Urology

Urology is the study of the urinary and reproductive organs, and the treatment of associated problems and diseases. Our main focus in urology is on nocturia (the need to get up several times during the night to urinate) and nocturnal enuresis (NE), more commonly known as bedwetting. Both conditions are usually caused by an overproduction of urine at night, and both can have a significant impact on a person's quality of life.

Additionally, our second main focus is prostate cancer, one of the most common cancers amongst men. This disease may not show any symptoms in the early stages, and is often discovered during a routine check-up. The treatment options vary depending on the stage of the cancer at the time of diagnosis. The growth of prostate cancer is dependent on testosterone; therefore many treatments are aimed at reducing the level of testosterone in the body.

Ferring also provides a treatment for the symptoms caused by low levels of testosterone in the body. Low testosterone occurs when the body is unable to produce sufficient quantities of testosterone. While it can be caused by genetic or medical conditions, production of testosterone can decrease with advancing age. It affects 1 in 10 men at age 50 to more than 1 in 4 men in their 70s. The goal of therapy is to restore testosterone levels into the normal range and to relieve symptoms.

If you are a patient or carer looking for more information, please click on the following links:

Bedwetting
Waking at night
Prostate cancer
Low testosterone

Myths, facts and history of bedwetting

Bedwetting has been a common problem in children and, to some extent, adults for over 4,000 years. During this time many myths and misconceptions to explain it have emerged.

Many parents believe that children wet the bed because they are stressed or worried, or in some cases simply out of laziness*. These misconceptions affect the way the bedwetter is regarded and treated.

But bedwetting is in most cases not a psychological or behavioural problem, it is a recognised medical disease, with more than 5 million children throughout Europe suffering from it. Yet, bedwetting can be treated simply and effectively saving the family a great deal of anguish.

Most children are dry during the day by the age of three, but bedwetting up to the age of five is not unusual. Children over the age of five who have not become dry at night and continue to wet the bed at least three times a week are considered to suffer from bedwetting. This condition can be treated with medicine or conditioning (alarm) therapy.

* Survey conducted by the UK-based charity ERIC (Enuresis Resource Information Centre)

Causes of bedwetting

• The kidneys produce more urine than the bladder can hold

• Most bedwetters have well functioning bladders and normal sleeping patterns, but they do not wake up when their bladder is full

Impact of bedwetting on the child and on the family

Children with bedwetting often feel angry, moody, ashamed and bewildered. They find it embarrassing and uncomfortable and they think they are the only children who do it.

This isolation makes them feel inhibited and they avoid taking part in any activities that mean they have to stay away from home overnight, such as school trips and sleep-overs at friends' homes for fear of being discovered.

If childhood bedwetting is left untreated, it can become harder to control and the sufferer can grow up to be an adult bedwetter, who can develop problems forming close relationships for fear of being exposed.

Parents also suffer and alternate between concern for their child and exhaustion from having their sleep interrupted and having to clean bedclothes regularly.

Sometimes parents can become annoyed by it all and come to believe that their child is doing it deliberately.

Please see our page Advice for Parents for more information.

The first thing to realise is that bedwetting is nobody's fault, and it is nothing to do with the way a child has been 'toilet trained'.

If you are worried about bedwetting please consult your family doctor, who can rule out the rare cases when the condition has an underlying illness such as diabetes, an infection or abnormalities in the structure of the urinary system, and initiate appropriate treatment and counselling.

Before consulting a doctor this should be tried out:

• Encourage the child to drink more during the day - some children drink little while at school and then make up for it by drinking in the evening

• Fluid intake should not be limited during the day, the child should still be encouraged to drink seven to eight cups of fluid

• Avoid caffeine containing drinks (such as tea, coffee and cola drinks) in the evening as caffeine leads to increased urine production

• Don't drink within two to three hours of bedtime

• Empty the bladder twice just before going to bed (about five to ten minutes apart)

• Make it easy for the child to reach the toilet from the bedroom and encourage the child to return to their own bed

• Record wet and dry nights - reward dry nights but don't blame wet nights

If this does not solve the problem, talk to your doctor and tell him/her:

• if your child has always wet the bed, or if he/she has recently started

• if your child produces large wet patches

• if either parent also suffered bedwetting

• if you think your child's school work or behaviour has suffered

Many cases of bedwetting are simple to treat and can be improved in a couple of months with the correct approach, encouragement, and treatment, rather than possibly dragging on for years without change.

Children require a great deal of patience and above of all they should not be criticised, punished or blamed as this can make things worse.

Nocturia or the need to wake up at least once a night to urinate is one of the most common causes of sleep loss affecting more than half of both men and women over the age of 50. Latest figures show that nearly 40 million adults in Europe regularly have their sleep disrupted by the need to pass urine, which causes day-time tiredness and subsequently health and psychological problems.

Importance of sleep

Sleep serves many vital functions such as conservation of energy, rehabilitation, repair and metabolism, but more significantly, it enhances cognitive function and extends life expectancy.

It is not the overall length of sleep that matters, but an adequate length of uninterrupted sleep. Five or six hours of undisturbed sleep are far more beneficial than ten hours of disturbed sleep.

The most important and deepest form of sleep occurs early on in the night, generally during the first three to four hours. Being woken during this phase of sleep has the biggest impact on the daytime performance of an individual.

Nocturia - a medical condition

At night, the body naturally increases the release of an antidiuretic hormone, called vasopressin, to reduce the volume of urine produced to about a third of the total daily output, and thus limiting the need to empty the bladder during sleep. However, in many cases of nocturia the average volume of urine produced during the night is greater than the amount the bladder can hold.

Nocturia has recently been recognised as a separate medical condition rather than a symptom of another disorder. It is usually caused by an imbalance between night-time urine production and bladder capacity. Recent research suggests that an overproduction of urine is the cause of the majority of all nocturia cases.

Treating nocturia

Nocturia can be treated by reducing the volume of urine produced while a person sleeps. 

Some men develop a condition whereby their body is unable to produce sufficient quantities of testosterone and their testosterone levels fall to below normal.

While it can be caused by genetic or medical conditions, the production of testosterone can decrease with advancing age. It affects 1 in 10 men at age 50 to more than 1 in 4 men in their 70s.

The goal of testosterone replacement therapy is to restore testosterone levels into the normal range and to relieve symptoms.

The symptoms of low testosterone

Men with low testosterone may feel tired or lack energy, have reduced sex drive and sexual performance and be irritable or depressed. They may also notice a loss in muscle mass, reduced strength, and more fat around their waist and body.

Longstanding low testosterone can reduce bone mineral density, increasing the risk for osteoporosis (loss of bone mass).

Because the symptoms of low testosterone are often subtle, and similar to those caused by other medical conditions, it often goes untreated.

A blood test is taken to confirm if a man has low testosterone.

Treatment of low testosterone

Testosterone replacement therapy restores testosterone levels into the normal range and it has been proven to improve both the physical and mental symptoms of low testosterone.

The benefits of testosterone replacement include improvements in mood, improved sexual desire and performance, a reduction in fat, increased muscle strength and increased bone mineral density.

Prostate cancer is one of the most common cancers to affect men; it is estimated that 1 in 5 men will develop the disease sometime during their lifetime, and three-quarters of all cases are in men aged 65 years or older.

While prostate cancer can grow quickly and spread, more often it grows slowly and may remain within the prostate gland for years (localised cancer). In its early stages, the disease has no symptoms. However, as the cancer develops, it can invade and damage the surrounding tissues, or spread to other areas of the body (metastasis).

Various tests may be used to screen for prostate cancer including the prostate-specific antigen (PSA), which measures the level of this protein in the blood. An elevated PSA level can indicate the presence of prostate cancer. A PSA test is often used in combination with a digital rectal examination.

If prostate cancer is diagnosed, the 'stage' of the disease tells the doctor how far the cancer has spread and helps him/her decide the best treatment option.

Tumours are usually staged using the TNM system, which considers:

In the early years of the disease, the growth of prostate cancer is dependent on testosterone. The goal of treatments is to reduce the level of testosterone circulating in the body. A decrease in testosterone levels can lead to the death of cancer cells and postpone by several years the progression of the disease.

International Continence Society (ICS)
Focused on furthering education, research, clinical practice and removing the stigma of incontinence

European Association of Urology (EAU)
Represents urology professionals worldwide with the mission to raise the level of urological care in Europe

International Children's Continence Society (ICCS)
Focused on the promotion of paediatric voiding dysfunctions in science and practice

American Urological Association (AUA)
The premier professional association for the advancement of urologic patient care

European Society for Paediatric Urology
Promotes paediatric urology, practice, education and exchanges between practitioners in genitourinary disorders

National Cancer Institute (NCI)
Coordinates the National Cancer Program, which conducts and supports research, training, & information dissemination

Continence Worldwide
The website for the Continence Promotion Committee of the International Continence Society

Us TOO International
Independent Network of Support Groups
Dedicated to communicating information enabling informed choices regarding detection and treatment of prostate cancer

Europa Uomo
The European advocacy movement for the fight against prostate cancer, and to increase awareness in Europe

ZERO, The Project to End Prostate Cancer
Committed to not only reducing prostate cancer or alleviate the pain from the disease but to end it

Cancer Help UK
The world's leading independent organisation dedicated to cancer research

ERIC
Provides education and resources for improving childhood continence

International Society for Men's Health (ISMH)
The ISMH is a worldwide, multidisciplinary organisation, dedicated to awareness of sex- and gender-specific medicine and men's health.

Please note that Ferring cannot accept liability for the content on the above sites, since they are not managed or controlled by Ferring.