Urology

Your Health, Your Hospital

Also known as genitourinary surgery, urology is the branch of medicine that focuses on the surgical and medical treatment of the human urinary tract system's and the male reproductive organs' disorder.

A Vital Discipline

Urologic conditions are common and often serious, making our job crucial. We care deeply about helping every patient thrive

The Future, Today

With robotic surgery technology, urologists can combine the best of both worlds — a surgeon’s expertise with superhuman precision

Wide-ranging Expertise

Our specialists have extensive experience treating patients across the entire range of urology subspecialties

In recognition of the wide scope of urology, the American Urological Association has identified 7 subspecialty areas:

  • Calculi (urinary tract stones)
  • Female Urology (urinary incontinence and pelvic outlet relaxation disorders)
  • Male Infertility
  • Neurourology (voiding disorders, urodynamic evaluation of patients and erectile dysfunction or impotence).
  • Pediatric Urology
  • Renal Transplantation
  • Urologic Oncology (cancer)

A urologist is required to possess vast knowledge of internal medicine, pediatrics, gynecology, and other specialties because of the wide variety of clinical problems encountered when treating patients. Urologists undergo a very rigorous post-graduate surgical training period for a minimum duration of 5 years, of which one year must be completed in general surgery and 3 years must be completed in clinical urology. The remaining 12 months are spent in general surgery, urology or other clinical disciplines relevant to urology.

There are many urologic disorders and diseases, which involve congenital or acquired dysfunction of the urinary system. Diseases of other bodily systems also have a direct effect on urogenital function. The diagnosis and therapy of urinary incontinence constitute a significant portion of most urology practices. The following are a selection of some of the diseases identified by the American Urological Association Foundation (AUAF) as common:

  • benign prostatic hyperplasia (BPH)
  • incontinence
  • urinary tract infections (UTIs)
  • kidney and ureteral stones
  • prostate cancer
  • bladder cancer
  • bladder prolapse
  • hematuria (blood in the urine)
  • erectile dysfunction
  • interstitial cystitis (“painful bladder syndrome”)
  • overactive bladder
  • prostatitis (swelling of the prostate gland)
  • non-renal urinary tract disease
  • urological cancers

New therapies, both surgical and non-surgical, are being constantly developed for treating a wide array of urologic problems. A few of the most common causes for urologic disorders and diseases include:

  • diabetes
  • weak bladder muscles
  • overactive bladder
  • weak sphincter muscles (muscles supporting the urethra)
  • enlarged prostate
  • diseases including Parkinson’s and multiple sclerosis
  • injury to the spinal cord
  • pregnancy or childbirth
  • urinary tract infections
  • constipation

In some cases, simple measures can be enough to address the problem, but if these approaches prove ineffective, your doctor may suggest surgery to correct the underlying cause.

Common tests performed in diagnosing urologic diseases include:

Biopsy

  • a piece of tissue is obtained and sent to a pathologist to determine if cancer is present
  • prostate biopsies are commonly performed
  • ultrasound guidance is used when obtaining a piece of tissue
  • the rectum is locally anesthetized before the urologist takes several cores of prostate tissue with a biopsy needle
  • other biopsies are also usually performed, such as those from the bladder

Blood Tests

  • used in order to determine the health of the urinary system
  • some of the more commonly performed tests are the creatinine, PSA, BUN and testosterone
  • the PSA is a test that helps to detect prostate cancer
  • the creatinine and BUN help assess kidney function
  • testosterone is important when evaluating male erectile dysfunction

CT Scan

  • computerized tomography and is an x-ray technique that is much more sensitive than regular x-ray
  • it helps diagnose a variety of urologic disorders, such as stones, tumors and cysts

Cystoscopy

  • this procedure is used to look inside a patient's bladder
  • a local anesthetic is used to numb the urethra
  • the urologist inserts a small telescope-like instrument into the bladder and fills the bladder with some water while examining the urethra, the prostate in men and the inside of the bladder
  • bladder tumors, other abnormalities of the bladder wall and stones are some of the conditions that can be observed with cystoscopy

Cytology

  • used to look for cancer cells in the urine
  • a urine specimen is sent to a lab for the pathologist to examine for the abnormal cells

Digital Rectal Exam

  • digital rectal exam (DRE) is an exam of the prostate gland and is used to measure the size and feel the texture of the prostate
  • the urologist inserts a gloved and lubricated finger into the rectum and feels the prostate

Post Void Residuals

  • It is often important to know about residual urine following surgery or when evaluating the patient's bladder for obstruction, especially from an enlarged prostate
  • a brief ultrasound study of the bladder After a patient urinates can show how much urine is left in the bladder

(Prostate Specific Antigen) PSA

  • PSA is a substance released from the prostate tissue and can be measured by a simple blood test
  • elevated levels of antigen in the blood can indicate prostate cancer and/or inflammation of the prostate

Semen Analysis

  • semen analysis is done as a first step in determining male infertility and is done after a vasectomy
  • the semen sample is examined for the presence of sperm and the motility and quality of the sperm

Stone Evaluation

  • the analysis of the stone composition can determine if future stones can be possibly prevented with medication or with dietary changes
  • urinary tract stones are analyzed in a laboratory after they are either passed by the patient or removed surgically

Other tests used in urology include:

  • ultrasound
  • urine flow study
  • urine tests
  • urodynamics testing
  • x-ray tests (KUB, IVP and VCUG)

This table shows the most common treatment methods used for a few disorders that we normally encounter in our patients.

Urologic Disorder

Treatment Method

Benign Prostatic Hyperplasia (BPH)

- Your doctor may choose to just monitor this condition or prescribe medications like alpha-blockers for treatment;

- It may also be treated with surgery if it is severe

Bladder Prolapse

- Avoid heavy lifting or straining;

- A pessary is placed within the vagina to hold the bladder in place;

- Estrogen replacement therapy

Hematuria

- No specific treatment, but your doctor will focus on treating the underlying condition that causes blood to appear in your urine;

- Taking antibiotics to clear a urinary tract infection;

- Prescription medication to shrink an enlarged prostate;

- Shock wave therapy to break up bladder or kidney stones;

- No treatment is necessary If the underlying condition is not serious

Incontinence

- Controlling fluid intake can be enough to address the problem;

- Surgery may be performed to correct an underlying cause

Interstitial Cystitis

- There is no simple treatment to eliminate the signs and symptoms of interstitial cystitis;

- No one treatment works for everyone;

- Various treatments or combinations of treatments will be required before you find an approach that relieves your symptoms;

- Physical therapy;

- Oral medications (nonsteroidal anti-inflammatory drugs; tricyclic antidepressants; antihistamines; pentosan);

- Nerve stimulation (transcutaneous electrical nerve stimulation (TENS); sacral nerve stimulation);

- Bladder distention;

- Medications instilled into the bladder;

- Surgery (fulguration; resection; bladder augmentation)

Kidney and Ureteral Stones

- Many people end up expelling these stones from the body without medical help;

- Surgery may be needed in some cases (shock wave lithotripsy)

Male Urological Conditions

- Antibiotics;

- Prescription medication;

- Surgery

Non-Renal Urinary Tract Diseases

- Antibiotics;

- Pain-relieving medication;

- Use a hot-water bottle to ease pain;

- Drink plenty of water;

- Avoid coffee, alcohol, and spicy foods, all of which irritate the bladder;

- Quit smoking (smoking irritates the bladder and is known to cause bladder cancer)

Overactive Bladder

- Bladder training;

- Pelvic floor exercises;

- Avoiding drinking caffeine or a lot of fluids before activities;

- Not drinking fluids right before you go to bed;

- Taking anticholinergics;

- Botox injections in the bladder muscle to relax it;

- Tricyclic antidepressants

Urinary Tract Infections (UTIs)

- Antibiotics can usually clear up most UTIs within a few days

Urological Cancers

- Chemotherapy;

- Radiation treatment in some cases;

- Surgical treatments;

- Immunotherapy;

- Targeted therapy;

- Active surveillance

New therapies, both surgical and non-surgical, are being constantly developed. Much recent research effort has evolved in the area of laparoscopic surgery. Many urologic operations can now be performed through the laparoscope and with the help of the da Vinci technology. The development of new cancer chemotherapeutic agents has significantly altered therapy for some urologic cancers.

If you have been diagnosed a urologic condition and surgery is imminent, ask your surgeon about the da Vinci surgery. As a result of da Vinci technology, da Vinci surgery for urologic conditions offers the following benefits:

  • low rate of complications
  • precise removal of cancerous tissue
  • low blood loss
  • low conversion rate to open surgery
  • quick return of bowel function
  • better cosmetic result compared to open surgery
  • quick return to a normal diet
  • short hospital stay

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Frequently Asked Questions

Urinary incontinence is the loss of bladder control, resulting in urine leaking or abnormally strong urges to get to a toiled.

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The Kegel method is a type of physical exercise that strengthens the pelvic muscles and the urethra.

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Yes, a making lifestyle improvements can have a beneficial effect on your urological health.

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Waking up at night repeatedly to urinate can be a sign of urinary illness, but it also depends on how many liquids you drank before going to bed.

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Urinary tract infections can be prevented by increasing the genital hygiene and by practicing safer sex.

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Faisal Ahmed, M.D.

Faisal Ahmed , M.D.

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Sameer Malhotra, M.D.

Sameer Malhotra , M.D.

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Thomas Johnson, M.D.

Thomas Johnson , M.D.

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Sepehr Nowfar, M.D.

Sepehr Nowfar , M.D.

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Shahrad Aynehchi, M.D.

Shahrad Aynehchi , M.D.

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Ernest Agatstein, M.D.

Ernest Agatstein , M.D.

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Nickolas Tomasic, M.D.

Nickolas Tomasic , M.D.

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Lawrence Paletz, M.D.

Lawrence Paletz , M.D.

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George Yamauchi, M.D.

George Yamauchi , M.D.

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Karyn Eilber, M.D.

Karyn Eilber , M.D.

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