TREATMENT

Treatment is the term describing any therapeutic intervention aimed at treating an illness following diagnosis.

Treatment is subdivided into:

  • Conservative (including all therapeutic interventions where no surgery is performed)
  • Surgical

Below, the available treatments (conservative and surgical) for common urological conditions are listed.

Contents:

Benign prostatic hyperplasia treatment

Benign prostate hyperplasia requires treatment if causing symptoms which affect patient quality of life.

Careful monitoring

If the symptoms are mild, no medication or surgery is required.

Instead, careful monitoring is needed.

Symptoms may improve with patient education and lifestyle changes, i.e.:

  • Less fluid intake at night, before going to bed, to reduce nocturia
  • Reduced consumption of tea, coffee and alcohol
  • Full bladder emptying in sitting position

Medication for the treatment of the symptoms due to benign prostate hyperplasia

There are five classes of drugs:

  • Herbal drugs
  • Alpha-blockers
  • 5-alpha reductase inhibitors
  • Muscarinic receptor antagonists
  • Phosphodiesterase-5 inhibitors

Surgical management is required in the following cases:

  • Failure of medication
  • Recurrent urinary tract infections
  • Post-void residual volume exceeding 100 mL
  • Bladder lithiasis
  • Kidney failure due to benign prostate hyperplasia
  • Uncontrollable hematuria originating in the prostate
  • Acute urinary retention

Types of surgical procedures

  • Transurethral prostatectomy (TURIS technique)

It constitutes the treatment option in patients with benign prostate hyperplasia.

The goal of the surgery is to remove the prostate adenoma causing the symptoms.

The surgery is performed via the urethra; no abdominal incision is required.

This type of surgery is known as Minimally Invasive Surgery (MIS).

  • Transvesical prostatectomy (Open prostatectomy)

The prostate adenoma is dissected through an incision in the lower part of the abdomen.

It is performed in patients with prostate volume over 80cm³.

Urinary tract stones treatment

It differs according to the type of stone and cause.

Small stones with few symptoms

Most kidney stones do not require aggressive therapy.

A small stone may be excreted in one of the following ways:

  • Drinking water

Drinking 2 to 3 liters of water on a daily basis can help excrete the stone.

  • Analgesic intake

Excreting a small stone can be painful. Which is why analgesics are recommended.

  • Medication intake

Drugs, known as alpha-blockers, relax the muscles of the ureter and help excrete the stone more quickly and less painfully.

Large stones causing symptoms

Stones which cannot be conservatively treated, either because they are too large to excrete spontaneously or because they cause bleeding, obstruction and recurrent urinary tract infections, require aggressive treatment.

Invasive methods include:

  • Ultrasound-guided extracorporeal lithotripsy

Percussion beams are targeted onto the stone, causing it to break down into small fragments.

It is a procedure well tolerated by the patient and its success rate is around 90%.

  • Ureteroscopy and intracorporeal lithotripsy

Applied on stones located in the ureter.

It is performed via an endoscopy instrument called ureteroscope which, once inserted through the urethra and the bladder, enters the ureter and reaches the stone.

There, a laser beam breaks the stone down into small pieces.

  • Percutaneous nephrolithotripsy

The method is applied on large kidney stones or stones not treatable with extracorporeal lithotripsy.

It is conducted through an incision on the skin which extends all the way to the kidney.

The nephroscope is inserted through the incision, and the stone is broken down into small fragments, using various energy sources.

  • Open surgery

Today, open surgery is less common and is used only in complex cases.

Prostate cancer treatment

The therapeutic option is determined by taking into consideration the age, disease stage, life expectancy, overall health status and personal choices of the patient.

The most significant factor in opting for a treatment is the stage and aggressiveness of the disease.

The treatment options are:

  • Radical prostatectomy
  • Radiotherapy
  • Hormonal therapy

Bladder cancer treatment

It depends on the stage of the disease, the aggressiveness of the cancerous cells and the overall health status of the patient.

  • For superficial tumors

The treatment comprises transurethral resection of the tumor. Next, the tumor tissue specimens are sent to the pathologist for examination.

A complementary intravesical therapy may be required, either with chemotherapy or immunostimulant agents.

  • For infiltrating tumors at an advanced stage

Radical cystectomy and urinary diversion are required.

After the surgery, if a lymph node disease is identified, systemic therapy is required.

In patients whose overall health status does not allow for a cystectomy or who are unwilling to undergo a surgical procedure, a combination of transurethral resection, chemotherapy and radiotherapy is applied.

Renal cancer treatment

This depends on the stage of the disease, tumor size, patient age and overall health status.

The treatment options are:

  • Tumors measuring less than 4cm are treated with partial nephrectomy (resection of a part of the kidney)
  • With larger tumors, radical nephrectomy is recommended
  • With advanced or metastatic disease, immunotherapy is recommended
  • Radiotherapy is applied as a palliative treatment to reduce the pain in patients with metastases

Renal pelvis and ureter cancer treatment

Surgical treatment is recommended

The kidney is removed along with the ureter.

In special cases, renal pelvis-ureter cancer can be treated:

  • Endoscopically with ureteroscopy–laser-assisted resection
  • Partial surgical resection of the ureter

Testicular cancer treatment

The affected testicle is surgically removed.

The surgical procedure can be effective, provided the disease is at an early stage and has not spread.

In cases of metastatic disease, radiotherapy or chemotherapy may be used.

Erectile dysfunction treatment

Many treatment options are available for erectile dysfunction.

Education and evaluation of the couple

An integral part of the treatment process is the understanding of the situation and its consequences.

The urologist may recommend a combination of medication and psychological approaches.

If you are in a relationship, it helps if your partner consents to the treatment option and knows how it works.

You should also bear in mind that treatment depends on your own status.

What may be helpful to others may be inappropriate in your case.

Advice on lifestyle changes

Improving your overall health status may help improve your symptoms.

To achieve that, you should:

  • quit smoking
  • drink less alcohol
  • exercise regularly
  • Adjusting the diet (diet low in sugar, salt and fatty food)

Medications

  • Phosphodiesterase type 5 inhibitors (PDE 5 inhibitors)

PDE 5 inhibitors are a drug class used in the treatment of erectile dysfunction.

These drugs relax the smooth muscle fibers of the penile vessels and induce increased blood flow.

They do not cause erection without sexual stimulation.

There are 4 types of approved drugs:

– sildenafil (VIAGRA)

– tadalafil (CIALIS)

– vardenafil (LEVITRA)

– avanafil (SPEDRA)

The above drugs are the most commonly used in the treatment of erectile dysfunction and are all equally effective

The applicability of each drug to a specific patient depends on the frequency of sexual activities and personal experience in the use of it.

Given the success of these drugs in the treatment of erectile dysfunction, many counterfeit drugs have flooded the market; they are not approved and they may even harm you.

  • Contraindications for PDE 5 inhibitors:

The use of these drugs is not recommended if you are on nitrates or alpha-blockers, because they cause low blood pressure.

Vacuum erection devices (penis pumps)

A vacuum erection device has a cylindrical shape and comes with a rubber or silicone ring which constricts at the base of the penis.

Such a device can help you achieve and maintain erection.

  • When vacuum erection device is not recommended – Contraindications

The device is contraindicated if you use medications for blood clotting (anticoagulants) or if you suffer from a blood clotting disorder.

  • Vacuum erection device side effects

They may cause some discomfort, difficulty in ejaculating and experiencing orgasm, skin bruises and numbness on the penis.

If you leave the ring at the base of the penis for more than 30 minutes, it may result in severe damage to the skin of the penis.

Shockwave erectile dysfunction treatment

A shockwave treatment is a therapeutic procedure in which targeted low-frequency shockwaves are directed onto the penis to improve erection.

The treatment requires many sessions and may be repeated, if necessary.

Shockwaves have been the subject of investigation as a new treatment option in erectile dysfunction.

Shockwave treatment is opted, in case you suffer from mild erectile dysfunction and you cannot or do not wish to receive any medications (PDE 5 inhibitors).

Intracavernosal injections

Another treatment option for erectile dysfunction.

A drug is injected into the spongy tissue of the penis to provoke vascular dilation.

Intracavernosal injections are opted for when all previous treatments, e.g. lifestyle changes or oral drugs, have proven ineffective.

Although most men are squeamish at the idea of a needle being inserted into their penis, more and more opt for this treatment, acknowledging the advantages of the procedure, and overcoming the discomfort from the inserted needle.

Penile prosthesis placement

If all the aforementioned therapies fail, a penile prosthesis procedure may be advised.

This constitutes a permanent solution, and it delivers very good outcomes and high patient satisfaction score.

Premature ejaculation treatment

Treatment is varied and depends on the type of premature ejaculation (primary, secondary).

In cases where it is caused by another disease (secondary premature ejaculation), such as chronic prostatitis or hyperthyroidism, then treating the underlying disease will help solve the problem.

Primary premature ejaculation is treated with medication and psychosexual treatment sessions.

Phimosis treatment

Treatment may be conservative or surgical.

  • Conservative treatment

Recommended during the early stages of the disease, when the foreskin is still elastic.

Hydrocortisone creams are applied for 20 to 30 days.

Improvement occurs after the second week of application.

  • Surgical management

When scar tissue has formed on the foreskin, medication is not effective and a surgical procedure, referred to as circumcision, is required.

In this procedure, which is conducted under anesthesia, the affected part of the foreskin is removed and suturing is performed according to plastic surgery standards.