Areas of care
Uro-Oncology
Uro-oncology is the diagnosis and surgical treatment of cancers of the urinary tract and the male reproductive organs, meaning the kidney, bladder, prostate, ureter, testis and penis. Many of these cancers are curable when they are found early. The single most important warning sign across the group is blood in the urine, and it needs investigating even when it happens once and disappears.
The cancers this covers
- Bladder cancer
- Usually announces itself as painless blood in the urine. Most cases are found while still confined to the lining, where treatment can be done through a telescope with no external cut.
- Kidney cancer
- Frequently found by chance on a scan done for something else. Small tumours can often be removed while keeping the rest of the kidney intact.
- Prostate cancer
- Often slow growing. A meaningful proportion of low risk cases are safely monitored rather than treated, while more aggressive disease is treated with surgery or radiotherapy.
- Upper tract cancer
- Tumours of the ureter and the collecting system of the kidney. Less common, and assessed with scans and a telescopic look at the upper tract.
- Testicular cancer
- The commonest solid cancer in younger men, and one of the most treatable of all cancers, including at advanced stages. It usually presents as a painless lump or swelling.
- Penile cancer
- Uncommon. Presents as a sore, lump or patch that does not heal, and early assessment allows more tissue to be preserved.
Warning signs worth acting on
- Blood in the urine, especially without pain, even a single episode that clears up
- A lump, swelling or firmness in a testis
- Persistent pain in the flank or back that does not settle
- Unexplained weight loss or ongoing tiredness
- A change in urinary pattern that develops over weeks rather than years
- A sore or patch on the penis that does not heal
Painless blood in the urine is the symptom people most often dismiss, because it stops on its own and nothing hurts. It still needs investigating.
How a diagnosis is reached
Investigation is staged rather than scattered. It begins with urine tests and blood tests, then imaging with ultrasound, CT or MRI depending on which organ is in question.
A telescopic examination of the bladder is the definitive test where bladder cancer is suspected, and it can be done under local anaesthetic. Tissue confirmation follows where it is needed, although in the testis the standard is to remove the affected testis rather than biopsy it. Once cancer is confirmed, staging scans establish whether it has spread, and that determines what treatment is appropriate.
Treatment approaches
- Active surveillance
- Some cancers, particularly low risk prostate cancer and small kidney tumours in older patients, are watched closely with scans and tests rather than treated straight away. This avoids the side effects of treatment for disease that may never cause harm.
- Telescopic removal
- Bladder tumours confined to the lining are resected through the urethra, with no external wound, sometimes followed by medication instilled directly into the bladder to lower the chance of return.
- Organ preserving surgery
- Where a tumour is small and well positioned, removing the tumour and leaving the rest of the organ preserves function. This matters particularly in the kidney.
- Radical surgery with reconstruction
- More advanced disease may need the whole organ removed. When the bladder is removed, a new route for urine is constructed at the same operation, and the options for that are discussed in detail beforehand.
- Combined care
- Chemotherapy, radiotherapy and newer immune based treatments are delivered alongside surgery for many of these cancers, planned jointly with medical and radiation oncology.
Follow up
Surveillance after treatment is part of the treatment, not an afterthought. Bladder cancer in particular has a strong tendency to recur in the lining, which is why regular telescopic checks continue for years after the first tumour is cleared.
Follow up schedules are set according to the type and stage of the cancer, and they are tapered over time rather than continued indefinitely at the same intensity.
Common questions
Questions patients ask
- I saw blood in my urine once and it stopped. Does it still need checking?
- Yes. A single painless episode that resolves on its own is one of the classic presentations of bladder cancer, and it is also the one most commonly ignored. It warrants proper investigation regardless of whether it returns.
- Does every prostate cancer need treating?
- No. Low risk prostate cancer is often managed with active surveillance, meaning close monitoring with the option to treat if it shows signs of progressing. This is a considered strategy rather than doing nothing.
- Will I need a urine bag after bladder removal?
- Not necessarily. Several ways of rerouting urine exist, including constructing a new bladder from bowel in suitable patients. Which options apply depends on the cancer, kidney function and individual circumstances, and they are discussed fully before surgery.
- Is a lump in the testis always cancer?
- No. Many scrotal lumps are benign, such as fluid collections or cysts. What matters is that a firm lump within the testis itself is examined and scanned promptly rather than watched at home.
- How quickly should urological cancer be investigated?
- Investigation should begin within weeks, not months. Most urological cancers are not medical emergencies in the way a blocked infected kidney is, but the outcome from early stage disease is considerably better than from advanced disease.
This page is general information and is not a substitute for a consultation. Your own situation may differ.
Appointments
Discuss this with a urologist
If any of the above sounds familiar, a consultation is the way to find out what is actually going on. Appointments are booked in advance.