Urologic Conditions & Treatments
Urologic Surgery Services at BIDMC
The Division of Urologic Surgery provides the most advanced treatments, including the latest minimally invasive/robotic options, for the entire range of urologic disorders affecting men and women, including urologic cancers.
We encourage you to call us for an appointment, during which we can discuss your particular condition and treatment options that will offer you the best possible outcomes.
Conditions We Treat
Benign Prostatic Hyperplasia
Benign prostatic hyperplasia (BPH) is a benign (non-cancerous) enlargement of the prostate. The prostate’s main function is to produce fluid that transports sperm during ejaculation,. In many middle-aged men the prostate begins to grow and presses on the bladder. This pressure can obstruct the flow of urine and cause symptoms such a frequent or urgent urination, difficulty starting urination, a weak urine stream, increased nighttime urination or an inability to completely empty the bladder.
In many cases medications can reduce or resolve symptoms and are usually the first treatment offered by your primary doctor or urologist. But sometimes the medications do not work well, lose their effectiveness over time or have side effects. In these cases, patients may require surgical intervention. We provide the latest treatments for BHP, which include:
Stone Disease (Kidney, Bladder, and Other Stones)
Stones are hard deposits of minerals and salts that stick together and can cause severe pain when passing through the urinary tract. Some stones may be as small as a grain of salt, while others can be much larger. Many smaller stones usually pass through the urinary system by themselves. However, larger stones may require an outpatient procedure or inpatient surgery.
Our Kidney Stone Service provides management of and the latest minimally invasive treatments for all types of stones, including complex conditions such as staghorn stones or kidney stones during pregnancy. Procedures we offer for the treatment of stones include:
- ureteroscopy: outpatient endoscopic procedure using a miniature scope to locate and remove small kidney and/or ureteral stones
- ureteroscopy with laser treatment of kidney and ureteral stones
- extracorporeal shock wave lithotripsy (ESWL): outpatient treatment using sound waves to break up small kidney stones
- percutaneous nephrolithotomy (PCNL): inpatient procedure to break up and remove large and/or complex kidney stones
- laparoscopic and robotic pyelolithotomy/ureterolithotomy: inpatient, intra-abdominal procedure for very complex and unusual kidney stones
Elevated PSA and Hematuria
Prostate Specific Antigen (PSA) is a protein made only by the prostate. It rises slowly with age and more quickly in patients with prostate cancer. If this number is rising quickly or appears too high for a patient’s age, the patient might require a prostate biopsy after consultation with a urologist. Hematuria is blood in the urine. This can be invisible (microscopic), or visible when red blood is seen mixed with the urine (gross hematuria). This is usually the result of non-cancerous causes such as bladder infection, bladder or kidney stones, or an enlarged prostate (BPH). Very occasionally a tumor of the urinary tract can cause this. Therefore patients with hematuria require an X-ray of their kidneys and a cystoscopy to directly see inside the bladder.
- Prostate biopsy – transrectal ultrasound guided
- Prostate biopsy – fusion biopsy using an existing MRI fused to the ultrasound image
- MRI- guided prostate biopsy – prostate biopsy performed in an MRI scanner for increased accuracy
- Cystoscopy – flexible scope performed in the urologist’s office to evaluate for bladder tumors (performed for patients with hematuria)
Kidney Blockage/Obstruction and Cysts
Blockage of urine outflow from the kidney is known as a ureteropelvic junction (UPJ) obstruction. This typically is caused by congenital (present from birth) scarring or a blood vessel pressing on the ureter (the tube that carries urine from the kidney to the bladder). This can result in pain, infection, kidney stones and loss of kidney function.
Treatment for Kidney Blockage/Obstruction
Pyeloplasty, or surgical removal of the UPJ obstruction (usually done robotically), returns the outflow of urine to normal. At BIDMC, we are experienced in robotic pyeloplasty, which offers cure rates equal to open surgery with less pain, a shorter hospital stay and quicker recovery.
Simple kidney cysts (abnormal fluid-filled sacs that form in the kidneys) are common and usually do not cause symptoms. Occasionally, however, they become large and can cause pain or infection, requiring treatment.
Treatment for Kidney Cysts
Treatment for simple kidney cysts includes needle aspiration, laparoscopic cyst decortication and open surgical removal. We are experienced in the minimally invasive treatment of kidney cysts, which offers cure rates equal to open surgery and a lower recurrence rate than needle aspiration.
Genitourinary Cancers: Kidney Cancer, Bladder Cancer, Prostate Cancer, Testicular Cancer, Penile Cancer
Many patients with genitourinary cancers (cancers of the kidney, bladder, prostate, testicles, or penis) will require surgical intervention in addition to medical and/or radiation therapy or immunotherapy.
As key members of the BIDMC Genitourinary Cancer Program, our urologists collaborate with BIDMC medical oncologists and radiation oncologists to develop a comprehensive, individualized treatment plan that reflects the patient’s unique needs and offers the best possible outcomes and quality of life.
The BIDMC Genitourinary Cancer Program offers special multidisciplinary programs for patients with prostate cancer (BIDMC Prostate Cancer Center) or kidney cancer (BIDMC Kidney Tumor Program).
BIDMC Urology is a national leader in the latest minimally invasive (robotic or laparoscopic) surgical procedures, even in patients with complex or large tumors. These procedures minimize pain and blood loss, shorten length of hospital stays, and reduce recovery times while offering the same cure rates as open surgery.
For example, for patients with muscle-invasive bladder cancer requiring the removal of their bladder and surrounding organs (uterus or prostate), we perform radical cystectomy and urinary diversion, as well as extended lymph node dissection (which improves long-term survival), entirely robotically. We have years of experience performing this highly complex operation and achieve excellent results.
We also offer active surveillance for patients with low-risk prostate and kidney cancer. In addition, we provide many patients with access to new treatment options through our extensive involvement in cancer clinical trials. For example, BIDMC is the lead site for kidney cancer of the Dana-Farber/Harvard Cancer Center (DF/HCC) and a co-lead site for prostate cancer at DF/HCC, reflecting the depth and breadth of our leadership in the research and treatment of kidney and prostate cancer.
To learn about some of the minimally invasive and traditional surgical procedures we offer for the treatment of urologic cancers, read our newsletter or click on the following links. You can also visit the BIDMC Genitourinary Cancer Program.
- cystoscopic tumor resection (TURBT)
- robotic radical cystectomy with robotic urinary diversion
Kidney Cancer (BIDMC Kidney Tumor Program)
- active surveillance
- laparoscopic radical nephrectomy
- robotic partial nephrectomy
- robotic nephroureterectomy (removal of kidney and ureter)
- radiofrequency ablation
Prostate Cancer (BIDMC Prostate Cancer Center)
- active surveillance
- ultrasound-guided prostate needle biopsy
- MRI-guided prostate needle biopsy
- robotic prostatectomy
- brachytherapy (seed implants)
- CyberKnife radioablation
- external beam radiation
- hormonal therapy
- removal of testicle (orchiectomy)
- robotic retroperitoneal lymph node dissection
- open retroperitoneal lymph node dissection
Urinary incontinence is the loss of bladder control resulting in leakage of urine. In some patients, incontinence means leaking when coughing or sneezing (stress incontinence) while for others, it means being unable to reach a bathroom on time (urge incontinence). There are different types of urinary incontinence and it is important that the type be accurately diagnosed so that patients receive the most effective treatment.
- stress incontinence
- urge incontinence
- overflow incontinence
- mixed incontinence (a combination of more than one of the above)
Treatment will depend on the type and severity of urinary incontinence and the patient’s gender. Often medications and lifestyle changes may be sufficient, but if they are not, we offer the latest non-surgical and surgical options for both men and women, including:
- urodynamic studies
- Botox bladder injection
- urethral sling for male and female incontinence
- sacral neuromodulation (InterStim)
Adrenal Gland Tumors: Benign and Malignant
The adrenal glands are small glands located on top of each kidney. They produce hormones that have many essential roles, including regulating the stress response, metabolism and blood pressure.
Tumors of the adrenal gland may be benign (non-cancerous) or, rarely, malignant (cancerous). While many adrenal tumors do not cause symptoms, some produce excess hormones that may cause symptoms. For example, pheochromocytoma is a rare tumor that can cause high blood pressure, headaches, rapid heart rate and other symptoms.
Adrenal gland tumors that require surgical treatment can usually be treated with a minimally invasive procedure to remove the tumor. As a referral center for both benign and malignant adrenal tumors, we perform an especially high volume of adrenal surgery. Almost all of these surgeries are performed laparoscopically or robotically.
Male Sexual Health (Infertility, Erectile Dysfunction)
In the U.S., approximately 15 percent of couples are infertile, meaning they are not able to conceive despite having unprotected sexual intercourse for more than a year. In about half of cases, infertility is due to an issue with the male, and may be caused by problems with the number or quality of sperm or a blockage in the reproductive tract. Many factors can play a role in male infertility, including illness, physical problems (varicoceles or undescended testicle), infections, medications and genetics.
Treatment for Male Infertility
Treatment for male infertility depends on the cause of the condition and can include lifestyle changes, medication or treatment by a urologist. We offer the latest options, which include:
- varicocele repair
- sperm aspiration
- testicular sperm extraction
- reconstruction, such as epididymovasostomy
Erectile dysfunction (ED), or impotence, is the inability to achieve or maintain an erection during sexual activity. ED occurs when not enough blood flows to the penis, preventing an erection. In most cases, ED is caused by health conditions that affect blood flow, such as atherosclerosis; psychological issues such as depression or anxiety; hormonal imbalances; chronic diseases such as diabetes; or certain medications.
Treatment for Erectile Dysfunction
Treatment for ED will depend on the cause, and may include oral medications, counseling to address psychological issues, exercise and weight loss, or hormone replacement therapy. We collaborate with other BIDMC specialists to ensure that patients receive the appropriate treatment. We also provide the latest non-surgical and surgical options for ED:
- penile injections
- penile vacuum device (VCD)
- penile implant (malleable or inflatable)
We also provide treatment for other conditions affecting male sexual health:
- Peyronie’s disease
- removal of skin lesions or tumors on the penis
- vasectomy reversal
Neuro-Urologic Conditions, Including Urinary Retention
Patients with neurologic disease such as multiple sclerosis, stroke, spina bifida or spinal cord injury may experience difficulties with urination, such as incontinence (urine leakage) or retention (the inability to urinate). Patients may also have dyssynergia, a condition in which the sphincter muscles and bladder muscle working against each other rather than in a coordinated fashion, or poor bladder compliance (elasticity), either of which can sometimes cause kidney damage. In addition to their adverse effect on health, urinary problems are a major source of frustration to patients with neurologic disease.
Diagnosis and Treatment
- urodynamic studies
- Botox bladder injection
- urethral sling for male and female incontinence
- sacral neuromodulation
- bladder augmentation
- catheterizable stoma creation (Mitrofanoff procedure)