Urological diseases

Benign Prostate Enlargement

Benign enlargement of the prostate, also known as BPH (benign prostatic hyperplasia) is a widespread disease that commonly occurs in older men. More than half of all men over 60 are affected by these changes. The problems they present can differ greatly. In addition to a decrease in urinary flow with increased duration of urination, common complaints include increased urination urge and frequent nocturnal urination.

The treatment requirements depend on the severity of the disease and, among other factors, the psychological strain on the individual.

1,900 patients underwent surgery for this disease at the HELIOS hospitals last year. Many other patients are treated with drugs. Before the treatment starts, a urologist should be consulted as to ruled out a malignant tumor (through determination of the PSA level).

Urological Tumors
Prostate Cancer (Prostate Carcinoma)

Prostate cancer is one of the most common tumor diseases in men. Early detection and therapy applied at the right time are therefore particularly important to the survival rate in the event of tumors on the prostate gland. In terms of therapy, there are several options that are geared towards the individual needs of the patient according to the type and stage of the tumor. In the early stage of the disease, recovery is possible through the operative removal of the prostate or different types of radiation treatment (percutaneous, seeds, afterloading).

If the tumor has already metastasized to other organs, long-term hormone therapy and chemotherapy can delay further growth.

Renal Tumors

The most common malignant tumor of the kidneys in adulthood is renal cell carcinoma. Today, this is increasingly detected and treated in the early stage in the context of a routine examination. The main priority in treatment is the operative removal of the tumor. In this case, the kidney can often be retained.

Testicular Tumors

Malignant neoformations on the testicle most frequently occur between 18 and 40 years of age. Due to the major advances in operative therapy and chemotherapy, this disease is curable in the early stages in over 80% of cases. Early symptoms are painless or painful testicular swellings, pulling or a feeling of heaviness in a testicle. If such symptoms are noticeable, a urologist should be consulted immediately.

Bladder Tumors

Blood in the urine might be symptom of a bladder tumor. Immediate clarification is therefore advised. Other symptoms, albeit ones that also occur with other diseases (bladder infections), can be strong urination urge, a burning sensation during urination and pain in the flank area. The diagnosis is generally made through a bladder examination (cystoscopy), an examination of the cells in the washings in the urinary bladder (cytology), as well as a contrast agent x-ray of the lower urinary tract (excretory urography). If a bladder tumor is diagnostically identified, it is generally removed through the urethra with a small electric loop (transurethral bladder tumor resection). As bladder tumors frequently tend to reappear elsewhere, regular checks by a urologist are advised. In severe cases, complete removal of the urinary bladder can also be necessary.

Other Urinary Bladder Diseases and Lower Urinary Tract Diseases

Common, non-malignant diseases in the urinary tract area are cystitis, known as irritable bladder, and involuntary urine loss (incontinence).

Urethral stenosis and constrictions in the ureter area are lower urinary tract diseases that can be successfully overcome with modern therapeutic techniques before secondary diseases (nephritis, kidney stones) occur.

Renal Diseases (Kidney Stones, Nephritis) 

The most common renal diseases include kidney stones (nephrolithiasis) as well as nephritis. The various types of chronic renal insufficiency, which can also be treated by internists, are not described here.

Kidney stones are deposits which result from the crystallization of substances that are normally dissolved in urine. Diet, amount of fluid intake, frequency of urinary tract infections and various metabolic diseases can be factors that influence the formation of stones.

Kidney stones are only painful if they enter the ureter and migrate slowly there. Often, the stones go unnoticed or are detected during a routine examination. However, kidney stones can also lead to the onset of renal colic, which is characterized by severe pain in the back, flank or hypogastrium area. In most cases, a kidney stone leaves the body naturally via excretion with the urine. If this spontaneous departure does not occur, the stones can be removed through fragmentation from outside or endoscopically through the entire urinary tract. In all cases, the cause that led to formation of the kidney stone must be treated. The most important measure for general prevention of kidney stone trouble is to drink enough (at least 2 liters per day).

Acute nephritis has symptoms including local pain, fever and shivering. It is triggered by specific bacteria (e.g. Escherichia coli).

Nephritis is usually cured with no further consequences if treated properly. In the event of inadequate therapy, renal insufficiency can develop from chronic progressions. Therapy mainly centers on targeted antibiotic therapy. Again, the possible cause of the inflammation (e.g. constrictions of the lower urinary tract) should be clarified and treated if applicable, and the drinking volume (at least 2 liters per day) should be increased.

Andrological Diseases

Andrology (men's health) mainly deals with hormonal and erectile disorders, impotence and malformations of the male genitalia.

Pediatric Urology

Pediatric urology centers on the treatment of urological diseases that occur in children from birth to the onset of adulthood. These are primarily urinary incontinence and dispositional malformations of the upper and lower urinary tract as well as the external sexual organs.

With many of these procedures, it is important to treat the condition before it causes any psychological harm to the child. Determination of the most beneficial time for treatment can be reached through consultation with HELIOS specialists.

Diagnosis and Therapy
Diagnosis

Physical examination and investigation of medical history (anamnesis)

• Laboratory examinations (urine test, blood test, PSA)
• Ultrasound examination (sonography)
• X-ray with contrast agent imaging of the kidney, excretory urography
• Computer tomography
• Magnetic resonance tomography
• Vascular imaging with contrast agents (angiography)
• Nuclear medicine techniques (renal scintigraphy)
• Bladder examination (rigid and flexible endoscopy), examination of the lower urinary tract, renal examination
• Uroflowmetry (urinal flow measurements)
• Extraction of tissue samples (biopsies)
• Neuro-urological bladder pressure measurements

Therapy  

• Drug therapy: including antibiotic therapy, chemotherapy, hormone therapy, litholysis (drug-based break-up of specific kidney stones)
• Operations: open, laparoscopic, endourological
• Laser therapy (green light laser)
• Dialysis
• Radiotherapy
• Brachytherapy
• Stone therapy using ESWL or frequency-doubled laser