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Urology

Procedures

Procedures

Cystectomy

A cystectomy is a surgical procedure in which a portion of the bladder is removed. Cystectomies may be performed to treat recurrent invasive or non-invasive bladder cancer. Cystectomies may also be performed to treat advanced colon, prostate or endometrial cancer, interstitial cysts or congenital abnormalities. Radical cystectomies in men involve removing the seminal vesicles and prostate in addition to the bladder. In women, radical cystectomies result in the removal of the bladder, the uterus, the ovaries and a part of the vagina. Cystectomies can be performed via an open procedure or using minimally invasive techniques.

The cystectomy procedure also deals with reconstruction of an alternate channel to divert and store urine in, after the bladder is removed. This can be done in a number of ways. The surgeon may harvest a small piece of the small intestine to make an ileal conduit. Neobladder reconstruction using a larger piece of the small intestine is also an option.

Pyeloplasty

Pyeloplasty is a surgical reconstruction technique for the ureter. It also helps drain and decompress the kidneys. The procedure is used to relieve an obstruction in the ureteropelvic junction. Pyeloplasty procedures can be performed laparoscopically or as an open procedure in teenagers and adults. In infants and small children, an open pyeloplasty is considered safer. The pyeloplasty procedure has the highest success rate in treating kidney and ureter obstructions. There is evidence of a good long-term prognosis for patients who have undergone a pyeloplasty.

During a pyeloplasty, the obstructed segment of the ureter is removed. The remaining ureter is then attached to the renal pelvis (on the kidney). A stent may also be placed to drain urine from the kidney and relieve pressure. Risks associated with the procedure include scarring, herniation, infection and blood clots.

Uroflowmetry

Uroflowmetry is a diagnostic screening procedure to calculate the patient’s urine output over time. The test is non-invasive and used to assess bladder and urinary sphincter function. During the uroflowmetry test, the patient is asked to urinate into a funnel until their bladder is completely empty. The funnel is connected to a measurement apparatus that measures urine flow rate with respect to time and converts the data into graphs. During normal urine output, the initial stream starts slowly, speeding up until the bladder is nearly empty. Then, the last part of the bladder empties slowly. The shape of the flow rate graph will vary if there is an obstruction, and the degree of variation will give the doctor information about the size and location of the obstruction in the urinary tract. Decreased flow rate could also be an indication of urinary incontinence caused by weak bladder muscles. The doctor may require a series of uroflowmetry tests over the course of multiple days. Uroflowmetry tests are used in conjunction with imaging tests to diagnose urological diseases like bladder cancer, urinary obstructions and enlarged prostate gland.

Urodynamic study

Urodynamic tests are used to measure urological nerve and muscle function, bladder pressure and urine flow rates. The tests essentially study how well the bladder, urethra and sphincters operate while holding and releasing urine. If the patient suffers from frequent painful urination, incontinence or problems with emptying the bladder completely, the doctor may recommend urodynamic tests to figure out the underlying problem. Types of urodynamic tests include cystometry, electromyography, uroflowmetry, pressure flow studies and postvoid residual measurements. A cystometric test measures bladder pressure via a catheter inserted up the urethra. Electromyography uses sensors to measure electrical activity of the bladder muscles and sphincters. Postvoid residual studies measure the urine that remains in the bladder after urination with an ultrasound.

Renal Stents

Renal artery stenting is a procedure used to unblock an obstructed renal artery, the main blood vessel that carries blood to the kidney. Renal arteries can get blocked due to atherosclerosis or fibrous artery disease. Blockage of the renal artery reduces blood flow and oxygen supply to the kidneys, resulting in deteriorated functioning. When the kidneys stop filtering the patient’s blood, it can lead to dangerous levels of toxins and wastes building up in the blood, poisoning the body and increasing renal pressure. A renal stent is inserted into the blocked artery to restore blood supply to the kidney.

Renal stents are inserted during a surgical procedure known as an angioplasty. This is a minimally invasive procedure, in which a balloon catheter is inserted into the renal obstruction through a small incision in the skin. The surgeon guides the tip of the balloon catheter to the precise site of the obstruction under X-ray fluoroscopy guidance. The surgeon will inject contrast dye to make the arteries easier to visualise, before inflating the balloon. The stent, made of a fine mesh tube, is inserted into the narrowed artery. It is left in place to maintain a path for blood flow. The patient will require periodic follow-up appointments to check if the artery is narrowing again.

Trans-Urethral Resection of the Prostate (TURP)

The prostate gland, found only in men, is located close to the bladder. Inflammation of the prostate gland or benign prostate hyperplasia can press on the bladder and the urethra causing discomfort and difficulty while urinating. Trans-urethral resection of the prostate is a minimally invasive surgical procedure to remove the enlarged prostate through the penis. The surgeon accesses the enlarged prostate by inserting an instrument through the urethra. The instrument is called a resectoscope and is a long tube with a camera on the end, valves that control irrigation fluid and a wire loop that can be used to make cuts and cauterize. The surgeon uses the wire loop to resect pieces of tissue blocking the urethra and flushes it out through the bladder with the help of the irrigation fluid. After the trans-urethral resection, a catheter is left in place for a few days as blood and residual tissue continues to be flushed out through the urine.

Prostate Biopsy

A prostate biopsy is a procedure to retrieve tissue samples from a suspicious mass in the prostate. The sample is tested further in the laboratory to identify the nature and cause of the abnormal mass. During the procedure, the urologist inserts a needle into the prostate gland to collect a tissue sample. The procedure is quick and only lasts about 10-15 minutes. The tissue sample is examined under a microscope to identify cell mutations in the mass to identify a probable cause and a course of treatment. A doctor may recommend a prostate biopsy if the patient has lumps during a rectal exam or elevated prostate-specific antigen (PSA). Prostate biopsies are associated with risks such as rectal bleeding, blood in the semen or the urine and in rare cases, infection.

Flexible Cystoscopy

A flexible cystoscopy is a procedure used to examine the inner lining of the ureters and the bladder. The flexible cystoscope, a hollow tube with a camera on the end, is slowly inserted into the urethra and advanced upwards into the bladder. The cystoscopy may be performed in an examination room, using a local anaesthetic jelly to numb the area. It may also be performed as an outpatient procedure under local anaesthesia or a surgical procedure under general anaesthesia. The attending physician will decide on the type of procedure depending on the condition of the patient. Flexible cystoscopy procedures could be used to diagnose, monitor or treat conditions affecting the bladder. The doctor may recommend a flexible cystoscopy to patients who present with blood in the urine, incontinence, painful urination or chronic urinary tract infections.

Intravesical Chemotherapy for bladder cancer

Intravesical chemotherapy is a technique in which chemotherapy is delivered directly to the bladder. Intravesical chemotherapy is effective in treating non-invasive tumours that do not spread beyond the bladder. Normally, chemotherapy is injected into the blood and allowed to work. This affects other parts of the body as well. In intravesical chemotherapy, the effects of the chemotherapy target the inner lining of the bladder, minimising side-effects in other parts of the body. Intravesical chemotherapy is often recommended after trans-urethral resection of bladder tumours, to kill any residual cancer cells. Experts typically recommend that the chemotherapy be administered within 6 to 24 hours of the tumour resection procedure, but the surgeon in charge of the case may decide the time based on the condition of the patient. The main side effects of intravesical chemotherapy for bladder cancers are blood in the urine and a residual burning sensation in the bladder.

Double J stent removal

A double J stent is a hollow plastic wire inserted in the ureter connecting the kidney to the bladder. The stent ensures a flow of urine from the kidney to the bladder without obstructions. An obstruction could cause renal hypertension (high pressure in the kidney), acute discomfort or pain during urination. The double J stent needs to be removed periodically due to the material of which it is made – flexible plastic. The stent needs to be removed within the specified time or else it could lead to complications in which the stent disintegrates and begins to pass through the patient’s urinary tract in pieces, potentially blocking the ureters and leading to infections. The double J stent is removed in a cystoscopy procedure. The cystoscope is inserted into the urethra, while the area is numbed with an anaesthetic jelly. Once the stent is visualised via the camera on the cystoscope, it is removed using endoscopic forceps. The entire procedure usually takes about 30 minutes. Mild burning sensations in the urethra and some blood in the urine are common after a cystoscopy procedure.

Penile Prosthesis implantation

A penile prosthesis is a device implanted in the penis to treat erectile dysfunction. The penile prosthesis is typically recommended only after other treatment options for erectile dysfunction have failed. The implant devices are usually malleable or inflatable. The inflatable implant is more advanced and generally preferred by most patients. The penile prosthesis is implanted in a surgical procedure. The recovery time for the surgery is usually around 6 weeks but varies according to the patient’s general health, the cause of the dysfunction or defect, the type of implant and reconstruction techniques involved.

Kidney preserving procedures

Kidney tumours discovered at an early stage have a good chance of curative treatment without removing the entire kidney. Partial kidney resection is recommended for small, non-aggressive tumours. This can be done through a partial nephrectomy. This is a laparoscopic procedure in which the tumour and surrounding margins are resected and removed laparoscopically. This allows preservation of the normal anatomy and function of most of the organ.

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