Urology

The kidneys play a vital role in sustaining good health. Their main job is to clean the blood by removing excess water and waste and passing them out of the body in the form of urine. Each kidney gets rid of up to 1.5 litres of urine per day and they ensure a stable balance of salts and other substances in the blood. They also produce hormones that help build strong bones whilst forming red blood cells

Kidney Problems

Kidney failure (renal failure)

The kidneys function is to get rid of waste products from the body in the form of urine. If they stop functioning properly, these waste products can build up.

Acute renal failure

Acute renal failure can be triggered by serious illness or an operation. In addition, it can be a result of significant blood loss, a sudden drop in blood pressure or severe dehydration.
It is important to see your GP straight away if you suspect that you have acute kidney failure to prevent it from developing into chronic kidney failure which can be life-threatening and is not currently curable.

Symptoms:

• Less frequency in passing urine
• Swollen ankles, feet, legs
• Drowsiness or lethargy
• Nausea or vomiting

Chronic renal failure

Chronic renal failure results from any disease that causes a gradual loss of kidney function with the most common causes being diabetes or hypertension (high blood pressure).

Symptoms:

• Tiredness
• General itchiness
• Loss of appetite
• Breathlessness
• Frequency
• Muscle twitching
• Fluid retention

Kidney cancer

Kidney cancer is 2 X more likely to be diagnosed in men than women. It occurs when cells begin to grow and divide abnormally forming a lump or tumour which can be benign (non-cancerous) or malignant (cancerous).

Symptoms:

• Blood in urine
• Pain in groin or abdomen
• A lump in the abdomen
• Persistent high fever
• High blood pressure
• Unexplained weight loss

Glomerulonephritis

Affects tiny structures in the kidney called Glomeruli. Glomeruli filter the blood and if diseased they cannot get rid of waste products and excess water. If left untreated, this condition can lead to kidney failure.

Symptoms:

Often, this condition does not present symptoms, especially in the early stages and is more commonly picked up on routine blood tests or urine samples. However, one or more of the following symptoms could be present:-

• Swollen ankles/puffy face
• Blood in urine
• Headaches
• Blotchy red skin rash
• Kidney pain

Nephrotic syndrome

This is a condition where the Glomeruli subsequently become damaged due to a kidney disease, infection, glomerulonephritis or cancer.

Symptoms:

• Swelling in legs or eyes first thing in the morning
• Swelling around the abdomen, chest or face
• Foamy urine due to excess protein
• High blood pressure

The bladder collects and stores urine. When the bladder is full, nerve signals are sent to the brain, instructing the sphincter to relax, ultimately triggering the urine to be released from the urethra.

Bladder Problems

Urinary Tract Infections (UTIs):

UTIs are infections of the urinary tract which is made up of the kidneys, bladder, ureters and urethra. They are very common and can be easily treated with antibiotics. If left untreated however, the infection could travel to the kidneys directly causing damage and scarring of the kidneys (pyelonephritis).

Symptoms:

• Frequency-needing to pass urine more often
• Pain or burning when passing urine
• Small amounts of urine passed despite urgency
• Cloudy or reddish urine (if blood is present)

Bladder cancer:

Cancer of the bladder is 2 x more likely to occur in men than women, particularly in individuals over the age of 50. It is the 4th most common cancer in men and 12th in women.

Symptoms:

• Blood in urine (Haematuria)
• Urine varies from rusty brown to deep red (symptom could disappear and then return
• Increased frequency
• Urgency to urinate without being able to pass urine

Urinary incontinence:

This condition is where an individual passes water involuntarily. It is important to note that incontinence is extremely common affecting approximately 3 million adults in the UK and can occur at any age.

Urge incontinence:

This is where the bladder contracts when you do not want it to. You may feel urgency to pass urine and experience leakage.

Stress incontinence:

This is when the pressure from coughing, sneezing, laughing or exercising vigorously can cause the leakage or urine. This type of incontinence mostly affects women as childbirth and ageing are both factors thought to increase this. In men, stress incontinence is usually associated with surgery.

Mixed incontinence:

A mix of the above two types of incontinence.

Overflow incontinence:

This is where the bladder overfills because it has not been emptied properly due to weakened muscles or a blocked urethra. This pressure causes an overflow into the urethra and urine is leaked. This type of incontinence affects more men than women as an enlarged prostate is thought to be a main cause.

Interstitial cystitis:

This condition affects both men and women but 9 out of 10 cases diagnosed are women. It is caused by an inflammation of the bladder lining. The protective layer of the bladder wall breaks down allowing toxins to irritate the bladder wall which then becomes inflamed and does not store urine properly.

Symptoms:

This condition is notoriously difficult to diagnose and does not respond to antibiotics though life style changes and other treatment can provide relief. Some symptoms may include:-

• Frequency
• Urgency
• General pain in the abdomen or urethra.

The prostate gland (only present in men) lies beneath the bladder, surrounding the urethra. It starts small in young boys growing larger during puberty due to an increase in testosterone levels. By adulthood, the prostate should be the size of a walnut.

Prostate Problems

Prostate cancer:

Prostate cancer is one of the most commonly diagnosed cancers in men with the diagnosis risk in Europe and North America being 30%.

Symptoms:

Early detection is critical with prostate cancer. Approximately 98% of men with low grade prostate cancer live for 5 years and over. However, 70% of men with advanced, high stage prostate cancer usually pass away within 5 years.
Men with prostate cancer may not experience any symptoms at all or may experience a number of symptoms such as:-

• Weak streams of urine
• Urgency
• Frequency
• Difficulty urinating
• Blood in the urine (Haematuria)
• Pain in the groin
• General bone pain
• Unexplained weight loss

Benign Prostatic Hyperplasia:

This is a gradually progressive disease that often affects men aged 40 and above. It is a disease that produces a non-cancerous growth of the prostate gland which can lead to urinary problems. 40% of men aged 60+ have lower urinary tract symptoms due to this disease and it is estimated that the quality of life is impaired in half of these men.

Symptoms:

• Hesitancy (difficulty starting urination)
• Urgency
• Frequency
• Weak stream
• Passing little urine
• Feeling of incomplete bladder emptying

Prostatitis:

This is a condition that causes inflammation of the prostate gland and is one of the most common urological conditions accounting for 25% of all urology consultations in the UK.

Acute bacterial prostatitis: occurs when bacteria infects the urinary tract

Chronic bacterial prostatitis: occurs when bacteria persists in the gland with recurring episodes of infection and symptomless periods in between.

Chronic abacterial prostatitis: when no bacteria is present and there are no recurring urinary tract infections but the cause is completely unknown.

Symptoms:

The symptoms of prostatitis can either be short term or long term depending on which form you have. These symptoms include;

• pain/discomfort between the scrotum and anus
• pain in the lower back, penis, testes or inner thighs
• Lower urinary tract symptoms such as burning when urinating or frequency

This term consists of two glands, the testes and the penis. These organs are prone to several common conditions, some which are easily treatable, some which may be psychologically distressing for an individual and some which, if left untreated, can be life threatening.

Problems

Testicular cancer:

This cancer is one of the most beatable and curable cancer when detected early with nearly all men (more than 98%) being cured.

Symptoms:

• Painless lump or swelling in one of the testicles
• Heaviness in the scrotum
• Dull ache or discomfort in the scrotum

If the cancer has subsequently spread into the lymph nodes other symptoms may occurs such as;-

• Back ache or a dull ache in the lower stomach
• Lump in lymph glands
• Tender or swollen breast tissue

It is important to note that, even if this particular cancer has spread, it is still curable.

Penile cancer:

Penile cancer rarely affects men under the age of 40, affecting 1 in 100,000 men overall.

Symptoms:

• Painless sores/lumps on the penis
• Persistent sore spot/ulcer on the penis that slowly spreads
• Tender or swollen lymph nodes in the groin/abdominal region
• Blood in urine (Haematuria)
• Pain/difficulty urinating

Erectile dysfunction (impotence):

Erectile dysfunction (ED) can often be a taboo subject, not spoken about widely. However, it is a very common problem affecting 1 in 10 men. There are many different treatments of ED that can usually be sorted by a simple visit to the GP.

Peyronie’s disease:

This condition only occurs in 1% of men in the UK and causes scar tissue/ a lump to form inside the penis. It is likely that trauma could be a cause but it is still unclear. This condition can often be treated by tablets, injections or possibly surgery.

Male infertility:

A man is deemed infertile after being unable to produce a child after one year of unprotected intercourse. It is thought that one out of six couples struggle to get pregnant and male infertility accounts for ¼ of these.

The team acted for a young man in his early 20’s who wanted to pursue a claim against his General Practitioner for failing to refer him for urological investigations. He had attended his GP on at least 3 occasions with pain and swelling in one of his testicles and he was not referred. When eventually he was referred it was discovered he had testicular cancer. He had to have the testicle removed and then chemotherapy. Unfortunately this led to abdominal surgery to remove a retroperitoneal mass.

Liability was admitted in that those representing the General Practitioner accepted that he breached his duty of care by not referring sooner. In terms of causation i.e. what damage had been suffered as a result of this delayed referral and diagnosis, we were advised that in any event the testicle would have been removed but he may well have avoided chemotherapy and would have avoided the need for abdominal surgery. In addition the abdominal surgery had left him with retrograde ejaculation and potential loss of fertility.

The case settled for the sum of £50,000 without having to proceed to trial.