Check-up: urological screening and diagnosis
The Paracelsus Hospital offers a series of diagnostic procedures to help prevent urological disorders, particularly urological cancers. These include various ultrasound scans (bladder, kidney, prostate) as well as determination of the PSA level with the aid of a blood test. The PSA level provides information about the possible presence of a prostate disorder. Where the PSA concentration is too high, the Paracelsus Hospital Golzheim uses MRI-guided (magnetic-resonance-image-guided) fusion biopsy, a new and very precise scanning method used by only a few hospitals. Here a high-resolution MRI-guided scan of the prostate is first carried out. The MR images obtained are then overlaid (fusioned) with the latest ultrasound images and so enable even the very tiniest and/or isolated prostate carcinomas to be verified. The fusion biopsy enables suspicious tissue to be sampled and examined with considerably better than pinpoint accuracy.
At the same time comprehensive urine tests can provide information about bladder, ureter or renal cancers. The urological check-up also includes tests for further disorders of the ureter, bladder or kidneys. As well as diagnostic services, the Paracelsus Hospital offers individual consulting and therapy planning according to diagnosis.
Prostate cancer: surgical removal of the prostate (prostatectomy)
If suspicion of a prostate carconoma has been confirmed, the doctors of the Paracelsus Hospital Golzheim discuss suitable therapy with the patient. In the case of younger patients surgical removal of the prostate is recommended, especially if the tumour is still confined to that organ. The surgical procedure can be either done "open", that is, by cutting open the abdomen, or minimally invasively by the keyhole method. In certain cases it may be possible to destroy just a few, locally confined tumour sites.
Kidney cancer is frequently identified by chance, for example, during a routine ultrasound scan. If the condition has been clearly diagnosed, in most cases a surgical procedure is carried out. As well as surgical removal of the whole kidney, it is possible in a few cases to as far as possible preserve the organ and remove only the affected tissue (partial kidney resection/tumour nucleation). If the tumour has already spread to other organs, further treatment is more difficult, as kidney cell carcinomas do not react positively either to chemotherapy or to hormone therapy or radiotherapy. Besides the surgical possibilities, the Paracelsus Hospital Golzheim tries other avenues and employs a new, promising therapeutic method: immunotherapy with what are known as checkpoint inhibitors. These are aimed at restoring the immune system’s tumour defence reaction so that the tumour cells are destroyed by the body’s own T cells.
Disorders of the bladder like bladder inflammation or bladder stones manifest themselves mostly by an increased urge to urinate and pain or a burning sensation while urinating. By contrast, bladder cancer often develops unnoticed over a longer period of time, meaning that the "classic symptoms" show themselves so much later on. One of the most important signs that might indicate bladder cancer is blood in the urine, particularly during painless urination. The earlier a tumour is identified, the better the prospects are for treatment. New forms of diagnosis like the narrow-band imaging procedure (NBI) and photodynamic diagnosis (PDD) enable the experts at the Paracelsus Hospital Golzheim to identify even very tiny supectedly tumorous sites in the bladder mucous membrane at a very early stage and to take tissue samples during an examination. The treatment depends on the kind, position and size of the tumour. As well as surgical procedures like local removal of the tumour or the entire surgical removal of the bladder (radical cystectomy), chemotherapy and radiotherapy are employed.
The most important symptoms of testicular cancer are palpable, painless and hard swellings on the testicle or lumps on or in the testicle. 80 % of all testicular tumours are identified at a very early stage by patients themselves. If the condition is suspected, further diagnostic procedures are necessary: so, as well as an ultrasound scan, blood samples are taken to determine tumour markers. Also hormones and testosterone are examined accordingly. A fine-tissue test gives confirmation. As a rule the affected testicle is surgically exposed and removed (orchidectomy). During the same procedure samples are taken from the testicle on the other side to ensure that no tumour has started to develop or will develop on the testicle on the other side. The tissue is sent to the pathologist for fine-tissue testing.
Incontinence is the word used by doctors for patients' inability to control their bladders or bowel movements. Actually incontinence is a widespread condition today. It is now estimated that something like 50 – 200 million people worldwide are affected by it; about 5 to 8 million in Germany alone suffer from uncontrolled loss of urine or faeces, and because of demographic developments the number is rising. Women in particular are affected by this barely mentionable condition: 35 per cent of women aged 50 and over suffer from incontinence and the consequences of uncontrolled urine loss. Both in the areas of diagnosis and therapy the hospital offers the full range of modern medicine for men and women.
Vasectomy (male sterilisation)
For a man who has decided that he does not want to have any (more) children sterilisation is one possible way of ensuring that he does not have them. As a rule it is men or couples who have fulfilled their family planning that choose this method. With vasectomy the man’s spermatic ducts are surgically severed. The procedure is mostly carried out in the out-patients department under local anaesthetic.
About ten per cent of sterilised men would like to resume family planning and to reverse sterilisation (vasectomy) in order to have another child of their own. This is made possible by what is known as refertilisation, microsurgical procedure by which the severed spermatic ducts are joined up again. A distinction is made here between vasovasostomy and tubulovasostomy. With vasovasostomy the spermatic ducts are exposed by making the tiniest possible cuts and then joined up again by means of fine stitches. If the spermatic ducts are not continuous, tubulovasostomy, one of the most demanding microsurgical operations in urology, is employed. By this method the upper end of the spermatic ducts is joined straight to the epididymal ducts.
Penile curvature, or penile distortion, may be congenital or may occur during life. In newborn children with penile curvature the deformity is the result of a genetic malformation of the penis and is also linked to hypospadias. In the case of acquired penile curvature the conditions may develop slowly or occur suddenly. The exact causes of acquired penile distortion have not yet been satisfactorily explained. Surgical penis straightening is aimed at enabling men affected to engage in sexual intercourse without pain and restrictions.
Contrary to widespread belief impotence, also known by the names erectile dysfunction, erectile or potency disorders, in most cases has physical causes. These include, for example, high blood pressure, overweight, blood flow disorders, inflammation of the genital organs (testes, epididymis) or hormonal disorders, to name just a few. We look after you from diagnosis through to therapy.
Urinary incontinence in children
Nocturnal bedwetting affects about ten per cent of seven-year-olds and even one to two per cent of adolescents. Hereditary predisposition may also play a part here. Boys are affected twice as frequently as girls. The causes have not been fully explained: in many case enuresis is associated with defecation disorders, hormone regulation disorders (ADH deficiency), severe unwakability and/or very deep sleep. There are various ways of diagnosing incontinence in children: decisive information can be obtained from a detailed discussion, a drinks diary (wee-wee chart), recording of bladder emptying (micturition) and precise observation of the child’s toilet habits. Other diagnostic methods involve urine testing to ascertain a bacterial infection or ultrasound testing of the kidneys and bladder. Our paediatric urology section has been specially set up for the treatment of children.
Hypospadias in children:
This deformity occurs relatively frequently in newborn boys (roughly on child in 300 to 400) and is normally identified shortly after birth. With hypospadias the urethral orifice may not be positioned as it should be, the foreskin may be longer on one side than on the other and the penis shaft may be curved.Depending on the severity of the hypospadias, persons affected experience difficulties in passing water (the urine stream is deflected downwards or backwards or sidewards), problems with ejaculation, and, depending on curvature, may have a painful erection or suffer pain during intercourse. Not to be underestimated is also the mental stress suffered by the person affected, which may be linked to the "different" look of the penis.
The aims of a surgical procedure a
- uprighting (straightening) of the penis
- reconstruction of the urethra, that is, relocation of the urethral opening into the penis head (glans)
- reconstruction of the penis head (glans)
- plastic correction of the penis skin
Vesicoureteral reflux (in children)
Vesicoureteral reflux (VUR) is a disorder where urine flows out of the bladder and backwards into the ureter or even the kidney. The effect of a VUR may be inflammation of the renal pelvis. Congenital (primary) reflux is normally caused by a deformity of the "valve" that allows urine to flow out of the kidney and into the bladder but not back again. If this mechanism is disturbed, urine may flow back into the ureter and rise as far as the kidneys. The urine collected there may lead to infections that go hand in hand with a high body temperature and may cause long-term damage to the kidneys. If infants and children frequently suffer from inflammation of the bladder linked to high body temperature and a poor overall wellbeing, this may indicate reflux. The Paracelsus Hospital Golzheim has at its disposal various diagnostic methods for identifying vesicoureteral reflux in children. These include ultrasound scanning of the bladder and kidneys, so-called micturition cystourethrography (MCU), the PIC cystogram and DMSA scintigraphy.Reflux can be treated conservatively (without surgery) or surgically. Which method is to be used depends on the age of the child and how serious the reflux is. Whichever method is used, the main thing is as far as possible to prevent future urinary tract infections.
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