Urology

Atlas University Faculty of Medicine Medicine Hospital Urology Department offers a wide range of diagnosis and treatment opportunities to our patients in the field of adult and pediatric urology. Our team of specialists treats common and rare diseases affecting urological functions and kidney. In our urology unit, examinations and treatments are carried out on kidneys, urinary tract, bladder, urinary retention problems, prostate, penile and testicular diseases, sexually transmitted diseases in men, infertility, sexual dysfunctions, urological cancers, pediatric urology and gynecological urology. It has the necessary equipment for all kinds of diagnosis and treatment required by today’s modern medical practices, with its Lithotripsy and Urodynamics unit, and operating rooms where all endoscopic and laparoscopic surgeries can be performed.

UROLOGICAL CANCERS

Prostate Cancer

Prostate cancer is usually a disease of men after the age of 50. More than 90% of men who have been diagnosed with prostate cancer themselves are older than 60 years old at the time of diagnosis. With the increase in the average age of the population, the frequency of prostate cancer is also increasing in our country. 30% of men over the age of 70 have hidden prostate cancer. Only a part of these tumors begin to grow faster at any given time and turn into a dangerous disease that needs to be treated.

Causes and Risk Factors for the Formation of Prostate Cancer

The causes of the disease have not been definitively established so far. But there are 3 definite risk factors revealed in prostate cancer;

• Age (the risk of occurrence increases with increasing age),
• Genetics (the risk is higher for those who have prostate cancer in their family, especially a first-degree relative),
• Race (it is quite high in the black race in America).

This disease is relatively common in Europe and North America, while it is less common in East Asia. For this reason, lifestyle and life circumstances are thought to affect the risk of getting sick. A diet with a lot of fat and little fibrin probably facilitates the formation of prostate cancer.

Apparently, there may be a higher risk in workplaces where the heavy metal Cadmium substance is present, for example, in men working in the tire industry.

Close relatives of prostate cancer patients suffer from this disease more often compared to other segments of society. Accordingly, genetic factors and a hereditary predisposition, apparently, play an important role.

Testosterone, which is a male sex hormone and is secreted from the testicles, is necessary for the function of the prostate. But it also helps prostate cancer cells grow. Prostate cancer does not occur without adequate function of the testicles.

But in general, there are very few finalized data on the causes of occurrence and risk factors. There is also no possibility of taking definite preliminary measures from the results to be extracted from them yet.

Clinical Manifestations of Prostate Cancer

As with many types of cancer, prostate cancer does not have typical early symptoms. At the initial stage of prostate cancer, the patient does not notice anything at first. This disease leads to ailments only at a relatively late time. Common symptoms of non-malignant benign enlargement of the prostate (prostatic hypertrophy), such as difficulty urinating and disturbances in emptying the bladder, occur only in advanced stages of cancer, and it may not be possible for the patient to completely recover from the disease. A malignant tumor often forms on the outer parts of the prostate gland, and only after the tumor has grown quite large, it narrows the urinary tract, which leads to symptoms.

Regional pains, as well as cases of blood mixing with urine or semen, can also be detected at an advanced stage. These symptoms are usually a sign that the tumor has now spread to other tissues next to the prostate.

Sciatica pains and bone pains can be caused by sister tumors (metastases) that form in the hip bones, lower sections of the spine, or other parts of the skeleton. Because up to 60% of prostate cancers at an advanced stage form metastases in the bones. These are the first pains caused by the tumor in some cases.

Opportunities for Early Detection of Prostate Cancer

The sooner the disease is diagnosed, the better it can be treated. If the cancer is limited only to the prostate at the time of diagnosis, the chances of a complete recovery from cancer disease are very high. For this reason, even if there are no complaints about urination, it is recommended that men consult a doctor for prostate cancer evaluation once a year from the age of 50. The goal is to detect the disease while it is limited inside the prostate, that is, during the period when there are no clinical symptoms. At this stage, we have two simple and less painful examination methods. A prostate exam and measurement of a substance called PSA in the blood PSA (Prostate-Specific Antigen) is not a substance specific to prostate cancer. The substance PSA is secreted from the secretory glands of the prostate and is also present in the blood at a certain level. Just as a low PSA level will not definitely indicate that a person does not have prostate cancer, a high one is definitely not a harbinger of the presence of cancer. However, PSA value is important for prostate cancer in that we evaluate the patient with digital prostate examination together and show the possibility of prostate cancer.

PSA can be elevated in the blood not only in the cancerous condition, but also in benign prostate enlargement. In addition, prostate inflammation, urinary tract infection, prostate stones, inserting a probe from the urinary tract, which can cause irritation on the prostate, can also cause an increase in PSA in the blood.

During a finger examination, the prostate gland from the last intestine (rectum) can be easily felt, and even small irregularities on the surface can be noticed in this way. Especially the feeling of hard areas with the finger means the suspicion of cancer. Since malignant tumors are usually formed on this surface of the organ, early detection of at least superficially formed cancers is possible with this finger rectal prostate examination method, in a way that is not too painful.

If your doctor detects the presence of a hard area during a rectal prostate examination with a finger, s/he will recommend a needle biopsy of the prostate, regardless of the PSA. In addition, even if there is no doubt in the prostate examination, if the PSA test result is abnormal, it will still be necessary to take a tissue biopsy from the prostate with a needle.

BLADDER CANCER

Bladder (urinary bladder) cancer is the formation of malignant tumor (cancer) cells that originate in the tissues that make up the wall of the bladder.
The risk factors that increase the likelihood of developing bladder cancer are listed below, respectively;

• Smoking,
• To be confronted with chemical substances in textile, paint and tire industry in an unprotected way,
• Excessive consumption of fatty and fried foods,
• At an advanced age, male and white race,
• Parasitic urinary tract infections that affect the urinary bladder in particular.

 What Can Be the Clinical Symptoms of Bladder Cancer?

The most common first symptom that we encounter in bladder cancer is bloody urine or painful urination. The cause of these and other symptoms mentioned below may be the presence of bladder cancer. Some other diseases can also make these symptoms. For this reason, when faced with such symptoms, it is necessary to consult a physician.Diagnostic Methods That Can Be Used in the Diagnosis of Bladder Cancer

• Physical examination,
• Ultrasonography,
• Urinalysis (full urinalysis),
• Cytological evaluation of urine is to evaluate the urine sample taken under a microscope and to investigate the presence of abnormal cells,
• Intravenous pyelography (IVP) is the evaluation of the contrast agent given intravenously and excreted by the kidneys by filling the urinary collecting system of the kidney, the urinary canal called the ureter, and the bladder.

Bladder Cancer Evaluation

Computed Tomography (CT): In addition to the detailed evaluation of the kidney and bladder in terms of the presence of cancer before and after the intravenous contrast agent, it gives an idea to understand whether the cancer has spread to the surrounding tissues. On the other hand, PET-CT is also used in the staging of our patients in terms of cancer recently.

Cystoscopy

It is the evaluation process by entering through the urinary canal with the help of a long thin telescope with a light and optical system and seeing the urinary canal and the inside of the bladder directly. While this procedure does not require any anesthesia in women, cystoscopy is easily performed under local anesthesia with an anesthetic given inside the urinary canal in men. During this procedure, a biopsy sample can also be taken from areas where a tumor is suspected with small biopsy collection tools. The pathological evaluation of these biopsy samples is the definitive diagnosis. However, valuable information about the bladder tumor is also obtained in the cystoscopic image.

What Are the Treatment Options for Bladder Cancer?

There are many treatment options available for patients with bladder cancer. While some treatment methods are still standardized treatments that are used for treatment purposes in the clinic, some treatments are at the evaluation and research stage for their clinical applications. Currently, there are four types of standard treatment options for bladder cancer.

• Surgery,
• Radiation therapy,
• Chemotherapy (Drug therapy),
• Biological Therapy.

Surgery

One of the surgical methods mentioned here can be applied depending on the situation at the stage of the disease.

Transurethral Tumors Resection (TUR)

It is the scraping of the tumor in the bladder with the endoscope (a thin long device with light and optical system) inserted into the bladder through the urinary canal called the urethra, and the system at the end of this endoscope that cuts the tissue with electrical energy and controls bleeding.

Radical Cystectomy

It is the removal of the bladder containing the cancer and the white blood glands around the bladder by open surgery. This radical cystectomy treatment;

• With the potential for superficial but aggressive progression in the bladder,
• It is applied to provide cure (full treatment) in cases of superficial but extensive cancer or advanced cancer to the muscle layers of the bladder.

After the bladder is removed, an artificial bladder can be made from a short bowel section and connected to the urinary canal, depending on the preference of the surgeon and the patient’s condition. We call this the “Orthotopic New Bladder”. With this surgery, patients can perform their urinary functions normally without wearing a bag.

Even if the cancer cells are not completely removed, radical cystectomy can also be performed to relieve the patient of bladder complaints (such as bleeding, inability to urinate, obstruction in the urinary tract). This is not done to completely remove the disease from the body, but only to prevent the patient from causing additional problems due to the condition of the cancer in the bladder. This is called “Salvage Cystectomy”.

Partial Cystectomy

It is the removal of the section with bladder cancer. This surgical method can be applied in a very limited patient group. (Sample: in tumors with a low progression potential, advanced to the bladder wall and limited in a very small area). Because after one part of the bladder is removed, the patient can resume normal urination function with the other part of the bladder.

Especially after TUR surgery, even if it is thought that the tumorous tissue in the bladder has been completely scraped, the possibility of cancer recurrence is minimized with chemotherapy or immunotherapy administered into the bladder at regular intervals. Because there may be further development of bladder cancer from the old tumor area or edge, as well as from another part of the bladder. In this regional treatment applied to the bladder, this possibility is reduced with the least side effects.

In bladder cancers that are superficial according to the results of the pathology evaluation after TUR, drugs such as BCG or Mitomyci C are administered into the bladder for 2 hours each week for 6 weeks, in order to reduce the recurrence of the cancer.

Biological Therapy

It is understood as a treatment that acts against cancerous cells by activating the immune system so that the body can fight against bladder cancer more actively.

This is aimed in the treatment of BCG tuberculosis vaccine administered into the bladder after TUR.

Kidney Cancer

While adenocarcinoma, also called kidney cancer, originates from small urinary ducts (tubules), a different form called transitional epithelial cell cancer may develop, originating from the pool and ureteral canal in the kidney.

The most common clinical symptom we encounter in kidney cancer is bleeding in the urine and a hard mass that appears in the abdomen. There are usually no symptoms in early stage kidney cancers. And these patients are usually recognized randomly during ultrasonography or radiological examinations performed for other reasons.

Evaluation in terms of kidney tumor is necessary in these following symptoms;

• Bleeding in the urine,
• A hard mass palpable in the abdomen,
• Long-term and persistent pain in the kidney,
• Loss of appetite,
• Weight loss,
• Anemia.

Examination of the abdomen and kidneys is necessary in the diagnosis and evaluation of kidney cancer. Today, thanks to early diagnostic methods, kidney tumors can now be detected very early and on a small scale. For this reason, “Partial Nephrectomy”, in which the kidney is maximally protected and only cancerous tissue is removed, has become increasingly important.

Testicular Cancer

Although testicular cancer is a rare type of tumor, it is the most common cancer in men aged 20-35 years. There are situations that are a risk factor for the development of testicular cancer.

• Finding a history of undescended testicles,
• Poorly developed testicular structure,
• Having a history of testicular cancer in the family,
• Klinefelter syndrome,
• The white race.

The most common symptoms of testicular cancer include hard swelling and a feeling of comfort in the testicular bag. Other other symptoms, such as these mentioned symptoms, may also appear as a clinical sign of testicular cancer. However, it should be remembered that some other diseases can also have similar clinical manifestations. If you have the following symptoms, you should definitely contact your doctor without waiting;

• Painless swelling in the testicle,
• Change in the normal sensation of the testicle,
• Blunt pain in the underbelly abdominal area or groin,
• Sudden accumulation of fluid in the bag where the testicles are (in the scrotum),
• Feeling of discomfort in the testicle,
• Examination of the testicle and some blood tests are used to diagnose testicular cancer,
• All or part of the tests listed below can be used to diagnose testicular cancer.

Physical Examination and Findings 

It is absolutely necessary to conduct a general examination of the patient, (especially whether there is a palpable mass in the abdomen?). In addition, both testicles should be carefully examined, respectively. The general structure of the mass that is palpated in the testicle during this examination (is it hard, are its boundaries irregular, approximate sizes. In which localization it is in the testicle) is evaluated.

Ultrasonography

With this evaluation, the internal structure of the testis, the characteristics and dimensions of the mass, and the vascularity of the tumor if Doppler ultrasonography is performed, are evaluated without causing any additional morbidity to the patient.

Serum tumor markers

In testicular cancer, the serum levels of certain substances (markers) secreted into the blood by cancer cells are measured. There are 3 tumor markers involved in the search for testicular cancer. Alpha-feto protein (AFP), beta-human chorionic gonadotropin (beta-HCG), lactate dehydrogenase (LDH) These substances must be checked before radical orchiectomy (removal of the testis).

PROSTATE

What is Prostate Gland? What Does It Do? 

The prostate is the gland that surrounds the urinary canal just at the exit of the urinary bladder in men. The task of the prostate gland is to produce a milky white secretion that is alkaline. This secretion makes up about 30% of the semen. This alkaline secretion neutralizes the acidic environment of the vaginal environment and ensures that the sperms stay longer.

PROSTATE DISEASES

What is Benign Prostatic Hyperplasia (BPH)?

Benign prostatic hyperplasia (BPH) very rarely causes distress in a person before the age of 40. However, symptoms due to BPH affect the daily life and quality of life of more than half of men in their 60s and 90% in their 70s.

This enlargement of the prostate gland surrounding the urinary canal presses on the urinary canal, causing obstruction in the urinary canal and inability to pass urine easily. For this reason, over time, thickening and sensitization due to strain in the bladder muscle, and overreacting to the slightest stimulus, begin. Even if some urine accumulates in the bladder, it starts to show itself with the feeling of urination. Over time, the bladder muscle gets tired, becomes weak, and urine begins to remain in the urinary bladder with the inability to empty the urine completely.

Why Does Benign Prostatic Hyperplasia (BPH) Occur?

The mechanism of formation of BPH in our time is still not clearly understood. This means that it is impossible to understand exactly what the risk factors are. The most important information we know in our time: BPH occurs in older men, while BPH does not develop in men who had to have their testicles removed for some reason before puberty. For this reason, some researchers believe that factors related to age and testicular function play a role in the development of BPH.

What Are the Symptoms of Benign Prostatic Hyperplasia (BPH) Occur?

Problems affecting the social life of the person include getting up from sleep to urinate during the night and the need to urinate frequently during the day. In particular, these two problems cause problems such as lack of sleep in the social life of the person, fatigue, and the search for the toilet where they want to go. In addition, the force and speed of the urine flow may have decreased and slowed down compared to the past. There may be waiting and difficulty in starting to urinate, as well as a drop of urine may still come after urinating after a major part of the urine has flowed. In addition, the person may feel that the bladder is not completely empty after urinating.

An enlarged prostate is usually in the form of a growth as a benign tumor. For this reason, people usually consult a doctor when they encounter problems with urination. The occurrence of symptoms may not lead to a significant health problem in benign prostatic hyperplasia, except for affecting social life. However, the rated complaints are classified as mild, moderate and severe. In prostate enlargement, which is thought to be benign with prostate examination, blood tests and prostate needle biopsy when necessary, the follow-up of the patients and treatment with medication or surgery are decided according to the degree of complaints.

In summary, diagnostic methods applied in the benign evaluation of the prostate;

• Finger prostate examination,
• Serum PSA (total and free PSA), creatinine levels,
• Ultrasonography,
• Prostate biopsy (when necessary),
• Measurement of urine flow velocity uroflowmetry,
• Cystoscopy (when necessary).

 What are the Options of Treatment?

The first step in the treatment of BPH should definitely be medical treatment. If the expected result of medical treatment is not obtained, or if the symptoms that have improved despite treatment occur again over time, different treatment alternatives should now come to the agenda. Drugs called alpha blockers relax the muscles in the neck of the bladder (urinary bladder) and in the prostate, allowing the enlarged and obstructing prostate to relax and reduce the pressure in the urinary canal. Since the effect of the drug in the form of tablets taken orally is 24 hours, it is necessary to take 1 tablet a day continuously to ensure a continuous effect.

Drugs called 5 alpha reductase inhibitors prevent the formation of active testosterone (male hormone), which has an effect on the growth of the prostate, and prevents the growth of the prostate as well as allows the prostate to shrink. However, this shrinking effect is evident in prostate volumes over 50 grams. In addition, for the minimizing effect, it is necessary to use the drug continuously for at least 6 months.

Transurethral resection (TUR) is performed with bipolar energy and plasma kinetic energy, or with monopolar energy.

CHRONIC PROSTATITIS

Often prostatitis is known as a disease of young men. But epidemiological studies show that prostatitis, unlike BPH and prostate cancer, is observed in all age groups. Chronic prostatitis begins to appear in men with the fact that sexual life becomes active. About 5 percent of men from their 20s to their 40s and 50s experience this condition. It is also the third most common disease in men over the age of 50. Chronic prostatitis, in addition to complaints such as burning during urination and frequent need to urinate, also causes pain in the genital area. Chronic prostatitis is not contagious, but it is a disease that is very difficult to treat definitively and can persist for many years.

Chronic prostatitis often leads to psychological problems in patients. Therefore, it also negatively affects sexual life. The fact that men with chronic prostatitis feel pain in their genital areas can also cause impotence anxiety in these people.

What is Chronic Prostatitis?

Prostatitis is a inflammatory disease (inflammation) of the prostate and sometimes the surrounding tissue and is a prostate problem that men often face. It is believed that in 4 out of every 10 men who go to the doctor with genital or urinary problems, the cause is prostatitis.
The prostate gland, which is present in all healthy men and is necessary for reproduction, can become inflamed, like every other organ in our body. Inflammation of the prostate or prostatitis with its scientific name is usually observed in young and reproductive-age men. If the prostatitis disease is not treated at an early stage, it is very prone to becoming chronic.

In some types of prostate, prostate inflammation occurs even without bacteria. Inflammation of the prostate is not one of the sexually transmitted diseases. It is a condition that can occur at any age after puberty.

Chronic (inveterate) prostatitis, which is quite common, may miss the diagnosis due to the fact that its symptoms are not obvious and are often found together with other urinary tract inflammations.

What Are the Symptoms of Chronic Prostatitis?

In people who are under stress and psychological tension, a lot of contraction of the muscle that keeps the urine increases the probability of getting this disease. However, using a bicycle and motorcycle for many years, being in a profession that sits constantly (long-distance driving, etc.) may also be effective in the development of this disease.

• Frequent urination,
• Mild pain and difficulty urinating,
• Decreased urine flow,
• Sudden feeling of urinating,
• Mild pain in the rectum or lumbar region,
• A stabbing pain between the rectum and the penis during coitus,
• Pain in the lower back or genital area,
• Weakening of the erection
• Decreased sexual desire,
• Premature ejaculation,
• Painful ejaculation,
• Seeing blood in the semen,
• Slight fever,
• Muscle pains.

 What is Prostate Inflammation Treatment? 

Antibiotics are generally used in the treatment of chronic prostatitis. This antibiotic treatment is applied for an average of 4 weeks. If the disease recurs or there is no result from the treatment, this treatment period can be extended. In addition, medications are given to eliminate swelling. Afterwards, drug therapy can be applied to ensure comfortable urination. In very rare cases, surgery is performed. It is a difficult disease to treat.

ENDOSCOPIC TREATMENTS IN KIDNEY STONE DISEASE

Percutaneous Nephrolithotripsy (PNL)

As a result of the crystallization of chemical salts in the urine and the fusion of these crystals with each other, kidney stones or stones occur in the urinary tract. Especially for stones larger than 2 cm in the kidney, there may be problems for the patient in breaking the stone with a stone crushing device called ESWL, or pouring such a large stone through the urinary canals after breaking (for example, long and repetitive stone-breaking sessions, insufficient breaking of the stone, inability to completely shed the broken stones, or pain when pouring and leading to kidney blockages, such as stone street, stein strasse, stone road). As indicated in the guidelines for the diagnosis and treatment of stone diseases published by the American Urological Association, the European Urological Association and the Turkish Urological Association, PNL should be the first treatment option for stones larger than 2 cm in the kidney. On the other hand, PNL should be discussed with the patient as a treatment recommendation, even in patients whose loss after fracture in the lower pool of the kidney will be difficult due to gravity.

Stone treatment with the PNL method is a surgical treatment that has been applied to many patients all over the world for many years. In almost a large proportion of patients with kidney stones, it is now a reliable method that has replaced stone treatment with open surgery. Approximately, the surgery takes between 2-4 hours, including preparation of the patient and awakening from general anesthesia. Stone treatment with the PNL method is carried out through a 1-1.5 cm hole opened into the skin in the lumbar region. After the intervention, a thin probe (nephrostomy tube) is inserted into the kidney through the hole where the surgery was performed and it is left for 1-2 days for rapid recovery after the surgery. After PNL, surgery-related pain is very short and less, and the duration of hospital stay and return to daily activities and work is significantly shorter compared to open surgery. Usually, the nephrostomy tube is removed on the 1st or 2nd day after surgery and the patient is removed after a few hours of wetting is observed through the hole. There is also a significant cosmetic advantage compared to the surgical incision made in open stone surgery.

Flexible Ureterorenoscopy (RIRC, Retrograde Intra Renal Surgery)

The English word “Flexible” means bendable. The ureter is the thin channel that carries the urine formed in the kidney from the kidney pool (pelvis) to the urinary bladder. The ureter is located in two, one in the kidney on the right and the other on the left. The word endoscopy, from the word “Endoscopy” in English, means looking at an organ in the body through a telescope, observing. “Flexible Ureterorenoscopy”, which consists of the combination of these three words, includes entering the ureter and kidney from the urinary canal through a very thin telescope that can be bent, without opening any holes in the body, and breaking or removing the stone or tumor there by laser.

Flexible ureteroscopes that can be bent are generally 8-10 Ch (3.-3.5 mm) diameter thick. There is a very thin working channel used for breaking and removing the stone with optical lenses or digital camera cables. We can easily break the stones in the kidney with the laser cable system passing through the thin working channel, and we can remove the broken large (4-5 mm stone pieces are considered to be large in a study of this fineness) with the basket method. Here, stone chips of 3 mm or less are not collected and can be dropped easily without pain.