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Urology

Cutaway view of the human urinary tractCommon urology services like cystoscopy, vasectomy and urinary incontinence procedures can be done in the physicians office and allows the patient to get further details directly from their physician. While other urology procedures, like the ones listed in detail below, must be performed in a hospital setting like Fort Sanders Regional Medical Center.

Urology is a branch of medicine specific to the diseases and conditions of the male and female urinary tract system and the male reproductive organs. The doctor that treats these conditions is called a urologist.

The urinary tract organs in this branch of study include the bladder,kidneys, sphincter, ureters, and urethra. The male reproductive organs include the epididymis, penis, prostrate, seminal vesicles, testes, and vas deferens.

Management of kidney stones

In most cases, treatment means letting a kidney stone pass naturally. Your health care provider may give you medication for pain relief, and then add fluids until the ureter builds up enough pressure to push the stone out. If the stone hasn’t passed in 8 to 12 hours, an urologist may be called in to push the stone back to the kidney so it can be broken up.

For stones that don’t pass on their own, alternative treatments are used:

Extracorporeal shock wave lithotripsy (ESWL)

This treatment directs shock waves through the skin and body tissue toward the stone. The shock waves break the stone into small fragments that can pass from the body in the urine.

Percutaneous stone removal

This treatment is used or stones too large or unable to be reached with ESWL. A surgeon makes a small incision in the person’s back and creates a tunnel to the kidney. The stone is then removed through a nephroscope. If the stone is very large, the surgeon can insert an energy probe to break it into smaller pieces and remove the fragments.

Ureteroscopic stone removal

The surgeon inserts a fiber optic instrument into the urethra and the bladder and then runs it into the ureter. After the stone is located, it’s removed with a cage-like basket device or shattered with laser beams or shock waves. Often, a stent is placed in the ureter to keep the tube dilated and ease passing of the fragments.

Robotic Procedures for Prostate, Kidney, and Bladder

Radical prostatectomy is surgery to remove your prostate gland. This is the gland below the male bladder that helps produce semen. Two ways your prostate can be removed are: Robotic prostatectomy – involves making several smaller cuts and removing the prostate using a tiny camera and surgical tools. This is called a laparoscopic prostatectomy. One way for a surgeon to do laparoscopic surgery is with the help of a robot.
Open procedure – The surgeon makes a fairly large incision (cut) into your lower abdomen to reach your prostate.

Radical prostatectomy is typically used to treat prostate cancer. The robotic system can help your surgeon in several ways. The camera magnifies the area, helping the surgeon see tiny structures more easily. The robotic system can make steady, precise movements in small places where the surgeon may have trouble reaching otherwise.

Compared with an open procedure, robotic surgery may have benefits including:

  • Less bleeding
  • Faster recovery
  • Shorter hospital stay
  • Fewer problems with bowel and bladder function 
  • Laparoscopic Surgery – Kidney/Bladder

Laparoscopic kidney and bladder surgery is performed by a surgeon in a hospital. The surgeon will begin by making several small incisions in your abdomen and side. Then, the surgeon inserts a laparoscope, a tool with a camera and light on it that lets him or her see your kidneys. Other long, thin surgical instruments are then used through the other incisions. You may have less pain, less scarring, and a faster recovery with this type of surgery than with open surgery.

Circumcision (adults)

Circumcision is a surgical procedure to remove the skin covering the end of the penis, called the foreskin. In many cultures, circumcision is a religious rite or a ceremonial tradition. It is most common in Jewish and Islamic faiths. In the United States, newborn circumcision is an elective procedure. It is usually done on the first or second day after the baby’s birth; however, can be done on older children and adults, but is more complicated because it requires general anesthesia.

Varicoceles/Hydroceles

Varicoceles are veins that have expanded, or dilated, because of swelling. The condition is much like varicose veins that occur in the legs of some adult women and men. Swelling occurs when veins inside the spermatic cord aren’t working properly. The spermatic cord is a structure that contains vessels and other tissues joining each testicle to the body. Veins in the cord normally take blood back to the heart and tiny valves inside the veins keep the blood flowing in the right direction. Valves that don’t fully close allow the blood to flow sluggishly or pool inside the veins, much like water in a dam. This buildup of blood causes the swelling.

Varicoceles most often occur in the left testicle. This could be because the sharp angle at which blood from the scrotum enters the kidney veins can cause pressure to build up in the scrotum.

A hydrocele occurs from a build up of fluid in the thin pouch that holds the testes within the scrotum called the tunica vaginalis. 

In the fetus, the tunica vaginalis is formed in the abdomen and then moves into the scrotum with the testes. After the pouch is in the testes, it seals off from the abdomen. Hydroceles can be communicating or non-communicating:Communicating hydrocele. A communicating hydrocele occurs from the incomplete closure of the tunica vaginalis, so that a small amount of abdominal fluid may flow in and out of the thin pouch. It is distinctive because the fluid fluctuates throughout the day and night, altering the size of the mass.

Non-communicating hydrocele. A non-communicating hydrocele may be present at birth and usually resolves on its own spontaneously within one year. A non-communicating hydrocele in an older child may indicate other problems, such as infection, torsion (twisting of the testes), or a tumor.

A hydrocele is present in as many as 10% of all full-term male live births; however, in most cases, it disappears without treatment within the first year.

Botox

Botox has been used to treat a leaky bladder. Botox helps urinary incontinence by relaxing the bladder, thus allowing it to store more urine. This treatment involves an injection of Botox into the bladder during cystoscopy. It sometimes requires general anesthesia.