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Clinical Specialties - Urology

Urological Conditions We Treat

Urology is a specialty area of medicine that deals with diseases of the male and female urinary tract (bladder, kidneys, ureters and urethra). It also deals with the male reproductive organs. A urologist is a doctor who has undertaken additional specialised education and training in the study of urology and of diseases and conditions of the urinary tract. To find a Urologist who practices at the San, please use our Find a Specialist search function.


Bladder Conditions We Treat

Many people have problems with bladder control (incontinence) at various times of their lives. It becomes a greater problem as we age; however, one in three women who have had a baby may experience bladder control issues.

The urinary bladder is a muscular sac in the pelvis, just above and behind the pubic bone. Urine exits the bladder into the urethra, which carries urine out of the body. Any unexpected leaking of urine from the bladder is not normal and in most cases often a simple lifestyle change or treatment can help to cure, improve or manage it, no matter what the cause. Some of the bladder conditions that San urologists treat are detailed below.

Bladder Cancer

Cancer of the bladder occurs when abnormal cells in the bladder grow and divide in an uncontrolled way. The most common form - ‘urothelial’ cancer - formerly known as transitional cell carcinoma, represents between 80-90 percent of bladder cancer cases and starts in the cells in the bladder wall’s innermost layer. The cause of bladder cancer is not known (but it is strongly associated with cigarette smoking) and there is currently no way of screening for it. The main symptom of bladder cancer is blood in the urine, which usually occurs suddenly and is generally not painful. A range of diagnostic tests are done to determine the extent of the cancer and a variety of treatment options may be available based on the diagnosis.

Urinary Incontinence

Urinary incontinence is widely known as a loss of bladder control and is a common and often embarrassing problem. The severity ranges from occasionally leaking urine when you cough or sneeze to being so urgent and sudden that you cannot make it to the toilet in time. Urinary incontinence is not something that you just have to deal with. If it affects your daily life and is getting you down, don't hesitate to see your doctor. Your doctor may then refer you to a urologist. For most people, simple lifestyle changes or medical treatment can ease discomfort or stop urinary incontinence altogether.

Interstitial Cystitis and Pelvic Pain

Interstitial Cystitis (IC) or Painful Bladder Syndrome (PBS) is a chronic bladder condition which refers to pain, pressure or discomfort within the urinary bladder. It is difficult to diagnose with symptoms often including an urgent need to urinate, pain if urination is delayed and a frequent need to urinate or a combination of symptoms. If some of these symptoms last for more than six weeks and have not responded to medication for other identifiable causes then IC/PBS may be diagnosed. Symptoms may disappear with treatment or without explanation, but sometimes can return days, weeks, months or years later. IC/PBS can be associated with irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome and other pain syndromes. It is felt to fall under the larger entity – chronic pelvic pain syndrome.

Neurogenic Bladder

Neurogenic bladder is the name given to bladder dysfunction in people who lack bladder control due to a brain, spinal cord or nerve problem. This could be as a result of diseases such as multiple sclerosis (MS), Parkinson's disease or diabetes or by infection of the brain or spinal cord, stroke, spinal cord injury, or major pelvic surgery. Nerves in the body control how the bladder stores or empties urine and problems with these nerves can cause overflow incontinence, frequency, urgency, urge incontinence, and retention. Neurogenic bladder is a serious condition, but with appropriate treatment and close monitoring, patients can see large improvements in their quality of life. Specific treatment for neurogenic bladder will be decided by your urologist.

Overactive Bladder

Overactive bladder is characterised by the sudden urge to urinate more frequently than required. Treatment can involve bladder training techniques, lifestyle changes, exercises, medication or neuromodulation. Your urologist will discuss an appropriate course of action for you.

 

Kidney and Adrenal Conditions We Treat

Adrenal Glands

Adrenal glandsThe adrenal glands located at the top of each kidney produce hormones; two of the most important hormones being cortisol and aldosterone. These hormones help the body control blood sugar, burn protein and fat, deal with stressful times such as major illness and injury and regulate blood pressure. The adrenal glands also produce small amounts of sex hormones called androgens, as well as a range of other hormones. Adrenal disorders are generally caused by too much or too little of a particular hormone and are treatable over the long-term.

Cystic Disease

A cyst is a sac-like pocket of tissue that contains fluid, air, or other substances. Cysts can grow almost anywhere in your body or on your skin. Cystic kidney disease is a group of diseases that cause abnormal pockets of clear, watery fluid (cysts) to form in the kidneys. Cystic kidney diseases include polycystic kidney disease, medullary cystic disease and medullary sponge kidney. The cysts interfere with normal kidney function and may cause kidney failure. Having a cyst on your kidney does not automatically mean that you have cystic kidney disease. Having one or more cysts on your kidney is common, especially in older people, and may not require treatment.

Infections

Kidney infection can occur when a urinary tract infection (UTI) that started in your urethra or bladder has not been treated early and travels up into your kidneys. A kidney infection requires prompt medical attention. If not treated properly, a kidney infection can permanently damage your kidneys, or the bacteria can spread to your bloodstream and cause a life-threatening infection. Kidney infection treatment usually includes antibiotics and often requires hospitalisation.

Kidney Cancer

Kidney cancer is the seventh most common type of cancer diagnosed in men and the eleventh most common in women. It is also referred to as renal cancer and is a disease in which kidney cells become malignant (cancerous) and grow out of control, forming a tumor. Almost all kidney cancers first appear in the lining of tiny tubes (tubules) in the kidney. This type of kidney cancer is called renal cell carcinoma, which accounts for approximately 90 percent of all cases. Usually only one kidney is affected, but in rare cases the cancer may develop in both kidneys. Treatment will vary based on the diagnosis, however, the main treatment for kidney cancer is surgery, either by itself or with radiotherapy and/or chemotherapy.

Stones

Kidney stones are relatively common with one in ten people having a kidney stone over the course of their lifetime. There is no single cause, however a range of factors may play a role in their development with the leading contributing factor being insufficient water consumption. Kidney stones generally form as a result of a build-up of a substance such as calcium, ammonia or uric acid in the body. The kidney stones may be small and pass unnoticed out of the urinary tract, but they may also cause extreme pain upon exiting. Kidney stones that remain inside the body can lead to many conditions, including severe pain and ureter (the tube connecting the kidney and bladder) blockage that obstructs the path urine uses to leave the body. Your specialist will determine the best course of treatment based on the size of the stone/s and its location.

 

Paediatric Urology Conditions We Treat

The San offers a range of children’s or paediatric urology services as well as paediatric urology specialists. Some of the services offered include the following:

Bed-wetting

Bed wetting (also called nocturnal enuresis) is a common occurrence in children with approximately 1 in 5 wetting the bed. It happens when the bladder empties without a child’s knowledge whilst they sleep. It can be a distressing experience for parents and children, with children often feeling a sense of embarrassment or guilt. Day time dryness will come first, but if your child is still wetting the bed once they have started school then there may be an underlying problem that should be discussed with a paediatric urologist.

Hydrocele / Hernia

Approximately 10 percent of male infants have a hydrocele at birth. For others, they can develop with swelling or injury of the scrotum. If a small part of the intestine drops into the scrotum with the testes then a hernia can occur.

Hypospadias

Hypospadias is a condition in which the opening of the urethra is on the underside of the penis, instead of at the tip. Parents may feel distressed if their son is diagnosed with hypospadias, however hypospadias is common and doesn't cause difficulty in caring for your infant. In fact, surgery usually restores the normal appearance of your child's penis and with successful treatment, most males can eventually have normal adult sexual function.

Kidney / Bladder Birth Defects

Birth defects are more common in the kidney and urinary system than in any other system of the body. Defects can develop in the kidneys, the tubes that transport urine from the kidneys to the bladder (ureters), the bladder, or the tube that expels urine from the bladder (urethra). Any birth defect that blocks or slows the flow of urine can cause urine to stagnate, which can result in infections or the formation of kidney stones. Many defects do not present any obvious symptoms, but others cause blood in the urine, urinary tract infections, or kidney stones. If your child shows any of these symptoms then seek the advice of a paediatric urologist.

Kidney Disease
Detecting kidney disease in adults is difficult, making diagnosis in adolescents or children even more so, due to the nature of the causes and ambiguity of the symptoms. In adults it is generally related to renal disease caused primarily by diabetes or hypertension, however in children it is generally associated with tubulointerstitial disease and the lack obvious symptoms trickier to diagnose. Adding to this difficulty, children might not be aware of some of the changes that are impacting their body and will not always let their parents know of potential issues. Some of the common symptoms for children are swelling (even mild) of the hands and feet and/or puffiness around the eyes caused by excess fluid build-up, to the point where the child’s ability to move around normally is compromised, as well as loss of appetite and decreased or increased frequency of urination. If your child exhibits any of these symptoms then speak to a specialist doctor.
Undescended Testicles

As a baby boy grows inside his mother's womb, his testicles typically form inside his abdomen and move down (descend) into the scrotum shortly before birth. But in some cases, that move or descent doesn't occur, and in these instances this condition is known as undescended testicles (or cryptorchidism). Treatment can include hormone injections to prompt the testicles to descend, although surgical correction is the preferred treatment and is advisable prior to two years of age.

 

Female Urology

Female urology is a sub-specialty of urology that focuses on the diagnosis and treatment of women’s urological conditions. These conditions are specific to females due to their unique anatomy and reproductive system. San specialists are experienced in treating the following conditions.

Complex Vaginal and Urethral Reconstruction

Complex urethral-vaginal surgery is primarily performed to restore function and often appearance to a sensitive and complicated region of the female anatomy to allow the patient to enjoy a full and healthy life. Reasons for needing vaginal and urethral reconstruction could include women who have suffered physical trauma to the region, women with vaginal wall prolapse, those born with birth defects affecting the area and possibly also cancer patients who have undergone extensive surgery or radiation treatment that has impacted on the reproductive system and urinary tract.

Vaginal Prolapse

Vaginal prolapse is a type of pelvic floor prolapse in which the muscles of the vagina are weakened and allow other pelvic organs such as the bladder, uterus or bowel to push into the vaginal wall. There are various types of vaginal prolapse, with the main cause of prolapse being pregnancy and birth, though a number of other factors such as family history, lifestyle and certain medical conditions can also cause prolapse. Treatment will differ depending on what organ has moved and how far, age and family history and whether or not you still want to have more children. Talk to your specialist about your options.

Interstitial Cystitis & Pelvic Pain

Interstitial cystitis is also more commonly known as painful bladder syndrome, is a chronic condition causing bladder pressure, bladder pain and sometimes pelvic pain. The pain ranges from mild discomfort to severe. With interstitial cystitis, the message to the brain that your bladder is full and you need to urinate gets mixed up and you often feel the need to urinate more regularly and with smaller volumes of urine than most people. The condition generally affects women and whilst there is no cure, there are a range of medications and therapies that you should discuss with your specialist that can greatly assist.

Urinary Incontinence

Urinary incontinence, or the involuntary leakage of urine, is a medical problem that can be treated or cured, and is not something you have to live with. There are several different types of incontinence, each with a different cause. These include stress incontinence which occurs with physical activity, urge incontinence (also called “overactive bladder”), overflow incontinence which is the involuntary loss of urine once the bladder has reached maximum capacity, mixed incontinence which involves a combination of both stress and urge incontinence, total incontinence (total loss of urine control) and urogenital incontinence which occurs as a result of some form of vaginal prolapse. Many women think they just have to learn to live with this embarrassing issue; however, there are a number of solutions available to deal with this problem that should be discussed with your urologist.

Urinary Tract Infection

Many women suffer from recurring urinary tract infections (UTIs), otherwise known as chronic UTIs. Chronic UTIs are defined as having at least two infections in six months or three infections in one year. Generally a UTI is caused by bacterial infection, with each new infection caused by a different strain of bacteria. Symptoms of UTIs include frequent or intense urges to urinate; pain or burning sensation when urinating and milky, cloudy or reddish-brown urine. More severe symptoms may also include fever or chills, pain in the back or side, nausea and vomiting. If you find you are continually getting UTIs , then it is best to discuss this with your urologist to determine whether there is a curable or manageable cause.

 

Male Urology and Reproduction

Urologists treat a range of conditions that affect males, including treatment for many reproductive problems. Whilst many males find talking to doctors about urological or reproductive problems difficult or embarrassing, it is important to remember that they deal with these types of problems all the time and you will feel greatly relieved if you can get some comfort, relief or a cure to a condition that you are experiencing. Below are a range of the conditions that we treat at the San. Please talk to your doctor if you are experiencing any urological issues and get them to refer you to one of our San specialists.

Male Urology

Hydrocele / Spermatocele

A hydrocele is a painless buildup of watery fluid around one or both testicles that causes the groin area to swell. This swelling may be unsightly or uncomfortable, but it is usually not painful and generally is not dangerous. A spermatocele is similar in that it is a buildup of watery fluid, however, it develops in the epididymis — the small, coiled tube located on the upper testicle that collects and transports sperm. Non-cancerous and generally painless, a spermatocele is usually filled with milky or clear fluid that might contain sperm. Hydroceles and spermatoceles often do not require treatment and may reduce and go away by themselves, however it is recommended that each case is discussed with a urologist to determine the best cause of treatment.

Hypospadias

Hypospadias is an abnormality of the urethra and penis that is present at birth and is where the urinary opening is not at the usual location on the head of the penis. This can cause problems with passing urine and also with erections. It can range in severity. Surgical correction is usually very successful and treatment should be discussed with a urologist.

Incontinence

Urinary incontinence is defined by the unintentional loss of urine. This could be a result of weak or damaged bladder muscles; overactive bladder muscles, certain prostate conditions, and nerve damage are just some of the possible underlying causes of urinary incontinence in men. If you are having difficulty with incontinence then it is recommended that you seek advice from a urologist who can prescribe the best course of action.

Infections

Whilst urinary tract infections are less common in males than females, they can still occur and are caused by bacteria that gets inside your urinary tract. Most bacteria that enter your urinary tract are expelled when you urinate. If the bacteria stay in your urinary tract, you may get an infection. Your urinary tract includes your kidneys, ureters, bladder, and urethra. Urine is made in your kidneys, and it flows from the ureters to the bladder. Urine leaves the bladder through the urethra. A UTI is more common in your lower urinary tract, which includes your bladder and urethra. A urinary tract infection will require antibiotics as a minimum course of treatment, but discuss all symptoms with your doctor who will recommend the best treatment for you.

Penile Cancer

Penile cancer is a form of cancer that affects the skin and tissues of the penis. It is fairly rare in the western world, however, if you notice and change to your penis, consult a doctor as soon as possible for advice.

Penile Curvature

Curvature of the penis is an abnormal bend in the penis that occurs during erection. It can also be called Peyronie's disease and should be discussed with your doctor.

Testicular Cancer

Testicular cancer, or cancer of the testes, occurs in the testicles (testes), inside the scrotum. The scrotum is a loose bag of skin under the penis. It is the second most common cancer in young men (aged 18 to 39). Testicular cancer may cause no symptoms. The most common symptom is a painless swelling or a lump in a testicle. If you have any concerns, then visit your doctor for further evaluation.

Testicular Torsion

Testicular torsion occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum. The reduced blood flow causes sudden and often severe pain and swelling. Testicular torsion usually requires emergency surgery. If treated quickly, the testicle can usually be saved.

Undescended Testicles

Testes (testicles) are male sex glands. They produce sperm and hormones for sexual reproduction. When the testes (one or both) do not move down into the scrotum it is called 'undescended testes'. It is also known as Cryptorchidism. Undescended testes (one or both) are not uncommon in new born boys, but will generally resolve itself within the first few months of life. If left untreated it could result in fertility issues and should be discussed with your doctor.

Urethral Strictures

Urethral stricture is an abnormal narrowing of the tube that carries urine out of the body from the bladder (urethra). It can cause decreased urine output. It is usually due to tissue inflammation or the presence of scar tissue. Scar tissue can be a result of many factors. Symptoms can include weak urine flow or a reduction in flow, pain or burning sensations and swelling amongst a range of other symptoms. If you are concerned that this could possibly be an issue, then consult your doctor.

Prostate

Benign Prostatic Hyperplasia (BPH)

Benign prostatic hyperplasia (BPH) is an enlarged prostate gland . The prostate gland surrounds the urethra, the tube that carries urine from the bladder out of the body. As the prostate gets bigger, it may squeeze or partly block the urethra. This often causes problems with urinating. BPH is non-cancerous and treatable. Symptoms include frequent urinating, frequent urge to urinate, getting up at night to urinate, difficulty urinating and dribbling of urine. Medical and surgical approaches are available to treat BPH. For more information on surgical treatments for BPH refer to information contained in our Prostate Centre section.

Prostate Cancer

For detailed information on Prostate Cancer, refer to our detailed material under Prostate Centre.

Prostatitis

Prostatitis and related pelvic pain conditions involve pain in and around the prostate. In most cases, you feel pain because of a prostate infection, inflammation or some other problem. Prostatitis can occur in men of all ages and symptoms generally include trouble urinating, pain in the bladder, testicles and penis and trouble and pain with ejaculation. The treatment for prostatitis depends on the type you have but it is generally treated with antibiotics.

Male Reproduction

Infertility

Male infertility refers to a male's inability to cause pregnancy in a fertile female. In humans it accounts for almost half of infertility problems. Generally the cause is due to quantity and quality of a male’s sperm. There are a range of options available to explore so that pregnancy can happen naturally and these are best discussed with your specialist doctor.

Sperm Banking

Sperm banking is the name for the collection and storage of semen. Semen is the fluid that contains sperm. Sperm banking is also known as sperm cryopreservation or semen storage. Some cancer treatments can affect men's fertility so that they are not able to father children afterwards and in these cases it can be useful to store some sperm prior to treatment. There are a range of other reasons including the fact that you may be reaching advanced reproductive age, might have a hazardous occupation or be about to undergo major surgery and would like to ensure that you have some sperm ‘banked’, just in case.

Varicoceles

A varicocele is an enlargement of the veins within the scrotum (the bag that contains the testes). They are similar to varicose veins of the leg. It's not certain what causes varicoceles, however, many experts believe a varicocele forms when the valves inside the veins in the cord prevent your blood from flowing properly. The resulting backup causes the veins to widen (dilate). This may then result in damage to the testicle and result in worsened fertility. Varicocele treatment may not be necessary. However, if your varicocele causes pain, testicular atrophy or infertility or if you are considering assisted reproductive techniques, you may want to undergo varicocele repair. Discuss your options with your specialist doctor.

Vasectomy and Vasectomy Reversal

A vasectomy is an operation designed to sterilise a man by cutting the tubes that allow sperm to leave the testicles. A man's sex drive, production of sex hormones and ability to reach orgasm are all unaffected. A vasectomy reversal is an operation that attempts to undo the vasectomy to allow the male to produce sperm and have the ability to father a child.

 

Sexual Dysfunction

Many San urologists have sub-specialties and experience in treating a range of conditions associated with sexual dysfunction. These include some of the following:

Androgen Deficiency (Low Testosterone)

Androgen deficiency means the body has lower levels of male sex hormones, particularly testosterone, than is needed for health. Causes of androgen deficiency can include problems and conditions of the testes, pituitary gland and hypothalamus. Androgen deficiency or low testosterone can lead to a range of symptoms from low sex drive to depression. Is treatable with testosterone replacement therapy and should be discussed with your specialist doctor.

Erectile Dysfunction

Erectile dysfunction (impotence) is when a man is unable to get and/or keep an erection that allows sexual activity with penetration. It can often have psychological consequences as it can be tied to masculine self-image and impact on relationships. The main organic causes of impotence are from cardiovascular disease and diabetes, neurological problems (for example, trauma from prostatectomy surgery), hormonal insufficiencies (hypogonadism) and drug side effects. Psychological impotence is where erection or penetration fails due to thoughts or feelings (psychological reasons) rather than physical impossibility; this is somewhat less frequent but can often be helped. In both cases, there are treatments available from drugs to injections to surgery, all of which should be discussed with your urologist.

Female Sexual Dysfunction

Many women experience problems with sexual function at some point, however, persistent, recurrent problems with sexual response, desire, orgasm or pain that distress you or put a strain on your relationship with your partner are known medically as female sexual dysfunction. If you are experiencing any of these, then you should talk to a specialist doctor who could assist in prescribing an appropriate treatment.

Premature Ejaculation

Premature ejaculation is the most common male sexual problem and affects men of all ages. It happens when a man is unable to control the timing of ejaculation, and ejaculates before he and/or his partner feels ready and this causes distress. There are several treatments available from sex therapy, to gels to reduce penile sensation, oral medicines and erectile dysfunction treatments (if erectile dysfunction is also a problem). Your doctor may refer you to a specialist such as a urologist.

Peyronie’s Disease

Peyronie’s disease is a form of erectile dysfunction that causes a bend in the penis that can make an erection quite painful. The condition may develop after trauma to the penis which produces subsequent scar tissue buildup. This scar tissue can generally be felt through the skin. Plaque normally forms on the upper side of the penis, but may also occur on the bottom or side. There is no cure for Peyronie’s disease, but it is treatable and may go away on its own. Speak to your doctor about appropriate medications.

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Sydney Adventist Hospital Clinical Specialties and Services