by Hannah Farrell
Our expert witnesses in urology specialise in the urinary tract, including the bladder, ureters, and urethra, and the male reproductive system. They are experts in performing cystoscopy, cystectomy, urethral sling surgery, TURP (transurethral resection of prostate), and insertion of suprapubic catheters.
Our experts in urology have a profound knowledge of managing conditions such as prostate cancer, benign prostatic hyperplasia (BPH), bladder stones, ureteric strictures, and lower urinary tract infections. Further, their extensive experience in the operating theatre means they can review operation notes and assess the practical nature of the surgical procedures performed.
With a strong understanding of appropriate standards of care and NICE Guidelines, in addition to a thorough knowledge of treatment pathways, our expert witnesses in urology can advise on causation, breach of duty, current condition, and prognosis in individuals who have suffered urological conditions or injury and have undergone surgery urological procedures.
See below for a brief overview on urology. Alternatively, contact an expert witness in urology to see how they can help.
What is the Urological System?
The urological system is comprised of the ureters, bladder, and urethra, in the female body. In the male body, it also includes the prostate and testes.
Ureteric Stones
The ureters carry urine from the kidneys to the bladder where it is stored until micturition (urination) occurs. Due to their anatomical location, the ureters are narrowest in three locations (uretopelvic junction, pelvic brim, entrance the bladder); ureteric calculus (kidney stones) most commonly obstruct urinary flow in these locations, causing severe renal colic (loin pain) and haematuria (blood in urine).
Urinary Incontinence
The bladder stores urine and aids in its expulsion from the body (urination); these processes are controlled by the nervous system. In the bladder is the detrusor muscle, which relaxes whilst the urethral sphincters contract to maintain urinary continence. When the bladder is full, the detrusor muscle contracts, increasing pressure within the bladder, and the external urethral sphincters relaxes, allowing urine to flow.
People can have four difference types of urinary incontinence, depending on the cause:
- Stress incontinence – urine leakage due to pressure on the bladder;
- Urge incontinence – urine leakage immediately when someone feels the need to urinate;
- Overflow incontinence – the bladder is overfilled and causes urine to leak out; and
- Neurological incontinence – a nerve lesion or neurological condition causes improper neurological control of the bladder leading to urine leakage.
Urinary Retention
Contrary to urinary incontinence, some individuals experience urinary retention where they are unable to urinate. This may be due to obstruction (benign prostatic hyperplasia, constipation), nerve dysfunction, infection, or certain medications.
Bladder Cancer
Most bladder cancers are transitional cell carcinomas and often present as painless haematuria. However, in cases of late diagnosis and the tumour has progressed, it may present a urinary retention with obstruction of the outflow of urine.
Urethra
The urethra transports urine away from the bladder and away from the body. In the female body, the urethra is relatively short, and leaves women more susceptible to developing urinary tract infections such as cystitis. The urethra in the male body is much longer and is also responsible for transporting semen. The urethra can become narrowed (urethral stricture) or obstructed.
Prostate Dysfunction
In the male body, the prostate is found below the neck of the bladder, above the external urethral sphincter, and in front of the rectum. Its location enables examination via a digital rectal examination. Its location also means that if the prostate enlarges or becomes inflamed (prostatitis), the person will present with urinary tract symptoms. Benign prostatic hyperplasia (BPH) is a common condition effecting men over the age of 40, where the prostate enlarges without malignancy; the urethra becomes compressed and the individual presents with urinary frequency, urinary urgency, nocturia, poor stream, intermittent urine stream, terminal dribbling of urine, and difficulty initiating urination. Prostate specific antigen (PSA) is measured in these individuals to monitor signs of the presence of prostate cancer. Medications, such as finasteride, can be prescribed to help manage BPH. Should the prostate need to be removed, surgery such as transurethral resection of the prostate (TURP) or open prostatectomy may be performed. In cases of prostate cancer, brachytherapy and hormonal therapy can be used as additional therapy.
Male Reproductive System
In the male body, the testes and epididymis are located within the scrotum and are a key element of the male reproductive system. As with all other parts of the body, these can become infected, inflamed, or become cancerous. Fluid may collect in the scrotum (hydrocele) or there may be a collection of blood (haematocoele). Further, the veins draining into the testes can become grossly dilated (varicocoele).
Catheterisation
When there is dysfunction of the urinary tract, individuals may require the insertion of a urinary catheter to allow excretion of urine from the body. There are several types of temporary and permanent catheters:
- Intermittent urinary catheter
- Indwelling urinary catheter
- Suprapubic catheter
Urinary Tract Investigations
The urinary tract can be viewed using cystoscopy, where an endoscope is passed through the urethra and into the bladder. This can also be used to take a biopsy of the urinary tract. Urodynamic studies can also be performed to assess the function of the lower urinary tract. These include:
- Uroflowmetry;
- Postvoid residual urine measurement;
- Cystometric testing;
- Leak point pressure measurement;
- Pressure flow study;
- Electromyography; and
- Video urodynamic testing.