Urologic Conditions/Diseases

A

  • Adrenal Cancer: Adrenal cancer is a rare cancer that develops in the small glands located on top of your kidneys (adrenal glands).  Adrenal glands produce hormones that give instructions to the many organs and tissues in your body. The two adrenal glands are responsible for making hormones that enable the body respond to stress (aldosterone, cortisol and adrenaline). They also make a small amount of sex hormones (testosterone and estrogen).  Adrenal cancer can be quite aggressive.  If detected early, adrenal cancer can be cured.  However, if the cancer has spread to areas beyond the adrenal gland, the odds for a cure become less likely. Treatments can be used to delay progression or recurrence. Noncancerous (benign) adrenal tumors can also develop in the adrenal glands. These tumors can at times secrete hormones and require removal or medications.

B

  • Benign Prostatic Hyperplasia (BPH) – Enlarged Prostate: The prostate is normally a walnut sized organ that sites below the male bladder. The urethra (urinary tube) travels through the prostate before entering the penis. When the central part of the prostate is enlarged it can impinge on the urethra. As a result, the urinary stream can become slower, it can become more difficult to empty the bladder, and urination urge can become more frequent.  Progressive BPH can lead to bladder and kidney damage, urine infection and bladder stones.
  • Bladder: Bladder function is affected by the functioning of the urinary tract.  Your urinary tract is made up of two kidneys, two tubes called ureters, the bladder and the urethra.  The kidneys filter unnecessary substances and extra water from your blood, creating urine (liquid waste). This urine travels from the kidneys through the ureters leading to the bladder which holds the urine before it is released through the urethra.  Following are some disorders/diseases related to the bladder:
    • Bladder Cancer: Most of the urinary tract is lined with a layer of cells called transitional cells.  Cancer can form in these cells, frequently in the bladder.  Cancer is a disease where cells begin multiplying rapidly and may form a tumor or lump of cancerous tissue.  Over time, these cancer cells destroy healthy tissue.  Cancer can spread to other parts of the body if not detected and treated timely.  There are 3 main types of bladder cancer:  Papillary tumors, Sessile tumors, and Carcinoma in situ (CIS). Bladder cancer is also linked strongly to cigarette smoking.
    • Bladder Stones: Bladder stones can develop from chronic obstruction from the bladder neck due to a large prostate or bladder neck scar. Bladder stones can also develop and grow when a kidney stone falls into the bladder but does not pass out through the urethra. Bladder stones are associated with urinary infections, bleeding from the bladder, and if left untreated can risk development of rare bladder cancers.
    • Neurogenic Bladder: When the bladder does not have adequate neural and or muscular function it is at times called “neurogenic.” Neurogenic bladder most typically refers to a bladder that cannot generate enough pressure to empty itself. Neurogenic bladders often require treatment, at least temporarily, with catheters.
    • Overactive Bladder: Bladders that are associated with strong urges to go to the bathroom with frequency and/ or leakage of urine are at times “overactive.” Overactive bladders are distinct from bladders with urge symptoms due to a cause such as infection or cancer. Overactive bladders represent a neuro-muscular imbalance and can often respond to medications, behavior changes, diet changes and nerve stimulations and surgery.
    • Urinary Incontinence: Involuntary leakage of urine in called urinary incontinence. A key distinction in the types of incontinence involves whether the leakage is day and/or night, Incontinence can be related to “stress” such as activity coughing and sneezing or “urge” leakage due to involuntary contracture of the bladder muscle. The latter leakage is often marked by a strong desire to go to the bladder but not being able to make it on time.

E

  • Erectile Dysfunction (ED): The inability to get or maintain an adequate erection is called erectile dysfunction. Erectile dysfunction can result from numerous causes including blood vessel damage, nerve damage, reduced levels of sex hormones, medications, depression or a combination of various issues. Erectile dysfunction can be treated by a variety of approaches including oral medication, medications placed in the penis, devices used to pull more blood into the penis or implants such as a penile prosthesis.

F

  • Female Pelvic Floor Disorders: At the vaginal opening, there are a group of muscles & ligaments that form a support structure which keep the pelvic organs in place and help them function correctly.  Disorders in the pelvic floor can affect the pelvic floor support structures and/or pelvic floor organs.  Some female pelvic floor disorders include:
    • Urinary Incontinence (Stress urinary incontinence, Urgency incontinence and Overactive bladder): This is a loss of bladder control leading to urinary accidents. Urinary incontinence affects one in three women. Two common types of urinary incontinence are urge incontinence (urinary leakage with the sudden need to urinate) and stress incontinence (urinary leakage that occurs with physical effort, such as coughing, sneezing or exercising).
    • Pelvic Prolapse: A loss of support structures around the vagina resulting in abnormal descent of surrounding organs into the vagina.
    • Cystocele: A cystocele occurs when the wall between a woman’s bladder and her vagina weakens and allows the bladder to droop into the vagina. This condition may cause discomfort and problems with emptying the bladder.
    • Enterocele: This is when the small intestine (small bowel) descends into the lower pelvic cavity and pushes at the top part of the vagina, creating a bulge.
    • Rectocele: This is a bulging of the front wall of the rectum into the back wall of the vagina.  This condition can result in discomfort and difficulty in having bowel movements.

H

  • Hematuria: Hematuria is blood in the urine. It can be either “gross” which means visible to the naked eye or “microscopic” seen only with magnification.  Blood in the urine can be the first and only sign or symptom of numerous medical problems such as infection, stones and cancer. Hematuria warrants investigation for a cause.
  • Hydronephrosis: Swelling of urine within the kidney is called hydronephrosis. Hydronephrosis can result from obstruction of the kidney by stone, infection, scar, cancer or other condition compressing the ureter (urinary tube between the kidney and bladder). Hydronephrosis can also result from reflux of urine from the bladder. If hydronephrosis is progressive it can result in kidney damage, infections, kidney stones, or kidney loss.
  • Hypospadias: The urethra (urinary tube in the penis) typically exits the tip of the penis. When the urethra exits the penis on the underside of the penis this is called hypospadius. Hypospadius can be associated with narrowing of the meatus (opening of the urethra) and difficulty emptying the bladder. Hypospadius can be associated with failure to conceive when ejaculate cannot be delivered in the vagina adequately.

I

  • Interstitial Cystitis/Painful Bladder Syndrome: IC is a complex condition that is associated with recurrent pain in the regions of the bladder with possible urinary urgency, frequency. It is important to distinguish IC from other conditions such as urinary infections and cancer.

K

  • Kidneys:  Two bean-shaped organs located near the middle of your back below the rib cage. Each kidney has about a million tiny structures called nephrons responsible for filtering the blood.  They remove waste products and extra water, which become urine.  Some kidney conditions include:
    • Kidney cancer: This is a malignant growth in the kidney. There are two main classes of kidney cancer: those involving the parenchyma or solid tissue of the kidney (generally renal cell carcinoma) and those involving the tissue that lines the inside of the kidney (urothelial carcinoma). Kidney cancers if left untreated can grow and progress leading to invasion into surrounding organs and/or spread to other parts of the body such as bone, lymph nodes, liver, lungs and brain.
    • Kidney Stones: These are hard rock like objects that develop in the kidney and can lead to obstruction or damage of the kidney. Kidney stones often develop as a result of dehydration. Other conditions such as high sodium or calcium intake can sometimes lead to kidney stones.  Additionally inherent metabolic abnormalities can lead to recurrent stone formation, typically in younger individuals.  Kidney stones can be at times followed, treated with medications, surgery, or shockwaves.

M

  • Male Infertility: Infertility is the inability to conceive a child through normal vaginal intercourse. Male infertility can result from abnormalities in the content of ejaculation or delivery of ejaculation. A male infertility evaluation typically involves assessment of a semen sample. 
  • Male Incontinence (Stress incontinence, Urgency Incontinence): This urinary issue can result from prostatic problems, injury, a side effect to surgery or other treatment on the pelvis. Urge incontinence refers to leakage due to involuntary contraction of the bladder muscle. Stress incontinence develops when the muscles of the sphincter (which close the urethra and bladder neck) cannot adequately maintain pressure in response to pressures in the bladder. These conditions can be treated with behavioral modifications, exercises, medications and surgeries.

N

  • Neurogenic Bladder: When the bladder does not have adequate neural and or muscular function it is at times called “neurogenic.” Neurogenic bladder most typically refers to a bladder that cannot generate enough pressure to empty it self. Neurogenic bladders often require treatment, at least temporarily, with catheters.

O

  • Overactive Bladder: Bladders that are associated with strong urges to go to the bathroom with frequency and/ or leakage of urine are at times “overactive.” Overactive bladders are distinct from bladders with urge symptoms due to a cause such as infection or cancer. Overactive bladders represent a neuro-muscular imbalance and can often respond to medications, behavior changes, diet changes and nerve stimulations and surgery.

P

  • Pediatric Urology Conditions:  Following are a quick list and description of urology conditions that could happen to children:
    • Urinary Tract Infection (UTI) – Characterized by blood in the urine, an unusual odor to the urine, or a change in urinary patterns.
    • Antenatal Hydronephrosis – Usually diagnosed with prenatal ultrasound, this condition is marked by collection of excessive urine in the kidney.
    • Hernia – Results when tissue protrudes through weakened areas.
    • Hydrocele – A fluid sac that develops around the testicle.
    • Hydronephrosis – Swelling of the kidneys with urine due to obstruction or back pressure of urine.
    • Hypospadias – A condition in which the urethra (the tube that carries urine from the body) opens on the bottom side of the penis instead of the tip.
    • Neurogenic Bladder – A complex condition in which normal nerve pathways to the bladder are damaged or are ineffective. 
    • Nocturnal Enuresis – This condition is when a child suffers from bedwetting.  This condition can signal delay in the bladders normal development and children often outgrow the condition.  
    • Spina Bifida – A condition in which the spinal column +/- cord fails to fully develop.  
    • Undescended Testes – When testicles are not in the scrotum.
    • Ureteropelvic Junction Obstruction (UPJ) – Obstruction of urine between ureter/kidney point where it may lead to pain and infection.
    • Vesicoureteral Reflux (VUR) – When urine from the bladder backs up to the ureter.  It can resolve with time, but if left untreated it can result in recurrent kidney infection and damage. 
  • Pelvic Prolapse: In females, a loss of support structures around the vagina resulting in abnormal descent of surrounding organs into the vagina.  See:  Female Pelvic Floor Disorders.
  • Penis:  Male organ located above the scrotum used primarily for urination and sexual intercourse.  There are several disorders that could occur affecting the penis:
    • Circumcision:  Male circumcision is a surgery to remove the foreskin, a fold of skin that covers and protects the tip of the penis. The foreskin provides sensation and lubrication for the penis.  Sometimes a circumcision is medically necessary, but in most cases it is elective and not medically needed.  Usually a circumcision is done soon after birth. The American Academy of Pediatrics (AAP) does not recommend circumcision as a routine procedure for newborn males. 
    • Erectile Dysfunction (ED): The inability to get or maintain an adequate erection is called erectile dysfunction. Erectile dysfunction can result from numerous causes including blood vessel damage, nerve damage, reduced levels of sex hormones, medications, depression or a combination of various issues. Erectile dysfunction can be treated by a variety of approaches including oral medication, medications placed in the penis, devices used to pull more blood into the penis or implants such as a penile prosthesis.
    • Penile Cancer:  This is a rare type of cancer that occurs when abnormal cells in the penis divide and grow uncontrolled.
    • Phimosis:  Narrowing of the end of the foreskin of the penis resulting in the inability to retract the foreskin.
    • Peyronie’s Disease: An abnormal bending of the penis due to a fibrous plaque of the penile tunica (or sheath around the erectile tissue).  With Peyronie’s disease, there could be issues in getting or maintaining erections, painful erections or difficulty with penetration. Peyronie’s disease can be aggressive and cause significant penile deformity. Peyronie’s disease can be treated with oral and injectable medications, therapies and surgery.
    • Testicular Issues:  See Testes.
  • Prostate:  The prostate is a gland which contributes fluid to semen. The prostate surrounds the tube that carries urine from the bladder and out of the penis (urethra).  A normal prostate is typically about the size of a walnut.  Prostate Issues can include Prostate Cancer, BPH and Prostatitis:
    • Prostate Cancer:  In American men, prostate cancer is the 2nd leading cause of cancer death of men.  Prostate Cancer is an uncontrolled growth of cells in the prostate which can spread to other parts of the body.  Prostate cancer becomes more likely to occur as a man gets older and may co-exist with BPH.  A full range of treatments is offered at Napa Valley Urology Associates.  If Prostate Cancer is detected early, before it has spread, there is a better chance of successful treatment.
    • Benign Prostatic Hyperplasia (BPH) – Enlarged Prostate: BPH develops when changing hormone levels cause the prostate to grow larger.  This can often happen if you are age 50+.  Excess tissue, blocking the urethra can make it hard for urine to pass. The enlarged prostate can press on the bladder making overactive bladder more common. Other symptoms include straining, slow urine stream, and a feeling that the bladder is not emptying completely.  It is important to note that BPH is not cancer and does not lead to cancer.
    • Prostatitis: The prostate becomes painful and swollen caused by an infection or inflammation.  This narrows the urethra and can block the bladder neck.  This can cause a burning feeling during urination.  Other symptoms of prostatitis include pressure or pain in the genital area, fevers and chills. It is most common in younger men.

T

  • Testes or Gonads:  The testes located in a man’s scrotum are 2 egg-shaped reproductive organs producing sperm and testosterone.  There are several disorders related to the testes:
    • Epididymitis: Epididymitis is infection or less frequently, inflammation of the epididymis (the coiled tube on the back of the testicle).  A common cause can be bacterial infection.  Epididymitis occurs more frequently between ages of 20 to 39. 
    • Hydrocele:  an accumulation of fluid that can occur in the scrotal sac.  Hydroceles can develop spontaneously, after trauma or infection, or in conjunction with cancer.  Symptomatic hydroceles are typically treated surgically.
    • Orchitis:  This is an inflammation of the testicle most commonly due to bacterial infection.  It is almost always comes on suddenly and generally subsides with treatment.
    • Orchalgia:  Pain in the testicles which is usually described as a deep aching, or sometimes burning pain.  Orchalgia can develop after trauma, infection or spontaneously.  
    • Spermatocele:  This is a cyst-like mass that forms within the epididymis.  It is usually filled with fluid and dead sperm cells.  Spermatoceles can, at times, be painful or uncomfortable.
    • Testicular Cancer:  This is abnormal growth of tumor tissue in the testicle. Testicle cancer most commonly affects young men aged 15-35 and men in their 60’s. Testicle cancer is rarely associated with pain or infection, most early testicle cancers are detected as a hard lump in the testicle.  If treated early, cure rates from testicle cancer are high.
    • Testosterone Deficiency (Low T):  Low levels of testosterone in the blood stream, also called hypogonadism can affect men due to normal aging, sleep apnea, genetic abnormalities, following injury or infection of the testicles, or due to failure of the pituitary gland. Low testosterone levels are detected through routine blood tests. Oftentimes low testosterone levels will be associated with decreased libido and sexual function, weight gain, fatigue, sleep abnormalities and loss of muscle mass. Testosterone deficiencies can at times be treated with replacement via creams, implants and injections.
    • Undescended Testicles:  The testicles normally should reside in the scrotum. If the testicles are not in the scrotum this is called undescended. Undescended testes should be brought down into the scrotum after the first year of life for ideal growth and development of the testicles, for the ability to self examine the testes for cancer and for optimal sperm production.
    • Varicocele:  Abnormally dilated of veins around the testicle that can be painful and/or associated with male infertility.  Varicoceles can be treated via surgery or interventional radiology procedures.

U

  • Undescended Testes: When testicles are not in the scrotum.  See: Testes- Undescended Testicles.
  • Ureteral Tumors: The ureter is a tube that connects the kidney to the bladder. A tumor of the ureter can result in bleeding, infection, kidney blockage and pain. Cancerous tumors of the ureter can spread to other parts of the body. Typically tumors of the ureter are treated with surgery, radiation and chemotherapy can be used for these tumors in certain circumstances.
  • Ureteral Reflux:  When urine flows back towards the kidney from the bladder this is called reflux. Vesico-ureteral reflux can result in recurrent urine infections, kidney damage or loss, and kidney infections. Reflux usually afflicts children but can be detected at later years. Children sometimes outgrow reflux; minimally invasive and open surgeries can be used for recurrent or severe reflux with excellent results.
  • Ureteral Stones: Kidney stones that begin the process of passage can get lodged in the ureter and become “ureteral stones.”  Ureteral stone can oftentimes be symptomatic and result in severe pain, bleeding and or infection. Ureteral stones can be managed with medications to ease their associated pain and assist in passage, temporary tubes (stents) can be passed up the ureter to facilitate urine passage with ureteral stones, minimally invasive surgeries urine lasers and shockwaves can also be used in the treatment of ureteral stones.
  • Ureteropelvic Junction Obstruction:  Obstruction between the kidney and ureter can result in swelling of the kidney, pain and infection. If left untreated, ureteropelvic junction obstruction can lead to kidney damage or failure. UPJ obstruction is found both in children and adults. Treatment for this condition can be surgical via a minimally invasive or open surgical approach.
  • Urethral Cancer:  Cancers of the urinary tube that empties the bladder can result in bleeding, pain and blockage of urine. Urethral cancer is not common but can be seen in in conjunction with more advanced cancers of the bladder lining.
  • Urethral Stricture: Disease Scar in the urinary tube that empties the bladder is often called a stricture. These strictures can develop after urethral trauma, infection, but also without a direct identifiable cause. Urethral strictures can be treated with dilation (or stretching) procedures, internal incisions through minimally invasive techniques and via formal open surgery to remove the scar.
  • Urinary Incontinence: Involuntary leakage of urine in called urinary incontinence. A key distinction in the types of incontinence involves whether the leakage is day and/or night, Incontinence can be related to “stress” such as activity coughing and sneezing or “urge” leakage due to involuntary contracture of the bladder muscle. The latter leakage is often marked by a strong desire to go to the bladder but not being able to make it on time.
  • Urinary Tract Infection (UTI): Infections of the urine are called UTI. UTI can involve the bladder, prostate and/or kidneys.  UTI can result in bladder pain, urgency to attend the bathroom, frequency, blood in the urine.  UTI are evaluated with urine tests and typically treated with antibiotics.
  • Urodynamic Studies: These tests involve filling and emptying evaluations of the bladder using pressure studies. Urodynamics testing is valuable in assessing bladder function, incontinence as well as neuromuscular behavior of the pelvic floor.

V

  • Varicocele: Abnormally dilated of veins around the testicle that can be painful and/or associated with male infertility. Varicoceles can be treated via surgery or interventional radiology procedures.
  • Vasectomy or Elective Male Sterilization: In this procedure a small segment of a man’s vas deferens is removed and the remaining ends of the tube are “ligated” or tied off.  This procedure produces permanent male infertility.
  • Vasovasostomy or Vasectomy Reversal:  This procedure reconnects a man’s tubes, or vas deferens that were removed during the original vasectomy.  A Vasovasostomy is an outpatient procedure and local, spinal or general anesthesia is usually administered.
  • Vesicoureteral Reflux: Reflex of urine from the bladder to the ureter tubes is called Vesicoureteral reflux. This condition is more commonly diagnosed in children and can result in urinary tract infections, kidney swelling and damage. If the condition is left untreated it can result in permanent kidney damage.