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Urological treatment

Circumcision

The male circumcision, i.e. the surgical removal of the foreskin, is most prevalent in the oriental population. Its primary aim was probably the prevention of certain diseases. At birth the foreskin is fused with the glans. This natural condition is called “cellular adhesion” by medical terms. As childhood progresses the foreskin and glans gradually separate, by the age of 3 foreskin can easily be retracted. Tight attachment of the foreskin may persist after the age of 3; in this case the foreskin is surgically separated from the glans, under local anaesthesia. Forced foreskin retraction in not recommended under the age of 3. 

Circumcision is a routine intervention for most of the urologists. There are different types of circumcision. The dorsal slit method is the most common solution, but it is rarely recommended at young age, first of all because of its unsatisfactory cosmetic outcome. In case of the so called full circumcision a ring like portion of the foreskin will be removed. Depending on the width of the ring, the remaining foreskin will partially or won’t cover the penis gland. The wound edges are stitched with absorbable sutures, what start to fall out on 8-10th day.


Prostate

Prostate cancer may develop in a relatively symptomless way. There are no specific symptoms warning to the development of the tumour.

Full scale urologic screening is mandatory for all patients consulting their physician with any urological disorder; all men over 50 should have a PSA (prostate specific antigen) blood test and digital rectal (DRE) examination, transabdominal ultrasound, and  transrectal ultrasound (TRUS) if indicated.
Even nowadays the DRE is essential for prostate cancer diagnostic. The tumours are mostly located in the peripheral zone and can be detected by bimanual examination through the rectum.
 

Generally the 4 ng/ml PSA value is considered as the upper limit of the normal condition.  Biopsy is indicated above this value. Biopsy can be recommended in individual cases, even at a PSA value lower than 4 ng/ml. Furthermore, biopsy can be indicated by persisting suspicion in spite of an earlier negative biopsy; pre-tumour condition identified by previous histologic examination, (e.g. Prostatic Intraepithelial Neoplasia (PIN), tumour suspect histologic findings) or by a histologic image suspecting tumour.


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