General Urology

What is General Urology?

General urology is a branch of medicine that deals with diagnosing and treating conditions and diseases affecting the urinary tract in men and women and the male reproductive system. 

This includes urinary incontinence, kidney stones, prostate problems, and urinary tract cancer. 

General urologists are trained to perform various diagnostic and therapeutic procedures, including surgery. Dr Wang treats a wide range of different general urological conditions and urination problems. These include

• Urinary Tract Infections,
• Hydrocele,
• Overactive Bladder,
• Nocturia, and
• Erectile dysfunction.

Urinary Tract Infections

What is a Urinary Tract Infection?

A urinary tract infection (UTI) is an infection that affects any part of the urinary tract, which includes the kidneys, bladder, ureters, and urethra.

UTIs are caused by bacteria that enter the urinary tract and multiply. The most common cause of UTIs is E. coli, a type of bacteria that lives in the intestine.

Types of Urinary Tract Infection

• Lower UTI (cystitis) - infection of the bladder
• Upper UTI (pyelonephritis) - infection of the kidneys.

Who Does UTI Affect?

Adult women are most commonly affected as their urethra is shorter than men's and opens nearer to the anus. This means it is easier for bacteria to enter the urinary system and cause an infection. 

About 40% of women get at least one attack of cystitis in their lifetime. It is more common in sexually active women, during pregnancy, after surgery and after menopause.

Recurring Infections in Women

Your body's ability to resist bacteria getting into the bladder and causing the infection may increase the susceptibility to infections. Having sex increases the chance of cystitis in some women.

The hormone oestrogen can influence your vagina, bladder and urethra. After menopause, the levels of oestrogen in the body reduce, and the tissues become thinner, weaker, and dryer, increasing the risk of recurrent cystitis. 

Infections are also more common during pregnancy because of changes in the urinary tract. In many cases, there is no apparent cause.

Higher Risk Patients

Old age, being female and post some surgical procedures can increase the chances of infection. Diabetes increases the risk, as do surgeries on or near part of the urinary tract. Immobilisation after surgery will also increase the risk.

Urinary Tract Infection Symptoms

Symptoms of UTI include:

• Pain or burning during urination
• A frequent urge to urinate
• Passing regular, small amounts of urine
• Cloudy, dark, bloody, or strange-smelling urine
• Pain or pressure in the lower abdomen or back
• Feeling tired or shaky
• Fever or chills (a sign the infection may have reached the kidneys)

Urinary Tract Infection Diagnosis

Testing of the urine may reveal pus or red blood cells. 

• A urine specimen is required to determine the type of bacteria in the urine and the appropriate antibiotic for treatment. 
• Cystoscopy may be required if you suffer from a recurrent urinary infection; you may be advised to have a cystoscopy in which the inside of your bladder is examined using a camera. Dr Wang provides outpatient cystoscopy procedures.

You may need an ultrasound scan to check your kidneys, ureters and bladder.

Urinary Tract Infection Prevention

How can I help reduce my risk of acquiring a urinary tract infection?

• Drink about eight glasses of water daily
• Do not let the bladder get too full. Pass urine regularly when you feel the need 
• After using the toilet, always wipe from front to back.
• Cleanse your genital area daily but not too frequently or vigorously. 
• Avoid irritants such as perfumed bath oils and vaginal deodorants.
• Lubricate adequately during sexual intercourse
• Go to the bathroom before and as soon as possible after having sex.
• Wear cotton underwear and loose-fitting clothes so the air can keep the area dry.
• If you have diabetes, keep your blood sugar under control.

Urinary Tract Infection Treatments

UTI treatments can include:

• Antibiotics to kill the bacteria causing the infection
• Drinking plenty of water to help flush out the bacteria
• Taking over-the-counter pain relievers, such as paracetamol or ibuprofen, to relieve discomfort
• Avoiding any irritants to the urinary tract, such as bubble baths or harsh soaps

It's essential to seek medical attention if you suspect you have a UTI, as if left untreated, a UTI can lead to severe complications such as kidney damage. Dr Wang can determine the best course of treatment for your specific situation.

Overactive Bladder

What is an Overactive Bladder?

An overactive bladder (OAB) is characterised by a sudden, strong urge to urinate, accompanied by frequency and urgency. It can be a chronic condition that affects a person's quality of life.

Who Does OAB Affect?

The risk factors for AOB include

• Age: OAB is more common in older adults.
• Gender: OAB is more common in women than men.
• Neurological conditions: such as stroke, Parkinson's disease, multiple sclerosis, or spinal cord injury.
• Bladder or prostate surgery.
• Bladder or pelvic tumours.
• Constipation.
• Certain medications: such as diuretics, antidepressants, and sedatives.

Types of Overactive Bladder

Overactive bladder can cause urinary incontinence. Urge urinary incontinence (UUI) is when a person loses urine due to a sudden, intense urge to urinate. Mixed urinary incontinence is when a person has symptoms of both stress urinary incontinence (SUI) and urge urinary incontinence.

Overactive Bladder Causes

OAB can be caused by:

• Nervous system disorders: such as Parkinson's disease or multiple sclerosis, can affect the nerves that control the bladder.
• Bladder or prostate surgery.
• Bladder or pelvic tumours.
• Certain medications: such as diuretics, antidepressants, and sedatives.

Overactive Bladder Symptoms

The symptoms of OAB include:

• Sudden, strong urge to urinate
• Frequent urination (eight or more times a day)
• Urgency (a strong need to urinate right away)
• Getting up frequently during the night to urinate
• Leakage of urine (urinary incontinence)

Overactive Bladder Diagnosis

• Urine test - to check for any signs of infection or blood in the urine
• Bladder diary - to track your symptoms and urination patterns
• Urodynamic testing - to measure the pressure inside your bladder and urethra

Overactive Bladder Treatments

• Medications: such as antimuscarinics, beta-3 agonists 
• Physical therapy: such as pelvic floor muscle exercises
• Bladder retraining: a technique that involves gradually increasing the time between trips to the bathroom
• Surgery: such as nerve stimulation or Botox injections

If left untreated, OAB can lead to complications such as urinary tract infections, bladder stones, and damage to the bladder and kidneys. It can also negatively impact a person's quality of life, causing emotional distress and limiting daily activities and social interactions. It's essential to seek medical attention if you have symptoms of OAB to determine the most appropriate treatment plan.

Nocturia

What is Nocturia?

Nocturia is a condition characterised by the need to wake up frequently during the night to urinate. It is a common condition that affects people of all ages.

Who Suffers from Nocturia?

Women generally experience nocturia after childbirth, menopause, or pelvic organ prolapse; in men, it can be directly attributed to an enlarged prostate.

Types of Nocturia

• Nocturnal Polyuria - This occurs when there is an overproduction of urine at night. According to the International Continence Society, this type of nocturia is defined by a nighttime urine volume greater than 20-30% of the total 24-hour urine volume.
• Global Polyuria - is a form of nocturia defined by both day and nighttime urine overproduction.

Causes of Nocturia

Nocturia can be caused by:

• Increased urine production at night
• Reduced ability to hold urine at night
• Obstruction of the urinary tract
• Neurological conditions: such as Parkinson's disease or multiple sclerosis, can affect the nerves that control the bladder.

Nocturia Symptoms

Symptoms of nocturia include:

• Waking up frequently during the night to urinate
• Difficulty sleeping due to the need to urinate
• Feeling excessively tired during the day.

Nocturia Diagnosis

Nocturia can be diagnosed by:

• Urine test - to check for any signs of infection or blood in the urine
• Bladder diary - to track your symptoms and urination patterns
• Nocturnal polysomnography - a sleep study that can help determine if nocturia is related to a sleep disorder
• Urodynamic testing - to measure the pressure inside your bladder and urethra

Treatments for Nocturia

Nocturia has only been recently researched in more depth, which means treatment options are currently limited. They will also depend on the diagnosis and any underlying causes. Treatments may include:

• Medications: such as antimuscarinics and beta-3 agonists
• Lifestyle changes: such as limiting fluid intake before bedtime, avoiding caffeine and alcohol, and avoiding smoking
• Bladder retraining: a technique that involves gradually increasing the time between trips to the bathroom
• Surgery: such as nerve stimulation or Botox injections

Nocturia can lead to chronic fatigue, sleep disorders, and reduced quality of life if left untreated. It can also lead to an increased risk of falls and accidents in older adults. It is essential to seek medical attention if you have symptoms of nocturia to determine the underlying cause and the most appropriate treatment plan.

Hydrocele

What is a Hydrocele?

A hydrocele is a condition in which fluid builds up around the testicle, causing it to swell. Hydroceles are most commonly found in newborns and older men.

Who is Affected by Hydrocele?

Hydrocele is common in newborns and usually disappears without treatment by age 1. 

Older boys and adult men can develop a hydrocele due to inflammation or injury within the scrotum.

Adult men can experience discomfort that can increase with the size of the inflammation. Sometimes, the swollen area might be smaller in the morning and larger later in the day.

Types of Hydrocele

• Congenital Hydrocele: present at birth and caused by a failure of the processus vaginalis, a sac in the abdomen that surrounds the testicles, to close properly before birth.
• Acquired Hydrocele: develops later in life and can have various causes, such as infection, injury, or inflammation in the area.

Hydrocele Causes

A hydrocele can form due to an injury or inflammation in the scrotum. An infection might cause inflammation in the testicle or the small, coiled tube at the back of each testicle.

A hydrocele typically isn't dangerous and usually doesn't affect fertility. But a hydrocele might be associated with an underlying testicular condition that can cause serious complications, including

• Infection or Tumour. Either might reduce sperm production or function.
• Inguinal Hernia. The loop of the intestine trapped in the abdominal wall can lead to life-threatening complications.

Hydrocele Symptoms

• Swelling of one or both testicles
• A feeling of heaviness in the scrotum
• Pain or discomfort in the scrotum
• A dull ache in the lower abdomen

Hydrocele Diagnosis

Diagnosis can include:

• Physical Examination - checking for pain in an enlarged scrotum, pressing on the stomach area and scrotum to check for inguinal hernia, 
• Blood and urine tests - to help find out if you or your child has an infection, and 
• Imaging test  - called ultrasound to check for a hernia, a tumour or other causes of swelling in the scrotum.

Hydrocele Treatment

A hydrocele might not need any treatment, but if the hydrocele does not resolve over time may need to be removed with surgery. 

A procedure may be required if the cause of the swelling is

• Varicocele,
• Hernia, or
• Hydrocoele or epididymal cyst resulting in discomfort.

In the case of Testicular Cancer, it requires an urgent urologist review. It has several treatment options, depending on the cancer's severity. Whether cancer has spread and how long it went undetected will determine your treatment.

Hydrocelectomy (Hydrocoele repair)

The removal of a hydrocoele may be required for a hydrocele that doesn't disappear on its own and results in discomfort.

An incision is made in the scrotum to remove the hydrocele. If a hydrocele is found during surgery to repair an inguinal hernia, the surgeon might remove the hydrocele even if it's causing no discomfort.

It is typically a day-case outpatient procedure and can be performed under general or regional anaesthesia.

You might need a tube to drain fluid, a bulky bandage for a few days, and a follow-up exam.



Erectile Dysfunction

What is Erectile Dysfunction?

Erectile dysfunction (ED) is an inability to achieve or maintain an erection sufficient for sexual activity. It is a common condition that affects men of all ages.

Erectile dysfunction is also called or referred to as impotence.

Who Does Erectile Dysfunction Affect?

Erectile dysfunction affects men typically with pre-existing medical conditions; these are noted below.

The largest group affected by erectile dysfunction are patients suffering from diabetes and obesity-related disorders.

Types of Erectile Dysfunction

• Primary ED: when a man has never been able to achieve an erection.
• Secondary ED: when a man has previously been able to achieve an erection but is now unable to.

Causes of Erectile Dysfunction

As men age, many contributing health conditions may lead to reduced erectile function. 

Lifestyle choices that contribute to heart disease and vascular problems also increase the risk of erectile dysfunction.

Common causes of erectile dysfunction include

• Reduced blood flow to the penis
• Damage to the nerves that control erections
• Low levels of testosterone,
• Psychological factors such as stress, anxiety, or depression.

How Does Erectile Dysfunction Occur?

An erection requires a precise sequence of events. Erectile dysfunction cannot occur when any of the events is disrupted. The sequenced events involve 

• Generation of nerve impulses in the brain, 
• Messages being sent down the spinal column to the area around the penis, 
• Muscle and fibrous tissue response, and
• Blood flows to the vasculature in and around the corpora cavernosa. 

Symptoms of Erectile Dysfunction

Erectile dysfunction might include recurring problems associated with

• Inability or difficulty gaining an erection.
• Trouble maintaining a firm erection sufficient for intercourse,
• Problems with premature ejaculation, and
• A sense of reduced sexual desire.

Diagnosis of Erectile Dysfunction

The diagnosis of erectile dysfunction typically involves a combination of physical examination, blood tests, and psychological evaluation.

• Physical examination: The doctor will perform a physical exam to check for any signs of medical conditions contributing to ED, such as diabetes, heart disease, high blood pressure, and high cholesterol. The doctor may also check the blood flow to the penis, the size and shape of the prostate, and the testicles for any abnormalities.
• Blood tests: Blood tests can be used to check for low testosterone levels or other hormones contributing to ED.
• Psychological evaluation: The doctor may also assess the role of psychological factors, such as stress, anxiety, or depression, in developing ED. This may involve a review of the patient's medical history and a psychological assessment.
• Nocturnal Penile Tumescence and Rigidity (NPT) test measures erectile function at night.
• Penile Doppler Ultrasound: This test is used to evaluate the blood flow in the penis. It's helpful to differentiate between venous leak and arteriogenic ED.
• Duplex Ultrasound: This test is used to evaluate the blood flow in the penis and to look for anatomic abnormalities in the blood vessels.
• Penile Angiography: This test is used to evaluate the blood flow in the penis. It's an invasive method and is used in specific cases.

Non-Surgical Treatment for Erectile Dysfunction

Conservative treatment measures to treat erectile dysfunction are always considered before invasive measures such as surgery.

Common, less invasive non-surgical treatments can include:

• Medications such as phosphodiesterase type 5 inhibitors (PDE5 inhibitors)
• Hormone replacement therapy
• Vacuum erection devices
• Penile implants
• Psychotherapy
• Lifestyle changes such as quitting smoking, drinking less alcohol, and exercising more

Surgical Treatment for Erectile Dysfunction

Surgery may be considered when conservative treatment measures are unsuccessful. The most common surgery performed for erectile dysfunction is Penile Implant surgery. 

Implanted devices, known as prostheses, can restore erections in many men with severe ED. For more information about surgical therapy, please book an appointment.

Consequences of Not Treating Erectile Dysfunction

If left untreated, ED can lead to low self-esteem and self-confidence and negatively impact sexual relationships and overall quality of life. It's essential to seek medical attention if you have symptoms of ED, as many effective treatments are available. Dr Wang can determine the most appropriate treatment plan for your specific situation.