Urology deals with the study of the urinary system and related to it human reproductive system, the physiological and pathological processes occurring in them, the diagnosis, prevention and treatment of diseases of the urogenital organs (urethra, bladder, ureters, kidneys, male genital organs). Urology intersects with other areas of clinical medicine ‒ gynecology, andrology, venereology, nephrology and surgery. Urologists are engaged in the treatment and prevention of the pathology of male and female urogenital systems.
Urogenital diseases are far from being harmless. Their consequences lead to the development of chronic foci of infection, impotence, infertility, the need for renal transplantation and even death. For a man a urologist is as important as a gynecologist for a woman. Therefore, regardless of complaints, it is necessary to visit the urologist on a regular basis, at least 1-2 times a year.
Urological disorders in men, women, children and the elderly have their own characteristics of development and course, which is explained by anatomical, physiological and age-related characteristics of their bodies. The most common pathologies of male urogenital system are inflammatory processes (orchitis and epididymitis, urethritis, balanoposthitis, prostatitis, cystitis), prostate adenoma and genital infections. Female urological diseases are urethritis, cystitis, sexually transmitted infections and their consequences. Both men and women have urolithiasis, pyelonephritis, urinary tract tumors and chronic renal failure. The most common disorders in children are congenital anomalies of the urogenital system, cystitis and enuresis. The elderly people more often suffer from urinary incontinence and tumor masses.
The most common manifestations of urogenital diseases are urination disorders (frequent or retention), pain in the lumbar area, in the genitals, burning and itching in the genital area, pathologic discharge from the urethra, sexual disorders, changes in urine color or amount, edemas.
Modern diagnostic possibilities in urology are great. Laboratory methods are used for examining urine and urethral discharge, ultrasound and X-ray diagnostics, endoscopic (urethroscopy, cystoscopy), instrumental (puncture biopsy, catheterization, bougienage) and measuring diagnostic methods (cystometry, uroflowmetry), etc.
Treatment of urogenital pathology has its own specific features. Since many urological diseases are transmitted through sexual contact, both sexual partners need to undergo appropriate treatment. Urogenital diseases are an intimate sphere of human life. Therefore, the doctor should be tactful and provide psychological support for patients during their treatment. Urological diseases affect the sexual function of men and women, so their adequate and timely treatment helps maintain your sexual health and family well-being. Surgical treatment of urological problems can be aimed not only at normalizing the work of the urinogenital apparatus, but also at aesthetic correction, which helps patients get rid of many psychological complexes.
The area of oncologic urology in Germany actively develops new approaches alongside with traditional surgical treatment and chemotherapy. For example, the doctors of urology department practise prostateсtomy using Green Light Laser technology that is applicable even for high risk patients. A targeted laser burns off the tumor without any damage of the surrounding tissues. Compared to other types of beam therapy Green Light Laser provides full tumor removal preventing the disease recurrence. It also prevents bleeding and reduces the postoperative period.
Men are more susceptible to urogenital diseases. Surgical and aesthetic urology is often of interest for men. Diseases, symptoms of various diseases in men cause not only health problems, but also severe psychological stress. Male diseases are often serious for several reasons. Urology-andrology is the area of study of male genital organs and urinary tract. This specialization studies male diseases by the nature of their course, structural abnormalities of the urinary tract, the structure of kidneys, prostate, and penis.
The most common male diseases and problems are:
- the problem of male infertility;
- prostate diseases;
- problems with urination (incontinence, retention);
- pain in the penis during sexual intercourse (for example, at the time of ejaculation);
- decrease in potency or its complete loss for a number of reasons;
- male menopause or the extinction of sexual function in men;
- penis or balanus curvature;
- venereal and infectious diseases (syphilis, chlamydia, herpetic lesions);
- renal failure (mainly, pre-dialysis stage);
- male urolithiasis of complex genesis;
- cancerous tumors in the organs of the urogenital system.
Diseases of the urinary system in men are brought on due to a variety of causes, both internal and external. The most common ones are:
- A variety of infections that provoke inflammation in the urinary and genital organs. The causative agents are bacteria, viruses, fungi, including microorganisms that cause venereal diseases (chlamydia, gonococci, mycoplasmas, trichomonads, etc.). The risk of the disease increases with unprotected sexual intercourse, frequent change of sexual partners, lack of personal hygiene, or therapeutic and diagnostic interventions on the organs of the urinary system.
- Genetic predisposition to the disease or congenital anomalies of the urinary system.
- Weakened immune system. Urological diseases often occur against a background of chronic concomitant pathologies, in the presence of foci of infection, leading to a decrease in the body’s defense mechanisms.
- Unhealthy lifestyle, lack of motion, bad habits, unhealthy diet ‒ factors that provoke problems with the heart and blood vessels, lead to impaired blood circulation in the pelvic organs, stagnation and the development of inflammation in the urinary system.
- Chronic stress, psychoemotional overstrain, hazardous work conditions, supercooling and other unfavorable environmental conditions exhaust the body and the nervous system and provide the site of entry for infections.
The symptoms of many urological pathologies affecting men and women are similar. They can be divided into several main groups:
- Common signs of inflammation ‒ temperature rise, weakness, loss of strength, fever, lack of appetite and other signs of intoxication.
- Changes in diuresis. If the person is healthy, urinary frequency is usually 4-6 times a day, with up to 1.5 liters of urine being excreted. As pathological processes in the urinary system develop, there arise such disorders as pollakiuria (frequent urination), stranguria (difficult and painful urination), urinary incontinence or abundant excretion at night-time.
- Pain syndrome. Taking into account the localization of pain, the doctor may suggest which organ is affected. The nature of the painful sensations can be different ‒ from dull, aching and constant pain to sharp, unbearable colic during a urinary stone attack. If discomfort is felt in the lumbar area, it is assumed that the patient has problems with the kidneys. If pain spreads to the groin area, most likely, the inflammatory process develops in the ureters. Pain syndrome, concentrated above the pubis, indicates the inflammation of the bladder, while in the perineum in men it points to the development of prostatitis, urethritis or sexually transmitted infections.
- Changes in urine. In case of urological diseases, the characteristic symptoms are changes in urine colour and density, the presence of salts, protein, blood and bacterial agents in it. The quantitative changes include polyuria (an increase in the daily volume of urine), oliguria (a decrease in the volume of urine excreted per day) and anuria (absence of urine in the bladder).
Diagnostic procedures include a set of measures aimed at identifying the cause and severity of urological pathologies. These are the following laboratory and instrumental testing methods:
- general and biochemical blood tests;
- urine analysis (general, Zimnitsky test and Nechyporenko test);
- inoculation urine sample test to identify the type of the causative agent;
- PCR ‒ a highly accurate method for the detection of infectious and genetic diseases;
- ultrasound, MRI or CT of the affected organ;
- endoscopic examination methods;
- radioisotope examination;
- intravenous urography.
Female urology is also called urogynecology. The specificity of this area is based on identifying and treating the processes of inflammation of the urogenital sphere in women. These include infectious processes in the external and internal sexual organs, in the bladder and urethral canal.
Problems of female urology declare themselves through the following diseases:
- inflammation of the bladder ‒ cystitis and paracystitis, which involves the fatty tissue that surrounds the bladder;
- inflammation of the renal pelvis ‒ pyelonephritis;
- inflammation of the urethra ‒ urethritis;
- urinary disorders ‒ overactive bladder, genital prolapse or pelvic floor dysfunction, urinary incontinence, enuresis;
- trophic changes of the mucous membrane in the genital area;
- congenital anomalies ‒ vesicoureteral reflux, urethral stricture;
- purely female urological dysfunctions ‒ vaginitis, oophoritis, endometritis, salpingitis;
- urogenital neoplasms ‒ cysts, papillomas, myomas.
The main causes of urological diseases in women include:
- lack of adequate treatment of infections caused by pathogens of different types ‒ conditionally pathogenic (E. coli) or urogenital, sexually transmitted diseases (chlamydia, mycoplasma, ureaplasma, genital herpes, etc.);
- the presence of abnormalities (trauma) of the female genital organs (due to childbirth, abortion or other surgical interventions);
- impaired metabolism, which leads to salts and stones deposition;
- weak pelvic floor muscles in the form of prolapse of the urogenital organs (genital prolapse), which can be a result of injuries and indicate sex hormone deficiency, menopause, venous congestion or varix dilatation;
- tumours of the genital tract (hysteromyoma, ovarian tumours, appendages tumours, adenomyosis, commissures);
- active sex life without the barrier protection with frequent changes of partners;
- causing damage to your health so as to look fashionable ‒ frequent wearing of tight synthetic clothes, strings and the use of daily liners.
Symptoms in women are in many cases similar to gynecological diseases. The manifestations of female diseases in urology are as follows:
- nagging pain in the lumbar area, appendages and lower abdomen;
- cramping pain in the lower abdomen and lower back;
- painful intercourse;
- frequent urge, pain and burning during urination;
- changes in urine colour;
- vaginal discharge, severe itching and burning;
- high temperature.
Taking into consideration the gravity of urological diseases, their diagnosis includes the whole range of the most informative and accurate methods:
- laboratory urine tests;
- endoscopic examination ‒ cystoscopy;
- ultrasound of the bladder and kidneys;
- radioisotope examination of the kidneys - scintigraphy;
- intravenous urography to identify possible pathology of the ureters or kidneys activity;
- MRI of the kidneys.
Pediatric urology diagnoses and treats diseases in children. These specialties in urology are directly related to the patient age criterion. In children, the structure of the genitals is considerably different in functionality, so you need to pay special attention to their hormonal background. Pediatric urological diseases often have urgent (scrotocele, inguinal hernia) or infectious nature (cystitis after supercooling, colds, pyelonephritis, etc.). Pediatric urology is necessary for both boys and girls.
Geriatric urology studies the problems of the genital and genitourinary system in patients of mature or extreme old age. The peculiarity of age-related urology is the diagnostic and treatment complexity in the course of irreversible natural processes in any person’s body.
To identify the disease, the symptoms of which may be similar to other diseases, there are methods of differential diagnosis. Operative urology often uses only instrumental methods of examination.
Urology reveals all diseases using minimally invasive methods.
It includes methods of examination that can solve the problem of diagnosis in both men and women in a short time. By using this method, it is possible to detect developmental or functional anomalies of the bladder, urethral canal, the presence of inflammatory fragments in the urinary tract:
- fibre optics;
The endoscopic method of diagnosis usually involves the introduction of optical elements into the organ by using a special tripod (or catheter). It gives the possibility to accurately make a picture of the disease.
Physical Diagnostic Methods
Such methods include obtaining echographic data. Ultrasound in urology makes it possible to quickly examine any tumour, pathological structural changes in the tissues of the kidneys and urinary tract. Images are saved on film or photographic paper for easy storage of information in the patient’s history.
X-ray photography of the urinary tract and genital organs is performed by using different medical techniques. The overview image reproduces several projections of the kidney and helps evaluate its filtering, accumulative and excretory functions.
The main diagnostic procedures are:
- excretory urography (use of a contrast agent);
- infusion (intravenous drip injection of contrast to visualize the work of the pelvic complex);
- retrograde ureteropyelography;
- antegrade pyeloureterography.
The procedure can take about several hours. It depends on what the patient’s medical history is. During this time, doctors take several pictures at each stage of accumulation and excretion of the contrast agent. These important parameters help identify the disease according to the shapes and assess the adequacy of the prescribed treatment.
Symptoms in men with some diseases are blurred, so the disease is quickly detected with the help of X-rays. If it is impossible to determine the nature of the disease by using the methods listed, in urology there are instrumental methods of diagnosis, for example, cystomanometry, uroflowmetry, biotesiometry.
Laparoscopy is the best-known minimally invasive treatment technique. Through tiny incisions in the skin (keyhole surgery), laparoscopes, featuring optical equipment and surgical instruments, are inserted into the abdominal cavity. New generation lasers (for example, green lasers) enable doctors to perform minimally invasive surgeries causing minimal blood loss.
In Germany, they are also applied when surgeries are combined with the use of blood clot dissolving medicines. Holmium laser is used for fragmenting kidney stones prior to their removal. Besides, urology in Germany uses it to remove scarry strictures in renal ducts or the urethra.
Robot-assisted surgery, such as, for example, da Vinci treatment, is an effective high precision non-invasive type of treatment.
Oncological urology or uro-oncology is one of the key branches in Germany. Uro-genital cancer types comprise over 40% of all malignant diseases. The most common ones include prostatic, bladder, testicular, kidney cancer, etc.
Urology in Germany diagnoses and treats all types of urogenital tumors. Prostate cancer - the most common one – is diagnosed in nearly 50,000 patients every year. Prostate cancer diagnosis involves PSA analysis, ultrasonography, rectal palpation and biopsy. Timely detection of prostate cancer is vital, since tumors discovered at early stages can be and are usually cured successfully through surgery and/or radiotherapy. Also, urology in Germany offers fairly effective methods of treatment of late-stage cancer, such as hormonal therapy.
Bladder cancer is the second most widely spread type of uro-genital tumor. Methods of diagnosis include urine test, particularly cytological analysis for the detection of traces of cancer cells, and visualization. Endoscopic examination provides all but one-hundred-percent certainty of the presence/absence of a tumor.
Many of you have certainly heard or read about such a method of treatment as TUR ‒ transurethral resection. To perform it special cystoscopes are used. The endoscopic technique makes possible various interventions for diseases of the bladder, urethra and ureters. This method of treatment has advantages over traditional open surgery as there is less trauma, blood loss, risk of complications and a shorter postoperative period.
Endoscopic methods of operations are used in the treatment of various pathologies of the bladder (cancer, benign tumours, papillomas, etc.), prostate adenoma, urethral strictures, pathology of the ureters, urolithiasis.
In the treatment of urolithiasis, in addition, percutaneous methods are now widely used for crushing and removing kidney stones ‒ the so-called remote lithotripsy.
Another sub-specialty of modern urology is laparoscopy. In addition to laparoscopy, retroperitoneoscopic interventions are also used in urology. The principle of laparoscopic operations is that instead of traditional incisions to get, for example, access to the kidney, all interventions are performed through special accesses by using trocars ‒ through mini-incisions, punctures. Moreover, the entire course of the operation is controlled by the surgeon with the help of a video camera, which transmits information to the monitor screen.
The range of application of laparoscopic and retroperitoneoscopic interventions in urology is quite wide. It is enough to list the surgical interventions that today are performed according to the principles of minimally invasive endosurgery, so that you can see what the prospects for the development of this area of urology are. These are such operations as:
- nephrectomy (including for donor transplantation),
- kidney resection,
- resection of kidney cysts,
- nephropexy (surgical treatment for nephroptosis),
- pyelolithotomy (removal of stone from the pelvis),
- ureterolithotomy (removal of stone from the ureter),
- plasty of the pelvic and ureteral segment,
- ureterolysis (release of the ureter from adhesions),
- orchiopexy (operation for cryptorchism),
- pelvic lymphadenectomy,
- ligation and resection of veins for varicocele,
- cystectomy with the creation of the intestinal reservoir,
- marsupialization of lymphocele,
- closure of the bladder rupture,
- radical prostatectomy and many others.
Another modern trend in urology is the microsurgical technique. Most often, these are operations connected with the restoration of organ integrity or its complete replacement by transplant. In this case, it is usually necessary to restore many small blood vessels and nerve bundles. Such operations are performed by using special microsurgical instruments and microscopes. For example, the microsurgical method is used in total phalloplasty when the complete replacement of the penis is performed.
Every year the famous weekly magazine FOCUS performs the survey of the best urology clinics and surgeons in Germany so that the patients could make a conscious choice and benefit from being informed We have studied the recent ratings (2015/2016) and summarized the most relevant information for those international patients who seek advanced treatment of urology problems.
How is the score of the best urology centers and specialists estimated?
The December issue of the German weekly magazine FOCUS published the current rating of the best urology specialists and clinics in Germany (2015/2016). This list features 65 top urology surgeons and 35 top-scoring urology clinics, which managed to meet the strictest quality criteria of an independent FOCUS team.
In order to get included into such a reputed list, the specialist or the clinic should provide the safe urology services (urology treatment and urology tests) at the highest level of modern European medicine. The key criteria are:
- The reputation of urology surgeon or urology clinic: more than 1400 German urology specialists had to estimate the services of their colleagues as well as to name the urology experts, which, in their opinion, can be trusted to.
- The number of scientific publications: Only those urology specialists who introduce the scientific innovations and breakthroughs into their practical routine as well as regularly contribute to scientific journals or conferences are included into the FOCUS rating of “Top German Urology specialists”.
- The number of treated cases (the so-called “Patient-volume” criteria): The best urology specialist should not only be scientists, but also practitioners. They should treat at least 300 patients a year and perform or guide at least 120 surgical interventions annually.
- Level of technological advance, employed at the urology clinic during the urology treatment or surgery is also important. The best clinics should be equipped with the newest laser and ultrasound devices, the digital endoscopes for minimally invasive surgery, powerful microscopes and modern robotic surgery devices etc.).
- Efficiency of treatment: Most severe forms of urology diseases can be effectively treated at the best German urology centers. Best urologists implement minimally invasive, sparing technologies, which help to eliminate the health problem as soft and quick as possible. The FOCUS team studies the success rates of treatments and takings this ratio into account during the estimation of the quality profile.
The best urologists in Germany have achieved extraordinary high results in prostate and kidney tumor treatment and other urogenital diseases. Such technologies as robotic surgery, green laser and other achievements and innovations of modern German medicine have already helped hundreds of thousands of international patients to overcome their disease and to restore health.
We want to make your choice of the best urology specialist as efficient as efficient and easy as possible. For this reason we have analyzed the health market situation in Germany as well as patients’ feedback and publish the list of the GMG rating “TOP Urology Surgeons” (2015/2016).
Top 10 urology specialists you can trust your health to!
Recommended by patients:
European expert in prostate cancer treatment, prostate surgeon.
Tops the list of the “Best German Urologists 2016”, according to FOCUS and JAMEDA rating.
Recommended by patients:
Specialist in minimally invasive prostate surgery, andrology, holistic (medicinal) tumor therapy and palliative care. Special accreditation 2009 in “Robot-assisted urologic surgical procedures (Da Vinci)” Dr. Barnhoum is included into the JAMEDA “List of 10 top urology experts” 2016.
Recommended by patients:
Awards: Dr. Müller is on the JAMEDA and SANEGO List of the “Top urology specialists 2015” in Germany. “The best urology surgeon”, according to FOCUS rating 2013 and 2015.
The scope of services, offered by Dr. Müller includes the diagnosis and treatment of benign and malignant diseases of the kidney, bladder, testis and prostate, urinary incontinence, the erectile and sexual dysfunction, of urolithiasis, cancer prevention and outpatient surgery.
Recommended by patients:
Department at the University Clinic in Munich, Head of the “Prostate Cancer Center” (DKG), Member of the urological “Tumorboard Munich”.
Performs surgery with the newest robotic surgery device “Da Vinci Si HD”.
This operating system was first installed in Europe in the Urological Clinic Munich Grosshadern and is the most sophisticated and advanced operating system available today.
Recommended by patients:
His professional team provides highly accurate diagnosis and treatment of all the diseases of the urinary tract, including malignant tumоrs, male sexual dysfunction, urinary incоntinence, pelvic pain, urinary stone disease, male infertility and prostate disorders. Special qualifications: Robot-assisted laparoscopy, reconstructive urological surgery, particularly urethral reconstruction surgery in children; Laser surgery of prostate enlargement (prostatitis).
Recommended by patients:
Specialist in urology, proctology and visceral surgery at the GKH Bonn. Since 01/2006 Founding partner of the Medical Centre Bonn – Friedensplatz (Urology center).
Special Qualifications: Robotic surgery with DaVinci system; Urologic Oncology; Pediatric Urology Neuro Urology; Harnsteinanalytik
Membership in professional associations: Member of the German Society of Urology – (DGU). Member of the Working Group of urinary cancer treatment - (DGU). Member of the Société Internationale d'Urologie –( SIU).
Special prizes: 1998 MSD Prize for scientific activity; 2000 Paul-Mellin Prize for innovative techniques of cancer treatment (NRW Urology Society).
Recommended by patients:
Awards: “TOP prostate cancer specialist”, according to the FOCUS ratings 2012, 2013 and 2016. Since April 2012, chief physician at Knappschaftskrankenhaus / Westfalen Clinic in Dortmund. About 30 years of practical experience in the field of prostate surgery.
Special Qualifications: Prostate cancer treatment, bladder infection management, vasectomy, infertility treatment, urodynamics assessment, cancer prevention, fertility treatment, shockwave treatment, incontinence treatment, laser therapy, chlamydia management, brachytherapy, syphilis management, anti-aging medicine, stress incontinence, brachytherapy, urethral stricture
The clinic of Dr. Meisse was one of the first clinics who launched PCA3 test (Prostate-cancer-Gen3 test). It is a new method of a molecular genetic test with excellent specificity for prostate cancer.
Recommended by patients:
Awards: “Top Urology Specialist” 2015 and 2016 according to the FOCUS rating.
Special qualifications: Minimally invasive kidney stone treatment, DaVinci surgery, treatment of tumоrs of the urinary tract, male sexual dysfunction, urinary incоnt inence, pelvic pain, urinary stone disease, male infertility etc. Honorary member of the Southwest German Society for Urology (SwdGU).
Scientific contributions: -numerous contributions; - regular contributing to medical journals and participation in scientific conferences.
Technological advance: -well-equipped; - highly-equipped urology center.
Prostate surgery: -good, -extremely good.
Cancer treatment: -highly efficient; -cancer treatment at special “Cancer center”.
Patient recommendation: –very recommended; -extraodinary recommended.