Many people associate the urologist primarily with a doctor for “elderly men”. – It is a harmful and dangerous myth – convinces urologist Dr. Przemysław Dudek, MD, a urology specialist from the SCM clinic in Krakow, deputy head of the Urology and Oncological Urology Clinic at the University Hospital in Krakow. It’s a good idea to start regular prostate examinations after your 40th birthday. Prostate cancer is one of the most common neoplasms among Polish men and is asymptomatic for a long time. What symptoms should prompt you to see a specialist?
Joanna Siemińska: Who should see a urologist and in what situations?
Dr. Przemysław Dudek, urologist, specialist at SCM clinic in Krakow: Certainly men for the prevention and diagnosis of diseases of the reproductive system. They are necessary in order to react quickly and effectively in the case of prostate or testicular cancer.
As part of the prostate cancer prophylaxis, it is recommended that every man aged 50 and over with a genetic burden after 40 years of age undergoes a checkup every year. Earlier visits are necessary when there are problems, for example, with urination (may mean a benign enlargement of the prostate gland, but also a cancer). During the visit, we conduct per rectum examination and ultrasound. In addition, we determine the concentration of a specific prostatic antigen in the serum, i.e. PSA. If the tests show abnormalities, the patient is referred, inter alia, to for prostate biopsy and magnetic resonance imaging.
- If your father, brother or grandfather has had the disease, the risk of prostate cancer increases tenfold
In turn, testicular cancer prophylaxis should include weekly self-examination by men of all ages. The detection of a lump, swelling or fluid build-up in the scrotum is an indication for an immediate urological visit. In a patient with this type of lesion, we first perform an ultrasound of the testicles.
Phimosis is also an absolute indication for a visit to a urologist. This is not only a hygienic problem. It may also contribute to the development of penile cancer.
Is a urologist a doctor only for male diseases?
Of course not! Every person (both male and female) with urinary tract problems should decide to visit a urologist.
Hematuria is a very disturbing symptom. It should absolutely be diagnosed. It is the primary symptom of urothelial tumors, which originate in the epithelium that lines the urinary tract. Of course, this symptom can also occur for minor reasons, such as inflammation of the urinary system, but it should never be ignored. In the case of bladder cancer, there may also be recurrent urinary tract infections, urinary pressure and more frequent urination. These are symptoms that should also prompt the patient to see a specialist.
- Men are afraid of this study. how exactly is the prostate controlled?
In such cases, the basic diagnostics we perform is general urine examination and ultrasound of the urinary system. Patients over 40 years of age should perform them prophylactically every year. It is during the ultrasound examination that renal cell carcinoma is very often accidentally detected, which in the initial stages does not give virtually any symptoms.
If deviations from the norm are noticed, we perform more extensive diagnostics, such as computed tomography, magnetic resonance imaging, and cystoscopy, i.e. endoscopic examination imaging the inside of the bladder. We also perform urine sediment cytology to detect neoplastic changes in the urinary tract epithelium.
It should also be remembered that any urination disorders are an indication to visit a urologist. They may indicate urological disorders, e.g. the presence of a neurogenic bladder and lead to the development of bilateral hydronephrosis, renal failure, and even the need for dialysis. Therefore, they should not be underestimated.
What are the treatments for urological tumors?
Prostate cancer – there are many methods of treatment, and the choice depends, among others, on age, disease stage or malignancy. In the case of medium or high risk cancer, we use radical methods. Radical prostatectomy is the surgical removal of the prostate with seminal vesicles, fragments of the vas deferens and sometimes lymph nodes. It is performed under general anesthesia using the open method or laparoscopically (through small incisions and with the use of micro tools). Laparoscopy is one of the less invasive methods of surgery. Complications occur less frequently after it, and the patient is not exposed to a long period of convalescence, thanks to which he quickly returns to fitness.
Testicular cancer – the patient is operated on very quickly after diagnosis, and the removed testicle is subject to histopathological examination. We also perform computed tomography of the patient’s abdominal cavity, pelvis and chest, which verifies the appearance of metastases. Sometimes it is necessary to undergo chemotherapy, radiotherapy or further surgical treatment.
Urothelial neoplasms – treatment depends on many factors, including the degree of malignancy and the stage of the disease. If the tumor crosses the muscle layer of the bladder, we perform radical treatment, i.e. removal of the bladder along with the urinary tract. Previously, we perform electroresection of the tumor to assess how deeply it infiltrates the muscle and whether it is malignant.
Kidney cancer – surgery is the basic method. The smaller the tumor, the less extensive the incision is (conserving nephrectomy). Large tumors require removal of the kidney, sometimes along with lymph nodes and the neoplastic plug in the event of infiltration and ingrowth into the renal vein and inferior vena cava (radical nephrectomy).
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Expert – Przemysław Dudek, MD, PhD – specialist in urology from SCM clinic in Krakow. Deputy Head of the Department of Urology and Urology Oncology at the University Hospital in Krakow.
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