Urology — Town Hospital

Urology at Town Hospital: an overview

Town Hospital's Urology department in the Fifth Settlement, New Cairo, diagnoses and treats conditions of the kidneys, ureters, bladder, prostate and urethra, and of the male reproductive organs, in men and women: from kidney stones, urinary infections and blood in the urine to an enlarged prostate, bladder control problems and men's health. The department's doctors are urological surgeons, among them a consultant who specialises in adult urology and men's health; you will find them in the list of doctors below.

The laboratory and radiology are open 24 hours a day, for urine tests and cultures, kidney function and the PSA test, and for ultrasound, 128-slice CT and a 3 Tesla MRI; so is the emergency department. Outpatient clinics are open every day from 10 am to 10 pm, and each urologist's days and times are shown in the up-to-date clinic schedule.

Conditions the department looks after

The urologist decides on diagnosis and treatment after the consultation and tests; these are the conditions patients most often come with. Weakened kidney function itself, without stones or a blockage, as in diabetes or high blood pressure, is assessed first by the Internal Medicine department.

Kidney and ureteric stones

Stones form when salts in the urine crystallise inside the kidney; not drinking enough, especially in hot weather, and a salty diet raise the risk. A stone can sit in the kidney without symptoms, but once it moves into the ureter, the tube that carries urine to the bladder, it causes renal colic: severe pain in the side or back that comes in waves and spreads towards the lower abdomen and groin, sometimes with vomiting or blood in the urine. Stones are diagnosed with a urine test, ultrasound and a CT scan without contrast. Many small stones pass on their own with fluids and pain relief, sometimes helped by a medicine the doctor prescribes to relax the ureter. Larger stones, or those that block the flow of urine, need treatment: shock waves from outside the body to break them up, a thin telescope passed up the urinary tract with a laser, or removal through a small opening in the back, chosen by the stone's size and position. The department treats ureteric and kidney stones with a ureteroscope and laser. Drinking enough and cutting down on salt lower the chance of new stones.

Enlarged prostate (benign prostatic hyperplasia)

The prostate is a small gland below the bladder that the urethra runs through. In most men it grows with age, especially after fifty, which can cause a weak or stop-start stream, a feeling that the bladder has not emptied, passing urine often, getting up at night and sudden urgency. A benign enlarged prostate is not cancer and does not turn into cancer, but the symptoms can overlap, so assessment includes a prostate examination, urine and kidney tests, a PSA test when needed, and an ultrasound scan of the prostate and of the urine left afterwards. Mild symptoms may need only changes such as drinking less before bed and less tea and coffee. The doctor may prescribe medicines that relax the prostate and bladder neck, which usually ease the flow within days, or that shrink the prostate gradually over months. Surgery is considered when medicines are not enough or complications such as being unable to pass urine appear; the most common approach removes the enlarged tissue through the urethra, with a telescope or a laser, leaving no external cut. The department carries out endoscopic prostate surgery through the urethra. Some cold and decongestant medicines can make passing urine harder, so ask the doctor first.

Urinary tract infections

An infection starts when bacteria reach the bladder, causing burning when you pass urine, the need to go often and lower abdominal pain, sometimes with cloudy or strong-smelling urine. It is more common in women; in a man, it usually prompts a search for a cause, such as an enlarged prostate or a stone. An infection that reaches the kidney brings a fever, shivering, pain in the side and vomiting, and needs prompt treatment; in older people, confusion may be the only sign. Diagnosis rests on a urine test and culture taken before any antibiotic, because the culture identifies the bacteria and the antibiotic that works against them. The doctor chooses the antibiotic and how long to take it; never take antibiotics on your own, because careless use makes bacteria resistant to treatment. Infections that come back twice or more in six months call for a search for the cause, which may include an ultrasound scan.

Blood in the urine

Blood can turn the urine pink, red or brown, or be invisible and found only on a urine test. Causes include infection, stones, an enlarged prostate and some kidney diseases, and it is sometimes the first sign of a tumour of the bladder or kidney, particularly in smokers and older people. So it should never be ignored, even if it happened once without pain, and even in someone taking blood thinners. Assessment includes a urine test and culture, kidney function and ultrasound, and the doctor may request a CT scan with contrast and a cystoscopy, in which a thin tube with a camera is passed along the urethra to look inside the bladder. Cystoscopy is done in the hospital. If a tumour is found, its treatment is planned with the hospital's Oncology department.

Bladder control problems and passing urine often

Leaking urine is not something you have to live with because of age. Leaking when you cough, sneeze or lift something heavy comes from weak pelvic floor muscles; it is more common in women and also affects some men after prostate surgery. An overactive bladder causes a sudden, strong urge that cannot be put off, with passing urine often by day and night. Assessment starts with a urine test to rule out infection and sugar and an ultrasound scan of the urine left after urinating, and the doctor may ask you to record when you drink and pass urine for a few days. Depending on the type, treatment includes timing your drinks, less tea and coffee, losing weight, pelvic floor exercises the doctor explains, bladder training to space out trips to the toilet, and, for urgency, medicines that calm the bladder muscle.

Men's health: erectile dysfunction and fertility

Erectile dysfunction is common and becomes more so with age. Its causes are mostly physical, such as damage to blood vessels from diabetes, high blood pressure, high cholesterol and smoking, low testosterone, or the side effects of some medicines, and psychological factors can play a part. It can be an early sign of heart disease, so assessment includes a blood pressure check and tests of blood sugar, blood fats and hormones. Treatment starts with the cause and lifestyle changes, together with medicines that increase blood flow to the penis, prescribed by the doctor; they must never be taken with nitrate medicines for chest pain, because the combination can cause a dangerous drop in blood pressure. When conception is delayed, the doctor may request a semen analysis and hormone tests for the man; testosterone should never be taken without an assessment, as it can reduce sperm production. These concerns are handled in complete confidence and with respect.

Testicular pain and swelling

Sudden severe pain in a testicle, especially in boys and young men, may be torsion, a twist that cuts off its blood supply; it is an emergency, because saving the testicle depends on the first few hours. Pain and swelling that build up gradually with a fever may be an infection, which the doctor treats with an antibiotic. A firm, painless lump needs a prompt appointment and an ultrasound scan, because testicular tumours mostly affect young men and are better found early. Other common conditions are a varicocele, swollen veins above the testicle that may ache after long standing and affect fertility, and a hydrocele, a usually painless collection of fluid around the testicle. Both are diagnosed by examination and ultrasound with Doppler, and surgery is considered for pain, an effect on fertility or a large size. The department operates on varicoceles and hydroceles.

Tests in the hospital

• Urine tests: a urine test and culture, to diagnose infection, choose the right antibiotic and look for blood, sugar or protein.
• Blood tests: kidney function, blood sugar and PSA, with hormones when needed, in a laboratory open 24 hours a day that takes walk-ins.
• Ultrasound: of the kidneys, bladder and prostate, including the urine left after urinating, and of the testicles with Doppler.
• X-ray and CT: a plain X-ray of the abdomen to follow some stones, and 128-slice CT without contrast to find stones, or with contrast to assess blood in the urine.
• MRI: on a 3 Tesla scanner, when the doctor requests it.
• Cystoscopy: a look inside the bladder through a thin tube with a camera, in the hospital.

You will find these tests on the Diagnostics page.

When you need emergency care straight away

Call an ambulance or go to the nearest emergency department straight away for:

• Being unable to pass any urine, with pain and swelling in the lower abdomen.
• Pain in the side or back with a fever or shivering, or kidney pain that painkillers do not ease or with vomiting that stops you keeping fluids down, especially if you have only one kidney.
• Sudden severe pain or swelling in a testicle, especially in boys and young men.
• Heavy bleeding in the urine, clots that block the flow, or blood in the urine after an accident or injury.
• A fever with urinary symptoms in an older person or someone with diabetes, with confusion or collapse.
• A painful erection lasting more than four hours.
• Sudden loss of bladder or bowel control with back pain, numbness around the buttocks and genitals, or weakness in the legs.

Town Hospital's emergency department is open 24 hours a day.

Your care, step by step

• Consultation: the doctor asks about your symptoms, any previous stones or infections, long-term conditions and current medicines, especially blood thinners, and examines you; for men this may include a prostate examination, which the doctor explains first. Bring previous results and scans, and any stone you have passed.
• Tests: the tests and scans your case needs, and no more, in the hospital, on the same day where possible.
• Decision: the doctor explains the diagnosis and the options, from monitoring and medicines to a procedure, with the benefits and possible risks of each, and you decide together.
• Treatment: many conditions are treated with medicines and follow-up in the clinic; when you need a procedure or an operation, the doctor explains what is proposed and the next steps. Urological operations and endoscopic procedures are carried out in the hospital's operating theatres, and the surgeon explains the preparation, the anaesthetic and the expected recovery beforehand.
• Follow-up: tests or an ultrasound scan as your case requires, and advice that lowers the chance of stones or infections coming back; never stop a medicine or change its dose on your own.

The hospital is contracted with more than 40 payers, including insurance companies, professional syndicates and government bodies, and cover depends on the payer and the terms of the contract; the list is on the Insurance page.