There is a wide range of urological diseases, including prostate disorders, kidney stones, and reconstructive urology (reconstruction, prosthetics). The editorial team of the Leading Medicine Guide spoke with Professor Dr. Wille to learn more details.
Benign prostatic enlargement (BPH) and kidney stone disease are two common urological conditions that primarily occur in older age. While benign prostatic hyperplasia is characterized by a non-cancerous enlargement of the prostate that leads to urinary symptoms, urinary stones (urolithiasis) are persistent mineral deposits in the urinary tract that can cause pain and blockage.
Both conditions significantly impair urinary function and require targeted diagnosis and individualized treatment, especially as symptoms increase. Reconstructive or prosthetic procedures are used when pronounced symptoms arise due to changes in the ureter, urethra, or in cases of incontinence, impotence, or pelvic floor prolapse.
Symptoms can vary greatly depending on the type of condition, its location, and severity. Common symptoms include pain or burning during urination, accompanied by frequent urination, nighttime urination, and occasionally blood or cloudy, foul-smelling urine. In some cases, abdominal pain or a feeling of pressure in the kidney or pelvic region may also occur.
„In benign prostatic hyperplasia (BPH), urinary emptying disorders are particularly common. Frequent nighttime urination is a typical symptom: While most men get up once or twice per night, patients with BPH often need to use the bathroom three, four, or even five times. Another key symptom is the so-called urgent urinary need. Men often report a sudden, intense urge to urinate immediately, which can severely restrict daily life.
In some cases, bladder control is so limited that involuntary urine loss occurs – known as urge incontinence. In general, we distinguish between obstructive and irritative urinary symptoms. With obstructive symptoms, urination is difficult: The start of urination is delayed, so affected patients often have to wait a long time before the first drop comes. The duration of urination is also prolonged; while younger men can empty their bladder in a few seconds, men with obstructive prostate symptoms often require 45 seconds to one and a half minutes.
Irritative symptoms resemble a bladder infection: frequent urination with a small amount of urine and strong urgency can lead to discomfort and dribble incontinence. Both symptom patterns result from prostate enlargement, which narrows the urethra and makes urination more difficult“, explains Prof. Dr. Wille at the beginning of our conversation, and describes additional symptoms:
„Residual urine often remains in the bladder – in some patients 250 to 800 milliliters, even though they have just urinated. In more severe cases, acute urinary retention can occur, where the bladder contains 800 or even 1,200 milliliters of urine and the patient cannot pass a single drop. This situation is extremely painful and may even require a patient to request an emergency landing during a flight.
Most men today speak openly about these symptoms. While incontinence in women is still strongly stigmatized, the aging male’s urinary issue is increasingly seen as a normal age-related phenomenon. Many men first consult their general practitioner and then a urologist. Typically, it takes patients three to six months before they take the step to see a doctor – unless they experience acute symptoms requiring immediate treatment“.
„The development of benign prostatic hyperplasia is a condition that progresses differently in every man. It is not influenced by diet or lifestyle. Beginning around age 30, the prostate starts to grow in all men due to hormonal changes, but how strongly and in which direction it grows varies individually. If the prostate grows outward rather than into the urethra, fewer symptoms occur. Thus, it cannot be said that small prostates are always harmless and large ones always problematic.
The general rule is: the larger the prostate, the more likely symptoms may appear. At the same time, some men with relatively small or mildly enlarged prostates can still have significant symptoms. The cause is largely genetic. Other factors such as lifestyle, diet, or other diseases typically play no role – except for rare conditions that additionally affect urination. Regular preventive check-ups, however, can influence the course of the disease.
Early treatment, for example with medication, can slow disease progression. If a man delays seeing a doctor, treatment options become more limited later on. Over time, the bladder muscle becomes thicker and the bladder increasingly stretched. Eventually, the bladder may become so weakened that the man can no longer urinate at all. In such cases, surgery is often the only option. Some patients come very late – one of my patients had urinary retention with two liters of urine in his bladder, more than five times the normal amount of about 350 to 400 milliliters.
Such cases require surgery, but even afterward, irreversible damage may remain. In this particular case, the patient can urinate better than before, but still requires a catheter. When surgery is performed in time, symptoms can usually be significantly relieved, and bladder emptying function preserved“, emphasizes Prof. Dr. Wille.
Diagnosis begins with a detailed medical history in which symptoms, their progression, prior incidents, and risk factors are assessed. Physical examination usually includes a rectal examination to evaluate the prostate.
Imaging plays a central role in diagnostics: Ultrasound (transabdominal or transrectal) is usually the first method used to visualize prostate enlargement, kidney stones, or bladder emptying disorders. For specific questions, computed tomography (CT) or magnetic resonance imaging (MRI) is used. To evaluate bladder emptying disorders in detail, urodynamic testing (bladder pressure measurement) is performed.
The following section outlines the treatment methods for benign prostatic hyperplasia (BPH), kidney stone disease, and reconstructive/prosthetic surgical procedures.
Regarding surgery, Prof. Dr. Wille explains: „During surgery, the goal is ultimately to reduce the size of the prostate and widen the urethra – this basic principle underlies all techniques. The prostate can be treated in various ways: it can be resected, lasered, expanded with metal baskets, or treated with steam. The goal is always the same: reduce the prostate, expand the urethra, and improve urination.
As with any procedure, there are potential consequences that patients should be aware of. The greatest concern among patients is irreversible damage to the sphincter muscle, which could lead to incontinence. In experienced hands, however, the risk is extremely low – in my more than 30 years of surgical experience, it has never occurred. Patients are informed about the risk, which is around 0.2 to 1 percent. A typical outcome of most procedures is retrograde ejaculation. This means that the man experiences a normal orgasm, but the semen does not exit the body; instead, it flows into the bladder and is expelled with the next urination.
This is not a complication, but a normal consequence of the procedure. Some techniques preserve visible ejaculation, although this may come with slightly reduced urinary outcomes. The technique chosen depends on the patient’s condition and their personal preferences. Visible ejaculation serves reproductive and sexual purposes – many patients simply value that semen exits the body in the 'normal' way.
The surgery does not affect erectile function. Occasionally, patients fear that potency may decline, but medically this is not plausible. Pain or other postoperative factors can temporarily influence sexual activity, but the frequency, firmness, and ability to achieve erections remain unchanged“.
Even after prostate surgery, regrowth can occur. Prostate growth cannot be stopped and varies significantly among individuals. In rare cases, re-treatment may be required after ten to fifteen years.
„In my experience over the past 30 years, this is relatively rare when the prostate has been thoroughly and properly removed. Occasionally, scarring or urethral narrowing occurs due to the instrumentation used during surgery. Such scar tissue may require correction later. In the first weeks after surgery, so-called dysuric symptoms may occur – burning during urination or frequent urination. You can imagine that the 'cavity' left after tissue removal is gradually covered by a protective lining, the epithelium.
As with a wound, new tissue forms, which may temporarily cause discomfort. Blood in the urine or small pieces of tissue may also be present. These effects generally subside after about four weeks, and completely by three months. There are various surgical procedures, most of them standardized. Over the years, I have focused on four methods that have proven effective: the classic TUR-P using the latest technology, the steam method in which the prostate is reduced and the urethra widened, a special wire basket inserted into the prostate and removed after about five days,
allowing significant improvement in urination under minimally invasive outpatient conditions. Additionally, for very large prostates, I perform adenoma enucleation, also with excellent results. The central goal of all methods remains the same: reduce the prostate and widen the urethra to permanently improve urination“, states Prof. Dr. Wille.
Urolithiasis, the formation of urinary stones, is a condition in which solid mineral and salt crystals form in the urinary tract. These crystals may develop in the kidneys, ureters, or bladder.
In urolithiasis, the goal is usually the rapid removal or fragmentation of stones to eliminate pain, blockages, and infections. Success rates for stone removal are generally very high; in most cases, stones are completely cleared after treatment, especially smaller stones. Stones form due to a concentration of minerals in the urine, promoted by risk factors such as obesity, dehydration, metabolic disorders, or hormonal changes.
The typical symptom of stones in the urinary tract is sudden, extremely painful renal colic, usually beginning in the flank or back and radiating to the groin or lower abdomen. These pain episodes are often accompanied by nausea, vomiting, blood in the urine (hematuria), and in some cases fever when infection or urinary blockage is present. Stones that remain in the bladder or obstruct urinary flow can also cause difficulty urinating or a feeling of incomplete emptying.
Treatment methods range from medication to dissolve small stones, to extracorporeal shock wave lithotripsy (ESWL), to minimally invasive endoscopic procedures or surgery for larger or impacted stones. Success rates for stone removal usually exceed 90%, and modern techniques such as laser-based fragmentation are highly effective and gentle. Side effects are usually minor and limited to temporary traces of blood in the urine, mild pain, or infections, all of which are treatable.
Professor Dr. Wille adds: „In urolithiasis, meaning stone formation in the kidneys or urinary tract, the cause is not clearly understood. Several theories exist: some describe it as a disease of affluence caused by too much meat or alcohol consumption. That is partially true, but not always – some people rarely drink alcohol or eat little meat, yet still develop stones.
Genetics plays an important role. Some people are simply more prone. Fluid intake and stress also influence stone formation: low fluid intake or high stress increases the risk, as shown in animal studies. In the past, patients were given long lists of foods to avoid – fried potatoes, spinach, Swiss chard, beer, coffee, fatty foods, dairy products – supposedly everything was harmful.
In practice, however, such restrictions often do little good and are burdensome for patients. Moderation is key: milk and cheese are not inherently harmful, even though most stones are made of calcium oxalate. In a healthy metabolism, the body can regulate excess calcium. Only in specific metabolic disorders does the risk truly increase“ and continues:
„Treatment depends on the stone’s size, location, and the patient. Small stones can often be managed by waiting, supported by increased fluid intake or medication such as alpha-blockers. Larger stones, especially in the renal pelvis, often require multiple sessions of shock wave lithotripsy (ESWL). In some cases, a ureteral stent is inserted, or the stone is surgically removed, especially if it cannot pass spontaneously.
Urolithiasis is not age-dependent – even children can develop stones. However, it becomes more common after age 40 or 50. Hydration plays a major role: those who drink too little, especially during hot summer months, are more likely to develop stones. That is why the most important recommendation is: drink enough. Exercise, relaxation techniques, or short breaks can also help reduce stress, even if occupational stress cannot be completely eliminated“.
One of the most important preventive strategies is adequate hydration: By drinking plenty of fluids, usually at least 2 to 3 liters per day, urine is diluted, reducing the concentration of minerals and salts and preventing crystal formation. For individuals prone to stone formation, personalized urine analysis can be helpful to identify specific risk factors such as elevated calcium, oxalate, uric acid, or underlying metabolic disorders that promote stone formation.
Top performance at the Beta Clinic! New high-performance laser and new ureteroscopes with direct suction function
„In addition to a modern range of instruments, we recently began using innovative technologies for stone removal: a high-performance laser for stone fragmentation and newly developed ureteroscopes that directly suction the resulting stone fragments, eliminating the need for an internal stent in many cases. Patients often find the internal stent uncomfortable.
The instrument is slightly larger but can collect the stone fragments using a special retrieval mechanism – a very elegant technique. This is important because residual fragments could theoretically form the basis for new stones if proteins accumulate on them and cause further growth. This method is particularly advantageous because it ensures a more thorough stone removal. In our private clinic, we can offer patients this high-end technology directly“, notes Prof. Dr. Wille.
In conclusion, Prof. Dr. Wille emphasizes: „The Beta Clinic is unquestionably – and this is confirmed not only by me but especially by the patients – a private clinic where radiological diagnostics, my private practice, surgical capabilities, and immediate comfortable inpatient care are closely integrated.
Patients receive a diagnostic and therapeutic concept immediately. If a patient arrives with colic, he drives into the underground garage, comes upstairs, and may be experiencing colic at that moment or recently. I perform an ultrasound and urine test, which takes three minutes, and shortly afterward, the high-resolution CT image is available on the screen. This special level of service is rarely possible in other clinics. This allows me to decide immediately whether the stone will pass spontaneously, whether shock wave therapy is appropriate, or whether surgical stone treatment is indicated.
We offer all stone treatments at the highest level – from shock wave therapy to endoscopic procedures to open stone removal when necessary. Even in elderly patients who cannot endure the pressure and fear of repeated colic episodes, we can act quickly. Even if surgery is not an emergency, treatment occurs without long waiting times. A unique feature of the Beta Clinic is that we treat patients flexibly and according to their individual needs. This ensures fast, effective, and comfortable care“.
Thank you very much, Prof. Dr. Wille, for this special insight into urology!
- Dr. Sebastian Wille is a world-renowned urologist at the Beta Clinic in Bonn and a specialist in prostate disorders, kidney stones, and reconstructive urology (reconstruction, prosthetics).
- Trained in Munich, Bern, Marburg, and Cologne, complemented by international training in Spain, France, and the United States.
- Founder and coordinator of the Continence and Pelvic Floor Center, characterized by scientific expertise and patient-centered practice.
- Innovator with developments such as the Wille capsule for catheter-free urodynamics and extensive experience in minimally invasive surgery.
- Author of numerous publications, reviewer, speaker, and organizer of medical conferences.
- Places great emphasis on individualized, empathetic patient care in a private facility offering the highest medical standards.
- Combines scientific progress with personal dedication, creating optimal conditions for successful treatment and long-term health care.
