Our medical staff are trained in the
very latest techniques &
offer a wealth of knowledge & experience in their respective disciplines
Our medical staff are trained in the
very latest techniques &
offer a wealth of knowledge & experience in their respective disciplines

Urology & Neurourology

Urology

Urology is a branch of medicine which specializes in the treatment of conditions and diseases of the male and female urinary tract system and the male reproductive system. Urologists diagnose and treat various conditions and disorders associated with the kidneys, bladder, ureters, urethra and the male reproductive organs such as prostate, penis, and testes. They are dedicated to clinical excellence in urology care and patient education so patients can make informed decisions about their healthcare.

Working Areas

Urinary and fecal incontinence (Incontinence)

Frequently asked questions

What is Urodynamics?

Urodynamic studies (UDS) test how well the bladder, sphincters, and urethra hold and release urine. These tests can show how well the bladder works and why there could be leaks or blockages.

There are many types of urodynamic tests. A health care provider may recommend one or more based on your symptoms, but they are typically performed together as one test.

These tests, which are explained on the following pages, are all UDSs:

  • Cystometry, or Getting a Cystometrogram
  • Electromyography, or getting an Electromyogram (EMG)
  • Urethral Pressure Profile
  • Uroflowmetry
  • Voiding Pressure Study (Pressure Flow Study)

Why Would I Need Urodynamics?

Urodynamics help find the cause of problems related to:

  • Urine leaks/controlling your urine
  • Bladder not emptying all the way
  • The need to go too often
  • The need to go suddenly
  • Weak urine flow
  • Urine flow stopping and starting (“intermittent”)
  • Getting urinary tract infections often

Urodynamics

Non-scapel Vasectomy

What is vasectomy?

Vasectomy is the procedure of choice for men who do not want to father any children (or any additional children). It is indicated for any fully informed man and can be carried out as an outpatient procedure. If the patient has previous scrotal surgery or has any other possible complicating factors (e.g. a needle phobia), the procedure can be carried out under a short general anaesthetic. The non-scalpel vasectomy (NSV) is an innovative approach to exposing the vas deferens tubes in the scrotum using two specialized surgical instruments. NSV, as compared to traditional incision technique, results in less bleeding and hematoma, less infection, and pain, and a shorter operative time.

Vasectomy

Urinary Infection

Urinary tract infections (UTIs) are common infections that can affect the bladder, the kidneys and the tubes connected to them.

Anyone can get them, but they’re particularly common in women. Some women experience them regularly (called recurrent UTIs), UTIs can be painful and uncomfortable.

Symptoms of UTIs

Infections of the bladder (cystitis) or urethra (tube that carries urine out of the body) are known as lower UTIs. These can cause:

  • A need to pee more often than usual
  • Pain or discomfort when peeing
  • Sudden urges to pee
  • Feeling as though you’re unable to empty your bladder fully
  • Pain low down in your tummy
  • Urine that’s cloudy, foul-smelling or contains blood
  • Feeling generally unwell, achy and tired

What is Pelvic Pain?

Chronic pelvic pain is one of the most common medical problems among women. Twenty-five percent of women with CPP may spend 2-3 days in bed each month. More than half of the women with CPP must cut down on their daily activities 1 or more days a month and 90% have pain with intercourse (sex). Almost half of the women with CPP feel sad or depressed some of the time.

Despite all the pain CPP causes, doctors are often not able to find a reason or cure to help these women.

CPP is any pelvic pain that lasts for more than six months. Usually the problem, which originally caused the pain, has lessened or even gone away completely, but the pain continues.

Pudendal Peripheral Nerve Block

Pudendal nerve blocks are a minimally invasive, non-surgical treatment for chronic pain. These nerve blocks can help in the diagnosis of chronic pelvic pain conditions such as vaginal pain, penile pain, scrotal pain, or perineal pain. In addition, this pain management technique can also provide therapeutic relief by reducing pain signals originating from these nerves.

The pudendal nerve is prone to damage either by compression or stretch. Common scenarios where this may occur include trauma, prolonged/difficult/traumatic vaginal childbirth, or chronic straining during defecation caused by constipation. Pudendal nerve entrapment, also known as Alcock canal syndrome, is less rare and is associated with professional cycling or repetitive trauma on perineal area or wrong posture.

Systemic diseases such as diabetes and multiple sclerosis can also damage the pudendal nerve.

How It Works

A pudendal nerve block is performed with neurophysiology guidance to increase the accuracy and safety of this procedure.

  • You will be asked to lie on your stomach.
  • Your lower back and buttocks will be cleaned with an antiseptic, and a sterile drape will be placed.
  • Your physician will direct a guide needle toward the intended target area under EMG ( C-MAP ) guidance. Bony landmarks will help facilitate safe placement of the needle.
  • A local anesthetic and a steroid (cortisone) will be administered in close proximity to the nerve to block signals from reaching the brain. The cortisone serves as an anti-inflammatory under the assumption the nerve is inflamed or irritated. The needle is then flushed and withdrawn, and a dressing is placed over the point of needle entry.

Risks

This procedure is safe. However, with any procedure, there are side effects, risks, and possibility of complications. The most common side effect is temporary pain at the injection site. Other less common risks include bleeding, infection, or injection into blood vessels or vital organs. Fortunately, serious side effects and complications are uncommon. Injections of anti-inflammatory steroid medications along with local anesthetic or local anesthetics alone can provide slow relief of nerve pain over three to four months. The bulk of nerve-pain patients respond to injections. Radio frequency ablation can be helpful as well.

PROSTATE CANCER SYMPTOMS

Urinary symptoms of prostate cancer

Because of the proximity of the prostate gland in relation to the bladder and urethra, prostate cancer may be accompanied by a variety of urinary symptoms. Depending on the size and location, a tumor may press on and constrict the urethra, inhibiting the flow of urine. Some prostate cancer signs related to urination include:

  • Burning or pain during urination
  • Difficulty urinating, or trouble starting and stopping while urinating
  • More frequent urges to urinate at night
  • Loss of bladder control
  • Decreased flow or velocity of urine stream
  • Blood in urine (hematuria)

Other prostate cancer signs & symptoms

Prostate cancer may spread (metastasize) to nearby tissues or bones. If the cancer spreads to the spine, it may press on the spinal nerves. Other prostate cancer symptoms include:

  • Blood in semen
  • Difficulty getting an erection (erectile dysfunction)
  • Painful ejaculation
  • Swelling in legs or pelvic area
  • Numbness or pain in the hips, legs or feet
  • Bone pain that doesn’t go away, or leads to fractures

Diagnostic procedures

  • Multichannel urodynamic tests (uroflowmetry, cystometry, pressure/flow study, urethral pressure profile, US post voiding residual evaluation, pelvic floor EMG)
  • Diagnostic/operative flexible and rigid cystoscopy
  • Somato Sensorial Evoked Potentials (SSEPs) , pelvic floor EMG, sacral area reflexes ( performed by neurophysiologist )
  • Rectal manometry (performed by coloproctologist)
  • ColorDoppler US for ED and infertility

Rehabilitation therapy

  • Pelvic floor electrical stimulation (FES) and bio-feedback (BFB)
  • Posterior tibial neuro stimulation (PTNS) invasive and transcutaneous
  • Clean intermittent catheterization (CIC)
  • Trans cutaneous sacral and pudendal neurostimulation

Therapeutic minimally invasive therapy

  • One day Surgery (circumcision, vasectomy, hydrocelectomy, varicocele, TURB, TURP, endoscopic lithotripsy of renal and bladder stones, penile surgery for erectile dysfunction)
  • Sacral roots neuromodulation for urinary and fecal incontinence, retention and CPP
  • Pudendal nerve neuromodulation for urinary and fecal incontinence, retention and CPP
  • Pudendal and obturator muscle nerve block for pharmacologic modulation of CPP
  • Pulsed radiofrequency of pudendal nerve for CPP
  • Intravesical instillation of drugs for Interstitial Cystitis

Patient Forms

History and Physical Form

ICIQ-UI Short Form

SHIM Score

International Prostate Symptom Score (I-PSS)

Studies

Urodynamics Studies

Pelvic Floor Dysfunction

Vasectomy

Pudendal Neuropathy

Male Pelvic Pain

Vulvodynia

Dr. Francesco Cappellano
Dr. Francesco Cappellano
Consultant Urology & Neurourology, Urodynamics FEBU (Fellow of European Board of Urology)

Book an appointment with Dr. Francesco our Urology specialist.

 

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