What is Urology?

Urology is a surgical specialty which deals with diseases of the male and female urinary tract and the male reproductive organs. Although urology is classified as a surgical specialty, a knowledge of internal medicine, pediatrics, gynecology and other specialties is required by the urologist because of the wide variety of clinical problems encountered. In recognition of the wide scope of urology, the American Urological Association has identified seven sub-specialty areas:

     

      1. Pediatric Urology

      2. Urologic Oncology (cancer)

      3. Renal Transplantation

      4. Calculi (urinary tract stones)

      5. Female Urology ( urinary incontinence and pelvic outlet relaxation disorders)

      6. Neurorology ( voiding disorders, urodynamic evaluation of patients, and erectile dysfunction or  

         impotence) 

 

Historically, the subject which clearly established the specialty of urology as being distinct from general surgery was the treatment of obstructive uropathy. This treatment ranges from the correction of obstructing posterior urethral valves or ureteropelvic junction obstruction in the infant to the correction of bladder outlet obstruction from benign prostatic hyperplasia in the older male. Through the decades, we have witnessed a tremendous increase in our general understanding of the diverse functional disorders of urine transport associated with various overt and covert forms of neuromuscular dysfunction. The rapidly evolving discipline of urodynamics has established itself as a major resource in the diagnosis and therapy of such disturbances.

 

Stone disease of the urinary tract has always provided a substantial portion of general urologic practice. The recent introduction of rigid and flexible ureteroscopy has greatly improved the capacity of the urologist to deal with the problem while the management of stones in the kidney has been revolutionized twice in the immediate past: first with the introduction of percutaneous methods for stone disintegration and extraction, and secondly by the application of extracorporeal shockwave lithotripsy. Collectively these techniques have largely rendered open surgical procedures for dealing with kidney and ureteral stones obsolete. These new technologies remain under urological stewardship. In addition, advances in the diagnosis and metabolic management of recurrent nephrolithiasis allow urologists to reduce the risk of recurrent stone formation.

 

Another area of major urologic concern is that of congenital anomalies. The urinary tract is affected by congenital anomalies more than any other organ system. These congenital abnormalities run the gamut from the relatively common problem of cryptorchidism to the complex area of intersexuality. Most urologists do surgically repair many congenital anomalies in children, but the more complex problems are often referred to urologists with specialized training in pediatric urology.

 

Involvement of the urologist in the problems of renal insufficiency and end-stage renal disease has been necessitated by an enormous increase in the number of patients on dialysis and requiring transplantation. In a number of centers, urologists are the prime surgical arm for renal transplantation and, in others, serve as members of the surgical team. This practice has tended to increase the experience of the urologist in vascular surgery which has been beneficially incorporated into other areas such as renal vascular reconstruction and in the new microvascular surgical procedures performed for certain cases of impotence. The enhanced communication between nephrologist and urologist often leads to involvement in the general area of hypertension and adrenal disorders.

 

The treatment of malignant disease is a very large portion of urologic practice. Some of the most encouraging results in the medical and surgical management of solid tumors have involved genitourinary tumors, namely testis tumors and Wilms' tumors. The development of multimodal therapy, in which chemotherapy, radiation therapy, and surgical treatment are used in conjunction, will hopefully improve the results of the treatment of other genitourinary malignancies. Newer diagnostic methods for the detection of prostate cancer have recently emerged and currently the diagnosis and treatment of prostate cancer occupies much of many urologists' time.

 

Urinary tract infections affecting every age group in both sexes comprise a significant fraction of urological practice. While urinary tract infection may be the obvious and definitive clinical symptom at presentation, it may also reflect other disorders of the urinary tract such as obstructive uropathy. Much recent interest has been focused on the characterization of pathogenic bacteria that are particularly prone to cause persistent urinary tract infections, specifically pyelonephritis. Bacteriuria is such a common clinical problem that there is inevitably a large cross-disciplinary approach to this problem. Urologists often interact with internists, pediatricians, and gynecologists in the management of patients with bacteriuria.

 

The importance of urologic problems seen primarily in women (stress urinary incontinence, interstitial cystitis, urethral diverticuli, etc.) is being increasingly recognized. The diagnosis and therapy of urinary incontinence constitute a significant portion of most urology practices. New therapies, both surgical and non-surgical, are being constantly developed. The number of female patients treated by urologists is substantial, and urologists need to understand gender differences in the medical and surgical approaches to these patients.

Male sexual dysfunction and infertility have become virtual subspecialties. The management of impotence has been revolutionized first and foremost by the introduction of prosthetic devices in urology. The area of prosthetics in urology has gradually expanded to encompass not only the various forms of penile prostheses, but also the use of the artificial urinary sphincter. The management of infertility in the male has generally focused on the surgical correction of various acquired and congenital obstructions within the genital system, and increasingly sophisticated efforts to diagnose and treat the problem of coexisting male subfertility and varicocele. Continued improvements in the medical management of male infertility require a high level of expertise in the area of reproductive physiology and endocrinology.

 

Trauma to the genitourinary system involves the urologist as one member of the trauma team during the initial evaluation of the multiply-injured patient. Recent improvement in imaging techniques for the evaluation of renal trauma and standardization of approaches to the problem of lower urinary tract trauma have significantly improved the care of such patients. There are a vast number of operative approaches to the problem of the late correction of injuries to the lower urinary tract which fall under the general heading of reconstructive surgery.

 

The specialty of urology is constantly changing. Much of this change has been the result of improved technology. Refinements in the area of ureteral and renal endoscopic surgery have already revolutionized the therapy of urinary tract stones and, working in conjunction with the new generation of extracorporeal lithotriptors, many of the traditional surgical and even endoscopic approaches to the problem of renal and ureteral calculi are now largely obsolete. Other traditional urologic procedures, specifically vasovasostomy and hypospadias repair have improved results in selected cases with the use of the surgical microscope. Skill and experience using the surgical microscope will undoubtedly be an important part of urologic practice in the future. Lasers are in their infancy, but will influence the practice of urology in the management of neoplasms and, in a somewhat different context, the management of ureteral calculi. Much recent research effort has evolved in the area of laparoscopic surgery. Many urologic operations which have been done by open surgery in the past can now be performed through the laparoscope. The development of new cancer chemotherapeutic agents has significantly altered therapy for some urologic cancers. In summary, urology is a rapidly changing and exciting area of medicine which requires practicing urologists to be actively involved in continuing education.

For Men

Men have always been reluctant to discuss the topic of impotence and for good reason. Impotence can leave a man feeling hopeless. But recent and ongoing advances in medical treatment programs can help.  Intracavernosal injections take advantage of the latest scientific discoveries in order to help you and your partner restore sexual intimacy in a discreet, convenient, and effective manner.

 

Impotence in common but treatable. 

  

Understanding Impotence

What is impotence?

Impotence is defined as the inability to achieve or maintain an erection sufficient for sexual intercourse.  Impotence occurs when not enough blood is supplied to the penis, when the smooth muscle in the penis fails to relax, or when the penis does not retain the blood that flows into it.

When and how does impotence occur?

Impotence can occur at any age.  According to studies by the National Institutes of Health, 5% of men have some degree of impotence at age 40, and approximately 15%-25% at age 65 or older.  Impotence affects all races, and crosses all ethnic and economic boundaries.

Physical causes of impotence

Although the likelihood of impotence increases with age, it is not an inevitable part of aging.  Impotence can be associated with physical factors, such as illness, accidents, injury, diabetes, high blood pressure or the side effects associated with medications used in treating certain diseases.  Heavy smoking and excess alcohol consumption also may contribute to impotence.  About 80% of impotence has a physical cause.

Psychological causes of impotence

Impotence can also be caused by psychological factors.  These include unpleasant associations with past sexual activity, stress, depression and anxiety.  When psychological conditions such as these occur for long periods of time, they can decrease sexual desire and result in impotence.   

Sexual activity and aging

The aging process may present some challenges that are often overlooked by couples.  Both men and women, for example, undergo various physical changes that alter sexual responsiveness.  These changes, however, are a normal and expected part of aging.

In undergoing your therapy for impotence, both you and your partner should try to avoid making comparisons to sexual performances when you were younger or prior to other changes that may have caused impotence.  But most important, be patient, maintain a sense of enjoyment and consider this time an opportunity to rediscover your sexual intimacy as a couple.

Resuming sexual intimacy after extended inactivity

If you are using an Intracavernous injection after an extended period of sexual inactivity, it is important that your partner also consider speaking to a healthcare professional.  Natural changes that occur during an extended period of sexual inactivity often involve making certain changes to your sexual habits upon becoming sexually active again.

Lubricants, for example, can help ease problems with foreplay and vaginal penetration, and should be water-based—especially if you use condoms to prevent pregnancy or transmission of sexually transmitted diseases.  (Petroleum-based lubricants should not be used as they may weaken the latex in the condom and cause it to break).  A number of water-based lubricants should be available at you local pharmacy.  Ask your pharmacist for more information.

 

Dosage for treatment of impotence:

Your first doses of Intracavernosal Injections should be given under the supervision of your doctor.   You and your physician will determine the proper dose of Intracavernosal Injections

Priapism is defined as a prolonged erection.

 

Erections should last 45 minutes to 1 hour.  If the erection lasts longer the patient can bring down the erection by taking a cold shower or applying ice wrapped in a towel on the penis or taking 60 mg of Sudafed.  Note:  If you have an erection that lasts more than 4 hours and you have tried the above, see a doctor promptly and take along the medication and package inserts.    

 

Side effects

The most common side effects that have been observed using Intracavernosal Injections are:

Aching in the penis, testicles, legs and in the perineum (area between the penis and rectum).

Redness of the penis due to increased blood flow          

Prolonged erection over 4 hours:

Please note:  If your erection is rigid for more than 4 hours, call your doctor promptly.

  • Swelling of leg veins

  • Light-headedness/Dizziness

  • Fainting

  • Rapid pulse

Occasionally but rarely the men using this medication do not get the desired results. If this medication does not work for you, please inform our pharmacists so that they may discuss with you the proper technique of injecting.  If this still does not work we will consult with your physician on an alternative medications combination that may be more effective. 

Pyronie's Disease and Treatment Options

Peyronie's disease is a medical condition characterized by the formation of scar tissue on your penis that causes pain and curvature during an erection. As an alternative to surgery, doctors sometimes use the drug verapamil to treat Peyronie's disease.

 

Verpamail gel functions by blocking the production of a substance known as collagen, which is used to form the scar tissue that causes Peyronie's disease, the Mayo Clinic reports.

 

Verapamil gel allows patients to apply the medication directly to areas of scar tissue, while leaving other areas of tissue unaffected. This is an important benefit of the gel form of the drug in comparison to the injectable form, which can cause inflammation and make Peyronie's disease worse over time.