General Urology FAQ's
General Urology
Frequently Asked Questions
What is prostate?
It is a small gland located just below the urinary bladder. Normal size is-20-25 ml or gm. Prostate growth is under influence of testosterone hormone. Present only in male.
What is the function of prostate?
What are the risks factors of enlarged prostate/BPH?
Older age is the most important risk factor. Others are hormonal, dietary calcium or vitamin d imbalance, smoking, different immunogenic or growth factors imbalance etc.
Can I prevent BPH?
Probably not as increasing age is the only important risk for enlarged prostate. However, education regarding prostate health and regular screening may help reduce consequences of BPH.
If family members had prostatic problem, can I have same problem in future?
May be. If family members (father, grandfather etc.) had BPH, then you may have higher chance of prostate related problems. This is called hereditary risk factor.
Is BPH is same like prostate cancer?
No. BPH is benign prostatic hyperplasia or enlargement. Prostate cancer is completely separate disease and need different test, evaluation and treatment.
What are the common problems of BPH/enlarged prostate?
Slow flow of urine, post void dribbling, repeated urination, urgency, straining during micturition, incompletes sense of voiding, dysuria/burning micturition, night time urinary frequency, urinary incontinence.
What are the rare or dangerous problem of BPH?
Hematuria, urinary retention, recurrent urinary infection, stone formation, kidney damage etc.
Does medicines cures BPH related problem?
Yes. Almost >80% patient will improve upon taking specific medicine for BPH. But it needs accurate assessment by urologist for having best treatment result. Empiric treatment and inadequate dose and duration will result same problem later on. Some patient may not improve adequately on medicines and they may be better treated with surgery.
What if dangerous problem like urinary retention occurs?
Even after urinary retention or recurrent UTI/hematuria, some patient may get recovered by appropriate and adequate medicines. It may take few weeks for having best results. This will be decided best by your treating urologists whether it is feasible for you or not. Rest patient will need surgery for best result.
Should I need surgery for enlarged prostate?
No. Most of the patient with enlarged prostate related symptoms does not need surgery. Only if medicines do not help to relief symptoms or problem is so sever that treatment is not improving, then surgery for prostate may be needed.
What are indications or condition for surgery for prostate?
If following problems occurs due to BPH, then prostate surgery may be better for appropriate patient. Unable to void after acute urinary retention, recurrent hematuria, recurrent urinary infections, bladder stone formation with enlarged prostate, kidney damage or swelling on ultrasound report etc. But patient may need surgery after medicines does not give adequate good response.
Is there any remedy other than medicines for BPH?
Yes. There are many indigenous treatments available from various parts of country and claims effective against BPH. But these are mostly anecdotal and they give only mild improvement of problems. However, adjusting fluid, adequate bowel habit and good healthy diet sometime decrease the severity of urinary problems. So, need for medication may decrease for some patients. But if one want to get maximum relief from prostate related problems, them medicines is the best therapy for some patient. However, your treating doctor will guide you for optimal therapy for enlarged prostate.
Does all enlarged prostate need to treat even if no urinary problem?
Not at all. If patient does not have any urinary problem, then mere enlargement of prostate (mainly seen on ultrasound) does not need any treatment. It is wrong to treat asymptomatic or minimally symptomatic BPH patient with medicines. It is also false impression that decreasing size of prostate is needed even if there is no urinary problem. However, there are accurate assessment tools available for treatment purpose and your treating doctor will guide you effectively for best treatment option to you.
What will happen if I don’t take medicines for enlarged prostate but having urinary problem?
There may be recurrent UTI, urinary retention, hematuria like dangerous problems if you don’t treat symptomatic BPH.
Is there any chance that I may develop cancer from my prostate (BPH)?
BPH does not itself a cancerous disease but cancer may developed eventually form long standing disease or denovo. It is difficult to say which enlarged prostate will develop cancer later on. However, regular screening and urologist checkup may assess your risk of developing prostate cancer.
What are the common surgeries for enlarged prostate /BPH?
All benign enlarged prostate surgery is now microsurgery. Microsurgery done through urinary passage, so there will be no scar mark on your body. Microsurgery are done with different techniques and using different system. Common procedures are monopolar TURP, Bipolar TURP, Laser surgery etc.
What is the best surgery for enlarged prostate?
There is no best surgery suitable for all patients. Surgery deepens on may factors like prostate size, shape, facilities available, surgeon expertise, cost of surgery, patients’ choice etc. Ultimately your treating urologist will determine best suitable operation for you.
What is the most commonly performed prostate surgery?
TURP. Transurethral Resection of Prostate surgery is most commonly performed worldwide for BPH.
Is LASER being best surgery for BPH?
No. Laser is suitable for selective BPH patients, not for all cases. It is mainly suitable for very large prostate, cardiac patients (on anti-coagulant) etc. Some BPH patient may have best result with TURP rather than Laser surgery. Sometimes, false or misleading advertisement have effects on patient regarding superiority of laser which is not true.
Is microsurgery (TURP/Laser) safe?
Yes. Overall, microsurgery is safe for most patients, even it can be performed in older age group. There are mild complications or side effects seen after surgery. Complications are less common in expert hand. Sometime, severe complications may occur which will be managed by your urologist. Pros and cons of every surgery should be explained to patient.
N.B: Information are for educational purpose only. For further queries and explanations, you can contact with your doctor/urologist.
What is BPH?
BPH is benign enlargement of prostate, common cause of urinary problem in men older than 50 years. Age increases, the incidence and prevalence of BPH also increase rapidly.
Is BPH always means treatment or medication needed?
Never. Simple enlargement of prostate without any urinary problem does not need any medical treatment. But careful observation and follow up needed.
How BPH medicines decided?
BPH related problems are called LUTS, i.e., lower urinary tract symptoms. These problems are scored as mild, moderate and sever. If someone has mild symptoms, then he may not need any medical treatment and moderate symptoms may be relieved by taking minimal medications and life style adjustment.
What is lifestyle adjustment?
For no symptoms or mild symptoms due to BPH, one can get relieved by following some diets, fluid intake and exercises. There is no need of taking prostate medication for these patients. However, treating doctor will give best advice for in this scenario.
What is lifestyle medication?
Education about prostate symptoms and reassurance-patient must understand prostate and urinary symptoms relation, BPH progression and consequences. They must be assured that enlarged prostate does not mean prostate cancer. And not all prostate patients will need surgery. Your doctor will guide and explained you.
Advice of fluid– Some patient had false belief increase fluid intake will be helpful for prostate related urinary problem, most of the time it is not true. On the other hand, fluid intake of 1.5-2L/day, may (increase half liter in summertime) decrease frequent urination. Or if someone talks 4-5 lit water daily, decrease that amount to 3-3.5 L/day. Increase fluid intake only help when there are urinary tract infection related symptoms. Body will require 1.5-2.5 lit water daily for good health, more than this may not needed. Specially kidney disease and heart disease patients will require less amount of daily fluid intake(1-1.5L/d).
Also restrict fluid intake during outdoor journey, travel etc. that will help decrease urinary frequency and urgency episodes.
For nocturnal urination, restrict fluid intake at night or after evening, specially 2-3 hrs. before bedtime. In that case, most of the fluid may be taken during daytime.
Avoid bladder irritant food-Decrease or avoid taking tea, alcohol, spicy food specially after evening time. Tea better to take at morning or before evening time will help decrease urinary problems like urgency or frequency.
Adjusting medications-This is very important. Adjustment of medication will simply prevent some urinary problems like frequency, urgency, nocturia etc. No of medicine at night should be decrease, if possible, this will help decrease taking water at night and nocturnal urinary frequency. Some anti-hypertensive like diuretics may be adjusted or replaced with non-diuretic medicine to prevent frequent urination. This needs coordination with physician. Many patients refuse to adjust medication because of their false belief that physician has prescribed their medications despite having urinary problem. This is not good practice and this can be solved after discussion with physician.
Also avoid constipation by increasing fresh vegetables, fruit etc.
Regular daily exercise, at least 30 min daily for 4- 5 days decrease tension and will help good bowel and toilet habit. Control of diabetes and hypertension will help decrease urinary problems. Also, optimization of neurogenic problems will have good effects on urinary control. Weight reduction for obese patient will help decrease some urinary problems specially stress incontinence.
Toilet and bladder training-Double voiding (twice voiding in single attempt) decreases post void dribbling of urine. Milking of urethra with hand will also decrease post void dribbling.
Regular pelvic floor training and perineal exercise will help reduce many urinary tracts problems like urgency, stress urinary incontinence, increase holding power of urine.
Urge suppression techniques may be well suited for some patients where every time patient must hold and suppress voiding urge for few seconds and gradually increase this time interval.
All these measures will eliminate need of prostate medication in most of the mild symptomatic patients and few of moderate symptomatic patients if followed optimally. These principles should be exercise in good spirit and may be monitored by health specialist best outcomes.
Where should I get all these in details?
Consult with your urologist for details and best practice guidelines.
What if these does not relief symptoms?
In that case, you may need some medications.
N.B: Information are for educational purpose only. For further queries and explanations, you can contact with your doctor/urologist.
What is CIC?
CIC is clean intermittent catheterization. This is a technique used to evacuate urine from urinary bladder in some patients. It is advised for underactive bladder (neurogenic) or stricture urethra patient after urethral dilation procedure.
What is stricture urethra?
It is narrow passage of urethra both in male and female (commonly occurs in male>female). Narrow urethra cause problem in passage of urine flow. Patient will have difficulty in passing urine, frequency of urine, burning micturition.
What is the operation for stricture urethra?
Stricture urethra is a chronic disease, that means it recurs very often. It does not respond to medicine and treatment is only surgery. Dilation of urethral passage done for good urine flow. CIC is sometimes advised for prevention of re-narrowing of urethral passage.
What is underactive or neurogenic bladder?
When urinary bladder is unable to remove urine with good force despite no urethral blockage, then it is called underactive or neurogenic bladder. It is usually seen in very older age, spinal cord injury and neurogenic patients.
How CIC done?
It is done with 12 or 14 Fr Nelatone catheter or commercially available E coli catheter. They need not to be sterile but must be clean. It is done at sitting position with clean hand. First, 2% lignocaine jelly to be applied in the urethral meatus, then few ml of jelly to be inserted inside urethra slowly. After lubricating urethra adequately, catheter is inserted slowly. Catheter to be inserted almost 15-18 cm in male patients and 2-4 cm in female patient. After that there will be urine coming via catheter. Once urine comes then insert the catheter another 1 cm and wait till last drop of urine comes. For stricture patient, urine may not need to clear completely and after insertion, one can slowly withdraw catheter. But for neurogenic bladder, bladder must be emptied completely and then only remove catheter slowly.
How to clean catheter?
After use, clean with normal water and dry in sunlight preferably. After drying, keep the catheter in a dry placed and use again when necessary. Don’t use hot water for cleaning.
Who will do CIC?
Patient himself can do once explained and teach properly. Patient who are debilitated, parkinsonism or have cognitive problem, they can’t do CIC. Female patient also gets some difficulty doing CIC, but proper training can teach female for CIC. If patient can’t do it, then family members or health care personnel can do CIC as prescribed by urologist.
How frequently should I do CIC?
For stricture urethra or narrow passage, your doctor will advise to how frequently to do CIC. Usually, it is done daily and then decrease gradually to once weekly or monthly.
For neurogenic bladder, patient need to do it all east 4-5 times a day or as prescribed by urologist.
Should I need lifelong CIC once started?
Not really. Your doctor will guide you how long you need CIC.
What if I don’t do CIC as advised by urologist?
For stricture patient, there may be problem over time, if you don’t follow CIC advise, stricture may recurs early. For neurogenic bladder, CIC is must or otherwise patient will need long term catheterization. In both cases, kidney may be damaged if urinary problems persist or there is chronic retention of urine.
What are the problems of CIC?
Pain, burning micturition, bleeding may occur during CIC. Usually, adequate lignocaine jelly will decrease pain and burning micturition. However, if problem persist, you should consult your urologist.
What happen if catheter is not going inside or there is difficulty in passing catheter?
You can apply extra jelly and use new catheter in this condition. There may be recurrent stricture or passage may not be adequate for passing catheter. Or sometimes catheter may get blocked due to false passage inside urethra. You should not put extra pressure in these cases. Rather consult your urologist immediately.
How long can I use one catheter?
For Nelaton catheter, one can use for many times and many days or even weeks if catheter is not broken or damaged. For E Coli catheter, usually they are single use and comes in branch of 50 or 100.
CIC or long-term catheter -which one is better?
CIC is less cost effective, less side effects, less long-term complication (UTI, Stone formation, cancer etc.) than long term Foley catheterization.
N.B: Information are for educational purpose only. For further queries and explanations, you can contact with your doctor/urologist.
What is DJ stent?
It is double J stent. DJ stent used after ureteric obstruction or kidney obstruction due to stone, tumor or infection. This is to keep urine flow from kidney intact and prevent kidney damage. This is also used in acute ureteric colic pian from stone.
Is it used after surgery?
Yes. DJ stent used after stone surgery (kidney or ureteric stones), pyeloplasty or ureteric reimplantation surgery.
Why used after stone surgery?
It used to prevent ureteric obstruction due to flakes, bleeding, or stone fragments. After kidney stone surgery (PCNL/RIRS), DJ stent is used. After ureteric stone surgery, in some uncomplicated cases DJ stent may not be needed. This is decided by treating surgeon.
Why happen after DJ stenting?
There is usually mild urine related problem after DJ stent use. There are called stent related symptoms. They are flank pain (usually mild), burning micturition (specially at the end of urination), frequency of urine, urinary incontinence. Some patients may develop bleeding and fever (UTI) also.
How long DJ stent remains in body?
After stone surgery, usually 10-14 days. But it varies depending on cases and types of surgery. In some surgery DJ stent removed after 4-6 weeks (like pyeloplasty).
Is it removed in operation theater or outdoor basis?
DJ stent may be removed in operation theater usually under local anesthesia. For some patient, it may be removed under sedation. It can be also removed in OPD with the use flexible scope.
Is it painful under local anesthesia?
Only mild or no pain. Procedure last for 2 min only.
What happen if I forgot DJ stent removal?
DJ stent should not be kept more than 3 months (usual type). Longer stay caused many problems like encrustation, stone formation, recurrent infection, bleeding etc. Forgotten stent may damage ureter or kidney.
Can it be removed on dare care basis?
Yes, mostly done in day care basis, same day discharge and patient can join work in the very next day.
N.B: Information are for educational purpose only. For further queries and explanations, you can contact with your doctor/urologist.
What is microsurgery?
Microsurgery means operation done through a smaller hole or puncture in the body. In comparison to old era of open surgery, microsurgery made through only small hole (few millimeter) with smaller and advanced instruments passed through this small hole. Like for kidney stone, previously it was done via open large cut in the body, now a days only small hole or puncture can do the same stone removal operation. Microsurgery help smaller cut, early recovery, less hospital stays and less pain.
What is endourology?
Endourology specifically denotes to urological microsurgery through urethral orifice. Here, even no hole or puncture is made in the body. They are done via already existing urinary passage with smaller and flexible scope and instruments. They are better for most of the advanced urological problems like prostate surgery (TURP/HOLEP), stone surgery, stricture or narrow urethra dilation surgery etc.
What is laparoscopy?
Laparoscopy is one types of minimally invasive techniques for surgery. In laparoscopy, there are usually 3-4 holes to be maid in the body unlike microsurgery where only one holes or no holes made in the body. Example includes laparoscopic gall bladder stone surgery or laparoscopic kidney tumor removal surgery.
Is robotic surgery being a minimally invasive surgery or microsurgery?
Robotic surgery is usually like laparoscopic surgery where 3-4 holes or puncture are made on patients’ body, it is a minimally invasive surgery. But it is not microsurgery.
What surgery is best for you?
This will depend on many things like your health condition, disease types, disease condition, expenditure, facilities available and surgeon expertise. One type of surgery may not be suitable for all patients. Best outcome after surgery will be decided by your treating surgeon.
N.B: Information are for educational purpose only. For further queries and explanations, you can contact with your doctor/urologist.
What is phimosis?
Phimosis is unable to retract prepuce skin. Here glans is covered completely or partially by preputial skin. It may occur by birth or acquired later on.
What are the problems for phimosis?
Difficulty in passing urine, burning micturition, swelling over glans during voiding are common problem.
Dose it happens after birth?
Phimosis most commonly occurs during birth, that is congenital. But it may happen even after birth or in adult due to many reasons. Infection (diabetes mellitus), trauma or post-surgery phimosis are also common now a days. These are called secondary phimosis.
Is phimosis treatable with medicines?
Congenital or newborn phimosis are mostly curable with gentle manual reduction and massage with ointment. Regular manual reduction with 1-2 months duration may reduce phimosis completely but this has to be taught and explained by urologist.
When does operation needed for phimosis?
If manual reduction not helpful or adult patient with tight phimosis, recurrent infection related secondary phimosis are usually treated with surgery.
What will happen if I don’t treat phimosis?
It will cause recurrent infection, urinary retention, sometime kidney damage due to back pressure changes.
Is phimosis surgery being safe?
Phimosis surgery called circumcision. It is completely safe and no need of admission. It can be done under local anesthesia in selected patient.
What is circumcision?
Circumcision most commonly performed operation for phimosis or tight preputial skin.
Is it a major surgery?
No, it is a minor surgery. Usually done in day care basis /discharged after 3-4 hours of surgery.
Is it done under anathesia?
Yes, usually for adult patient, local anathesia is sufficient. But for children and some high-risk patient, anesthesia may be needed (spinal or general anesthesia).
What is the best circumcision surgery?
In expert hand, any type of surgery is best. But in inexperienced hand, even laser surgery is worst. So, good doctor/urologist is first choice rather than type of circumcision.
What is laser circumcision?
In this type, circumcise cut is done by using special type of laser. It is not suitable for all types of phimoses but your doctor will decide whether it is suitable for you or not. Even after laser circumcision there may be some suturing needed.
What is stapler circumcision?
Another type of circumcision. It is done with special stapler instrument. This is also not suitable for all circumcision. Your doctor will decide whether this will applicable to you or not. Usually, no suturing needed.
What are the problems after circumcision operation?
Usually, mild pain last for 1-2 days. For some patients, swelling of penis, bleeding, infection and narrowing of urethral passage may happen. If bleeding or infection occurs, you have to report your doctor urgently.
Is rest needed after circumcision?
No, patient can join light duty after surgery or one can take 1-2 days’ rest maximum. Take your doctor’s advice for this.
N.B: Information are for educational purpose only. For further queries and explanations, you can contact with your doctor/urologist.
What is uroflowmetry test?
Your urologist may advice uroflowmetry test. This is to objectively assess the flow or speed of urine. This may suggest obstructive in urinary passage or underactive urinary bladder for both male and female patients. However, to interpret this test, it must be performed in adequate and optimum condition.
How is it done?
One has to void in a well deigned bucket or large urine pot for assessing urine volume and flow patten. This has to be done when there is maximum urge to void or adequate bladder distension (after taking adequate water or liquid before the test) so that at least 150 ml of urine is voided. For children, 150 ml volume may not be needed. It takes around 2- 3 min for voiding but time depends on adequate distension of urinary bladder and patient’s disease condition. If your bladder is empty, then it my takes 2-3 hrs. for adequate distension of bladder. One can do this test easily if he or she hold urine for 2-3 hrs. or maximum time possible and then reach laboratory for test. If single test is not adequate sometime, repeat test may be performed on the same or different day.
What are interpretations of uroflowmetry test?
UFM test is frequently doe for urinary problem, especially obstructive voiding like enlarged prostate, stricture urethra etc. This test helps determine adequate treatment decision. Without this particular test, some problem of urinary tract may not assess adequately and treat effectively.
What happen when test is abnormal or obstructive?
Your doctor will assess you and may suggest some medicines or advice further test depending on suspected urinary problems.
Is it separate from urodynamic test?
Yes. Uroflowmetry is only one part of urodynamic test, there are multiple other parts of UDS test.
Is it done in every lab?
No. this is done where uroflowmetry machine is available. This test is separate from urine routine an microscopic examination.
N.B: Information are for educational purpose only. For further queries and explanations, you can contact with your doctor/urologist.