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Southern DHB Urology - Otago

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    The SDHB Urology Otago service provides specialist inpatient and outpatient services from Dunedin Hospital to patients who have conditions of the male reproductive organs, kidneys, bladder and urinary tract. The urology team provides specialist care to patients requiring surgical and non-surgical treatment. A Urology Nurse Specialist also forms part of the team providing advice and support to patients who have complex conditions.

    An acute service for emergencies is provided 24 hours a day and non-urgent referrals are accepted from general practitioners according to access criteria which assist to prioritise the urgency of the referral.

    Mobile surgery on the lithotripsy bus is conducted at Dunedin Hospital for patients with kidney stones.

     

    Practitioners

    • Mr Alastair Hepburn

      Urologist
    • Mr Kampta Samalia

      Mr Kampta Samalia

      Urologist
    • Mr Serge Luke

      Urologist
    • Associate Professor Amir Zarrabi

      Associate Professor Amir Zarrabi

      Urologist
    • Dr Ramesh Kamalakannan

      Urologist
    Procedures

    Urinalysis

    Urinalysis is a test that examines the content of urine for abnormal substances such as protein or signs of infection. This test involves urinating into a special container and leaving the sample to be studied.

    Urodynamic Tests

    Urodynamic tests measure the storage of urine in the bladder and the flow of urine from the bladder through the urethra. Your doctor may want to do an urodynamic test if you are having symptoms that suggest problems with the muscles or nerves of your lower urinary system and pelvis.

    Proteinuria

    This term means protein in the urine and may indicate that there is a problem with your kidneys.

    Haematuria

    This term means blood in the urine and may be the result of inflammation or other problems with your kidneys, blockages in your ureter, infection or other problems with your bladder or problems with your prostate.

    Urinary Tract Infections (UTIs)

    A UTI is caused by an infection in the urinary tract. Women get UTIs more often than men. UTIs are treated with antibiotics. Drinking lots of water also helps by flushing out the bacteria. If the infection is in the bladder it is called cystitis. If the infection is in the kidneys it is called pyelonephritis.

    Urinary Incontinence

    Urinary incontinence or loss of bladder control is the involuntary passage of urine (passing urine without meaning to). There are many causes and types of incontinence, and many treatment options. Treatments range from simple exercises to surgery. Women are affected by urinary incontinence more often than men.

    Urinary Retention

    Urinary retention, or abnormal holding of urine in the bladder, is a common urological problem. Possible causes of acute urinary retention (sudden inability to urinate) include a blockage in the urinary system, stress or nerve problems. Chronic urinary retention (some urine is always left in the bladder after emptying) may be caused by bladder muscle failure, nerve damage, or obstructions in the urinary tract. Treatment for urinary retention depends on the cause.

    Bladder Cancer

    What causes bladder cancer is not always clear, but the risk of developing bladder cancer can be increased by smoking, getting older, long term bladder problems and unsafe exposure to aniline dyes which are used in some industries. Bladder tumours usually form in cells lining the bladder. Once a tumour begins to enlarge, it may stay in the lining or grow into the wall of the bladder. If untreated, the tumour may then grow into other structures such as lymph nodes. If the cancer enters the bloodstream it may spread to other areas of the body (metastasis). Often the first symptom noticed is blood in the urine, other symptoms such as needing to pass urine more often or feeling as if you need to go but can’t affect about 1/3 of people with early bladder cancer. As the tumour grows these symptoms affect more people. The first test to diagnose bladder cancer is usually a urine sample. Sometimes a tube will be inserted through the urethra and the bladder will be washed with liquid to try to wash out some cancer cells for diagnosis. If cancer is suspected, the next step is usually a cytoscopy (a tube to allow the doctor to look inside the bladder). If there is to be a tumour the doctor can take a small sample (biopsy) for testing. CT or MRI scans are also used to scan the body to see if the cancer has spread to other areas. Treatment depends on the size of the tumour and how much it has grown into the bladder wall. Surgery may be considered especially if the tumour is still small. The surgeon can insert a cytoscope through the urethra and cut out the tumour or burn it away. If the tumour has grown more deeply the surgeon may cut open the abdomen and remove some or the entire bladder (a partial or full cystectomy). If the whole bladder is removed an artificial bladder will be created on the inside or a urostomy bag on the outside. Radiotherapy (an x-ray beam) can be used as the main treatment in some people and in others may be used after surgery to remove any remaining cancer cells. In early cancer, drugs (chemotherapy) or another treatment called BCG may be placed directly into the bladder to kill cancer cells (intravesical treatment). Usually though, chemotherapy is used in the later stages where it can attack cancer cells throughout the body (not just the bladder) and help stop the cancer spreading.

    Kidney Stones

    This term refers to stones in the urinary system. They form in the kidneys but can be found anywhere in the urinary system. They vary in size and the amount of pain they cause. Many of these stones can pass though without help but some require medical intervention. Extracorporeal shockwave lithotripsy (ESWL) is the most frequently used procedure for the treatment of kidney stones. In ESWL, shock waves that are created outside the body travel through the skin and body tissues until they hit the denser stones. The stones break down into very small particles and are easily passed through the urinary tract in the urine.

    Kidney (Renal) Failure

    Kidney failure occurs when the kidneys cannot remove waste products from the blood or control the amount of water in your body. Acute kidney failure occurs suddenly and may be the result of injury, loss of large amounts of blood, drugs or poisons. Kidneys may return to normal function if they are not too badly damaged. Chronic renal failure means a slow decline in kidney function, which may not be noticed immediately. If renal function continues to deteriorate dialysis may be needed.

    Benign Prostatic Hyperplasia (BPH)

    This is an enlargement of the prostate gland. In BPH there may be difficulties in passing urine as the enlarged prostate can cause a blockage. Patients with BPH often notice an increased urge to empty the bladder, especially at night. Many men over 60 years of age have some BPH. There are many different treatment options available for people with BPH. Most commonly your doctor can prescribe tablets to improve urinary function.

    Prostatitis

    This is the term used to describe inflammation of the prostate gland. Symptoms can include increased need to pass urine and pain on passing urine as well as perhaps lower back pain. Sometimes this inflammation is due to an infection and an antibiotic will be prescribed, otherwise pain relief medication may be prescribed.

    Prostate Cancer

    Prostate cancer typically consists of many very small, tumours within the prostate. At this stage, the disease is often curable (rates of 90% or better) with standard treatments such as surgery or radiation. Unfortunately, at this stage the cancer produces few or no symptoms and can be difficult to detect. If untreated and allowed to grow, the cells from these tumours can spread to other parts of the body in a process called metastasis. Once the cancer has spread beyond the prostate, cure rates drop dramatically. In most cases, prostate cancer is a relatively slow-growing cancer, which means that it typically takes a number of years for the disease to become detectable, and even longer to spread beyond the prostate. However, a small percentage of patients experience more aggressive forms of prostate cancer. Treatments options for prostate cancer include surgery, radiation, hormone treatment and chemotherapy. Which treatment is chosen depends on factors such as the stage of the cancer and the patient’s age, other health issues and willingness to undergo certain procedures or therapies – some of which may have side effects.

    Vasectomy

    A vasectomy is a minor surgical procedure carried out to make a man sterile (he is no longer able to father a child). It is a commonly used form of contraception. A tiny incision (cut) is made in the scrotum and a short length of the vas deferens (the tube carrying sperm away from the testicles where it is produced) is removed and the cut ends sealed.