What is Urology?
Urology is the specialty of surgery and medicine that is concerned with diagnosing and treating disorders of the male and female urinary system and the male reproductive system. Ask your urologist about the latest medical and surgical treatment options for your specific urologic condition.
The urology topics on this website are intended to provide only brief general information about some common urologic conditions. This information is not intended to be comprehensive and should not be used to assist with the diagnosis or treatment of any conditions without face-to-face evaluation and counseling with your physician. If you have any general, non-urgent questions, or would like to arrange a consultation, please click here.
Common conditions treated by Dr. Yew include:
- Difficulty with urination due to prostate enlargement (BPH)
- Urinary Stones in the Kidneys, Ureters, or Bladder
- Cancers of the Prostate, Kidneys/Ureters, Bladder, or Testicles
- Erectile Dysfunction
- Urinary Incontinence
- Blood in the Urine (Hematuria)
- Urinary Obstruction (Hydronephrosis or Strictures)
Prostate Enlargement (Benign Prostatic Hyperplasia)
Benign Prostatic Hyperplasia (BPH) is a non-cancerous overgrowth of normal prostate cells that causes enlargement of the prostate gland. It occurs in virually all men. As men age, this enlargement can restrict and cause irritation of urinary flow.
Symptoms of BPH may include:
- frequent urinarion
- sudden & urgent need to urinate
- need to push or strain to urinate
- burning urination
- incomplete bladder emptying
- dribbling
- slow urine stream
- leaking (incontinence).
More than 50% of men over the age of 50 years old will have some symptoms due to BPH. Fortunately, some do not require any treatment. Others will respond to medications. If symptoms are severe and medical therapy no longer helps, surgical treatments are usually required.
How bad is my BPH? Download this symptom questionnaire
Surgery for BPH
Trans Urethral Resection of Prostate (TURP)
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Open Simple Prostatectomy for Large-Gland BPH
If the prostate gland is very large, it may be difficult and unsafe to remove it endoscopically with a TURP. In these cases, a patient may require removal of the obstructing central portion of the prostate via an abdominal/pelvic operation. Traditionally, this involved a big incision from the umbilicus (belly-button) down towards the base of the penis. The advantage is that a large amount of obstructing prostate gland can be removed. Disadvantages are that a large incision is required, significant bleeding can occur, several days in the hospital are required, and a longer period of recovery with the urinary catheter is required.
Robotic Laparoscopic Simple Prostatectomy for Large-Gland BPH
With modern advanced robotic laparoscopic techniques, large amounts of obstructing prostate gland can be removed in a minimally-invasive fashion through small poke holes (a.k.a. "keyhole surgery") instead of the large abdominal incision of Open Simple Prostatectomy (above). Usually, the patient will stay in the hospital only a few days.
Greenlight PVP Laser Prostatectomy
>Click for Video
Photoselective Vaporization of Prostate (PVP) is a new minimally invasive surgery that uses a specialized high-energy laser to vaporize obstructing BPH prostate tissue. Heat from the laser seals the treated vaporized areas so usually there is very little, if any, bleeding. This procedure is also done endoscopically via a cystoscope, like the TURP (above). Greenlight PVP can usually be done on an outpatient basis. Patients usually can go home a few hours after surgery without a urinary catheter. In some cases, patients may be observed overnight in the hospital and may have to go home with a urinary catheter for a day or two. Advantages: minimally-invasive with less bleeding and pain. No hospital stay. No urinary catheter usually. Can be combined with traditional TURP for large prostates. Disadvantages: may take longer than TURP for larger prostates. No removed prostate tissue for analysis for cancer.↑ back to top
Urinary Stones (Urolithiasis)
Urinary stones are hardened mineral deposits that accumulate and grow into stones. These stones can have varying chemical composition and be located in the kidneys, ureters, or bladder. Some people may have stones that cause no symptoms; however, many patients develop significant pain, infection, and sometimes kidney damage from urinary stones. The majority of the time, small stones causing pain will eventually pass out in the urinary stream. With patience and adequate pain control, many of these patients will not require any invasive surgery. If pain is severe or symptoms persist, or if there is signs of urinary infection, then surgical intervention is usually required.
Surgery for Urinary Stones
Cystoscopy and Ureteral Stent Placement
It may be necessary to decompress the urinary system to allow urine to bypass the blocking stone. This may be due to the presence of urine infection or if the patient has severe pain. A soft plastic tube is passed up the ureter and alongside the blocking ureteral stone up to the kidney. This allows urine to pass easily by the stone, relieving pain and urine obstruction. This is done endoscopically with a cystoscope inserted into the bladder. Sometimes, a black string, attached to the end of the stent, will be left exiting the urethra and urinary opening. This will allow you or your doctor to easily remove the stent later without requiring an uncomfortable cystoscopy procedure.
Shock-Wave Lithotripsy
Depending on stone size and location, some stones may be treated with focused external ultrasound waves (shocks) that are directed through the skin under x-ray guidance. This has the advantage of requiring no incisions or instruments placed in the urethra or bladder. Occasionally, a ureteral stent may be required before, during, or after shock-wave lithotripsy. Usually, patients can go home right after the procedure.
Ureteroscopy and Laser Lithotripsy
Some stones in the ureters may have to be visualized and removed or broken up into smaller fragments. This usually requires passing a narrow rigid or flexible camera into the urethra and bladder. The camera is then guided carefully up the ureter to the stone. Once the stone is seen, it can be grabbed with a soft wire basket and removed, or it can be obliterated with a focused laser fiber(called Holmium Laser). Somtimes, a ureteral stent will be placed after laser lithotripsy. Video
Percutaneous Nephrolithotomy and Stone Extraction (PCNL)
For larger stones in the kidney (a.k.a. "Staghorn"), it may be necessary to go directly into the kidney through a puncture site in the back. A tube is inserted directly into the kidney. A camera and various instruments can then be inserted to locate, break-up, and remove large amounts of stone. Previously, large stones in the kidney required a major operation with a large flank incision. Using endoscopic percutaneous nephrolithotomy techniques, the back incision is usually less than 1-inch. Patients will usually require either an internal ureteral stent, or an externally-draining nephrostomy tube following PCNL surgery. Large, complex stones may require multiple procedures.