Surgical Specialties

Urologic Surgery

Urologists diagnose and treat problems of the urinary system – kidneys, bladder, ureter and urethra – and the male genital system. Among the most common problems treated by urologists are infections, tumors, urinary stones, infertility, impotence, incontinence and prostate problems, including prostate cancer.

Common urologic surgeries include prostate surgery for cancer or prostate enlargement, and bladder surgery to remove tumors.

Urologists treat Kidney and ureteral stones as well as kidney cancer. They also assist women living with stress urinary incontinence.

Urologists diagnose and treat problems of the urinary system – kidneys, bladder, ureter and urethra – and the male genital system. Among the most common problems treated by urologists are infections, tumors, urinary stones, infertility, impotence, incontinence and prostate problems.

Prostate cancer, the most prevalent cancer in men, is the second most common cause of death in men due to cancer. PSA (prostate-specific antigen) testing performed in conjunction with a digital rectal exam can identify many early cases of prostate cancer, thus improving cure rates. PSA levels should be determined in men over age 50. Testing should begin at age 40 for men with a family history of prostate cancer.

The urologist may perform an ultrasound study to identify prostate abnormalities. If an exam suggests cancer, and a biopsy confirms it, treatment combining surgery and/or radiation may be recommended.

Prostate surgery is done either by passing a cystoscope – a tubelike telescope used for examining or repairing the interior of the bladder and ureters – through the urethra, or with an open approach when removal of the gland is necessary.

Prostate enlargement often causes annoying symptoms. Medications are available to treat enlarged prostates, and a procedure called laser prostatectomy is used to vaporize the part of the gland that squeezes the urethra. Because laser surgery causes less bleeding, fewer complications, and shorter hospital stays, it is the preferred surgical treatment.

Superficial bladder tumors are removed with a cystoscope. If a tumor is invasive, removal of a portion of the bladder may be necessary. These procedures are often combined with radiation therapy and/or chemotherapy. The use of BCG – a chemical that is injected into the bladder – reduces the recurrence of tumors.

Kidney and ureteral stones were once usually treated by open surgery. But nephroscopy now lets the urologist examine the kidney through a scope inserted in an incision near the hip, and if necessary, remove or shatter the stone. Many patients with kidney stones are treated with shock wave lithotripsy, a procedure in which shock waves crumble the obstruction into sand-like particles that pass easily out of the urinary tract.

Stones in the ureter are also treated with shock waves or by laser. A small laser fiber is threaded up the ureter and placed in contact with a stone, which is then fragmented so it may pass out of the body.

Kidney cancer treatment modalities include a combination of surgery to remove tumors and immunotherapy for treating metastases – resulting in improved patient survival rates.

Pediatric urologic surgery includes techniques for correcting hypospadias, a congenital abnormality of the penis. In many circumstances surgery can be performed on an outpatient basis. Recurring urinary tract infections in children due to a condition known as reflux are also corrected with surgery.

For women with stress urinary incontinence, a natural protein is implanted into the urethra wall, adding bulk to the tissues surrounding the urethra so that it can close tightly enough to prevent urine leakage. The procedure is done on an outpatient basis and does not require general anesthesia.