Categories: Urology

Urological Problems in Men

Though there are many common urological problems that concern both males and females, some are unique for only males. Urology deals with the field of surgical intervention of kidneys, ureters, urinary bladder, testis, prostate and penis whereas a nephrologist is in charge of medical management of kidneys. This difference is significant and people seem to live in oblivion. There are many occasions when males need to consult a urologist.

Most common of these are probably related to the prostate.  These may include prostatitis (infection in prostate) which is to be dealt with antibiotics. Prostatitis may follow a waxing and waning course and may be frustrating to treat as antibiotic penetration in the prostate is difficult. One may be harbouring benign enlargement of the prostate as the age advances and may have symptoms like difficulty in passing out urine, increased urinary frequency and slowing of the urinary stream. These are dealt with medicines in the majority of cases with endoscopic surgery being required albeit in a low number of men. Above mentioned conditions are innocuous. However prostatic cancer may not be so innocuous especially when diagnosed in the late stages. Beware especially if there is a positive family history of prostatic cancer and consult your urologist timely to discuss the varied management options including radical surgery, chemo/hormonal and radiotherapy.

Another set of common and ever-increasing male problems is the gamut of infertility. These problems are on a rise because of the stressful nature of current jobs and fast-paced life. These may include varicose veins whose only effective treatment is surgical if the problem is interfering with the effective production of sperms, erectile dysfunction which may be treated with appropriate lifestyle modifications and medicines. With advancing age comes the complex problem of late-onset male hypogonadism or andropause as it is more commonly known. Associated with it are psychological markers of depression and frequent mood swings. This might be correctable with testosterone supplementation and adequate focus on maintaining bone health. Peyronies disease (plaque in the penis) and Chordee (abnormal penile curvature) might be indirectly contributory to male factor infertility and an Andrologist (sub-specialization) should be promptly seen for corrective surgeries.

Many males may be interested in adopting Birth Control measures apart from barrier methods. Vasectomy is the solution to it and it is also a prerogative of urologist to perform such surgeries which are daycare procedures without major cut on the body (no-scalpel vasectomy). Many of you may be interested in the reversal of vasectomy. This may sound a complex surgery but can be easily done by an andrologist under microscopic magnification.

Another common set of diseases involve the penis and can be classified as congenital (problems a male child is born with) or acquired (which come later in life). The most common congenital condition being hypospadias in which the urinary opening is situated on the undersurface of the penis and may require staged surgeries for correction depending on the degree of abnormality. Balanoposthitis refers to infection of the glans penis and inside surface of the foreskin. It is a common occurrence in uncontrolled diabetics and may require antibiotics and circumcision (surgery to remove foreskin) in refractory cases. It is imperative to maintain good genital hygiene and properly control blood sugars in order to stay away from this largely avoidable menace. Phimosis (inability to retract foreskin) may be congenital or acquired. It impedes the proper cleaning of the glans penis, may be a risk factor for future penile carcinoma and may cause difficulty in the evacuation of urine. Treatment is simple and requires circumcision as a daycare procedure. Penile fracture/trauma is disastrous and scary. The diagnosis is self-evident and is promptly correctable when acted in expedite manner. Cancer of the penis has its roots etched in tobacco intake in any form and poor genital hygiene. Although this affliction is rare in India (0.7-2.3 cases per 1, 00, 000 men), it can be psychologically devastating. Such men tend to delay medical attention due to embarrassment, guilt, fear and personal neglect. Multimodality early treatment need to be offered. The 5-year survival rate is modest at 65 % with the number being a healthy 80 % for early disease.

Testis can also be an organ of affliction in various ailments. Undescended testis is one of the commoner congenital problems in which one or both of them are in the abdomen and fail to descend normally in the scrotal sac resulting in permanent loss of function or fertile grounds for the development of cancer. Surgery needs to be performed till the child is in school going. Epididymal orchitis (inflammation of epididymis and testis) is fairly common and often responds well to antibiotics and after taking care of the inciting causes. Not so rare and intriguing is the Torsion of the testis that can compromise its vascularity and needs urgent surgery to prevent loss of function. Testis like other organs can also be affected with malignancy with 1 in 270 men being affected with it during some point in their lifetime. With a promising cure rate of more than 95 percent, it is one of the few malignancies having excellent survival.

Urinary bladder stones, albeit not exclusively found in males, is a disease reminiscent of chronic bladder outlet obstruction which is mostly found in aging males due to enlarging prostate. Treatment is simple endoscopic breakage often needed to be coupled with resection of enlarged and obstructing prostate.

Above is not the exhaustive list of urological disorders found in males. However, they are the ones found exclusively in them. Others like kidney stones, kidney cancer and urinary bladder cancer are found in both sexes with a slightly male preponderance.

The message is loud and clear. Lockdown or no lockdown. Don’t let these ruin your precious health. Stay healthy. Be under constant supervision of your urologist via physical consultation or avail of teleconsultation at the comfort of your doorstep.

Dr. Abhinav Jain, Consultant – Urology & Kidney Transplant, Dharamshila Narayana Superspeciality Hospital, Delhi

Narayana Health

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