Urology Surgery

What is Urology?

Urology is a surgical specialty which deals with diseases of the male and female urinary tract and the male reproductive organs. Although urology is classified as a surgical specialty, a knowledge of internal medicine, pediatrics, gynecology and other specialties is required by the urologist because of the wide variety of clinical problems encountered.

Historically, the subject which clearly established the specialty of urology as being distinct from general surgery was the treatment of obstructive uropathy. This treatment ranges from the correction of obstructing posterior urethral valves or ureteropelvic junction obstruction in the infant to the correction of bladder outlet obstruction from benign prostatic hyperplasia in the older male. Through the decades, we have witnessed a tremendous increase in our general understanding of the diverse functional disorders of urine transport associated with various overt and covert forms of neuromuscular dysfunction. The rapidly evolving discipline of urodynamics has established itself as a major resource in the diagnosis and therapy of such disturbances.

The specialty of urology is constantly changing. Much of this change has been the result of improved technology. Refinements in the area of ureteral and renal endoscopic surgery have already revolutionized the therapy of urinary tract stones and, working in conjunction with the new generation of extracorporeal lithotriptors, many of the traditional surgical and even endoscopic approaches to the problem of renal and ureteral calculi are now largely obsolete. Many urologic operations which have been done by open surgery in the past can now be performed through the laparoscope. In summary, urology is a rapidly changing and exciting area of medicine which requires practicing urologists to be actively involved in continuing education.

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Common Urologic procedures/treatments

Preventative Care
All men above the age of 50 should undergo a yearly serum prostate specific antigen (PSA) measurement and a digital rectal examination to evaluate for the presence of prostate cancer. In addition, all patients seen in the urology clinic may submit a urine specimen to be evaluated for the presence of infection or blood.

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Hematuria (Blood in Urine)
The presence of blood in the urine may indicate the presence of urinary tract stones, infections, tumors, or other conditions requiring treatment. The standard evaluation consists of x-rays of the kidneys (IVP, ultrasound or CT scan) followed by cystoscopy (looking into the bladder through the urethra with a scope).

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Bladder Outlet Obstruction
This typically occurs in men as a result of benign prostate growth. Symptoms of this condition include frequent urination, presence of a sudden, strong urge to void which is difficult to control, rising during the night to urinate, a feeling of incomplete bladder emptying, straining to urinate, and a weakened urinary stream. Usually, treatment with medications is sufficient to control the symptoms, but sometimes procedures are required to relieve the obstruction. Such procedures include the standard "TURP" (transurethral resection of the prostate) as well as newer techniques such as TUNA (Transurethral Needle Ablation of the Prostate (RF)) and laser treatment.

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Cystoscopy
Using a lighted, fiber-optic telescope (cystoscope), this office procedure is done under local anesthesia usually using a flexible cystoscope. The inner lining of the bladder and urethra is examined. The urethra is the tube through which urine passes from the bladder to the outside. The sphincter control mechanism is located along portion of the urethra. Common indications for cystoscopy include 1) frequent or persistent urinary tract infections, 2) blood in the urine (hematuria), 3) loss of bladder control (incontinence), 4) abnormal cells found in urine sample, 5) painful urination or unexplained pelvic pain associated with urination, 6) poor bladder emptying due to prostate enlargement or stricture of the urethra, and 7) any abnormal growth, lesion, or tumor seen on other imaging studies.

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Urinary Tract Infections (UTI)
The presence of recurrent bladder or kidney infections may indicate a functional or anatomic abnormality of the urinary tract. A careful history and physical examination followed by an examination of the urine, including a urinalysis and urine culture, are an essential part of the initial evaluation. Radiologic studies may be performed in certain patients to check for kidney stones, obstruction, and other anatomic abnormalities. Most cases of recurrent urinary tract infections may be successfully treated with antibiotics, but surgical procedures are occasionally needed to remove a source of infection.

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Kidney Stones
Many kidney stones will pass out of the body without the need for a procedure. However, in cases of persistent pain or infection, it is necessary to relieve the urinary obstruction caused by the stone. Using the cystoscope, a temporary silicone stent may be placed inside the ureter to relieve the obstruction and pain. The stone can then be fragmented using shock waves from outside the body (extracorporeal shock wave lithotripsy - ESWL), or it can be removed using a small scope which is passed into the bladder and ureter (ureteroscopy). Following stone removal, tests of the blood and urine may be performed to identify why the stone formed and how to prevent more stones from occurring.

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Lithotripsy
Lithotripsy is a medical procedure that uses shock waves to break up stones in the kidney, bladder, or ureter (tube that carries urine from your kidneys to your bladder). After the procedure, the tiny pieces of stones pass out of your body in your urine.

Extracorporeal shock wave lithotripsy is the most common type of lithotripsy. "Extracorporeal" means outside the body. You will wear a medical gown and lie on an exam table on top of a soft, water-filled cushion. You will be given a mild sedative or pain medicine before the procedure starts. You will also be given antibiotics before the procedure starts to prevent infection.

High-energy shock waves, also called sound waves, will pass through your body until they hit the kidney stones. You may feel a tapping sensation when this starts. The waves break the stones into tiny pieces. Often, you will be given anesthesia for the procedure. The lithotripsy procedure should take about 45 minutes to 1 hour. A tube may be placed through your bladder or back into your kidney. This tube will drain urine from your kidney until all the small pieces of stone pass out of your body. The tube may be put in place before or after your lithotripsy treatment.

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