Comprehensive Guide to Urology: Understanding Treatments and Specializations

urology care

Top Urology Treatments in Dubai: Expert Care from the Best Urologists

Urology is the specialty that deals with all diseases of the urinary tract and adjacent organs like the adrenal gland. It involves the adrenal gland, the kidneys, the ureters (which are the passages of urine from the kidneys to the bladder), the urinary bladder, and in men, the prostate gland. It also includes the male and female genital tracts.

Nowadays, urology has become subspecialized. You have specialties like laparoscopy, endo-urology, urological oncology, female urology, functional urology, and kidney transplantation. Pediatric urology, which deals exclusively with children, is also now considered a subspecialty.

Modern technology has advanced significantly, making the treatment of diseases of the urinary tract much easier and more comfortable for the patient. Most conditions occur within the passages of the urinary tract, from the kidney down to the ureter, the bladder, the prostate, and the urethra. All these can be visualized by specialized, small, highly complex technological instruments, and almost every corner of the urinary tract can be accessed by these instruments.

One of the common conditions in urology is kidney stones and stones in other parts of the urinary tract. In the past, to treat kidney stones, we had to make large incisions, which took a very long time to heal. Patients could not return to work early enough and had a lot of cosmetic disabilities due to these cuts. Nowadays, stones in any part of the urinary tract can be treated safely with minimally invasive surgery through endoscopes. This is called endo-urology.

When we put a scope into the urethra, it is called urethroscopy; in the bladder, it is called cystoscopy; in the ureter, it is called ureteroscopy; and in the kidney, it is called flexible ureteroscopy or retrograde intrarenal surgery. A combination of these endoscopes and machines like lasers and lithoclasts are very effective in treating stones as well as tumours, obstructions, and enlargements of the prostate, and tumours in the ureter, kidney, and urinary bladder.

Sometimes if a stone in the kidney is too large, like more than 2.5 or 3 cm in size, the endoscope is passed through a small puncture in the skin of the patient’s back. This is called percutaneous endo-urology or going into the kidney system through the skin.

Children are also affected by most of the conditions that affect adults, like infections, stones, tumours, and more importantly, birth defects or congenital anomalies. These anomalies are some of the most common abnormalities children are born with. In fact, they are more common than abnormalities in any other system in the body. You can have obstructions to the flow of urine from the kidney called pelvic-ureteric junction obstruction causing hydronephrosis. You can have problems with the valve where the ureter joins the bladder, leading to backflow of urine into the kidney. This is called vesicoureteral reflux. You can have conditions where there is an obstruction to the urinary passage or urethra by valves called posterior urethral valves. These are some of the most common conditions.

In addition, phimosis, or the inability to retract the prepuce, is a very common condition in children. All these can be treated with minimally invasive techniques nowadays and hence it has become a subspecialty in urology where the instrumentation used is even smaller than what is used in adults. Hence, these children do not have to suffer major scars on their bodies, which may cause body image issues when they grow into teenagers and adults.

Female urology deals specifically with conditions related to the female urethra and genital tract. Some of the common conditions are urinary tract infections and inability to control urine, or incontinence of urine. Sometimes the incontinence may be due to weakness of the muscle control of the urinary passage. So every time the patient coughs or sneezes, they may lose urine. This is called stress urinary incontinence. Sometimes they have too much urgency due to an overactive bladder, and this is called urge urinary incontinence. Finally, they can have a combination of both. These can be treated by detailed investigation in the form of urine examinations, urine flowmetry tests, urodynamic estimation of the function of the urinary bladder, and endoscopy. They can be successfully managed by programs of physiotherapy, bladder training, medicines, and sometimes surgical intervention by minimally invasive techniques.

One of the rare complications of prolonged labour or gynaecological operations in difficult situations is an injury to the urinary bladder or to the ureter. When this happens, the urinary bladder or the ureter gets connected by an abnormal tract to the vagina. This results in continuous leakage of urine and is a very depressing condition where the woman is always wet and smells of strong-smelling urine. These are called ureterovaginal or vesicovaginal fistulae. Nowadays, after investigation, even these conditions can be treated successfully for these unfortunate women by minimally invasive means or laparoscopy.

What is laparoscopy? To give you a simple example, Asians and Indians tend to eat with their hands. So that is like doing open surgery, where you literally put your hands into the patient’s abdomen to operate. Whereas in the Far East, like in Japan and Korea, people eat with chopsticks. So basically, they don’t put their hands anymore into the abdomen, but through small holes, we put in the chopsticks and do the same job as we would do with our hands. So basically, laparoscopy is a minimally invasive surgery, where small holes are made, between 5 and 10 millimetres in size, 3 to 4 in number, to perform the same surgery that could be done by making a big open incision. This procedure is now used for cancer surgery, for treating congenital abnormalities, to treat stones, to treat almost any problem with the adrenal gland, and even for major complex cancer surgeries.

The importance lies in that it helps early recovery, causes less pain, reduces the chance of infection and blood transfusion, and provides very good cosmetic results.