Medical Check-ups and General Urology

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Medical Check-ups and General Urology
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Urine infections

Urine infections affect any part of the urinary system: urethra, bladder, ureters, kidneys. Most occur in women and are limited only to the lower part of the urinary system (bladder, urethra) causing annoying symptoms but usually do not involve any severity. On the other hand, infections in women that affect the upper part of the system (ureters, kidneys) or infections in men (mainly prostatitis) can become serious.

Women are more likely to get a UTI than men, due to their anatomy and hormonal changes during the menstrual cycle.


Urinary tract infections do not always cause symptoms. But when they do, they can understand:

  • Imperative and constant need to urinate.
  • Burning sensation when urinating.
  • Urinating frequently in small amounts.
  • Cloudy-looking urine and very foul-smelling.
  • Red, bright pink, or brownish urine (a sign of blood in the urine).
  • Pelvic pain in women, especially in the center of the pelvis and around the pubic bone area.

Localization of urinary tract infections

Depending on their location, infections acquire different nomenclature and cause specific symptoms:

Part of the urinary tract affected

Signs and symptoms
Kidneys (acute pyelonephritis)
  • Pain in the upper back and side (flank)
  • High fever
  • Tremor and chills
  • Nausea
  • Vomiting
Bladder (cystitis)
  • Pelvic pressure
  • Discomfort in the lower abdomen
  • Frequent and painful urination
  • Blood in the urine
Urethra (urethritis)
  • Burning when urinating
  • Transurethral discharge


UTIs usually occur when bacteria enter the urinary tract through the urethra and begin to multiply in the bladder. Although the urinary system is prepared to prevent the entry of these invaders, these defenses sometimes fail. When this occurs, bacteria can proliferate into a fully developed infection.

  • Bladder infection (cystitis). It occurs mainly in women. This type of urinary tract infection is usually caused by Escherichia coli (E. coli), a type of bacteria frequently found in the gastrointestinal tract. However, sometimes other bacteria are responsible.

Sexual intercourse can cause cystitis, but you don’t have to be sexually active to get it. All women are at risk for cystitis because of their anatomy; specifically, because of the short distance from the urethra to the anus and from the urethral opening to the bladder.

  • Infection of the urethra (urethritis). This type of urinary tract infection can occur in women when bacteria in the gastrointestinal tract spread from the anus to the urethra. Also, because the female urethra is close to the vagina, sexually transmitted infections (herpes, gonorrhea, chlamydia, and mycoplasmosis) can cause urethritis. In men, urethritis is usually secondary to sexually transmitted diseases.

Risk factors

Risk factors for UTI include:

  • Female anatomy. Women have shorter urethras than men, which shortens the distance bacteria must travel to reach the bladder. That makes these types of infections more frequent in women.
  • Sexual activity. Sexually active women are likely to have more UTIs. Having a new sexual partner also increases the risk.
  • Certain types of birth control. Women who use diaphragms for birth control may be at higher risk, as may women who use spermicides.
  • Menopause. After menopause, the decrease in circulating estrogen produces changes in the urinary tract that make you more vulnerable to infection.
  • Abnormalities in the urinary tract. Babies born with urinary tract abnormalities that do not allow urine to leave the body normally or cause urine to back up into the urethra are at high risk for UTIs.
  • Urinary tract obstructions. Kidney stones or an enlarged prostate can cause urine to become trapped in the bladder and increase the risk of UTIs.
  • Depressed immune system. Diabetes and other diseases that impair the immune system (the body’s defenses against germs) can increase the risk of UTIs.
  • Use of catheter. People who can’t urinate on their own and use a tube (tube) to urinate on their own are at high risk for UTIs. This may include people who are hospitalized, those who have neurological problems that make it difficult to control their ability to urinate, and people who are paralyzed.
  • Recent urinary procedure. Urological surgery, as well as a urinary tract exam that includes the use of instruments, can increase the risk of urinary tract infection.


When treated quickly and properly, lower urinary tract infections are uncommon to have complications. But if a UTI is left untreated, it can have serious consequences.

Complications of a UTI may include:

  • Recurrent infections, especially in women who have two or more urinary tract infections in a six-month period, or four or more in a year.
  • Permanent kidney damage due to an acute or chronic kidney infection (pyelonephritis) caused by an untreated urinary tract infection.
  • Elevated risk for pregnant women of having a low birth weight or premature baby.
  • Stenosis (narrowing) of the urethra in men with recurrent urethritis who previously had gonococcal urethritis.
  • Sepsis, a life-threatening complication of infections, especially if the infection spreads to the upper urinary tract.


At Uros Associats we carry out a thorough study of urinary tract infections. We indicate urine examination, urine culture, renovesical ultrasound and, in some cases, abdominal x-rays, CT scans and cystoscopies. Each study contributes significantly in the choice of treatment.


UTIs are treated with antibiotics, with rare exceptions. These antibiotics are chosen depending on the sensitivity profile specified in the urine culture antibiogram. That is why it is so important to have a urine culture before starting any treatment. The duration of therapy varies depending on the type and severity of the infection.

In addition to antibiotics, at Uros Associats we indicate several prophylactic medications that aim to create a protective barrier in the urinary tract. These treatments are adjuvant. We also assess the possibility of using antibacterial vaccines depending on the patient’s profile and clinical picture.


At Uros Associats we emphasize several well-known measures that collaborate with antibiotic treatment:

  • Plenty of fluids, especially water. Drinking water helps dilute urine and ensures increased urinary frequency, allowing bacteria to be expelled from the urinary tract before infection can begin.
  • Intake of cranberries. While studies are inconclusive about the properties of cranberry juice to ward off UTIs, it is probably helpful and not harmful.
  • Correct way to perform intimate hygiene. Cleaning should be done from front to back. Doing this way after urinating and bowel movements helps prevent bacteria from the anal region from spreading to the vagina and urethra.
  • Urinating after sex for women (not men).
  • Do not use potentially irritating feminine products. Using deodorant sprays or other feminine products (such as douches and powders) in the genital area can irritate the urethra.
  • Change your birth control method. Diaphragms or condoms without lubricant or with spermicide can contribute to the growth of bacteria.
  • Avoid using bidets. Contrary to what is commonly thought, the bidet favors the transfer of intestinal bacteria to the vaginal or urethral area.

Epididymal pathology, pathology of the spermatic cord and scrotum

The epididymis is a tubular bean-shaped structure, which is located attached to the testicle in its posterior portion. Its function is to store sperm until they have matured. The spermatic cord is the set of structures on which the blood supply, venous drainage, part of the suspension and innervation of the testicle depends; It reaches the scrotum from the groin on each side. The scrotum is the pouch of skin that lies below the penis and anterior and above the perineum and stores the testicles.

These organs can be affected, together with or separated from the testicle, by various diseases or conditions.

  • Epididymal cysts and spermatic cord cysts They are very common in adulthood and usually do not pose a major problem than aesthetics. If they are very bulky or cause pain from compression or obstruction of neighboring structures, they can be removed by an operation under anesthesia.
  • Epididymal or spermatic cord tumors are generally benign; malignant tumors are rare. Surgical removal is the treatment of choice, and may involve partial or total excision of the epididymis.
  • Epididymitis is an inflammation of the epididymis usually caused by bacteria that are contracted with sexual intercourse or that are typical of the urinary tract (Chlamydia trachomatis, Neisseria gonorrheae, E. coli, Proteus, Klebsiella and others). It can also be caused by some viruses, mainly in childhood. It is an acute picture, of rapid establishment. In addition to pain and swelling, they can cause fever, malaise, involvement of the testicle on that side and, in the long term, sterility due to fibrosis or obstruction of the spermatic passages. Treatment should be started soon, and antibiotics, anti-inflammatories and local physical measures are used. Rarely, surgical exploration may be necessary.
  • Testicular torsion or torsion of the spermatic cord is a medical emergency, which is established acutely, and can compromise the vitality of the affected testicle if it is not resolved within a few hours. It is more frequent in children and adolescents (65-70% of cases). It causes severe pain in the testicle and groin and occasionally vegetative symptoms (nausea, vomiting). A medical history, physical examination, and urgent testicular ultrasound (Doppler) diagnose torsion in 95% of cases. Treatment is almost always surgical.
  • Torsion of the testicular appendix It is a pathology that can be confused with torsion of the spermatic cord. This appendix is an embryological vestige that sometimes remains pedicled in the scrotal sac so it can twist. Although in certain cases the picture yields only with anti-inflammatories and analgesics, most of the time the form of presentation requires surgical exploration of the testicle to rule out a torsion of the spermatic cord.
  • The hydrocele It is the accumulation of serous fluid in a compartment of the scrotal pouch located between both tunica vaginalis. It is common in children under 2 years of age, in which it mostly resolves on its own. After 2 years it is difficult to disappear spontaneously. Hydrocele is a benign and painless process, but it can cause aesthetic and ergonomic discomfort to patients when the amount of accumulated fluid exceeds 100cc. In these cases, the resolution is surgical.
  • Varicocele is a dilation of the veins that drain the testicle, which is collectively called the pampiniform plexus. It affects 10-15% of men, and in 20% it is associated with infertility. The left is more frequent (85-90%). Only in 5% of cases is it symptomatic (testicular pain or heaviness). Depending on the grade (I, II, III), it can be palpated or seen in the scrotum. It can appear at any age, and in rare cases may be associated with intra-abdominal masses. They are diagnosed with physical examination and ultrasound. Its surgical correction is justified in symptomatic patients, grade III varicoceles and those associated with sterility.
  • In the scrotum, complicated or uncomplicated inguinal hernias may also appear that compress and affect the spermatic cord. Its diagnosis is made with physical examination and imaging tests. The correction is surgical.
  • Sebaceous cysts, epidermal inclusion cysts, lipomas, soft fibroids and warts They can affect the skin of the scrotum. Some patients are more likely than others to suffer from them, and there are underlying diseases that sometimes predispose to develop any of these dermatological anomalies. The treatment is surgical, removing the lesion completely, and then sending it to the laboratory for pathological analysis if necessary. This is done in the operating room scenario usually, with local or regional anesthesia.

Male surgical contraception: vasectomy

Vasectomy is a male birth control modality that prevents sperm from entering semen. It is done by cutting and closing the vas deferens that are the ones that transport the sperm.

Before having a vasectomy, you should be sure that you will not want to have a child in the future. While vasectomy can be reversed, it should be considered a permanent male birth control method. It is a safe, effective technique and can usually be performed in the outpatient setting under local anesthesia. It does not offer protection against sexually transmitted infections.

Advantages of vasectomy

  • Vasectomy is almost 100 percent effective in preventing pregnancy.
  • It is an outpatient surgery with low risk of complications or side effects.
  • The cost of a vasectomy is much less than the cost of female sterilization (tubal ligation) or the long-term cost of contraceptive medications for women.
  • Having a vasectomy means you won’t need to take contraceptive measures before having sex, such as using a condom.


One possible concern with vasectomy is that the patient may later change their mind about wanting to be a parent. Although it may be possible to reverse vasectomy, there is no guarantee that it will be achieved. Reversal surgery—called VASO VASOSTOMIA, also performed by our team with the help of a surgical microscope—is more complicated than vasectomy. Other resources such as epididymis biopsy / aspiration are also assisted reproduction techniques that can be used after a vasectomy to obtain sperm. These procedures can be costly and, in some cases, ineffective.

Surgical risks of the procedure may include:

  • Bleeding or bruising inside the scrotum
  • Blood in semen
  • Infection at the site of surgery
  • Mild pain or discomfort
  • Inflammation of the surgical site

Future complications, all of which are very rare, may include:

  • Chronic pain, surgery although it is very rare.
  • Fluid buildup in the testicle, which can cause mild, annoying, ongoing pain that worsens with ejaculation but is usually transient and disappears after a few days
  • Granulomas of the differential ends that do not usually have any consequences
  • Pregnancy, if the vasectomy fails (rare). It is extraordinary but any sectioned duct can be rechanneled in the body, in the case of the vas deferens the possibility of recanalization is greater in the first weeks and that is why we will perform a control with seminogram after a few weeks of surgery before you can stop the contraceptive measures. However, there is always a remote possibility of late rechanneling.
  • A small cyst (spermatocele) that manifests in the small spiral tube located in the upper testicle that collects and transports sperm (epididymis)
  • A fluid-filled sac (hydrocele) surrounding the testicle


Many men fear that a vasectomy can cause serious problems; But these fears are unfounded. For example, a vasectomy:

  • It will not affect your sexual performance. Vasectomy will not affect your sex drive or masculinity in any way. Many men have reported increased sexual satisfaction after a vasectomy.
  • It will not cause permanent damage to the genital organs. There’s very little risk of your testicles, penis, or other parts of your reproductive system being injured during surgery.
  • It will not increase the risk of getting certain types of cancer. While there was previously some concern about a possible link between vasectomy and testicular or prostate cancer, no link has been proven.
  • It will not cause severe pain. You may feel mild pain and a stretching sensation during surgery, but severe pain is rare. Similarly, after surgery you might experience some pain, but for most men it is mild and goes away after a few days.


Vasectomy requires you to take certain details into account.

Medication to be discontinued

Your doctor will likely ask you to stop taking aspirin, nonsteroidal anti-inflammatory drugs, or other blood-thinning medications several days before surgery. These include warfarin (Sintrom), heparin, and other over-the-counter pain relievers such as ibuprofen.


Bring tight underwear to wear after the procedure to support the scrotum and reduce inflammation.

Other care

Shower or take a bath on the day of surgery. Be sure to carefully wash the genital area. Shave hair all over the scrotum to facilitate surgery and avoid problems with wound healing. Ask someone to drive you home after surgery to avoid movement and pressure in the surgery area caused by driving.

What to Expect Before the Procedure

Before you have a vasectomy, your doctor will want to meet with you to make sure it’s the right birth control method for you.

At your initial appointment, be prepared to discuss the following:

  • That you understand that vasectomy is permanent and that it is not a good option if there is any chance that you will want to be a parent in the future
  • If you have children and how your partner feels about the decision, if you are in a relationship
  • Other contraceptive methods available to you
  • What vasectomy surgery and recovery entail, and what are the possible complications

Vasectomy is usually done in an operating room under local anesthesia, which means you’ll be awake and given medication to numb the area of the operation. There is also the possibility that vasectomy will be performed under sedation (general anesthesia), for which it will be necessary to complete a preoperative and a pre-anesthetic visit.

What to expect during the procedure

Surgery for a vasectomy usually takes between 25 and 30 minutes. To perform a vasectomy, your doctor may take the following steps:

  • He or she will anesthetize the surgical area with an injection of local anesthesia with a thin needle into the skin of the scrotum.
  • With the “no-scalpel” technique, you will make a small puncture in your scrotum instead of an incision.
  • He or she will locate the tube where sperm pass from the testicle (vas deferens).
  • He or she will remove part of the vas deferens through the incision or puncture.
  • He or she will cut the vas deferens in the removed part of the scrotum.
  • He or she will seal the vas deferens with heat (cautery), suturing, or a combination method. The doctor will then place the ends of the vas deferens back into the scrotum.
  • He or she will close the incision at the surgical site with stitches. In some cases, the wound may be allowed to close on its own over time.

What to Expect After the Procedure

After a vasectomy you may have some small bruising on your skin as well as some swelling or pain. Usually, these symptoms will improve within a few days. Your doctor will give you instructions for recovery. Your doctor may ask you to:

  • Call right away if you have signs of infection, such as bleeding from the surgery site, redness, fever over 38°C, or if the pain or swelling gets worse.
  • Protect the scrotum with a bandage and tight-fitting underwear for at least 48 hours after vasectomy.
  • Apply ice packs to the scrotum for the first two days.
  • Limit activity after surgery. You’ll need to rest for 24 hours after surgery. You’ll be able to do light activity after 24 hours, but avoid sports, lifting, and heavy lifting for about a couple of weeks. Moderate or heavy exertion could cause pain or bleeding inside your scrotum.
  • Avoid sexual activity for about a week. If you ejaculate, you may feel pain or see blood in your semen. If you have sex, use another method of birth control until your doctor confirms that there is no sperm in your semen.

After a vasectomy you will ejaculate semen, but it will no longer contain sperm once you have ejaculated about 20 times. Vasectomy blocks sperm produced by the testicles from reaching the semen. Instead, the body absorbs sperm, which causes no harm. Anyway, you should consider that you are still fertile until we confirm that the semen analysis shows that you are no longer fertile.


Vasectomy does not provide immediate protection against pregnancy. Use an alternative method of birth control until your doctor confirms that there is no sperm in your semen. Before having unprotected sex, you’ll need to wait several months and ejaculate at least 15 to 20 times or more to remove all sperm from semen.

At Uros Associats we perform a spermiogram control in 3 months after vasectomy to ensure that there is no viable sperm left. You must provide the laboratory with semen samples for examination, we will make the request. To collect a semen sample, your doctor will ask you to masturbate and ejaculate in a container or use a special condom without lubricant or spermicide to collect semen during sex. The semen is then examined under a microscope to see if it contains sperm.

Short frenulum

The frenulum is the fold of skin that joins the glans to the inner surface of the foreskin in order to help retract over the glans. Normally, in situations where the penis is not erect, the frenulum remains hidden behind the foreskin. When the foreskin is removed, the frenulum is exposed, allowing a triangle-shaped piece of skin to be seen extending to the urinary opening.

As for the functions of the frenulum, we can differentiate two:

  • On the one hand, it protects the glans and helps keep the foreskin in the correct position on the glans.
  • On the other hand, it facilitates the sexual act by allowing the displacement of the foreskin during erection.

The frenulum can present several problems, among which is the abnormality of the short frenulum. It is considered short frenulum to one that restricts the movement of the foreskin on the glans and can cause pain during erection or sexual intercourse.

This condition can develop for several reasons:

  • Genetics: it is simply a condition inherited congenitally from your parents, so you are already born with the shortening of the frenulum. You may not have been diagnosed until puberty or adolescence.
  • Infections: as a result of having suffered some infectious pathology in the genital area, it is possible to develop inflammation and changes in the tissue that forms the frenulum, so that the frenulum is shortened, as well as that the skin becomes thicker, preventing the correct retraction of the foreskin.
  • Braulum breakage: Although it is possible for the rupture itself to be caused by a short frenulum, it is also possible that it is caused by injuries during sexual intercourse or masturbation. In case the rupture occurs due to injury, the frenulum may heal incorrectly, which would lead to shortening and its consequent problems.
  • Phimosis: It consists of an abnormality in the skin that covers the penis. This condition occurs when the foreskin is too narrow in the area of the glans, so it cannot be completely or partially retracted. This abnormal growth of the preputial skin usually leads to the frenulum also developing incorrectly, being shorter than normal and leading to the need for circumcision.

Symptoms that may result from short frenulum are:

  • Pain: can occur due to the tension exerted by the short frenulum both during erections and by the retraction of the foreskin. Even when the shortening is very pronounced, sharp pain can cause impotence.
  • Cracks in the skin of the foreskin: due to shortening, the skin changes its appearance by the forced and constant tension of the skin. It is possible that due to the cracking of the skin the tissue also becomes irritated and you feel intermittent itching.
  • Bleeding: can be caused by injuring the shortened frenulum, that is, by breaking it. In case this happens, the bleeding is usually very abundant and prolonged, being necessary that you go to the emergency room of Uros Associats or to the emergency room of one of the centers where we are the team on duty (Teknon Medical Center and Sagrada Familia Clinic)
  • Infection: occurs as a result of the wound caused by the breakage or lack of proper hygiene of the penis due to the difficulty of retracting the foreskin. This can lead to an infection of the foreskin or even a general infection.
  • Inclination of the head of the penis during erection: due to the tension exerted by the short frenulum, the foreskin does not correctly discover the glans and it remains wedged between the tissue, this leads to excessive inclination of the head of the penis or a curved shape of the erect penis.


The diagnosis of short frenulum is made with medical history and physical examination. Our urologist will immediately identify if it is a short frenulum or not.


It is possible to treat the anomaly by making skin movements and applying steroid cream to ensure that the skin has better elasticity although normally this anomaly is solved by surgery. Depending on the problem would be performed, a frenuloplasty or frenectomy or even a circumcision

Non-surgical treatments

If you do not want to resort to surgery as a first option, there is the possibility of resorting to exercises and the use of steroid cream to achieve greater elasticity of the tissue. It is possible that, in very mild cases of frenulum shortening, non-surgical treatment will solve the problem.

  • Short frenulum stretch with steroid creams: You will need to apply the steroid cream on the area. This type of cream decreases the thickness of the tissue and gives greater elasticity to the skin. However, when you stop applying the steroid, the skin is rebuilt again. You will need to consult with us the type of cream and the duration as well as follow-up of the treatment.
  • Stretches for short frenulum: It consists of applying a slight pressure of the skin of the foreskin, at least for 5 minutes twice a day, always under the advice of a specialist in Urology who can advise you and adapt the exercise to your case. During exercise, you should try to retract the skin until you feel some discomfort, yes, without feeling pain. When you get it, hold the position for about 30 seconds and pull the skin forward again, relax and repeat the exercise for 5 minutes.

Although it is true that treatment with exercises and corticosteroid cream usually has favorable effects in patients who have a very mild frenulum shortening, urologists agree that non-surgical or pharmacological treatment does not usually work in the vast majority of cases, they only delay the time of surgery.

Surgical treatments

Procedures for repairing the short frenulum consist of releasing the tension point. The urologist is the main person in charge of advising the patient on which of these techniques is the most appropriate for him depending on his specific case. At Uros Associats we will advise you individually and help you choose the best option.

In the 3 interventions, local anesthesia is used and the wound is sutured with a resorbable material.

  • Frenuloplasty: It is the technique of reconstructive plastic surgery of the frenulum. With it a much more aesthetic result is obtained, by also eliminating the excess skin surrounding the frenulum, in addition to eliminating the frenulum.
  • Frenectomy or frenulectomy: The procedure involves the complete removal of the frenulum. Its objective is purely functional, it is to release the frenulum.
  • Circumcision: through this technique the foreskin is completely cut, so that the glans is completely exposed.

These procedures usually last about 15-30 minutes and their recovery is relatively fast, since it usually ends completely after about 4 weeks.

Phimosis and paraphimosis

Phimosis is the presence of a closed foreskin that prevents the glans from coming to the surface. That is, we will say that a male has phimosis when the skin surrounding the glans narrows and can not slide down, so the glans does not appear because a ring is produced.

Although it is a pathology that affects children with greater incidence, it is true that it can also manifest itself at any age. In adulthood and especially with the onset of sexual intercourse, the gg will require submitting the patient to a surgical intervention. In addition, in adults it is common to speak of phimosis as a result of recurrent balano-preputial infections. Other consequences caused by phimosis in adults are difficulty urinating, pain during sex and


(strangulation of the glans by the phimotic ring). This last condition is an urgency; It requires a manual reduction through a maneuver that is usually performed in the emergency room.


Phimosis is diagnosed with a medical history and physical examination. In general, no further studies are required.

Treatment: circumcision

It consists of the excision of the foreskin or redundant skin of the penis, and thus expose the glans permanently. Unlike frenuloplasty, it is a longer intervention (between 30-45 minutes). The technique is usually performed under local anesthesia, although there is the possibility of performing it under sedation, after the request of a complete preoperative and a pre-anesthetic consultation. Then the patient can lead a normal life, with the only recommendation to avoid sexual intercourse for 1 month and physical exercise for at least 2 weeks.

Circumcision is probably the most commonly performed surgery in the world.

This surgery is necessary in men affected by preputial phimosis or suffering from states of inflammation of the foreskin and glans. Other situations where we recommend it is the possible existence of foreskin tumors and possibilities of tearing of the frenulum. They are less common, but circumcision is also prescribed to reduce the risk of

Penile cancer

and transmission of human immunodeficiency virus (HIV). In addition, there are comparative studies that report that this surgery can significantly improve premature ejaculation, by reducing the hypersensitivity of the glans that patients with redundant foreskin usually have.

Circumcision in adults is performed more often than we think and due to certain alterations that doctors consider can affect the penis. In children it is basically done because, in many cases, problems of infections and possible sequelae in the adult life of men are prevented. Circumcision is also frequently indicated in the elderly. With age the skin of the foreskin loses elasticity, dries out and dermatological diseases may appear that make circumcision necessary.

The technique in adults is very similar to when performed in younger men, with local anesthesia, although sometimes it may be necessary to perform reconstructive techniques since there may be adhesions between this skin and the glans.


Balanitis is the term used to refer to inflammation of the glans. Factors that can cause balanitis include the following:

  • Poor hygiene. When proper body hygiene is not performed, microorganisms of the local flora can behave as irritative pathogens.
  • Adhesions on the foreskin. Adhesions or preputial sclerosis can cause the phimotic factor, which can lead to balanitis.
  • Postcoital hypersensitivity or traumatic cause.
  • Bacterial or fungal growth in a humid area, giving rise to the infectious factor.
  • Result of a sexually transmitted infection (STI).
  • Allergies or contact with irritants such as soaps, detergents or condoms.
  • Other diseases: systemic pathologies such as diabetes or HIV, can cause it.

Symptoms reported by a patient with balanitis may include:

  • Redness of the area accompanied by stinging or pain.
  • Urethral discharge, sometimes with a foul odor.
  • Appearance of red sores on the glans.
  • Inability to retract the foreskin.
  • Painful urination.


The main form of prevention is a good habit of hygiene and keeping the area clean and dry. If the inflammation is related to condom use, it is recommended to use protection designed for sensitive skin.

Types of balanitis

  • Candidal balanitis: produces redness, pain or stinging in the glans. It is produced by fungi that grow in a humid environment. It is more common in immunosuppressed patients, with poor hygiene or in diabetics.
  • Bacterial balanitis: can be due to two types of germs: anaerobic or aerobic. The appearance of fissures, edema, suppuration, redness and pain is common.
  • Herpes balanitis: caused by herpes simplex type 2 (STI). It manifests itself with painful ulcers that, after 10-14 days, become crusty. It can be accompanied by the appearance of swollen inguinal ganglia.
  • Lichen sclerosus: the typical lesion is whitish plaques on the glans that sometimes also affect the foreskin. There may be hemorrhagic vesicles and, less frequently, blisters and ulcerations. The involvement of the skin produced by lichen sclerosus can cause a narrowing of the foreskin, thus appearing phimosis.
  • Circinated balanitis: this type of balanitis can be associated with other pathologies such as Reiter’s syndrome or reactive arthritis.
  • Premalignant lesions: erythroplakia of Queyrat and Bowen’s disease; these lesions are associated with an elevated risk of progressing to invasive cancer. It is estimated at around 30 percent in erythroplakia of Queyrat and 20 percent in Bowen’s disease. They appear as confluent reddened plaques.
  • Zoon’s Balanitis: occurs especially in elderly men who do not have a correct hygienic habit. Reddish-orange lesions appear with delimited edges.


Balanitis is diagnosed with a medical history, physical examination and complementary studies. These studies are: smear culture of glans secretions, urine cultures, and sometimes biopsy of lesions with premalignant or malignant appearance is also necessary.


To treat balanitis we recommend:

  • Hygiene. Keep the area clean and dry. At a minimum, a thorough cleaning of the area is suggested 1 time a day with soap and water.
  • When bacterial infection is suspected, ointments accompanied by systemic treatments can be applied. If STIs are suspected, specific treatment will be administered.
  • In cases where the disease occurs repeatedly or accompanied by phimosis/paraphimosis, circumcision may be performed.

The prognosis of this disease depends on what was the cause and the risk factors it presents. In most cases, it disappears quickly if the appropriate treatments are followed.


Hypospadias is a birth defect in males in which the opening of the urethra is not at the tip of the penis. In children with hypospadias, abnormal urethral formation occurs between weeks 8 and 14 of pregnancy. There are different levels of severity of hypospadias; Some may be mild and others more severe The abnormal opening can be located anywhere from the area just below the tip of the penis to the scrotum.

Hypospadias is the most common congenital anomaly of the penis. Its incidence varies in each geographical region; in Western Europe the incidence is close to 3 cases per 1,000 NB (EUROCAT Registry).

Types of hypospadias

The type of hypospadias your child has will depend on the location of the urethral opening:

  • Balanic: The opening of the urethra is located somewhere near the head of the penis.
  • Penian: the opening of the urethra is located in the shaft of the penis.
  • Penoscrotal: The opening of the urethra is located in the area where the penis joins the scrotum.

Boys with hypospadias sometimes have a hunched penis. They may have problems with the abnormal way urine comes out and may need to sit down to urinate. In some boys with hypospadias, the testicles have not fully descended into the scrotum. If hypospadias is not treated, it can cause problems later in life, such as difficulty having sex or urinating.


Most hypospadias present as isolated abnormalities of unknown cause. Different causes of occurrence of the malformation have been described.

  • Family cause: Between 5 and 25% of hypospadias have a familial incidence. The overall incidence of hypospadias in the sons of an affected father is 7-10% and in siblings of a child with a severe form of hypospadias rises to 20%.
  • Hormonal cause: Hypospadias has been linked to the production of fetal hormones. Failures in the process of production or transformation of testosterone or its receptors can lead to the appearance of the malformation. The administration of progestogens to the mother to facilitate pregnancy has been linked to the increased prevalence of hypospadias. Environmental “estrogenic pollution” (consumption of meat from animals treated with hormones to improve production) and hormone disruptors present in the environment (pesticides, chemicals used in the agri-food industry and in cosmetics) and in diets rich in plant estrogens have been shown to cause hypospadias.
  • Syndromic cause: there are more than 100 genetic syndromes that include hypospadias among their manifestations.
  • Abnormalities of sexual differentiation: when hypospadias is associated with uni- or bilateral testicular maldescent, micropenis or scrotal anomalies, it is mandatory to rule out ADS.
  • Other factors: advanced age and maternal smoking, testicular abnormalities or subfertility in the father, intrauterine growth retardation and low birth weight also predispose to the appearance of hypospadias.


Hypospadia is usually diagnosed during a physical exam after the baby is born.


The goal of treatment is the correction of all defects associated with the malformation. The curvature of the penis (orthoplasty) will be corrected, a urethra of adequate length and caliber (urethroplasty), glans plasty (glanduloplasty), adequate skin coverage and correction of anomalies of the position of the scrotum if they exist.

In most cases the defect can be corrected in a single surgical act, however, in some cases it may be necessary to perform the correction in several times. This decision will be made based on the degree of curvature, the length of the urethra to be built and the amount of skin available.

  • Orthoplasty– for the correction of curvature it is necessary to completely separate the skin of the penis and perform an artificial erection. If curvature persists, it may be necessary to section or remove the urethral plate, fold the penis on the dorsal part or in the most severe cases elongate the ventral part of the corpora cavernosa using different tissues. The plication of the penis allows to correct the curvature of the penis, but produces a certain degree of shortening.
  • Urethroplasty: multiple techniques have been described (there are more than 300 published in the literature) and there is none that provide better success rates with fewer complications. So the choice of technique is based on the surgeon’s preference and the specific anatomy of the case. The chosen technique should allow to place the meatus in the apex of the glans, the erection straight and achieve the best functional and aesthetic result.
  • Glanduloplasty: aims to give a conical appearance to the glans and cover the new urethra with it.
  • Skin covering: The ventral skin of the penis is usually insufficient, so the foreskin is used to cover the defect. Opening the foreskin obtaining two lateral flaps that rotate and join in the midline, is the most used technique.
  • Scroplasty: Scrotal bifidity is corrected by removing a strip of skin from each hemiscrotum in the midline. Complete scrotal transposition (the scrotum is placed above the penis) is associated with severe hypospadias that usually require reconstruction in two stages. At first, orthoplasty and correction of transposition are performed using cutaneous plasties.

Hypospadias is a complex treatment pathology with a considerable rate of complications:

  • Immediate complications include bleeding, infection, loss of flap vitality, blockage or loss of the probe, and mobilization of the dressing.
  • After removal of the catheter, inhibition of urination and urinary retention may occur.
  • In the medium term, a single or multiple urethrocutaneous fistula may appear, which consists of the communication of the urethra with the skin through a hole through which urine comes out.
  • Meatal stenosis (narrow urinary meatus that makes it difficult to stream urine) and neourethra stenosis (the entire new urethra narrows) may occur early or during follow-up.
  • It may also persist from ventral curvature or reappear in adolescence.
  • Late ballooning of the neourethra or diverticula (dilation of the urethra that looks like a “lump” in the ventral part of the penis). Diverticula can cause pseudoincontinence (the child wets clothes by dripping urine after urinating).
  • In the adult patient, problems related to the appearance of hair in the neourethra and rarely erectile dysfunction can be seen.

Treatment of these complications may require further surgery.

At Uros Associats we have urologists specialized in urethra, who evaluate the case thoroughly to ensure the best possible treatment. In addition, our multidisciplinary approach to patients with hypospadias, assisted by pediatric surgeons in the case of cases in children under 16 years of age, is a resource that we have and that results in benefits for our patients.

General urological check-up

Urology is the branch of medical sciences that is responsible for the study of the urinary system and the male reproductive system. It treats various very common pathologies, such as urolithiasis, urinary infections, benign prostatic hyperplasia and various tumor diseases, such as prostate cancer, kidney cancer and bladder cancer, among others. Just as women go to the gynecologist, it is very important that all men go to the urologist for a general check-up from the age of 50, since the early detection of prostate and kidney diseases ensure a timely, curative treatment with minimal repercussions, unlike those diseases diagnosed late.

In Spain, approximately 50% of men over the age of 50 have never been to the urologist. However, more than 70% know that prostate cancer is the first tumor in incidence and the second in mortality, after lung cancer, and that 90% of prostate cancers occur after age 50. The root causes of not attending the consultation are disinterest, lack of need, apprehension or shame. Despite the many sources of information available to us today, there is still a widespread taboo regarding the examination of the male genital organs. Women, on the other hand, have overcome this taboo by noting the clear advantages for their health of the annual visit to the gynecologist.

When is it necessary to go to the urological consultation?

It is recommended that men have an annual urological check-up from the age of 50 if there is no history of urinary or prostate tumors in the family, or from the age of 40 if there is a family history of prostate cancer. This review will allow detection in less advanced stages potentially serious urological problems

such as tumors of the prostate, bladder or testicle, and other pathologies such as benign prostatic hyperplasia or erectile dysfunction.

Although an annual check-up is recommended, some warning symptoms should be taken into account that should make the man go to the urologist before, such as difficulty or discomfort to urinate, the presence of blood in the urine or sperm, pain in the testicles or perineum and erection or ejaculation disorders.

What is done at a general urological visit?

In a general urological consultation we carry out an interrogation on the urinary and sexual habits of the patient, a physical examination that covers the abdomen, penis, testicles and prostate through a digital rectal examination, and a blood test to determine the prostate-specific antigen (PSA), which will allow the specialist to assess a possible prostatic involvement, either by benign increase in size or by a neoplasm. In case of any alteration, the urologist will be responsible for requesting other examinations such as an ultrasound, a flowmetry (which allows studying the patient’s way of urinating) or a prostate biopsy.

If alterations in sexual desire, erection or ejaculation are detected, the doctor may also carry out other studies such as analytical to assess hormone levels, imaging tests to observe the integrity of the urethral tract or evaluate the vascular functioning of the penis if there are erection problems.

Women should also see a urologist if they have frequent urinary tract infections or urinary incontinence. Also, the presence of blood in the urine, chronic pelvic pain and the history of kidney stones are pathologies that should lead the woman to the urological visit.

Diagnostic tests that may be indicated at a first visit to the urologist

General and urine analysis: allows us to comprehensively know the internal state of the patient, showing their hematimetric data, renal function, liver profile, lipid and hormonal profile. The urine test tells us about its appearance, color, degree of acidity, presence of bacteria or blood.

The prostate-specific antigen (which is analyzed by blood tests) is a marker that helps us detect problems in the prostate such as benign hyperplasia, cancer or infection. It is a specific marker of prostate, not prostate cancer, so an elevation does not always carry the possibility of prostate cancer. It can be elevated in both benign and malignant diseases.

Urological ultrasound:
This routine test looks at the kidney, bladder, and prostate. It guides us about the state of each of these organs, being able to detect stones in the kidneys, tumors in the kidneys and urinary bladder, as well as assess the prostate size.

Examination of the study of the rate with which urine is emitted. The normal thing is that the urine comes out quickly and with quantity, but if you have a problem that makes it difficult for the urine to come out normal, it will be appreciated that it comes out in smaller quantities and more slowly, a problem that arises in patients who have benign prostatic hyperplasia.

Abdominal X-ray: radiological test of the abdomen; useful in the diagnosis of urinary and bladder stones. In addition, it provides information about the condition of the spine, stomach and intestines.

Urodynamics: allows to assess the functioning of the bladder both at the time of filling and emptying.

Radiological test in which contrast is administered to be able to observe with total clarity the structure and shape of the bladder and urethra. Useful in urethral strictures and in certain disorders of bladder filling and emptying.

Intravenous urography: Tests the kidneys, bladder, and ureters using x-rays and intravenous contrast injection.

Cystoscopy: is a urological procedure whose purpose is the visualization of the inside of the urinary bladder using a very thin endoscope. It allows to rule out the presence of bladder tumors, take special urine samples, biopsies, and the extraction of foreign bodies.

Urological magnetic resonance imaging: studies in depth the kidneys, ureters, bladder, testicles and penis, without the need to emit radiation.

Multiparametric magnetic resonance imaging of the prostate:
Diagnostic method for the detection and local staging of prostatic neoplasia. As MRI has a very high negative predictive value, prostate biopsies can be avoided if the results of the resonance show no signs of disease, so in the event of an elevation in PSA, it should be performed mandatory. It provides an improvement in diagnosis and staging in 60% of cases. In cases where a prostate lesion appears on the MRI, the biopsy can be directed specifically to the place indicated by this radiological test, which increases the chances of correctly diagnosing the disease.

Urological tomography (UroTAC): provides us with images of the anatomy of the entire urinary tract (kidneys, ureters, bladder and its adjacent organs). This test exposes the patient to a small amount of radiation and requires administration of intravenous contrast.

If you still hesitate to come to our consultations…

General urological screening results in invaluable health benefits, so embarrassment or apprehension should not be excuses to avoid visitation. At Uros Associats we strive to make the first contact with the urologist a pleasant and profitable experience.

PSA: what is it and what does it mean when it is elevated?

Prostate-specific antigen (PSA) It is a protein produced by the prostate that acts by dissolving seminal fluid. Its production depends on the presence of androgens (male sex hormones) and prostate size. It occurs almost exclusively in the prostate, although other organs, such as the ovaries and salivary glands, produce tiny PSA values, undetectable in conventional tests. The PSA is used in medical practice as a marker, i.e. a measuring resource to detect the presence of a disease. Unfortunately it is an imperfect marker, because It rises in both benign and malignant pathologies.

It has more utility in prostate cancer. A very small part of the PSA produced by the prostate passes into the bloodstream and it is precisely this that is measured for the diagnosis, prognosis and monitoring of prostate cancer.

Reference values for serum PSA vary from laboratory to laboratory, although a value equal to or less than 4 ng/mL is usually considered normal.

Blood PSA levels can vary depending on certain situations. In healthy males the levels are very low. Ejaculation or physical exercise can also modify PSA levels. Prostatic massage or prostate biopsy may transiently raise serum PSA levels. In tumor or infectious processes it is common to find values above normal.

Patients with prostate cancer have a lower percentage of free PSA, while those with benign prostatic hyperplasia have a higher proportion.

What common conditions raise PSA?

Clinical situations that are commonly related to an elevation of this marker are:

  • Prostatitis or urinary tract infection.

PSA levels correlate with tumor size and extent, i.e. PSA levels will be higher the larger and more widespread the tumor is. However, a certain percentage of prostate cancer patients have normal PSA levels.

Elevated PSA levels can also occur in other prostate pathologies such as benign prostatic hyperplasia or prostatitis. Therefore An elevated PSA value in itself is not a diagnosis of prostate cancer, although it is of great help to the urologist for its diagnosis along with other tests, such as digital rectal examination.

Before a high value of PSA in isolation it is advisable to confirm these elevated levels after a while, and another test that can be performed is the so-called free PSA.

Role of PSA in Prostate Cancer Follow-up

Once the diagnosis of prostate cancer is established, PSA is useful for monitoring the effectiveness of therapy.

For this it is very important that PSA measurements are always carried out with the same technique and, if possible, in the same laboratory. In this way it is ensured that the variations found are due to the evolutionary process of the tumor and are not technical alterations.

The form of lowering serum PSA levels depends on the therapy chosen:

  • Patients undergoing radical prostatectomy: PSA is reduced to undetectable levels after about a month if all tissue has been removed. A subsequent elevation of these levels would mean tumor recurrence.
  • To monitor prostatectomized patients, a type of “ultrasensitive” PSA determination method is used, which has the particularity of detecting PSA levels as low as 0.01 ng/mL.
  • If treatment is with radiation therapy, levels slowly decrease until they stabilize around the reference range, called PSA NADIR. There may be a transient increase in PSA levels during radiation therapy, which is not a sign of disease progression.

Hormone therapy for prostate cancer also lowers PSA levels to baseline values.

Prostate biopsy

Prostate biopsy is currently the only way to definitively diagnose prostate cancer. It is also used for Differentiate between cancer and benign prostatic hyperplasia. It is indicated in patients who have a PSA repeatedly elevated, in those with a suspicious digital rectal examination (nodular, stony), and in those in whom a prostate magnetic resonance has detected a lesion suspicious of malignant tumor.

Prostate biopsy may be done:

  • By ultrasound: It uses a finger-sized ultrasound probe inserted into the patient’s rectum, and a needle to remove tissue from the prostate after local anesthesia is administered. It does not allow to identify in real time suspicious areas of normal areas, so the procedure is carried out randomly, taking samples from several areas of the prostate.
  • By fusion of ultrasound and MRI images: Sometimes it is difficult to biopsy the exact area of the prostate where the tumor is located. When MRI detects a clearly suspicious image of cancer, it is indicated to biopsy exactly that area. Using this new technique, the 3D images obtained in the resonance are merged with the live image of the ultrasound (what is called fusion of resonance image and ultrasound). This is how the urologist is told the exact situation of the lesion and it is possible to take one or more samples with a needle. It is also Useful in patients who have previously undergone a biopsy whose result has been negative, although the suspicion was high and who want to improve the resolution of the procedure and the accuracy of the biopsy. MRI-directed biopsy can be performed with an endorectal approach or with a transperineal approach. For endorectal biopsy, the patient usually lies on his stomach. The biopsy device has a built-in endorectal coil to aid in visualization and an orientation groove for biopsy needle insertion. For transperineal biopsy, the patient usually lies on his back, and the biopsy is usually performed with an orientation template placed against the perineum (just below the scrotum). These procedures are performed under sedation or general anesthesia.

Preparing for biopsy

Before the biopsy, it is imperative that you tell your doctor:

  • Medications that are commonly taken, especially anticoagulants and antiplatelet drugs. Stopping these medications will be insisted days before the procedure.
  • Allergies to medications, such as local anesthetics, disinfectants, anti-inflammatories, and antibiotics.

In addition:

  • A general and coagulation analysis will be indicated.
  • A basic preoperative may be ordered, including electrocardiogram, chest x-ray, and anesthetic assessment.
  • Remember to eat a light diet for 2 days before the procedure, and empty your bowels the hours before the biopsy.
  • You may be given a small enema hours before the procedure to clean your bowels and clear your rectum of stool so that your prostate can be seen more clearly with ultrasound to reduce your risk of infection.
  • A prophylactic antibiotic will be prescribed, to avoid possible infections induced by the procedure.
  • If it is performed under sedation, the importance of coming with you to be taken home after the biopsy will be remembered.

On the day of the procedure:

  • You should come fasting, with comfortable clothes.
  • Any metal objects, such as hearing aids, watches, rings and other jewellery, must be removed.

Material used in the biopsy

Ultrasound equipment (ultrasound)

Ultrasound scanners consist of a console containing a computer and electronic systems, a display screen for video, and a transducer or probe that is used to perform the scan. The transducer sends inaudible, high-frequency sound waves into the body and then listens to the return echoes.

The ultrasound image is displayed on a video screen that looks like a TV or computer monitor. The resulting image depends on the amplitude (volume) and frequency (pitch) of the signal. Ultrasound creates an image taking into account the travel time of the signal, the composition of the tissue, and the type of body structure through which sound travels.

The ultrasound probe used in prostate biopsies is about the size of a finger. Once the probe has been placed in the rectum, the biopsy is performed using a biopsy needle. This needle is very thin, and when introduced into the tissue is able to take samples in the form of a cylinder that are collected to send them for analysis.

Magnetic resonance imaging (MRI


equipment and fusion imaging biopsy


The traditional MRI unit is a large cylindrical shaped tube surrounded by a circular magnet. Unlike conventional x-ray exams and computed tomography (CT) scans, MRI does not use radiation, but instead uses radiofrequency waves that realign the hydrogen atoms that exist naturally within the body. As hydrogen atoms return to their usual alignment, they emit different amounts of energy depending on the type of body tissue they are in. The NMR scanner captures this energy and creates a photograph using this information. It produces images of very fine cross-sections of the body, which are then studied by a radiologist.

MRI has a better ability to differentiate between diseased tissue and normal tissue than X-rays, CT, and ultrasound.
MRI helps to obtain more detailed images of the prostate and surrounding structures. It also allows your radiologist to make a
NMR spectroscopy
which can provide additional information about the chemical composition of the cells present in the prostate gland. In addition, MRI of the prostate can measure the movement of water molecules (called water diffusion) and blood flow (called perfusion imaging) within the prostate to help differentiate abnormal (diseased) tissue from normal prostate tissue. The result of this data is collected in the PIRADS (Prostate Imaging Data Processing and Reporting System) classification to inform how likely a suspicious area is to be a clinically relevant cancer. PI-RADS scores range from 1 (most likely not cancer) to 5 (very suspicious). The five scores include:

  • PI-RADS 1: very low
  • PI-RADS 2: low
  • PI-RADS 3: intermediate (indeterminate)
  • PI-RADS 4: high
  • PI-RADS 5: very high

In the
Prostate biopsy by fusion of images
, a special robot integrates the images of the MRI and ultrasound in real time, which takes advantage of these two techniques together, and gives the operative the
ability to accurately identify the suspected area of neoplasm
, and biopsy it instantly.
The diagnostic profitability of fusion biopsy is almost double that of conventional biopsy, standing at 62%.

How is the procedure?

Prostate biopsy is performed by a radiologist or urologist. The patient will be under sedation, a kind of light general anesthesia. The position used is that of lithotomy, that is, similar to the gynecological examination position.

First, the doctor will perform a digital rectal exam with a gloved finger. An ultrasound probe is then inserted into your rectum. The catheter is sterilized, covered with guards to ensure protection against any infection or contamination, and lubricated to help it slide easily into your rectum.

After ultrasound examination of your prostate, your doctor will perform the biopsy. The images or photographs that the doctor can see on the ultrasound screen are used to guide a very thin needle through the wall of the rectum to the prostate and take a tissue sample. With continuous ultrasound images, the doctor can see, in real time, the biopsy needle as it moves toward the prostate. If the biopsy is performed with fusion images (MRI and ultrasound), the doctor will also be able to see the exact site of the suspicious lesion identified by the MRI, which will allow him to biopsy that specific area.
Fusion biopsy is performed transperineally using an orientation template; That is, the needles are not inserted through the rectum, but through the perineum, which is the space between the anus and the scrotum.

Several samples are taken from the abnormal area, and several samples are also taken from the normal-looking areas, to ensure that there is no other hidden cancer. Usually, Between 10 and 24 individual samples are taken during the procedure, and sent to a laboratory for analysis by the pathologist.

After the biopsy samples are taken, the tube is removed and the patient is awakened from the anesthesia. The patient remains under observation for a few hours, after which he can be discharged.

The total biopsy procedure takes 45 – 60 minutes.

Analysis of samples

A pathologist examines the removed tissue specimens and makes a final diagnosis. Results are usually available to your doctor within a few days after the procedure. The time it takes may vary depending on the complexity of the examination, the preparation time of the specimens, the need for a second opinion, and other factors.

What can happen after a prostate biopsy?

  • Some patients experience a small amount of bleeding from the rectum or perineum immediately after the biopsy procedure. If this occurs, it can be stopped with gentle pressure.
  • You may feel pain and discomfort in the prostate area for a few days after the biopsy, especially when you are sitting.
  • Blood is common in the stool, semen, and urine over the next few days. These incidents remit spontaneously in days or weeks, and should not worry the patient. Forcing hydration is a good measure to decrease bleeding.
  • Infections They are very rare. The prophylactic antibiotic that is prescribed before the biopsy greatly reduces the chances of infection, but if it occurs, the patient usually requires hospital admission and intravenous antibiotic therapy. Symptoms that suggest an infection are: fever, chills, malaise, inability to urinate or drip urine, severe pain when urinating, and perineal pain.
  • Urinary retention (temporary inability to pass urine) is rare. If it occurs, the patient will need placement of a drainage catheter (urinary catheter or suprapubic size) until the prostate inflammation resolves.

Benefits of Prostate Biopsy

  • Conventional prostate biopsies and image fusion help accurately diagnose prostate abnormalities and speed up the initiation of appropriate treatment.
  • Biopsies help distinguish between cancer and BPH.
  • Ultrasound and MRI imaging does not depend on ionizing radiation.
  • Recovery time for both procedures is short and patients can resume their usual activities soon.
  • MRI images of the prostate are clearer and more detailed than those obtained with other imaging methods, making them a valuable tool in early diagnosis and assessment of tumor extension.

Limitations of prostate biopsy

The biopsy can only show whether or not there is cancer in the samples taken, so cancer found in areas that were not sampled may not be detected.

For MRI-directed biopsy, high-quality images are guaranteed only if you are able to remain completely still while the images are being recorded. If you feel anxious, confused, or in a lot of pain, it will be very difficult to remain still during imaging, and the resulting images may not be of sufficient quality to serve as a diagnostic tool.

Similarly, the presence of an implant or other metal object sometimes makes it difficult to obtain clear MRI images. A very large person may not fit into the opening of certain types of MRI machines.

MRI imaging cannot always distinguish between cancer tissue and inflammation or the presence of blood products within the prostate that sometimes occur in connection with a previous prostate biopsy. To avoid confusion between the two, MRI imaging of the prostate should be done six to eight weeks after a prostate biopsy.


Hematuria is defined as the presence of blood in the urine. It is a very frequent sign in the daily consultation that accompanies most nephrourological processes or syndromes, although its origin may also be due to other causes. In hematuria, the urine has a reddish, purple, brownish, blackish or even light green appearance.

Microscopic hematuria is defined as the presence of more than 2-3 red blood cells per field, in the absence of other abnormalities. It is usually a chance finding on a urine test at a standard checkup. Gross hematuria is identified by direct observation of urine, asking the patient to urinate into a bottle.

Hematuria should always be studied since its importance does not depend on its intensity, but on the cause that motivates it.


The most common causes of hematuria are:

  • Urinary tract infections. They occur when bacteria enter the body through the urethra and multiply in the bladder. Some of the symptoms are: constant need to urinate, pain and burning when urinating, and urine with a very intense odor. In some cases, especially older adults, the only sign of the disease may be microscopic blood in the urine.
  • Kidney infections (pyelonephritis). They can occur when bacteria enter the kidneys from the bloodstream or through the ureters. Signs and symptoms are usually similar to those of bladder infections, although kidney infections are more likely to cause fever and flank pain.
  • Bladder or kidney stone. Sometimes minerals present in concentrated urine form crystals on the walls of the kidneys or bladder. Over time, the crystals can be transformed into small, hard stones, which are called “stones.” These stones usually don’t cause pain, so you probably won’t notice them until they block or pass through your urinary tract. That’s when the symptoms become unmistakable: ureteral stones, in particular, cause a strong cramping pain. Kidney or bladder stones can also cause visible or microscopic bleeding.
  • Metabolic disorders of crystal excretion. One of the most common causes of microhematuria is hyperuricosuria (excretion of uric > acid 750 mg/dl in women and 800 mg/dl in men) and hypercalciuria (excretion of calcium > 400 mg/kg/day). In these patients, a family or personal history of renal lithiasis is often found.
  • Benign prostatic hyperplasia. The prostate gland, which lies below the bladder and surrounds the top of the urethra, usually enlarges as men approach middle age. Then, it compresses the urethra, so the flow of urine is partially blocked. Some of the signs and symptoms of an enlarged prostate are difficulty urinating, urgent or constant need to urinate, and visible or microscopic blood in the urine. Prostate infection (prostatitis) can cause the same signs and symptoms.
  • Kidney disease. Microscopic urinary bleeding is a common symptom of glomerulonephritis, an inflammation of the kidneys’ filtration system. Glomerulonephritis can be part of a generalized disease, such as diabetes, or it can occur on its own. Viral or strep infections, blood vessel diseases (vasculitis), and immune problems, such as immunoglobulin A nephropathy, which affects the small capillaries that filter blood in the kidneys (glomeruli), can trigger glomerulonephritis.
  • Cancer. Visible bleeding in the urine can be a sign of cancer of the kidney, upper urinary tract, bladder, urethra, or prostate. Especially in the case of bladder cancer, gross hematuria is the main diagnostic symptom.
  • Inherited disorders. Sickle cell anemia, an inherited defect in the hemoglobin of red blood cells, causes blood in the urine, in the form of visible and microscopic hematuria. Another possible cause is Alport syndrome, which affects the filtering membranes in the glomeruli of the kidneys.
  • Kidney trauma. A blow or other injury to the kidneys from an accident or from playing a contact sport can cause visible blood in the urine.
  • Drugs. Anticoagulants, antiplatelet agents, some antibiotics and chemotherapeutic agents (such as cyclophosphamide) are associated with hematuria.
  • Strenuous exercises. Rarely, strenuous exercise causes gross hematuria, the cause of which is unknown. This may relate to trauma to the bladder, dehydration, or the breakdown of red blood cells, which may be due to ongoing aerobic exercise. Usually, people who run are the most affected, although anyone can suffer visible urinary bleeding after an intense workout.

Most frequent causes by age

  • In the infant: secondary to dehydration such as diarrhea, high fever, profuse sweating, etc.
  • Middle Ages. Urinary lithiasis is the most common cause. In women, in this period, acute cystitis is the most frequent condition.
  • Adults (> 50 years). The most frequent cause of hematuria is bladder tumor, followed by benign prostatic hyperplasia in men.


  • Medical history It is fundamental. It is necessary to inquire if the hematuria is total, initial or terminal; whether it has appeared suddenly, slowly, uniquely, iteratively, with or without clots; if it goes with other signs or symptoms (voiding disorders, lithiasis, etc.). The family, physiological, personal and pathological history of the patient should be assessed, asking about hereditary or family diseases, also ruling out liver diseases, coagulopathies or metabolopathies.
  • Physical exam It will reveal if there is pain in the renal fossae or pelvis (suggestive of ureteral lithiasis), presence of petechiae / ecchymosis (suggestive of blood dyscrasias), pelvic or abdominal masses (which may be tumors). The Genital examination It is essential, both in men and women. The Digital rectal examination in men assists in the evaluation of the prostate.
  • Examination of urinary sediment with an optical microscope. It’s very specific. The values considered normal are 2-3 leukocytes per field, 1-2 red blood cells and few hyaline cylinders. The presence of abnormal casts (blood and granular), proteinuria or dysmorphic red blood cells would indicate the existence of glomerulonephritis. Eosinophilia in urine (more than 5% of leukocytes in the urine) indicates the existence of tubulointerstitial nephropathy. Pyuria and bacteriuria are signs of urinary tract infection. Hematuria and pyuria without demonstrable bacteriuria indicate the possibility of renal tuberculosis.
  • Analytical renal function, hematimetry and coagulation. These are essential general examinations.
  • Urinary cytologies. They help identify suspicious cells of neoplasia in the urine. It is a method that is not very sensitive, but very specific.
  • Radiological examination. Initially, the study will begin with a simple x-ray of the urinary system and a complete abdominal ultrasound, and at a later stage it will be completed as required with a CT scan and an MRI. Other radiological studies may be ordered, depending on the case.
  • Cystoscopy / ureteroscopy. They are invasive studies to explore the bladder and upper lines endoscopically, which may be requested according to diagnostic suspicions.
  • Bladder biopsy / renal biopsy. They are indicated when a confirmatory diagnosis is required. They can also be therapeutic, if the entire lesion causing hematuria is removed. An anatomopathological analysis of the extracted material is required.


It will depend on the cause, and includes from simple observation to surgery.