Cardiology
Cardiology Services at Da Medika Polyclinic A unique approach to blood pressure disorders that includes
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Diagnosis and treatment of all urological conditions using the most advanced medical methods. The Urology Center is led by Associate Professor Dr. Aleksandar Janičić, an internationally recognized urologist and doctor of medical sciences in the field of urology with extensive experience.
Urology is a specialist branch of medicine which focuses on the diagnosing and treatment of the diseases of the urinary tract with both sexes (urethra, urinary bladder, ureters and kidneys) and male reproductive organs (penis, testes, epididymides and prostate - chestnut-shaped muscular and glandular organ below the bladder). Our urinary system filters blood and removes toxins, excess water and salts as well as all matter which is the product of our metabolism and should be removed from our body through urine. It also takes part in the regulation of the blood volume in the organism, blood pressure and controls the level of salts (electrolytes – potassium, sodium, chlorine calcium, magnesium, phosphorus etc.) in the cells of our organism and in blood. A serious disorder of the level of electrolytes may be even life-threatening.
Do you know that your kidneys work non-stop, filtering all your blood 24 hours a day and that they produce hormones which take part in regulating blood pressure? Thus, the urinary tract is important for the whole organism and it is not only in charge of urination.
The most common reasons for which we address a urologist are bacterial infections of the urinary bladder, benign enlargement of the prostate, urinary incontinence (the inability to control the emptying of the bladder), kidney infections, kidney stones. Urologist also deal with male infertility and impotence as well as with with the dropped (prolapsed) bladder with women. Urology is also a surgical branch, and that means that kidney, bladder and urethral calculi as well as bladder, kidney, prostate and testicular tumours are removed surgically.
The symptoms which may indicate that there is a need for an examination by a urologist are as follows:
None of these symptoms should be neglected. If you address a urologist and start treatment as soon as a problem arises, you will prevent complications and the treatment will be more efficient and effective.
All men over 45 are recommended preventative urological examination once a year as they are at greater risk from prostate changes and prostate cancer respectively. If it is discovered in an early stage, patients survive in 95% of cases. Six new cases of prostate cancer are discovered in Serbia on a daily basis.
Urologist examination or clinical urological examination begins with a conversation between the urologist and the patient to understand the patient’s symptoms and determine which urinary conditions they might indicate. If the patient has already completed some laboratory tests, such as blood and urine analysis or a urine culture with an antibiogram, the urologist reviews these results. Next, while the patient is lying down, the urologist palpates the abdominal area where the pain is reported, searching for painful spots, enlarged internal organs, or any pathological masses.
The clinical urological examination differs for men and women due to their different anatomies. For men, a digital rectal examination is performed, primarily to examine the prostate, along with an examination of the reproductive organs. The examination of female reproductive organs is conducted by gynecologists.
An ultrasound examination of the urogenital region is often a necessary complement to the clinical examination to ensure an accurate diagnosis.
An examination by a urologist may reveal problems, such as:
The ultrasound of the urogenital area requires preparation. A day before the ultrasound of the urogenital area food which causes bloating (legumes, fresh fruit, sparkling drinks). Easily digestible food (boiled potatoes and carrots, boiled rice, boiled chicken, apple compote) should be eaten. In the afternoon on the day prior to the examination, a laxative (a medicine for emptying the bowels) recommended by a doctor should also be taken.
If the ultrasound of the urogenital tract is performed in the morning, a patient should not eat anything. If the examination is done in the afternoon, the patient may have light breakfast (toast or cookies and some tea) early in the morning. Chewing gum must not be chewed as well since air is swallowed in that way, which leads to bloating. In order to expel gas, the patient should take one or two capsules of Espumisan. Approximately an hour and a half before the examination, the patient is to drink between a litre and a litre and a half of water or unsweetened tea and hold urine over that time.
The ultrasound of the urogenital tract is most usually done while a patient is lying on his or her back. Firstly, gel is applied to the skin of the abdomen in the area of the lesser pelvis and to the scrotum (with men), which is used to pass the ultrasound waves. A urologist slides the probe of an ultrasound machine across the areas which are being examined, while looking at the images on the screen which are created by means of the ultrasound.
A urinary bladder, i.e. its size, the thickness of its wall and the state of mucosa are thoroughly examined with both sexes. The urinary pathways (ureters, urethra) are also examined. The ultrasound helps in discovering whether there are diverticula (pouches in the bladder), grit, stones or tumours. Following that, kidneys are examined, their position and structure are determined, and the ultrasound helps in discovering potentially present cysts, kidney gravel, stones or tumours.
Men also have their prostate, penis, scrotum and testicles examined. Their size and structure are evaluated and potentially present tumours are discovered.
A urologist can diagnose and treat the following conditions and diseases:
Infections of the urinary system (the urinary tract). Most often bacterial infections of the urinary bladder (cystitis), the urinary pathways (the urethra and the ureters –urethritis) and the kidneys (pyelonephritis).
Cystitis (bladder inflammation): The most common causes of infections are the bacteria Escherichia coli and Proteus mirabilis. The types of bladder inflammation are as follows:
Inflammation of the bladder (cystitis) has the following symptoms: a burning sensation and pain when you urinate (dysuria), blurred urine of unpleasant smell, frequent urination, the felling of incomplete emptying of the bladder. Apart from an examination by a urologist and the ultrasonography of the bladder, laboratory blood and urine tests (a urine culture test with an antibiogram), based on which antibiotic treatment is prescribed, are imperative.
Pyelonephritis (inflammation of the kidneys): Apart from the symptoms which are present with cystitis, inflammation of the kidneys may additionally display: blood in urine (haematuria), high fever, shivering, pain in the abdomen, the loins and the back, nausea. In order the establish the diagnosis, the following is required: a clinical examination by a urologist, laboratory blood and urine tests (a compulsory urine culture test with an antibiogram), the ultrasound of the kidneys, kidneys scan and potentially the biopsy of the kidneys. It is treated with antibiotics based on the antibiogram and, if needed, with antipyretic drugs and sometimes with corticosteroids as well.
Urethritis (inflammation of the urethra): Inflammation of the urethra may be caused by the same bacteria which cause the inflammation of the bladder and the kidneys, but also the sexually transmitted diseases which are frequently caused by a gonococcus (Neisseria gonorrhoeae), chlamydia (Chlamydia trachomatis) and mycoplasma (Mycoplasma hominis and Mycoplasma genitalium) and even by viruses (HPV, herpes symplex HSV2).
Gonorrhoea (an infection caused by a gonococcus) shows the following symptoms with men: a burning sensation during urination, itching, mucus and pus from the penis, while with women, frequent urination, increased vaginal discharge and redness around the urethra are present.
An infection with chlamydia is usually without symptoms with men, but it may cause urethritis, epididymitis, and inflammation of the prostate. With women, it causes itching, increased secretion and pain in the lesser pelvis. Chlamydia may lead to infertility with both sexes.
Infection with mycoplasma with women may cause pain and tightness in the lower abdomen, frequent urination, increased secretion, pain during a sexual intercourse, fever. With men, a burning sensation and pain during urination, penile discharge and pain and swelling in the joints are present.
For establishing the diagnosis, laboratory tests (swabs and an antibiogram) are required, based on which antibiotic treatment is prescribed.
HPV infection causes the occurrence of condyloma (genital warts) which may be seen even with the naked eye with men on the occasion of the urological examination as they are to be found on the genitals or around the anus. With women, they may be found on the external genitalia, around the anus, but also inside the vagina and on the cervix, and thus an gynaecological examination is required. As they are caused by viruses, they are easily transmitted and thus they have to be removed using a thermocauter, a laser or radiofrequency.
Genital herpes (HSV2) occurs on the vulva, the vagina and the cervix with women, and with men, it occurs on the penis. It may appear on the anus with both sexes. It is accompanied by itching, pain and stinging in the affected area. Around six hours after the first symptoms develop, painful blisters (vesicles) appear. It passes after around ten days. An examination by a urologist or a gynaecologist is required, who will prescribe the antiviral treatment (aciclovir, famciclovir, valaciclovir) in the form of a cream, but also in the form of pills or to be administered through the infusion.
For establishing the diagnosis, a clinical examination of a urologist and the ultrasound of the urogenital tract are required.
Man can pass stones smaller than 4mm spontaneously (in 80% of cases). Alpha blockers, phytotherapy and analgesic drugs are prescribed to help passing a stone. If the stone is larger than 6mm, surgical methods are employed.
Incontinence with men is the sign of the diseases, such as the enlarged prostate, diabetes, neurological diseases (Parkinson’s disease and multiple sclerosis), constipation, urinary infections, overactive bladder. It can also be the consequence of the prostate surgery.
To establish the diagnosis, the following is required: completing a questionnaire and keeping a record of urination, a clinical examination by a urologist and a digital rectal examination (for men), laboratory blood tests, the ultrasound of the urogenital tract, urodynamics etc. Treatment depends on the cause of incontinence, and it may also be surgical.
To establish the diagnosis, a clinical examination by a urologist, the ultrasound of the urogenital tract, cystoscopy, biopsy, urine cytology test, CT scanning, magnetic resonance imaging, bone scanning, a lung x-ray are required. Treatment may involve surgical removal of the bladder and various oncology procedures (radiation, chemotherapy, immunotherapy).
It is diagnosed on the basis of laboratory blood and urine tests, ultrasonography, x-ray, CT and/or MRI scans. Treatment is surgical and it involves the complete removal of the kidney (a radical nephrectomy) or the tumour is removed only (partial nephrectomy).
Typical early signs include a painless lump, swelling or thickening of the whole testicle. Later on, the following may be present: abdominal and back pain, painful ejaculation and blood in seminal fluid and even gynecomastia (the enlargement of breasts). Diagnostics includes a clinical examination by a urologist, the ultrasound of the scrotum, blood tests for tumour markers (beta-hCG, AFP, LDH) and a x-ray of the lungs, and, if needed, a CT or an MRI scan. Depending on the stage of the disease, treatment may be surgical and it involves the removal of the testicle, while in case of metastases, it includes radiation and chemotherapy.
An examination by a urologist means that a doctor who is a specialist in urology examines the urogenital tract with man and the urinary tract with women. During the interview with a patient, a urologist finds out about the problems which are present and which symptoms indicate a urological disease. Since a cause of urological problems is sometimes a disease of another organ or system, the urologist takes thorough personal and family medical history of the patient (an anamnesis). If the patient brought laboratory blood and urine test results and some other medical reports, the urologist reviews them. Upon that, the urologist conducts a clinical examination which is different for women and men due to the anatomy, i.e. the position of the urogenital tract. He/She most often conducts an ultrasound examination of the urogenital tract. When required, the patient is referred for additional urological diagnostics, laboratory tests, having swabs taken, examinations by other specialists, x-ray, CT or MRI scanning. At the end of the examination, the patient receives a report from the urologist with the established diagnosis and recommended treatment.
With women, the entire urinary system is practically in the abdominal cavity, while only the entrance to the urethra can be seen from the outside. Women most often come for an examination by a urologist for problems, such as urinary incontinence, overactive bladder, frequent urination at night (nocturia), dropped (prolapsed) uterus or bladder, pelvic pain and pain in the area of the kidneys. Bladder infections without complications and sexually transmitted diseases with women are treated by gynaecologists.
The examination starts with an interview with the patient so that the urologist would learn about the problems the female patient has and which symptoms could indicate a urological exam. Detailed personal and family medical history (the anamnesis) is taken. The urologist reviews the laboratory test results and other medical reports, if the patient has them and brought them with herself. Following that, most usually the ultrasonography of an organ of the urinary tract is conducted. If needed, the urologist refers the woman for further diagnostic procedures. At the end of the examination, a report with the established diagnosis and prescribed therapy is drafted. When a clinical and ultrasound examinations are not sufficient for reaching a diagnosis, the urologist refers the female patient for additional diagnostics.
Men address a urologist for infections of the urogenital tract, problems with urination, the prostate, the penis, the scrotum, the testicles and sexually transmitted diseases.
As with women, the examination of men starts with an interview with the patient so that the urologist would learn about the patient’s problems and the symptoms which indicate a urological or genital disease. The urologist takes the personal and family medical history (the anamnesis). If the patient brought previous medical documentation, laboratory blood and urine test results, the results of urethra swab analysis, x-rays, CT or MRI scans with himself, the urologist reviews them.
During an examination of men, a urologist examines the genitals of the patient (the penis, the scrotum, the testes) thoroughly. The other part of the examination of men is a digital rectal examination. During this examination, the man is lying on his side with his legs bent in the knees or he is standing bent in the waist. The examination is performed by a urologist putting on a glove and applying a lubricant to it (a gel or vaseline) and then he/she inserts one finger into the rectum of the patient so as to palpate the prostate. The urologist presses the abdomen in the area where the prostate is to be found with his/her other hand. This is the most reliable examination of the prostate, by which its shape and size are determined, and it can also reveal the presence of tumours on the prostate. This examination may also reveal the haemorrhoids (piles), anal fissures and tumours in the final section of the large intestine. A digital rectal examination can be slightly uncomfortable or the patient may feel the urge to urinate during it for the pressure the urologist puts on the prostate. Bleeding may occur only if the patient has haemorrhoids or anal fissures, so they can bleed.
Following that, an ultrasound examination of the entire urogenital tract is conducted, including both external genitals and the urethra and the bladder, ureters, prostate and kidneys.
At the end of the examination, the urologist produces a report with the diagnosis and recommended treatment. When a clinical and ultrasound examinations are not sufficient for establishing a diagnosis, the urologist refers the patient for further diagnostics.
The urologist examination at Da Medika Polyclinic is conducted by Associate Professor Dr. Aleksandar Janičić, a specialist in urology and a doctor of medical sciences in the field of urology.
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