The kidneys lie securely tucked away at the back of the abdominal cavity shielded from harm by the lower ribcage. They filter the entire bloodstream around 400 times a day, getting rid of many waste products efficiently. They have so much extra capacity that it is possible to live a normal life on only a fraction of a single kidney.
Kidney stones are a common problem affecting 1 in 7 people. Often due to not drinking enough fluid. Occasionally due to an imbalance of salts in the urine. Different treatments are required depending on the size and location of the stone:
Small stones can be broken up with shock wave lithotripsy (ESWL) without needing an anaesthetic. Harder stones can be broken and removed by a ureteroscopy procedure under a short anaesthetic. In this operation the kidney is accessed using the natural passages through the bladder without any need for a surgical incision.
Larger, more complex stones can require a keyhole procedure called PCNL.
Cancers on the kidney can be observed if they are very small, as they often grow very slowly. If they grow, they can be dealt with by freezing them or by partial nephrectomy, removing only the growth, leaving the kidney intact. Larger growths can be removed with good results by taking the whole kidney out, often by keyhole surgery.
In some people one or both kidneys don’t develop fully leading to an obstruction of urine drainage. This can produce chronic pain in the side, especially after drinking fluid. If left untreated the kidney can stop working, develop infections or kidney stones.
The best operation to save the kidney’s function is a keyhole laparoscopic pyeloplasty as it restores the normal anatomy virtually without scars. The success rate is very good for this procedure.
The bladder lies low down in the pelvis. It collects the urine that is continuously being produced by the kidneys. It has the ability to stretch quietly in order to accommodate a large volume of urine without the brain being consciously aware of it. In healthy individuals it normally sends signals that it is filling up with plenty of notice.
This will mostly affect women, although men and children can also suffer from bladder infections. There are a number of preventative measures and treatments available.
In men, urine infections should never be ignored as they are often a sign of an enlarged prostate, prostatitis or other structural problem. Infections can also sometimes be caused by kidney stones.
An overactive bladder produces a strong need to rush to the toilet with little warning. Some sufferers are unable to control the urges and can wet themselves.
There are a number of measures patients can take to improve this, including dietary changes and medication. Successful treatments include Botox injections, sacral nerve stimulators and bladder surgery.
An intensly uncomfortable condition that is often mistaken for recurrent urine infection. In this condition, repeated urine cultures do not grow any bacteria. Although more common in women, in men interstitial cystitis can be mistaken for prostatitis.
Treatments include bladder instillations and bladder stretches which can be very effective.
A common cancer. More frequent in smokers and ex-smokers. Also seen as a consequence of exposure to certain chemicals as well as due to chronic bladder irritation. Sometimes, urinary tract cancer is mistaken for kidney stones, as symptoms include visible as well as invisible blood in the urine and occasionally pain. It can easily be diagnosed with a virtually painless flexible cystoscopy under local anaesthetic and a CT urogram.
If found early bladder cancer is easy to treat in a minimally invasive fashion.
The prostate gland lies underneath the bladder. The urethra (male water pipe) passes through it. It makes prostatic fluid, which is important for reproduction by allowing sperm to swim in a healthy environment so they can fertilise an egg successfully.
The prostate gland grows throughout a man’s life. As it does, it gradually causes a restriction in the flow of urine through it. The enlargement is usually due to BPH (benign prostatic hyperplasia). Some patients also suffer from irritation of the bladder. Symptoms include having to wait for the urine to start, a poor flow, incomplete emptying, getting up in the night to void, having to rush to the toilet and sometimes, dribbling of urine.
There are a range of treatments including lifestyle changes, medication and a variety of surgical procedures depending on the severity of the problem. These include HoLEP laser prostatectomy, the traditional TURP or TURIS, the newer Urolift procedure, Rezum steam treatment and Prostate Artery Embolisation.
One of the commonest cancers affecting men and more likely if a close male relative has also had it. Prostate cancer is often picked up late as the onset can be entirely or minimally asymptomatic. A simple PSA (Prostate Specific Antigen) blood test and prostate examination by an expert can put your mind at ease. Prostatitis or bladder catheterisation can also cause a raised PSA so, if there is doubt, further tests including an MRI and prostate biopsy can exclude prostate cancer or pick it up while it is still completely curable.
For early cancers still confined to the prostate, curative treatments include radical prostatectomy surgery, radiotherapy or radioactive seed treatment.
More advanced cancers can be successfully controlled with medication and radiotherapy for many years.
Pain felt in the lower abdomen, the penis. testicles or the perineum (the area between the scrotum and the tailbone) can be due to a number of conditions including kidney stones. bladder problems and prostatitis. This can be a disabling condition. In some men it is mild while in others it can be severe and last many years. If due to infection it is easy to treat but if chronic it can be difficult to deal with. Prostate massage can be very helpful.
A number of conditions can affect the penis in boys and adult men.
If a previously soft foreskin stiffens up and becomes white at the tip, it could be due to a condition called BXO (Balanitis Xerotica Obliterans). This rarely affects boys but is common in men of all ages, especially in diabetes sufferers. The condition is progressive and can spread on to the head of the penis where it can cause permanent scarring of the opening of the urethra (male water pipe). A circumcision can prevent this and provide a complete cure.
The penis can begin to bend on erection in some men. This is called Peyronie's disease. The bend becomes progressively worse over a few months. It usually stabilises and sometimes improves after a year. If the bend prevents normal intercourse it can be corrected successfully by one of several surgical procedures.
Erectile dysfunction can affect men for many reasons including stress, diabetes, high cholesterol, smoking and high blood pressure. Sometimes treatments for other conditions such as high blood pressure can also cause erection problems as a side effect.
Erectile medication can be very effective but if this doesn’t work, other treatments include vacuum pumps, injections and penile prostheses.
The testicles produce both the male hormone testosterone and sperm.The testicles descend into the scrotum shortly before birth or within the first three months of life.
Lumps in the scrotum are very common and can be due to testicular swellings or swellings on other parts such as the epididymis. Most lumps are not serious if they are not on the testicle itself and do not change in size.
An examination by an expert can often make the diagnosis and an ultrasound scan can confirm it. If the lump is due to a bothersome cyst or a collection of fluid around the testicle (called a hydrocoele) the treatment can be completed as a Day Case procedure.
This is a rare condition, more common in younger men but can still affect men at any age. Testicular cancers grow as a lump on the testicle itself. If a testicular lump grows quickly it must never be ignored as it could be due to a testicular cancer. If you think you might have this you should seek urgent medical review. A simple examination and ultrasound scan can make the diagnosis. Prompt, early surgery is usually curative.
A swelling around the testicle is often caused by fluid building up around it. If it gets very large the testicle can become heavy or uncomfortable. Treatment to remove the fluid involves a straightforward day case surgical procedure.
Varicose veins draining the testes are found in many men. They are much more often found on the left side due to differing testicular vein anatomy. They often cause no symptoms but can cause a testicular ache especially if standing a long time.
Varicocoeles have been linked to poor sperm quality. Some men with a low or poor quality sperm count can improve it if their varicocoele is treated.
Varicocoele treatment usually involves embolisation under local anaesthetic.
A chronic pain in one or both testicles that is not due to any physical process such as a cyst, kidney stones, prostatitis, nor a testicular or bladder infection. Treatment is usually by modulation of pain signals from the affected testis rather than by any sort of surgical procedure.
Bladder problems in children can affect both boys as well as girls equally.
The testes and penis in boys often complete their development after birth. For some conditions it is safe to wait for natural development to occur. Other conditions require help.
The foreskin softens and eventually retracts in most boys at a young age. A number of boys may not be able to retract their foreskins until they become teenagers. This is perfectly normal and does not require treatment unless it causes infections of either the head of the penis (balanitis) or the urine. Scarring conditions in the foreskin of boys are rare. In some teenagers a tight foreskin can be due to a short frenulum.
Treatments include frenuloplasty, preputioplasty and circumcision.
A swelling around the testicle in boys is due to an incomplete closure of the sac around the testicle. Sometimes it can be associated with a hernia, where fat or bowel from the abdomen descends into the scrotum. In very young boys with a minor swelling the condition can correct itself. For those that don't, treatment involves a straightforward day case surgical procedure.
The testicles are present in the scrotum or descend in most boys within a few months of birth. If they don’t come down they will not develop properly. If a testicle is not brought down it may not produce testosterone or normal sperm later in life. There is also an increased risk of the testicle becoming cancerous many years later.
Most undescended testes are found only a little way up so a simple operation will place them in a normal position, allowing them to grow and develop normally.
Children can also suffer from an overactive bladder. This causes them to need to rush to the toilet with little warning. Some are unable to control the urge and can wet themselves.
There are a number of measures parents can take to improve this. Medication is also often very helpful in children who suffer wetting.
Male sterilisation is one of the most effective forms of contraception. It can be performed under either a local or general anaesthetic.
A no-scalpel vasectomy is performed without any cuts by stretching the scrotal skin in one place and takes about 20 to 30 minutes to do. This significantly reduces the chance of bleeding after the procedure without compromising the success rate.
For men who have undergone a vasectomy and then decide they wish to father more children. A single surgical procedure to restore fertility allowing natural conception to take place.
If a long time has elapsed from the original vasectomy the success rates of reversal is lower so it is important to choose the most successful reversal method.
A microsurgical vasectomy reversal uses a high precision operating surgical microscope to accurately visualise the vasa. This allows the most accurate join of the two ends using sutures finer than human hair, producing the best results.
For more information on any services or to book an appointment, please contact Mr Rix's PA today. Face to face outpatient, telephone and video consultations are all available.
Mr G H Rix FRCS (Urol)
Oaks Hospital, 120 Mile End Rd, Colchester, CO4 5XR
Copyright © 2020 Mr Gerald Rix- All Rights Reserved.