Urology surgeries are surgical methods used to solve problems arising in the urinary tract and reproductive organs. These surgeries are usually performed after evaluating the patient’s medical history and health condition. Problems such as urinary tract infections, stones, cancers, prostate diseases, reproductive system and sexual health problems, and urinary incontinence may require urology surgeries. Various operations are performed in the field of prostate surgeries, stone treatments, cancer surgeries, infertility interventions and pediatric urology. In this article, the types of some urology surgeries and the situations in which they are performed will be examined more closely.
Prostate Surgeries: Open Prostatectomy, Endoscopic Prostate Surgery (TUR)
Stone Surgeries: Kidney Stone Surgeries, Bladder Stone Surgeries, Ureter Stone Surgeries
Cancer Surgeries: Radical Cystectomy in Bladder Cancer, Radical Prostatectomy in Prostate Cancer, Bladder Tumor Surgery with Endoscopic Method in Bladder Cancer, Testicular Tumor Surgeries, Kidney Tumor Surgeries
Infertility (Having Children): Varicocele Surgery
Pediatric Urology: Urinary Reflux (VUR) Surgeries, Undescended Testicular Surgery, Circumcision
Kidney Surgeries: Nephrectomy Surgeries (Kidney Removal), Kidney Cyst Surgeries, Kidney Outflow Stenosis Surgeries
These surgeries target a range of conditions, from urinary tract infections to stone disease, from cancer to reproductive health. While prostate surgeries are performed to solve problems in the prostate gland, stone surgeries aim to remove stones in the kidney, ureter or bladder. While cancer surgeries are used in the treatment of various types of cancer, infertility surgeries offer solutions to the problems of having children. Pediatric urology is applied to special conditions seen in children. These surgeries aim to improve the quality of life of patients and prolong life with the techniques provided by modern medicine.
Prostate Surgeries
Prostate surgeries are surgical procedures performed to solve problems related to the prostate gland in men. Open prostatectomy and endoscopic prostate surgery (TUR) are among the methods used in the treatment of benign prostatic hyperplasia.
Open prostatectomy is a traditional surgical approach. In this surgery, the doctor removes the part of the prostate gland that has grown and blocked the urinary tract. It may be preferred in benign prostate enlargements if the prostate weight is over 80-100 grams. This method is usually performed under general anesthesia and is completed in approximately 60 minutes. The patient’s hospital stay is usually 2 days, and the recovery period may be slightly longer.
Endoscopic prostate surgery (TUR) is a less invasive option and is also a method used in benign prostate enlargements. In this procedure, an endoscope (camera) is used to enter the urinary tract and prostate tissue is removed. Since TUR is performed through the urinary tract, it generally offers a faster recovery process. It can be done with standard methods or with methods such as Holmium or Thulium laser. It is especially preferred in cases where urine flow becomes difficult due to the enlargement of the prostate.
Both methods are chosen depending on the doctor’s evaluation and the patient’s condition. Which method will be used is determined by taking into account the type and size of the prostate problem and the general health condition of the patient.
Stone Surgeries
Stone surgeries are surgical methods used in the treatment of stone formations that are frequently encountered in urology. Kidney stone surgeries are performed by different methods depending on the size and location of the stones formed in the kidney. The open method is now rarely used in the treatment of kidney stones and stones can be treated with endoscopic (closed) methods. Large kidney stones can be removed with a camera inserted through a small hole opened in the back (Percutaneous Nephrolithotomy), while smaller stones can be broken through the urinary tract and broken by endoscopic methods, allowing the patient to excrete them with urine (Retrograde Intrarenal Surgery (RIRS)).
The ureter is a thin tube-shaped structure that lies between the kidney and the bladder and whose average size in adults can vary between 25-28 cm. Today, all ureteral stone surgeries can be performed by a closed method by entering through the urinary tract with the help of a thin device called Ureterorenoscopy (URS). The stones are broken by laser and excreted through the urinary tract. After the surgery, a stent is usually placed and removed after an average of 4 weeks, depending on the course of the surgery and the surgeon’s preference.
Bladder stone surgeries aim to remove stones formed in the urinary bladder. These surgeries are usually performed using endoscopic methods. Using endoscopic instruments, the bladder is reached and the stones are broken up and removed.
These surgeries require specialized approaches depending on the size and location of the stones and the health status of the patient. As a result of the evaluations made by expert urologists, the most appropriate treatment option is determined and the aim is to restore the patient’s health.
Cancer Surgeries
Cancer Surgeries involve the surgical treatment of various types of cancer in the field of urology.
In this case, it is important whether the cancer is superficial or has reached the deep muscle layer of the bladder. In the presence of bladder cancer, the first thing to do is to understand the pathology by performing endoscopic TUR surgery. If it is superficial and not widespread, it can be followed endoscopically. However, if it is very widespread or has progressed to the muscle layer, an operation called radical cystectomy can be performed. This surgery involves completely removing the bladder and also cleaning the regional lymph nodes. Afterwards, a new bladder is made from the small intestines and either placed around the navel or, in suitable patients, can be connected to the old urinary tract.
The surgery for prostate cancer is radical prostatectomy. In this procedure, the prostate gland and surrounding male glands are removed. Surgery can be performed by closed methods such as open, laparoscopic or robotic methods. Although the methods are different, the purpose and procedure are the same and there is no difference between the methods in terms of cancer control.
Kidney tumors are also among the common tumors in the field of urology. Nowadays, most kidney tumors are detected incidentally during methods such as ultrasonography or Computed Tomography or MRI performed for a different reason. It is less frequently detected in patients presenting with complaints such as severe flank pain and bleeding in the urine. Treatment of kidney tumors is surgery. Elderly patients with very small tumors, comorbidities, and risk of anesthesia can sometimes be followed or different treatments can be applied. Depending on the location and size of the tumor, either the entire kidney is removed (Radical Nephrectomy) or only the tumor tissue is removed (Partial Nephrectomy).
Testicular tumors are a tumor that especially affects young men and manifests itself as a growing mass in the testicle. After appropriate evaluations, the testicles of patients with suspected tumor are removed (orchiectomy) and sent for pathological examination. Sometimes testicular tumors can spread (metastasize) to the lymph nodes in the abdomen, and if they do not regress after chemotherapy treatment, surgical removal may be necessary. This surgery should be performed by urologists with high surgical experience. .
Infertility (Having Children)
Varicocele surgery, which is a promising solution for couples facing infertility problems, is a common intervention in the field of urology. This surgery is used in the treatment of enlarged veins called varicocele seen in men. Varicoceles are enlargements of the veins around the testicles and can negatively affect sperm production. During the surgery, these enlarged vessels are ligated and the aim is to improve sperm quality. In this way, couples’ chances of having children increase. Varicocele surgery is usually performed using microsurgery methods, which means a less invasive intervention. This surgery can be an important option for men who have infertility problems.
Pediatric Urology
Pediatric urology deals with special urological conditions seen in children. Urinary reflux (VUR) surgeries have an important place among the urological surgeries performed in this field. Urinary reflux refers to the backflow of urine from the bladder to the kidneys and can cause urinary tract infections in children and result in kidney failure in the future. These surgeries aim to correct problems in the urinary tract.
Another pediatric urology surgery is undescended testicle surgery. In this case, one or both testicles are found not to have descended where they should normally be. Surgery allows the testicles to be placed in the correct position, because the incidence of testicular cancer increases in patients with undescended testicles in later ages, and if descent is delayed, it may cause permanent damage to the testicle and lead to reproductive health problems in the future. Therefore, early diagnosis and treatment is important.
Circumcision is also a common surgery performed in the field of pediatric urology. In this procedure, the foreskin of the penis is surgically removed. It is known that circumcision has various cultural and religious reasons, as well as being recommended for hygiene and health reasons.
Kidney Surgeries
Kidney Surgeries have an important place in the field of urology and are used in the treatment of various conditions. Simple nephrectomy surgery, other than surgeries performed for kidney cancer, is the process of completely or partially removing the kidney. This surgery can generally be performed in cases where the kidney loses its function and becomes inoperable due to various reasons such as stones, reflux, renal outflow stenosis. Additionally, nephrectomy may sometimes be necessary in cases of trauma.
Kidney cysts are fluid-filled sacs and are often benign. While a follow-up protocol is usually sufficient, sometimes they can grow too large and put pressure on the kidney, causing pain. In this case, surgery to remove the cyst can be performed laparoscopically. Sometimes kidney cysts can be seen as a variant of a kidney tumor, and in cases where there is a serious suspicion of cancer, they need to be removed surgically.
Renal outlet stenosis is a condition that can cause swelling in the kidney and therefore pain and loss of function over time. When such a situation is detected, this stenosis must be corrected.
Source:
https://www.klinikhaus.com/en/branch/urology
https://www.mayoclinic.org/departments-centers/urology/sections/tests-procedures/orc-20336022
Prof. Dr. Gökhan Koç graduated from Gazi University Faculty of Medicine in 2000. After his graduation, he worked as a research assistant in the urology clinic at Tepecik Training and Research Hospital for 5 years and became a specialist doctor in 2007. He currently provides services in urological surgery in İzmir.