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Endourology

Transurethral Resection of the Prostate (TURP)

A transurethral resection of the prostate (TURP) is a surgical procedure that removes portions of the prostate gland through the penis. A TURP requires no external incision.

This procedure is mainly done for BPH patient with LUTS and may be done occasionally for patients with prostate cancer as well. The aim is to remove part of the prostate gland from inside creating a good channel to pass urine. The instrument called resectoscope is introduced through the penis and the prostate is resected using a monopolar current loop (TURP) or by a bipolar resection kit (TURIS). After the procedure a catheter is inserted which stays for a day or two before removed. Most of the patients complain of some urgency, frequency and mild pain which settles quickly. The improvement in the urinary flow is usually excellent

Transurethral Resection Of Bladder Tumor (TURBT)

Similar to TURP, this procedure is done through an instrument inserted through the urinary passage and the tumour inside the bladder is resected. Commonly done for suspected or proven bladder cancers, it is rarely done for patients with lesions in the bladder for the sake of achieving a diagnosis. The removed tissues are sent for the histological diagnosis. After the procedure, in some patients, catheter is inserted which remains inside for a short while. This is subsequently removed. In some patients a chemical ( chemotherapeutic drug or BCG) might be instilled inside the bladder.

Cystoscopy

A cystoscopy is an examination of the inside of the bladder and urethra, the tube that carries urine from the bladder to the outside of the body. In men, the urethra is the tube that runs through the penis. The doctor performing the examination uses a cystoscope-a long, thin instrument with an eyepiece on the external end and a tiny lens and a light on the end that is inserted into the bladder. The doctor inserts the cystoscope into the patient's urethra, and the small lens magnifies the inner lining of the urethra and bladder, allowing the doctor to see inside the hollow bladder. Many cystoscopies have extra channels within the sheath to insert other small instruments that can be used to treat or diagnose urinary problems.

Urologist may perform a cystoscopy to find the cause of many urinary conditions, including

  • Frequent urinary tract infections
  • Blood in the urine, which is called hematuria
  • Frequent and urgent need to urinate
  • Unusual cells found in a urine sample
  • Painful urination, chronic pelvic pain, or interstitial cystitis/painful bladder syndrome
  • To assess urinary blockage caused by prostate enlargement or some other abnormal narrowing of the urinary tract
  • Suspected growth, polyp, tumour, or cancer in the urinary tract

URS

Ureteroscopy (URS) involves the use of small telescopes that are inserted through the bladder and into the opening of the ureter. The telescope allows visualization of stones in the ureter and/or kidney. Depending on the size of the stone and the diameter of the ureter, the stone may be fragmented and/or removed. The most common method of fragmentation is performed using a laser. The laser is passed through a tiny channel in the telescope and used to fragment the stone into smaller pieces. One benefit of this treatment is the ability to directly visualize the fragmentation process. Moreover, stone fragments can be collected for analysis by passing a stone basket through the telescope and capturing the fragments for removal.

The holmium laser is considered the safest, most effective of all ureteroscopic lithotripsy devices for breaking up stones. It has several advantages. It can transmit its energy through a flexible fibre, which allows its use in both the ureter and the kidney. It is much less likely to cause damage when used within the ureter, and it has the ability to fragment all stones regardless of their composition. The holmium laser also produces significantly smaller fragments compared with other ureteroscopic devices.

Passage of the ureteroscope may result in swelling of the ureter. Therefore, it may be necessary to temporarily leave a small tube inside the ureter called a stent. The stent travels from the kidney, down the ureter and into the bladder. The stent may also assist in the passage of any residual stone fragments. It is not uncommon for some patients to experience some discomfort from the stent. As with ESWL, a minor amount of blood is expected in the urine while the stent is in place. URS is usually performed as an outpatient procedure, requiring use of anesthesia.

URS can be used safely in pregnancy and may be the favored approach in patients with bleeding disorders, on blood thinners or who are morbidly obese. In addition, patients with stones in an abnormally formed kidney may be treated best with URS.

URS is considered safe and effective, but, as with any procedure, risks exist. They include perforation of the ureter and formation of scar tissue that narrows the diameter of the ureter. These adverse events are encountered more frequently when a stone is found lodged or embedded in the wall of the ureter. If perforation occurs, an attempt will be made to place a temporary stent within the ureter to allow the area to heal. In the event that a stent cannot be safely placed, a small tube may need to be placed into the kidney to direct urine away from the damaged area. Fortunately, scar tissue formation in the ureter is rare, occurring in less than 1% of cases. However, when it happens, obstruction to the flow of urine may result. Obstruction can cause pain and may damage the kidney if allowed to persist. Additional intervention is often necessary to treat the narrowed area.

The reasons for a ureteroscopy include the following conditions:

  • Frank hematuria
  • Abnormal cells found in a urine
  • urinary blockage caused by an abnormal narrowing of the ureter
  • stone in the ureter
  • growth, polyp, tumor, or cancer in the ureter