Urology is a surgical subspecialty that tackles a wide spectrum of diseases involving the male and female urinary tract, the male reproductive system, and the female pelvic floor. Urologists manage afflictions ranging from genitourinary malignancies (renal cell carcinoma, prostate carcinoma, transitional cell carcinoma, testicular carcinoma, etc.) and renal stones to congenital genitourinary defects, perineal reconstruction, and male infertility.
Different types of Urology Problems and Treatments
1. Prostate enlargement or Benign Prostate Hyperplasia (BPH)
It’s common for the prostate gland to enlarge as men get older. The condition is known as benign prostatic hyperplasia (BPH). This is benign and there is no evidence that it leads to cancer. In some cases, it becomes large enough to put pressure on the urethra (the tube that carries urine out of the penis). This can cause problems with urination, such as frequent trips to the toilet, including having to get up several times in the night, and dribbling of urine.
Treatment of Prostate enlargement
A transurethral resection of the prostate, or TURP for short, involves a thin, tube-like telescope called a resectoscope, which is put into the opening of your penis and passed up the urethra towards the prostate. An attachment at the end of the resectoscope is used to cut away part of the prostate using electrical energy. The operation lasts for about an hour. Afterwards, a catheter is inserted to allow urine to flow freely. This is a thin, sterile tube that is inserted through the urethra and into your bladder. TURP usually involves a hospital stay of up to five days
- Laser Prostate Surgery or Green Light Laser
Laser prostate surgery is a treatment using high powered laser energy (eg: HoLEP Holmium laser or GreenLight laser) to remove or enucleate obstructive prostatic tissue or vaporise tissue with the aim of leaving a wide channel and restoring normal urinary function. Under anaesthesia a small flexible fibre-optic is inserted into the urethra. Light pulses are then sent through this fibre, to cut away the obstructing prostatic tissue which is removed from the bladder with a morcellator.
2. Kidney Stone
A kidney stone is a small stone, usually made up of calcium crystals, that forms inside the part of the kidney where urine collects. The stone usually causes little problem until it falls into the ureter, the tube that drains the kidney into the bladder, and causes an obstruction, preventing urine from draining out of the kidney and often causing severe pain.
Treatments of Kidney Stones
- Shock Wave Lithotripsy
A machine called a lithotripter is used to crush the kidney stone. The procedure is performed by a urologist on an outpatient basis and anesthesia is used. In shock wave lithotripsy, the person lies on a table or, less commonly, in a tub of water above the lithotripter. The lithotripter generates shock waves that pass through the person’s body to break the kidney stone into smaller pieces to pass more readily through the urinary tract.
- Tunnel Surgery or PCNL (Percutaneous Nephrolithotomy)
In this procedure, a wire-thin viewing instrument called a nephroscope is used to locate and remove the stone. The procedure is performed by a urologist in a hospital with anesthesia. During the procedure, a tube is inserted directly into the kidney through a small incision in the person’s back. For large stones, an ultrasonic probe that acts as a lithotripter may be needed to deliver shock waves that break the stone into small pieces that can be removed more easily. The person may have to stay in the hospital for several days after the procedure and may have a small tube called a nephrostomy tube inserted through the skin into the kidney. The nephrostomy tube drains urine and any residual stone fragments from the kidney into a urine collection bag. The tube is usually left in the kidney for 2 or 3 days while the person remains in the hospital.
A ureteroscope—a long, tubelike instrument with an eyepiece—is used to find and retrieve the stone with a small basket or to break the stone up with laser energy. The procedure is performed by a urologist in a hospital with anesthesia. The urologist inserts the ureteroscope into the person’s urethra and slides the scope through the bladder and into the ureter. The urologist removes the stone or, if the stone is large, uses a flexible fiber attached to a laser generator to break the stone into smaller pieces that can pass out of the body in the urine. The person usually goes home the same day.
3. Radical Prostatectomy
A radical prostatectomy is an operation to remove the prostate gland and some of the tissue around it. It is done to remove prostate cancer. This operation may be done by open surgery. Or it may be done by laparoscopic surgery through small incisions.
Laparoscopic surgery may be done by hand. But some doctors now do it by guiding robotic arms that hold the surgery tools. This is called robot-assisted prostatectomy.
- Open surgery
In open surgery, the surgeon makes an incision to reach the prostate gland. Depending on the case, the incision is made either in the lower belly or in the perineum between the anus and the scrotum. When the incision is made in the lower belly, it is called the retropubic approach. The surgeon may also remove lymph nodes in the area so that they can be tested for cancer.
- Laparoscopic surgery
For laparoscopic surgery, the surgeon makes several small incisions in the belly. A lighted viewing instrument called a laparoscope is inserted into one of the incisions. The surgeon uses special instruments to reach and remove the prostate through the other incisions.
- Robotic-assisted laparoscopic radical prostatectomy
This surgery done through small incisions in the belly with robotic arms that translate the surgeon’s hand motions into finer and more precise action. This surgery requires specially trained doctors. The main goal of either open or laparoscopic surgery is to remove all the cancer. Sometimes that means removing the prostate and the tissues around it, including a set of nerves to the penis that affect the man’s ability to have an erection. Some tumors can be removed using a nerve-sparing technique. This means carefully cutting around those nerves to leave them intact. Nerve-sparing surgery sometimes preserves the man’s ability to have an erection.