Category Archives: Treatments

Retrograde Intra-Renal Surgery (RIRS)

Retrograde Intra-Renal Surgery (RIRS) involves removal of small to moderate sized renal stone using a highly advance and miniaturised instrument  flexible ureteroscope. This instrument which has got only half the size of your little finger can reach to all the nuke and corners of your kidney. All these can be achieved thorough native urinary tract without making any holes on your body.

RIRS

After this procedure patient could leave hospital the very next day and resume his daily routine .  The advantages of this modality compared to traditional ones are that no damage to kidney tissue , least risk of complication as well as maximum stone clearance rate.

Urethroplasty

Urethroplasty

What is Urethral Surgery – Urethroplasty?

Urethroplasty is a surgery where the urethra is reconstructed to cure problems like urethral strictures. The types of surgeries are varied and depend upon the location, cause and length of the stricture. Most surgeries take between 3–6 hours to complete. An incision is made over the area of the stricture in the penis, scrotum or perineum (the area between the scrotum and the anus). After surgery, a urethral catheter is left in for 2–4 weeks depending upon the type of surgery that was performed. When patients return to clinic the bladder is filled with x-ray contrast and the catheter is gently removed. While x-rays are being taken, the patient voids and the area of the surgery is evaluated. If the area of surgery is healed, then the catheter is left out and patients begin to void normally.

How long will recovery take?

Recovery time depends a lot on the type of surgery that was performed. Typical patients will be in the hospital overnight after surgery. As soon as they can eat, walk and care for their catheter they can leave the hospital. It is important to limit activities after urethroplasty until adequate healing has occurred. This means no heavy lifting, strenuous exercise or work for at least 2 weeks. Generally, it is best if patients do not work while the catheter is in place, however, patients can start doing work that is not physical after 10-14 days. The catheter can be worn draining to a smaller bag that straps to the lower leg under a pair of pants. Wearing a catheter like this is unobtrusive and very manageable.

What is the follow-up after surgery?

The follow-up after urethroplasty is very important; this is because most urethral strictures recur within the first year or two after surgery. Patients are seen every 3–6 months in their first year after surgery. At the first appointment patients undergo cystoscopy of the urethra in the office and the urinary flow rate and residual urine is measured in our office. Cytoscopy is a scope exam of the urethra where a small scope is placed into the urethra from the penis, very similar to catheterization and the area of the surgery is examined for recurrent strictures. Follow up schedule is individualized depending upon the findings of these exams.

What happens when strictures come back after surgery?

When strictures come back after surgery they often are thin and web-like. These strictures can cause a lot of obstruction but often can be treated internally by cutting the stricture with a scope procedure. This is dissimilar to the initial stricture that often has too much scarring to respond long-term to an internal cutting procedure. Some strictures are too dense and do not respond to internal cutting and further surgery is indicated.

What is the success after urethroplasty?

Different surgeries have different success rates. Generally, strictures can be resolved in 75–85% of cases. If strictures come back, only about one half cause symptoms. In other words if a stricture comes back, it has to be very tight to cause blockage of urinary flow, just like the original stricture. If patients have symptoms, then an internal cutting surgery with a scope is usually tried (direct vision internal urethrotomy). If this doesn’t work, then patients may need additional surgery, which is a rare circumstance.

HoLEP

HoLEP (Holmium Laser Enucleation of Prostate) involves enucleation of prostate rather than resection to achieve a near total removal of prostate gland. The procedure can be compared to peeling off orange from its capsule.

holep

This procedure achieves  maximum prostate gland removal through endoscopic route with least complications .

Advantages of this procedure compared to traditional TURP

  • Least incidence of bleeding and blood loss (use of aspirin not a contraindication)
  • No risk of TURP syndrome
  • Maximum gland removal
  • Least reccurence risk
  • Better Urinary flow
  • Less hospital stay
  • Cardiac  safety

Radical Cystectomy with an Orthotopic Neobladder

WHAT DOES YOUR URINARY SYSTEM LOOK LIKE?

The human urinary system normally has two kidneys, two ureters, one bladder and one urethra. The kidneys are urinsys1bean shaped organs that filter your blood and remove water and waste through the urine. Connected to each kidney are narrow tubes called ureters. Ureters carry urine to the bladder. The bladder is the storage area for the urine until you are ready to urinate. The urine leaves the bladder through a narrow tube called the urethra. The female urethra passes through the vagina. The male urethra passes through the prostate gland and penis.

What happens to your urinary system when you have a Radical Cystectomy with an Orthotopic Neobladder?

A cystectomy is an operation to remove the bladder. In men, the bladder, prostate, seminal vesicles and lymph nodes are removed. In women, the bladder, urethra, part of the vagina and lymph nodes are removed. In addition, the uterus, fallopian tubes and ovaries may be removed.

urinsys2

After the bladder has been surgically removed, your doctor will create a new urinary resorvoir in place of the old bladder. Orthotopic means “in the same place”. Neobladder means “new bladder”. Your doctor will make a new bladder in the same place from a piece of the small intestine called an ileum. Once the piece is removed from your small intestine, it is reconnected.

The piece of the intestine that is removed to make the bladder is sewn together to form a pouch. The bottom portion of the pouch is connected to the urethra. This new pathway is made to act like your normal urinary system. Temporary tubes are used to drain your newly created bladder to help the healing process. They are ureteral stents, a suprapubic catheter and a urethral catheter. These drains will be described in more detail.

Since the neobladder has been created out of a piece of bowel, it will produce mucus. Mucus is a thick substance made by the lining of your intestine. This mucus can clog the tubes and build up on the lining of the neobladder, so you will learn to irrigate your catheter.

Your nurse will teach you how to irrigate your catheter. This will begin during your hospital stay and continue after discharge through your follow-up appointment. The catheter needs to be irrigated every six hours. Your doctor will tell you when you may stop.

The”new bladder” made out of small intestine may not work as well as a normal bladder, and may leak urine. This can happen especially at night. If the catheter does not drain well on its own, your doctor may have you use a catheter for a longer period of time. Your doctor will be following you closely to see how your new bladder is working and to answer any of your questions.

What Should You Do Before Surgery?

To be safe, talk with your doctor, surgeon and nurse about all herbals and remedies you use. Tell them how often and how much you take when you have your exam before surgery.

Studies are being done to learn more about how herbs and other remedies affect bleeding and anesthesia. Much is not known. Some herbs may change or lengthen the effects of medicines used with anesthesia. Others may affect bleeding or clotting. Some can change blood pressure or interact with medicines used during surgery. In some cases the effects may be slight but still important for the anesthesiologist and doctor to know about.

In many cases it is best to stop taking herbal remedies at least 2 to 3 weeks before surgery. Anesthesiologists here at OSUMC support this advice. The anesthesiologist is the doctor who balances the medicines that keep you safely in a very deep sleep for surgery. If it happens that you do not have enough time to stop taking herbs or remedies in advance of your surgery, bring them with you to show the doctor. Bring the products in their original bottle or container. This way the anesthesiologist can read what they contain and see how much you take.

Talking openly with the doctor about all herbal remedies and health practices before you have surgery is very important. This helps keep you safe.

bladder cancer websites

CANCER-RELATED RESOURCES

Bladder Cancer Advocacy Network

www.bcan.org

American Bladder Cancer Society

www.bladdercancersupport.org

Bladder Cancer WebCafe

www.blcwebcafe.org

National Comprehensive Cancer Center Network

www.nccn.org

Arthur G James Cancer Hospital and Richard J Solove Research Institute

www.cancer.osu.edu (The James)

American Cancer Society (ACS)

www.cancer.org

OSTOMY RESOURCES

United Ostomy Associations of America Inc (UOAA)

www.uoaa.org

The Phoenix Magazine

http://www.phoenixuoaa.org/