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Urology


Overview


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Definition

Urologic surgery is the integration of surgical activities for the pelvis the colon, urogenital, and gynecological organs primarily for the treatment of obstructions, dysfunction, malignancies, and inflammatory diseases.


Common urologic operations include : -

  • renal (kidney) surgery
  • kidney removal (nephrectomy)
  • surgery of the ureters, including ureterolithotomy or removal of calculus (stones) in the ureters
  • bladder surgery
  • pelvic lymph node dissection
  • prostatic surgery, removal of the prostate
  • testicular (scrotal) surgery
  • urethra surgery
  • surgery to the penis

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Purpose

Conditions that commonly dictate a need for urologic surgery include neurogenic sources like spinal cord injury; injuries to the pelvic organs; chronic digestive and urinary diseases; as well as prostate infections and inflammations. There are many other common chronic and malignant diseases that can benefit from resection, surgical augmentation, or surgery to clear obstructions. These conditions impact the digestive, renal, and reproductive systems.


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Most organs are susceptible to cancer in the form of tumors and invasion of the surrounding tissue. Urologic malignancies are on the rise. Other conditions that are seen more frequently include kidney stones, diseases and infections; pancreatic diseases; ulcerative colitis; penile dysfunction; and infections of the genitourinary tract.

Urologic surgery has been revolutionized by striking advances in urodynamic diagnostic systems. Changes in these areas have been particularly beneficial for urologic surgery: laparascopy, endoscopic examination for colon cancer, implantation procedures, and imaging techniques. These procedural and imaging advances have brought the field of urology to a highly active and innovative stage, with new surgical options created each year.


Demographics

According to the National Kidney Foundation, kidney and urologic diseases affect at least over 260,000 deaths. As the population ages, these conditions are expected to increase, especially among ethnic minorities who have a disproportionate share of urologic diseases. Major urologic surgery includes radical and partial resections for malignant and benign conditions; and implantation and diversion surgeries.


Cancer

Prostate cancer is the most common cancer affecting males in the world. One in 10 men will have the disease at some time in his life. It is, however, treated successfully with surgery. According to the Urological Foundation, more than 50,000 new cases of bladder cancer are detected each year. bladder cancer is the fourth most common cancer in men and the ninth most common for women.

Kidney cancer occurs in 30,000 patients per year. It is the eighth most common cancer in men and the tenth most common cancer in women. Renal cell carcinoma makes up 85% of all kidney tumors. In adults ages 50-70 years, kidney cancer occurs twice as often in men as women. At the time of diagnosis, metastasis is present in 25-30% of patients with renal cell carcinoma.


Other Conditions

Enlarged prostate (benign prostate hyperplasia, or BPH) is very common, and often treated with surgery. Interstitial cystitis (bladder infection of unknown origin) often affects women with severe pain and incontinence. The condition, like other forms of severe incontinence, requires surgery. Incontinence is an increasingly diagnosed problem among the aging population in the World, and is gaining recognition for its highly debilitating effects both in its fecal and urinary forms. Fecal incontinence affects people of all ages; many cases are never reported. Women are five times more likely than men to have fecal incontinence. This is primarily due to obstetric injury, especially with forceps delivery and anal sphincter laceration.

Many surgical procedures are now available to correct both fecal and urinary incontinence. They include retropubic slings for urinary incontinence, artificial sphincter implants for urinary and fecal incontinence, and bladder and colon diversion surgeries for restoration of voiding and waste function with an outside appliance called an ostomy. Kidney surgery and transplantation account for a large segment of urologic surgery. Benign conditions include sexual dysfunction, kidney stones, and fertility issues.






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