Urological Care That Supports Your Daily Life
Men’s urological conditions include a wide range of issues, such as benign prostatic hyperplasia (BPH) causing frequent urination, residual urine sensation, and difficulty urinating, as well as malignant tumors like prostate cancer, bladder cancer, and kidney cancer, and bacterial infections of the urinary and genital tracts.
Early diagnosis and treatment are essential. Please consult a urologist as soon as you notice any concerning symptoms.
Conditions Treated at Our Clinic
Common Urological Symptoms in Men
If you are experiencing any of the symptoms below, please feel free to consult our clinic.
Urination-Related Concerns
- Increased frequency of urination (frequent urination)
- Waking up multiple times at night to urinate (nocturia)
- Sudden, urgent need to urinate
- Urine leakage or fear of leakage
- Poor urine stream or weak flow
- Takes a long time to urinate
- Feeling of incomplete bladder emptying
- Pain during or after urination
- Blood in the urine (hematuria)
- Pus-like discharge from the urethra
Symptoms Related to the Genitals or Testicles
- Pain in the testicles or scrotum
- Swelling of the scrotum, or asymmetry in size
- Feeling that the testicles have shrunk
- Prominent veins on the scrotum (varicocele)
- Enlargement of the testicles or scrotum
Concerns About Test Results
- Hematuria or proteinuria was found in a health checkup
- Told that PSA (a marker for prostate cancer) levels were high
Sexual Function Concerns
- Difficulty achieving or maintaining an erection (ED)
- Decreased libido
While urinary symptoms may occur with aging, they may also indicate underlying urological conditions.Early detection and treatment can often improve symptoms and prevent disease progression.
If your current medication for urinary issues has not been effective, please consult us.
If you are experiencing symptoms such as frequent urination or waking up at night to urinate:
- Urinating more than 8 times a day
- Waking up 2 or more times at night to urinate
These are general indicators.
However, symptoms vary from person to person. If you feel your urination frequency has increased, please consider visiting us early.
Benign Prostatic Hyperplasia (BPH)
Benign Prostatic Hyperplasia (BPH) is a condition in which the prostate enlarges with age, compressing the urethra and causing urinary problems. It is particularly common in men over the age of 50, and its incidence increases with age.
Symptoms of BPH
- Frequent urination
- Waking up multiple times at night to urinate (nocturia)
- Weak urine stream
- Difficulty starting urination
- Intermittent urine stream
- Feeling of a weak flow
- Feeling of incomplete bladder emptying
Causes and Mechanism
he prostate is located just below the bladder and surrounds the urethra. As men age and hormone levels change, the prostate can enlarge, compressing the urethra and leading to urination problems.
Diagnosis of BPH
We begin with a thorough interview to assess symptoms, when they started, medical history, current medications, and concerns.Additional tests may include urinalysis, blood tests, ultrasound, and residual urine volume measurement.
Ultrasound (Echo)
Ultrasound is used to measure the size of the prostate.
Blood Test
PSA (Prostate-Specific Antigen) levels are measured via blood test. PSA levels above 4 ng/mL may suggest prostate cancer.However, elevated PSA does not always indicate cancer.Further tests such as MRI and prostate biopsy may be considered to confirm or rule out cancer.
Treatment of BPH
Treatment generally begins with medication.The choice of medication is tailored based on prostate size, amount of residual urine, frequency, and urgency.In most cases, symptoms improve with medication, but surgery may be considered if ineffective.Laser surgery may be performed to remove the enlarged prostate tissue.
Prostatitis
Prostatitis is an inflammatory condition of the prostate gland and is classified as either acute or chronic. It is a common urological condition affecting men of all ages, from young adults to older adults, causing discomfort during urination and pain in the lower abdomen or perineum.
Types of Prostatitis
Acute Prostatitis
Usually caused by a bacterial infection, acute prostatitis presents with symptoms such as frequent urination, pain during urination, and difficulty urinating, often accompanied by a sudden high fever (over 38°C). As it progresses, symptoms may include chills, muscle aches, and joint pain, and in severe cases, urinary retention may occur.
Chronic Prostatitis (Bacterial / Non-Bacterial)
Chronic prostatitis may be due to bacterial infection or may occur without any detectable cause (non-bacterial). Symptoms include discomfort during urination, dull pain in the lower abdomen or perineum, and blood in the semen. Unlike acute prostatitis, fever is typically not present.
Causes and Mechanism
Acute Prostatitis
Acute prostatitis is a bacterial infection caused by bacteria entering the prostate through the urethra.Escherichia coli (E. coli) and other intestinal bacteria are common culprits, leading to sudden fever, painful urination, frequent urination, and urinary difficulty.
If left untreated, it can lead to serious complications such as prostatic abscess or sepsis. Prompt medical attention is necessary if systemic symptoms like fever are present.
Chronic Prostatitis (Bacterial / Non-Bacterial)
Chronic prostatitis is defined as ongoing pelvic or lower abdominal discomfort and urinary issues lasting over three months. It may be caused by bacteria or be non-bacterial (chronic pelvic pain syndrome).
- Activities that put pressure on the prostate, such as cycling or motorbike riding
- Prolonged sitting, such as during desk work or driving
- Due to its location, the prostate is prone to blood congestion, leading to inflammation
- Irregular lifestyle, lack of sleep, and stress
- Alcohol, spicy foods, caffeine, and other irritants
- Weakened immunity and lack of exercise increase infection risk
Non-bacterial prostatitis (Chronic Pelvic Pain Syndrome) is believed to be associated with nerve or muscle tension and autonomic nervous system imbalance, with no clear bacterial cause.
Diagnosis and Testing for Prostatitis
We begin with a detailed consultation to understand your symptoms, when they started, your medical history, current medications, and any concerns you may have. Additional tests may include urine analysis, blood tests, ultrasound (echo), and post-void residual urine measurement as needed.
Testing and Diagnosis of Acute Prostatitis
- Urinalysis: To check for white blood cells and bacteria, assessing the degree of inflammation or infection.
- Blood tests: To evaluate inflammatory markers and, if necessary, measure PSA (Prostate-Specific Antigen), a marker for prostate cancer.
Testing and Diagnosis of Chronic Prostatitis
- Urinalysis: To check for white blood cells and possible bacterial infection.
- Ultrasound (Echo): To examine for swelling, calcification, or abnormal blood flow in the prostate indicative of chronic changes.
Treatment of Prostatitis
Treatment for Acute Prostatitis
- Treatment focuses on suppressing infection using oral or IV antibiotics.
- In severe cases with high fever or intense pain, hospitalization and IV treatment may be necessary.
- In some cases, acute urinary retention may occur, requiring immediate attention.
- We work closely with partner hospitals to ensure smooth referral for hospitalization, further testing, or surgery if needed.
Treatment for Chronic Prostatitis
- Oral antibiotics and anti-inflammatory pain relievers
- Medications to regulate the autonomic nervous system
- Lifestyle adjustments, such as avoiding prolonged sitting, managing stress, limiting alcohol, and reducing irritant intake
While treatment approaches differ between acute and chronic prostatitis, early detection, accurate diagnosis, and appropriate treatment are key to recovery. If you have concerning symptoms, we recommend seeking medical attention promptly.
Prevention of Prostatitis
Chronic prostatitis often recurs even after symptoms improve. Incorporating daily lifestyle habits that reduce stress on the prostate can help lower the risk of recurrence.
Avoid prolonged sitting
Extended periods of sitting (e.g., desk work or driving) reduce blood flow and place pressure on the prostate. Stand up and walk every 1–2 hours, and use cushions to relieve pressure.
Warm your body in the bath
Soaking in a bath can improve blood flow in the pelvic area. Outside of bathing, take steps to keep the lower body warm using thermal clothing or abdominal warmers.
Incorporate regular, moderate exercise
Light activities like walking or stretching improve blood circulation and help reduce stress. Continue at your own comfortable pace.
Limit alcohol intake
Alcohol can irritate the prostate and worsen inflammation or swelling. Avoid drinking as much as possible during symptomatic periods.
Prostate Cancer
In 2020, prostate cancer became the most frequently diagnosed cancer in Japan. Although the five-year survival rate is relatively high, early detection increases the chances of treatment without the need for complete prostate removal.For this reason, regular screening is recommended for men over the age of 50.
Prostate cancer screening is done through a blood test for PSA (Prostate-Specific Antigen), allowing for easy screening through a simple blood draw. If abnormal PSA levels are found, we refer patients to our partner, Edogawa Hospital, for MRI or prostate needle biopsy for accurate diagnosis.
Symptoms of Prostate Cancer
Prostate cancer often presents no noticeable symptoms in its early stages. As the disease progresses, the following symptoms may appear:
- Difficulty urinating or slow urination
- Frequent urination at night (nocturia)
- Blood in the urine (hematuria)
- Bone pain (if metastasis has occurred)
These symptoms require medical evaluation, as they may overlap with other prostate conditions such as BPH or prostatitis.
Causes and Risk Factors
The exact causes of prostate cancer are not fully understood, but several risk factors are known.These include: aging (especially over 60), family history (having a father or brother with prostate cancer), high-fat diet, and the influence of male hormones.
While having these risk factors does not guarantee the development of cancer, regular PSA screening is crucial for early detection.
Screening and Diagnosis of Prostate Cancer
The initial step is a blood test to measure PSA levels—a protein secreted by the prostate. Elevated levels can indicate not only cancer, but also BPH or inflammation.
PSA Test (Prostate-Specific Antigen)
PSA is measured through a blood test and serves as a tumor marker for prostate cancer. It is an effective screening tool, and further testing is typically recommended if levels exceed 4.0 ng/mL.
Note: Elevated PSA levels do not necessarily mean cancer, as they can also be due to BPH or prostatitis. At our clinic, we carefully evaluate results and, if necessary, refer patients to Edogawa Hospital for MRI or biopsy.
Treatment of Prostate Cancer
Treatment depends on the cancer stage, the patient’s age, and overall health. Common treatment options include:
Surgical Treatment
One curative option for prostate cancer is total removal of the prostate (radical prostatectomy).
- Open surgery: removal through a lower abdominal incision
- Laparoscopic surgery: using small incisions and instruments to remove the prostate
- Robot-assisted surgery (Da Vinci): enables precise, minimally invasive procedures
Surgery may result in complications such as urinary incontinence or sexual dysfunction. Treatment decisions are made with careful consideration of physical burden and quality of life.
Radiation Therapy
This method uses high-energy radiation to destroy cancer cells.It is also a treatment option for early-stage cancer or for patients who are not suitable for surgery. However, it may cause irritation to the urethra or rectum.
Hormone Therapy (Endocrine Therapy)
Since prostate cancer cells grow in response to male hormones (testosterone), hormone therapy aims to suppress this effect and slow disease progression.
Chemotherapy
Used in cases like castration-resistant prostate cancer where hormone therapy is no longer effective. Chemotherapy inhibits cancer cell growth using anticancer drugs.
Focal Therapy (Localized Treatment)
This method targets only the cancerous area when the cancer is confined to a part of the prostate.
- It preserves healthy prostate tissue and nerves, minimizing impact on urination and sexual function.
- Some cases can be treated as outpatient or with short-term hospitalization, reducing physical burden.
- If the patient is eligible, we provide treatment in collaboration with Edogawa Hospital.
Focal therapy is ideal for those who prefer functional preservation over radical prostatectomy. We offer counseling at our clinic for those interested.
Collaboration with Edogawa Hospital
If surgery is necessary, it will be performed at Edogawa Hospital, where our Director, Dr. Shoji Koga, also serves as Vice President.Postoperative follow-up, hormone therapy, and routine check-ups are continued at our clinic.We provide seamless coordination between local and advanced care to ensure patient safety and reduce the burden of treatment.
Urinary Tract Infections (UTIs)
Urinary tract infections (UTIs) are a general term for conditions in which bacteria or viruses infect the urinary tract and cause inflammation. Urine is produced in the kidneys and travels through the ureters, bladder, prostate (in men), and urethra to be excreted from the body. Inflammation along this pathway can cause various symptoms.
Symptoms of UTIs
Depending on the site of inflammation, UTIs can be classified as urethritis, cystitis, pyelonephritis, or prostatitis. Urethritis and cystitis typically cause pain during urination, frequent urination, and blood in the urine. Pyelonephritis, prostatitis, and epididymitis may present with fever, back pain, lower abdominal pain, or testicular pain.
Causes and Mechanism of Infection
The main cause of UTIs is infection by bacteria—most commonly Escherichia coli (E. coli)—that enter through the urethral opening. Normally, urine has bactericidal properties, and the flow of urine helps prevent bacterial invasion. However, the following factors can weaken these defense mechanisms and increase the risk of infection:
- Urinary retention (due to BPH or bladder dysfunction)
- Decreased urine output due to insufficient fluid intake
- Habitual suppression of the urge to urinate
- Sexual activity (especially in women)
- Presence of a urinary catheter
Examinations and Diagnosis
- Urinalysis (to detect bacteria, white blood cells, and inflammation levels)
- Ultrasound (to examine the kidneys and bladder condition)
Treatment of UTIs
- Treatment with antibiotics (oral or intravenous)
- Further testing is performed for severe or recurrent cases
Even mild symptoms, if left untreated, may progress to pyelonephritis. If you experience pain or discomfort during urination, fever, or lower abdominal pain, please consult a doctor promptly.
Urethritis
Urethritis is an inflammatory condition of the urethra. It is usually caused by bacterial or viral infection, leading to symptoms such as pain or discomfort during urination, itching, and discharge. If left untreated, the infection may spread to the prostate, bladder, or kidneys, so early diagnosis and treatment are essential.
Symptoms of Urethritis
- Burning pain during urination
- Itching or discomfort in the urethra
- Discharge from the urethral opening (pus or mucus)
- Cloudy urine or sensation of incomplete emptying
- Fever (in advanced cases)
Note: Symptoms in women may be mild or absent.
Note: Men tend to experience more pronounced symptoms.
Causes and Mechanism of Infection
The causes of urethritis can be broadly divided into two categories:
Infectious Urethritis
Often transmitted through sexual contact, infectious urethritis is sometimes classified as a sexually transmitted infection (STI).
- Gonorrhea (Neisseria gonorrhoeae): A sexually transmitted infection characterized by severe pain during urination and purulent discharge.
- Chlamydia: An STI that may cause mild pain on urination and sticky discharge.
- Other bacteria (e.g., E. coli): Can result from contact or use of urinary catheters.
Non-infectious Urethritis
Urethritis may also result from non-infectious causes such as:
- Medical procedures involving catheter insertion or cystoscopy
- Irritation from strong soaps or cleansers
- External irritation to the urethra (pressure or injury)
- Allergic or immune responses
Examinations and Diagnosis
Based on symptoms and the likelihood of infection, the following tests may be conducted:
- Urinalysis (to detect white blood cells or bacteria)
- Culture test of urethral discharge
- PCR testing for STIs such as Chlamydia and Gonorrhea
- Ultrasound or blood tests as needed
Treatment of Urethritis
The primary treatment is antibiotics selected according to the specific cause.
Concurrent treatment of sexual partners may be necessary.
To prevent recurrence, it is important to complete the full course of prescribed medication as directed.
Epididymitis
Epididymitis is an infection-induced inflammation of the epididymis, located behind the testicle.
The epididymis temporarily stores sperm produced in the testicles, allowing them to mature before being sent through the urethra during ejaculation. When bacteria enter this sperm passage and travel backward to the epididymis, infection and inflammation can occur.
Symptoms of Epididymitis
Symptoms often begin with mild pain and rapidly worsen within several hours to a day, so early medical attention is crucial.
- Swelling and severe pain on one side of the scrotum (testicular sac)
- Fever above 38°C and chills
- Red, swollen scrotum with tenderness to touch
- Discomfort during urination, frequent urination
- Groin discomfort severe enough to hinder walking
Causes and Mechanism of Infection
- Common bacteria such as E. coli—typically from the urethra or bladder—can reach the epididymis due to urinary retention or voiding dysfunction.
- Sexually transmitted infections (STIs) such as chlamydia or gonorrhea are common causes in younger individuals.
- In middle-aged and older men with conditions like BPH, infections may occur due to backward flow of urine.
Examinations and Diagnosis
Urinalysis to check for bacteria and white blood cells
Scrotal ultrasound to examine the epididymis, testicles, and blood flow
Blood tests to assess inflammation and the spread of infection
Treatment of Epididymitis
- Mild cases: oral antibiotics and rest
- Severe cases or those with high fever and significant swelling require intravenous treatment
- Cooling and support of the scrotum can help relieve pain
- If an STI is the cause, partner treatment is also essential.Advanced testing is performed for severe or recurrent cases
Inflammation may block the vas deferens (sperm duct), preventing sperm from being ejaculated properly and potentially leading to male infertility. Even after symptoms improve, semen analysis and regular follow-up with a urologist are recommended.
Sexually Transmitted Infections (STIs)
Sexually transmitted infections (STIs) are diseases mainly spread through sexual activity. Common STIs include chlamydia, gonorrhea, genital herpes, condyloma acuminatum (genital warts), syphilis, and HIV. People of all ages and genders are at risk. Many STIs are asymptomatic, so individuals may unknowingly transmit infections to their partners.
Symptoms of STIs
- Pain or itching during urination
- Genital itching, sores, or blisters
- Fever, lower abdominal pain
- Warts around the genitals or anus
Types, Symptoms, and Treatments
Chlamydia Infection
The most common STI, often progresses without noticeable symptoms.
- Men: Painful urination, urethral itching, clear discharge, testicular pain or swelling
- Women: Lower abdominal pain, pain during intercourse, whitish discharge, severe menstrual pain
- Treatment: Diagnosed via urinalysis or PCR test, then treated with antibiotics (macrolides, fluoroquinolones, etc.)
Gonorrhea
Caused by Neisseria gonorrhoeae, can lead to infertility or inflammatory diseases if untreated.
- Men: Severe pain during urination, yellow purulent discharge, epididymitis
- Women: Often mild symptoms, but may include increased discharge or abdominal discomfort
- Treatment: Antibiotics. Often co-infected with chlamydia, so combined treatment is common.
Genital Herpes
Caused by the herpes simplex virus (HSV), resulting in painful small blisters.
- Symptoms (both genders): Blisters or ulcers around the genitals, pain, swollen lymph nodes, painful urination
- Recurrence: May recur during immune suppression; treated with antiviral medications.
- Rare complication: Elsberg syndrome causing urinary dysfunction (mainly in women)
Condyloma Acuminatum (Genital Warts)
Caused by human papillomavirus (HPV), leading to warts around the genitals or anus.
- Symptoms: May appear as multiple comb-like warts. Usually painless but prone to recurrence.
- Treatment: Topical agents (e.g., imiquimod cream) or cryotherapy with liquid nitrogen. We select the appropriate treatment based on individual symptoms.
Syphilis
A bacterial infection caused by Treponema pallidum, which progresses to systemic symptoms if untreated.
- Early stage: Firm, painless sores on the genitals or other areas
- Later stage: Widespread red rashes (roseola), fever, and other symptoms
- Treatment: Oral penicillin-based antibiotics
HIV Infection
HIV infection weakens the immune system and may progress to AIDS (Acquired Immunodeficiency Syndrome).
- The early stage is often asymptomatic, but early testing and diagnosis are critical due to the risk of transmission.
- Treatment: Antiviral medications can now suppress HIV replication, allowing long-term health if treated early.
Male Menopause (Late-Onset Hypogonadism, LOH Syndrome)
Male menopause, also known as Late-Onset Hypogonadism (LOH) Syndrome, is a condition where declining levels of testosterone due to aging or stress lead to various physical and psychological symptoms. While it is common in middle-aged men in their 40s and 50s, younger men may also develop the condition, making awareness important regardless of age.
Symptoms of Male Menopause
Physical Symptoms
- Hot flashes, excessive sweating, chills, palpitations
- Fatigue, low energy, muscle weakness
- Frequent urination, constipation, diarrhea, stiff shoulders, joint pain
- Erectile dysfunction (ED), reduced morning erections
Psychological Symptoms
- Irritability, anxiety, depressive moods
- Lack of motivation, difficulty concentrating
- Sleep disturbances (insomnia or oversleeping)
Sexual Symptoms
Emergency condition where the foreskin cannot return to its original position
- Reduced libido
- Decreased erectile strength
These symptoms can interfere with daily life, and if left untreated, may increase the risk of lifestyle-related diseases such as hypertension, dyslipidemia, diabetes, as well as serious conditions like heart attack or stroke.
Causes and Mechanism
- Decline in Testosterone
Testosterone plays a vital role in maintaining muscle, bone, sexual function, and cognitive ability. Its production decreases with age, which contributes to menopause-like symptoms in men. Poor sleep, nutritional imbalance, and chronic stress can further reduce testosterone levels.
Hormonal imbalance also disrupts the autonomic nervous system, leading to symptoms such as depression, sleep problems, and fatigue.
Diagnosis
Medical interview and AMS (Aging Males’ Symptoms) questionnaire
Blood test to measure levels of free testosterone
Treatment for Male Menopause
- Testosterone Replacement Therapy (TRT): Administered by injection, TRT may improve muscle mass, sexual function, and mood.
- Lifestyle adjustments including sleep, exercise, and diet
- Stress management