What Is Urological Surgery? Types And Treatments

What Is Urology?

Urology is a type of medical specialty that is associated with the treatment of male and female urinary tracts including the kidneys, ureters, bladder, and urethra. It also deals with male reproductive organs such as the penis, testes, scrotum, prostate, etc.

Urology surgery is the procedure done to treat any obstructions, dysfunction, malignancies, and inflammatory diseases of the urinary tract and the associated organs.

Why It’s Done 

Until the late twentieth century, urological surgeries generally involved open abdominal surgery where the surgeon would make full incisions, and patients had to stay long periods at the hospital for their recovery.

Today, with the development of new surgical techniques and less invasive operative methods, surgery is less traumatic, with shortened hospitalizations.

One of these new methods of minimally invasive surgeries is the laparoscopic procedures that are improving non-stop and are performed through small keyhole incisions, and therefore, cut down on lengthy hospital stays and recovery times.

Laparoscopic surgery is effective for many urological treatments involving the kidneys, prostate, and bladder complications.

Conditions that can commonly be remedied by urological operations include:

• Neurogenic sources like spinal cord injury
• Injuries to the pelvic organs
• Chronic digestive and urinary diseases
• Prostate infections and inflammations
• Cancer

Conditions that affect the function of the digestive, renal, and reproductive systems, can also be corrected by urological surgery, to clear obstructions and make augmentations.

Other cases that are seen more frequently include:

• Kidney stones, diseases, and infections
• Pancreatic diseases
• Ulcerative colitis
• Penile dysfunction
• Infections of the genitourinary tract

Types Of Urological Surgery

Depending on the condition you have, and the type of treatment you need, there is a range of various procedures that can be done to help care for your complications.

Some of the more commonly performed treatments in the field of urology include but are not limited to:

1. Prostate Biopsy
2. Prostatectomy
3. Transurethral Resection Of The Prostate
4. Nephrectomy
5. BPH Treatment

Your doctor will determine which type of surgery will suit your needs best.

1) Prostate Biopsy

The prostate gland is the organ that sits below the bladder and wraps around the tube that carries urine out of the body (urethra), and is also significant in making semen. This gland only exists in men.

A biopsy is a type of procedure done to remove a small piece of tissue or cells from the body so it can be examined under a microscope.

During a prostate biopsy, your doctor will remove tissues from the prostate gland, using biopsy needles, to then examine the removed tissues under the microscope to look for any cancerous tissues or abnormal complications.

Why It’s Done

A prostate biopsy is performed to detect cancer.

Your urologist will recommend you to have a prostate biopsy if:

• A PSA test shows levels higher than normal for your age
• Your doctor finds lumps or other abnormalities during a digital rectal exam

There may be other reasons for your doctor to recommend a prostate biopsy.

Types Of Prostate Biopsy

A prostate biopsy can be done in various ways. These include:

1. Transrectal method: This is done by passing the needle through the wall of the rectum and is the most common type.

• Transurethral method: This is done through the urethra using a cystoscope (a flexible tube and viewing device).
• Transperineal method: This is done by inserting the needle through the area of skin between the scrotum and the rectum. An MRI or CT scan is generally used to guide this procedure.

During A Prostate Biopsy

1. Your specialist will ask you to either lie down on your side or your stomach and then insert a thin ultrasound probe through the rectum to identify the area that needs to be numbed with an injection to reduce discomfort associated with the biopsy.

2. After the area is numbed, using a spring propelled needle, your doctor will remove thin sections of tissue and cells from your prostate.

 You may feel very brief uncomfortable sensation each time the spring-loaded needle takes a sample.

3. Your doctor will take the needed number of tissue samples – usually between 10 to 12 samples – and then finish the procedure.

The entire biopsy takes about 10 minutes.

After A Prostate Biopsy

Your doctor might recommend you to do only light activities for 24 to 48 hours following the procedure.

You may experience:

• slight tenderness and some light bleeding from your rectum
• Have blood in your urine and stool for a few days
• Notice that your semen has a red or rust-colored tint caused by a small amount of blood in your semen. This can last for several weeks

Risks Of A Prostate Biopsy

Some possible complications of a prostate biopsy may include:

• Bruising and discomfort at the biopsy site
• Bleeding
• Infection
• Trouble urinating

Be sure to discuss any concerns with your doctor before the procedure.

2) Prostatectomy

Prostatectomy is a surgical procedure performed to remove either a part, or the entire prostate gland due to complications of the prostate.

Why It’s Done

Prostatectomy can be performed to treat various types of conditions. These include:

• Localized Prostate Cancer
• Enlarged Prostate

Types Of Prostatectomy

1. Radical prostatectomy: is performed to remove the whole prostate gland and the surrounding lymph nodes, usually to treat localized prostate cancer.

Your doctor can perform this, by using various techniques such as laparoscopic, robot–assisted, and open radical prostatectomy.

• Simple prostatectomy: in this procedure, your surgeon doesn’t remove the entire prostate, as in radical prostatectomy, but instead removes just the obstructive part of the prostate that’s blocking the flow of urine.

This type of prostatectomy is commonly performed to treat men with enlarged prostates and severe urinary symptoms.

During A Prostatectomy

1. You will be put under general anesthesia, which means that you will be asleep during surgery and feel no discomfort.

2. Depending on the type of procedure you are having, your doctor will make incisions, take out the entire or gland, or just fix the areas that are obstructing the flow of urine.

3. Once your doctor has removed the part of your prostate causing symptoms, one to two temporary drain tubes may be inserted through punctures in your skin near the surgery site.

4. Your surgeon will then close the incisions.

After A Prostatectomy

•     You will be given pain medication through an IV

•       Your doctor will take you to walk after the surgery

•       You will have a catheter in place for 7 to 10 days following the procedure

•       Your doctor will ask you to take it easy and refrain from strenuous activities until full recovery in about 4-6 weeks.

•        You will not be able to drive for a few days after the surgery.

 

 Risks Of A Prostatectomy

Just like any surgery, prostatectomy carries complications and risks.

 Radical prostatectomy risks include:

• Bleeding
• Urinary Tract Infection (UTI)
• Erectile dysfunction
• Urinary incontinence
• Formation of cysts containing lymph (lymphocele)
• Injury to the rectum (rare)
• Narrowing of the urethra or bladder neck

Risks of open simple prostatectomy include:

• Bleeding
• Injury to neighboring organs and structures
• Erectile dysfunction
• Urinary incontinence
• Dry orgasm
• Narrowing of the urethra or bladder neck

3) Transurethral Resection Of The Prostate (TURP)

Transurethral resection of the prostate (TURP) is surgery to remove parts of the prostate gland through the penis, by inserting an instrument called a resectoscope through the penis and into the tube that directs urine out (urethra). This procedure doesn’t involve any incisions.

Why It’s Done

This procedure is a surgery performed to relieve urinary complications that are caused by an enlarged prostate,  that can press against the urethra and interfere with or obstruct the flow of urine out of the body.

This is generally due to Benign Prostate Hyperplasia (BPH) and is a common part of aging.

Urinary symptoms caused by benign prostatic hyperplasia (BPH) include:

• Difficulty starting or slow urination
• Frequent need to urinate
• Urinary tract infections (UTIs)
• Stopping and starting urination

Other types of conditions that can be treated by TURP include:

• Kidney or bladder damage
• Blood in the urine
• Inability to control urination to urinate at all
• Bladder stones

During TURP 

1.  You will be under general anesthesia – meaning you will be unconscious and sleeping – or in other cases given spinal anesthesia – that numbs only certain areas.

2. Without any incisions, the resectoscope will be passed into the urethra. This instrument is used to cut away the pieces of prostate tissue that are bulging or blocking the urethra.

3. After removing the tissues, your doctor will put in a catheter into your bladder to help you urinate after surgery.

After TURP

• You will be asked to stay in the hospital for 2 to 3 days, and the catheter will likely stay in place for 24 to 48 hours.
• Pain medications will be administered to you via an IV line.
• You will likely notice some blood in your urine.
• Your doctor will give you proper care instructions when you leave the hospital.

 

 Risks Of TURP

As with any surgery, TURP can carry certain risks and complications. Some possible risks may include:

• Bladder injury
• Bleeding
• Infection
• Inability of erections
• Painful or difficult urination
• Retrograde ejaculation (when ejaculate goes into the bladder and not out the penis)
• Electrolyte abnormalities

4) Nephrectomy

Nephrectomy is a procedure done to remove all or part of the kidney. It may be done to treat kidney cancer or other conditions of kidney diseases and traumatic injuries.

Nephrectomy can also be performed to harvest a healthy kidney from a living or dead donor for a kidney transplant.

Types Of Nephrectomy

There are 2 types of nephrectomy that can be performed:

1) Partial: Where only the diseased or injured portion of the kidney is removed

2) Radical: Where the entire kidney is removed, along with a section of the tube leading to the bladder (ureter), the gland that sits atop the kidney (adrenal gland), and the fatty tissue surrounding the kidney.

Nephrectomy can also be performed either laparoscopically, robot-assisted, or by open surgery.

During Nephrectomy

1. A nephrectomy procedure is performed during general anesthesia, meaning you will be asleep throughout the procedure and won’t feel any pain.

2. Depending on the type of surgery recommended by your physician, they will make incisions and remove parts or all of the kidney.

3. Your doctor will then close the incisions with sutures.

After Nephrectomy

• You will have a catheter attached to help you urinate, which will stay in place for a short while.
• Depending on your condition, you may be asked to stay for 1 to 7 days following the surgery.
• Your doctor will ask you to refrain from strenuous activities for at least 6 weeks after the operation.
• Your health care team will give you specific post-operative instructions to follow when you get discharged. Make sure to follow them properly for a seamless recovery.

Risks Of Nephrectomy

Nephrectomy is typically a safe procedure. But as with any surgery, it can carry some risks of complications, including:

• Bleeding
• Infection
• Injury to adjacent organs

5) BPH Treatment

The enlargement of the prostate is called Benign Prostatic Hyperplasia (BPH). An enlarged prostate gland can cause uncomfortable urinary symptoms, such as blocking the flow of urine out of the bladder. It can also cause bladder, urinary tract, or kidney problems.

BPH is common in men older than 50 years

BPH Symptoms

When the prostate is enlarged, it can bother or block the bladder.

Symptoms may include:

• Frequent need to urinate, every 1 to 2 hours and mostly at night
• Feeling that the bladder is full, even right after urinating
• Slow urinating
• Stopping and starting to urinate several times
• Trouble starting to urinate
• Needing to push or strain to urinate

Types Of Treatments For BPH

Most common types of BPH treatment include:

·      Laser therapy: where a high-energy laser destroys or removes overgrown prostate tissue

·      Prostatic urethral lift (PUL): where special tags are used to compress the sides of the prostate to increase the flow of urine.

There are other types of minimally invasive procedures, used to treat BPH including Transurethral resection of the prostate (TURP), Transurethral incision of the prostate (TUIP), Transurethral microwave thermotherapy (TUMT), Transurethral needle ablation (TUNA).

Depending on the severity of your symptoms and condition, your urologist will recommend the best type of treatment for you.

Make sure to contact our team of medical experts via our free medical consultation services for any additional questions regarding your treatments or condition.