuss about sign, symptoms and possible cures of 'their' disease. Sometimes, an on-line diagnosis is made. For the doctor, paging through all this information, it is often astonishing to learn how little some patients know about the disease they are suffering from and how deep they are prepared to dig in the pile of information called Internet. Unfortunately, not everyone can discern between trustworthy medical information and the not-so-trustworthy kind. It seems quite probable that some companies are using the Internet to try to sell their products (which they don't seem to be able to sell the normal way).
    Some coaching seems therefore necessary, more so because for some laymen-specialists on the Internet the medical knowledge, especially on anatomy and function of several parts of the body, is still far from basic.

  • Who is editing the Urology Page? The information on this page is edited by Joop Noordzij, urologist and working in a group of urologists in Amsterdam, and Bram Zeijlemaker, urologist and working in Hilversum, both in the Netherlands.

  • The small print. The editors of the Urology Page are responsible for its contents. We try to be as clear and accurate as possible, while updating the information when required. But even Internet has its limits, while the allotted space on our server is not infinite; therefore, omissions or even plain mistakes can not always be avoided. Your doctor could then come to another diagnosis or advise another kind of treatment than you would expect on the basis of the information on the Urology Page. The information contained within the Urology Page is therefore not intended to replace your doctor; it can however serve as an addition. In all cases you are advised to consult a doctor if it was your original intention to do so. In short:
    The editors of the Urology Page do not accept any responsibility concerning the inaccuracy of information presented on this Page, nor do they accept responsibility concerning decisions made by the reader(s) of the Urology Page on the basis of this information, i.e. diseases, examinations, treatments, etcetera. They wish to point out that the reader should seek medical attention other than this Page if there is any reason to do so.



 
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Last update: 14 July 2010.