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Urology

It is a medical department examining and treating urinary tract of women and urinary and reproductive tract of men.

Treatments Applied In our Urology Department

Main urological treatments such as open-closed Stone removal operations (uretheroscopy, percutaneous nephrolithotomy), Stone breaking treatment (ESWL) and TUR operations as well as urological cancer operations, pediatric urology surgeries and operations and procedures related with male sexual function disorders are performed in our urology department.
In treatment of patients with prostate disease, open operations as well as plasma kinetic technology, TUR method and modern drug therapies are used.

Furthermore, prostatectomy for treatment of prostate cancer and radical cystectomy operation for treatment of bladder cancer may be performed.  Urological-oncologic surgeries such as kidney and testicle cancer may be performed.  Endoscopic (closed system) operations may be applied for treatment of urinary system Stone disease.  Furthermore, diagnostic cystoscopy is performed by local anesthesia in polyclinic environment by a flexible cystoscope.  Erection and ejaculation problems called as erectile dysfunction and examinations, tests and treatments for male infertility are performed by planning the process with other medical departments.

PCNL (percutaneous Nephrolithiotomy)

PCNL is endoscopic kidney Stone operations.  An incision of 1 cm at most is performed and the Stone is imaged on the screen with an optical device and it is removed via specific devices.

The most important reason to prefer percutaneous operation is application by preserving body tissues and return of the patients to their normal lives in a shorter period.  In case of low achievement rates of ESWL treatment for stones in lower section of the kidney, PCNL surgery creates a better alternative with a high achievement rate.

ESWL UNIT

ESWL (Extracorporeal Shock Wave Lithotripsy) is the most frequent and reliable method used to treat kidney and urether Stones today.  This method bases on sending shock waves outside the body and breaking the Stone by these shock waves and this method works without damaging the surrounding tissues.  . Stones are broken şnto sand particles and they may be extracted by the urine easily.  ESWL is a more comforted and cheaper treatment method with lesser risk than the surgery which allows to remove kidney and urether Stones without necessity of surgery.  Recovery period is shorter as not to compare with the surgery.

What is benign Prostate Hyperplasia?

Prostate is a secretion gland on a nut size which exists in male only.  It exists on the base of urinary bladder and surround the urinary tract.  It starts to grow by hormonal changes that may appear after 45 years of age.  Benign prostate Hyperplasia (BPH) is a problem affecting life quality of a man seriously.

What are the Symptoms?

  • Sense of not complete discharge of the bladder after urinating
  • Frequent urination
  • Urinating at night
  • Urinating by force
  • Urinating intermittently
  • Decrease on urine flow

 

How is BPH Diagnosed?

1. Anamnesis : These complaints may be collected under 2 titles in general:
Symptoms that obstruct the urinary tract called urethra and prevent the urine flow; and symptoms irrelevant to obstruction of urine flow called irritative.- Obstructive urinating findings are present in the patient:

  • Hesitancy
  • Patient waits longer for urination than normal (it may be observed in urethra stenosis as well)
  • Projection decrease: Decrease on urine flow and calibration:  Less than 20 ml/sec.
  • Terminal dribbling: (dipping after urination)
  • Inability to urinate while the bladder is full (Acute urinary retention)
  • Intermittent urinating
  • Residual urine sense after urination

– Irritative findings generally accompany to these.

  • Frequency (frequent urination)
  • Nocturia (awaking for urination at night)
  • Urgency
  • Dysuria (Burning sense while urinating)

2. Physical examination:

Rectal examination by finger: (DRM) it is the most informative method.

Prostate size, shape, consistency, symmetry and presence of mass (nodule) are assessed.  The urologist makes a rectal examination by his finger first for diagnosis of prostate hyperplasia.  Many patients find this treatment method as irritating.  However, it is superior to all developed diagnostic methods and it should be done.  Because anus is in front of the prostate and behind the bones, examination with another method is not possible.  It is especially valuable for differential diagnosis of prostate hyperplasia with cancer.  When ultrasonography and PSA tests are combined with finger examination, they provide more significant results.

3. Laboratory tests:

Routine biochemical assessment including PSA and kidney functions is performed.  

PSA: Prostate Specific Antigen:  It is an enzyme responsible from liquidation of the semen.  It is released from prostate secretion cells into the urinary tract via channels.  If the barrier between secretory cells and vascular cells in the prostate disrupts, its blood level increases.  It increases lesser in BPH and increased very much in prostate cancer.

4. Assessment of the urination:

– Uroflowmetry: It is measurement of urine flow rate and change of flow per time.  The fastest flow (qmax) and average flow (Qav) rates and total urination time, urination curve and total urination quantity are assessed.  Quantities lesser than 150 cc should not be assessed.

– Cystometry, Pressure-Flow measurements:  A pressure gauge placed into the bladder records pressures before, during and after urination.  Uroflowmetry and rectal pressure may also be recorded spontaneously.  It is more complex than uroflowmetry and it is not necessary for most of the patients in general.

– International prostate symptom score (IPSS): Although it includes relative and personal differences, it should be applied onto the patients.  It is an assessment system necessary to assess the status before and after the treatment as well.

5. Imaging methods:

– Ultrasonography:  It may be performed transabdominally and transrectally.  A full bladder is necessary.  Prostate size, tissue homogenicity, capsule status, presence of adenoma or tumor may be detected.  Growth of middle lpbe of the prostate into the bladder may be observed.  Hydronephrosis, changes on renal parenchyma, presence of Stones are assessed by ultrasonography in the kidneys.
6- Interventional Methods:

– cystoscopy: Urinary tract and inside of the bladder are visualized via a tool with a light inserted from urinary tract in the cystoscopy.  It may be performed for patients whom surgery is planned in particular.  It provides very valuable information in determination of the surgery type.  Furthermore, it provides to determine another diseases such as urinary tract stenosis which may present similar symptoms to BPH.

 

How is it treated?

Prostate is treated via drug treatment or surgical procedure.  Exact solution for prostate treatment is surgical.  The actual purpose of the prostate treatment is to protect the kidneys.  If the patient is on surgery stage but he does not have the surgery, function of the bladder may be disrupted and kidneys may be affected.  The patient may need dialysis treatment eventually.  Patients whose treatments have delayed may not have a complete cure even they are operated.  Surgical methods are divided into two as open and closed methods in prostate treatment.  Unless very specific cases are present today, open prostate operation is applied frequently.  Closed (endoscopic) interventions are preferred for rapid recovery of the patient.

Advantages of Plasma Kinetic Treatment

Closed prostate operation creates 90% of surgical treatment methods.  In this method known as closed operation colloquially, the prostate is removed in pieces without any pain or cleared by vaporization by entering from penis.

The tissue removed via plasma kinetic method is sent to pathology to detect whether it is malign or benign.  Pathological examination can not be done because the tissue can not be removed with methods such as laser.

Period with catheter is shorter than other methods.  Bleeding risk is very less.  The patient may be discharged from the hospital within one to two days.

No loss on male functions and no retention of the semen into the bladder again is observed.  The patient may continue on his private life with the same standards.

The method where urinary incontinence is lowest after the operation is Plasma Kinetic.  Prostate size does not create any complication because it is applied with physiological saline.  It may be applied for any prostate size.  One of other advantages of this method is that it may be applied for patients with cardiac and pulmonary diseases.

CYSTOSCOPY

It is direct assessment of the urethra and bladder via optic tools like telescope.

 

In which cases is cystoscopy performed?

– To research causes of bleeding which are visual during urination or detected in the urine analysis

– To control patients followed because of bladder cancer periodically

– For diagnostic purposes in male with benign prostate Hyperplasia (BPH)

– For urinary tract infections which can not be explained or repeats persistantly against medications

– For suspicious lower urinary system complaints; to take graphs by administrating contrast agent to image upper urinary system

In which cases is cystoscopy not performed?

– An Active urinary tract infection

– severe prostate obstruction

– General condition disorder

– hemorrhagic diathesis

– Cystoscopy should not be performed reliably because failure risk is much for patients with very low bladder capacity.

Are patients prepared specially before cystoscopy?
After the procedure is explained to the patient, local, regional anesthesia or general anesthesia may be applied fort he procedure depending on decision of the anesthetist and urologist.  Local (regional) anesthesia is used commonly.  However, the procedure is performed by giving an anesthetic gel into outer urinary tract and providing to keep this gel for a while (5 to 10 minutes).

 

What are types of cystoscopic tools?
There are two cystoscopic tools including rigid and flexible cystoscopes.

 

What Are Advantages of Flexible Cystoscopy?

– High patient comfort

– Possibility to perform the procedure on supine position

– easy passage of the device even in bladder neck elevation

– Possibility to observe each angle of the bladder by flexible end

– It is applied easily under polyclinic conditions in our polyclinic.

 

FREQUENTLY ASKED QUESTIONS

How can I Notice whether  have prostate cancer?

Prostate cancer may not provide any sign especially during the early period.  Prostate cancer may be detected with urological examination and blood test (PSA) with a high ratio.  Although recovery chance from the disease by surgery in early stage prostate cancers is very high, the result is not hopeful in advanced stage prostate cancers.

 

What is the most suitable age for circumcision and the most suitable circumcision form?

The most appropriate period for circumcision is within one week following the brith (newborn crcumcision) and after 6 years.  We do not advice circumcision between 3 to 6 years because it may create a castration phobia.  An ideal circumcision should be applied in a hospital under superficial general anesthesia.

 

I always pass kidney Stones. Is there any way to prevent this?

Stone formation in urinary tract is a repeatable problem.  Risks for stone formation should be detected for individuals who create kidney stone continuously; the stone should be analyzed and the type should be determined and a protective treatment fort he cause should be started.  This kind of treatments are necessary for children with kidney stones in particular.

 

My physician told met hat I have prostate hyperplasia.  Should I have the surgery?

Prostate hyperplasia does not require surgery absolutely.  Drug therapy is started in general for prostate gland hyperplasia which reduces life quality of the patient by making him dependent to toilet or creates kidney damage.  Surgery is suggested if the patient is not benefited from this treatment.

 

What are treatment options for erection dysfunction?

The treatment varies according to psychogenic or organic origin of the disease.  The cause of the problem in a young male who have night erections and do not have any disorders in physical examination and laboratory tests is probably psychogenic.  The most efficient treatment will be sexual consultancy and psychotherapy by a psychologist in such patient.  Drug therapies may be added to support this treatment in some cases.

For disorders with organic origin (oral drugs, injectable drugs which are injected into the penis directly or into the urethra from the penis) and vacuum device and surgical treatments (vascular operations and penis prosthesis) are other treatment options.

Doctors in this department.

Dr. Bilgin Öztürk

Dr. Bilgin Öztürk
Urology Specialist