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Urology – Urological Consultation
Urology is a surgical specialty, which deals with the diagnosis and treatment of disorders affecting the male and female urinary system, as well as the male reproductive system. Due to the various clinical aspects encountered in the urological practice, specialists in this field require, in addition to surgical expertise, a thorough understanding of other medical branches, such as internal medicine, gynaecology, paediatrics, or neurology.
There are multiple reasons to consult a urology specialist. These may include urinary bladder infections, urinary incontinence, erectile dysfunction, renal lithiasis, male infertility, or a tumour pathology of the uro-genital system.
During the urologic consultation, a specialist in this field will listen to your medical history and the history of the disorder that prompted you to seek our assistance. If you have records of prior imaging investigations, such as X-rays or CTs, or laboratory tests please bring them with you for the consultation. These will be reviewed by your urologist, sometimes together with a specialist in radiology or medical imaging.
After establishing your medical history, a general clinical examination and an examination focused on the urinary system will be carried out. It may be necessary to add laboratory tests, blood and urine samples, or ultrasound investigations.
Ultrasound investigation during the urologic consultation
In current medical practice, ultrasound (US) has been used for over 50 years and has become one of the most widely used methods for diagnosis in modern medicine. It uses high frequency sound waves to produce images of the structures of internal organs. It is a safe method, as it does not use ionising radiation, and it can also be used for diagnosing disorders in pregnant women or children.
In terms of technology costs, it is an inexpensive, portable, and repeatable method as compared to other imaging techniques, such as computed tomography or magnetic resonance.
It is a painless investigation, with the exception of cases of acute disorders (for example, kidney stone with ureteral migration, bladder globe), when mild discomfort or slight pain may be experienced when the transducer is pressed against certain areas.
The examination is performed by “passing” a probe over the area under investigation. The probe produces the ultrasound waves that bounce off different tissues in the body, which are sent to a computer generating images. Before starting the procedure, the doctor will apply a gel on the area that will be examined. The gel facilitates the contact between the transducer and the skin or mucosae. In most cases, the patient must lie down on a flat surface (a bed) while the procedure is being performed.
Patient’s preparation for a transabdominal ultrasound examination
In is important that the bladder is full during the examination, therefore it is recommended to drink liquids (500 – 750 ml of non-carbonated water) approximately 1-1 ½ hours before the examination, and the patient must refrain from urinating for 1 ½ – 2 hours before the ultrasound is performed.
In urology practice, sometimes special ultrasounds may be performed – testicular ultrasound, a quick and simple investigation which does not require special preparation, or endorectal ultrasound.
Robotic surgery
With a 9-year experience in urologic robotic surgery, the team of EndoPlus Clinic has performed robot-assisted surgery at the Saint Constantine Hospital in Brasov from March 2017.
The main beneficiaries of surgeries performed with the DaVinci surgical robot are patients diagnosed with localised prostate cancer; the surgical robot provides remarkable facilities for the extirpation of prostate cancer in conditions of oncological safety, and also for the preservation of the urinary sphincter and neurovascular bundles responsible for urinary continence and sexual function.
Another category is formed by patients with renal cancer, who may benefit from the extirpation of the renal tumour in conditions of oncological safety, while sparing the rest of the healthy kidney. For bulky renal tumours, when the full extirpation of the kidney is required, this can be done with minimal blood loss and quick recovery of the patient to a good biological condition. The removal of the bladder in cases of infiltrating bladder cancers is another indication for the use of robotic surgery, and the procedure can be performed with minimal blood loss in conditions of maximum oncological safety, while also giving the chance to make a new urinary bladder for the patient by using a segment of the small intestine, all with just a few small incisions in the skin, with minimal postoperative pain, and quick recovery of the patient.
The clinic team also has experience in performing retroperitoneal lymphadenectomies for testicular cancer, in the surgery of adrenal glands, in correcting malformations of the urinary tract (robotic pyeloplasty for congenital or acquired hydronephrosis, robotic ureteroneocystostomy for vesicoureteral reflux, retrocaval ureter, etc.) or in the correction of vesicovaginal fistulae which are so disabling for patients undergoing surgery or irradiation for gynaecological disorders.
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Minimally invasive surgery – “Keyhole surgery 5-12 mm”
Minimally invasive surgery is the surgery of the 21th century and the future, and it refers to interventions with minimal impact on the tegument, which are easily tolerated by the patient. This concept includes endoscopic surgery (performed by using the natural orifices, such urethra) and laparoscopic surgery (performed by making small 1-2 cm incisions which become almost invisible after complete healing).
The major benefits of this approach consist in the quick recovery, shorter hospitalisation, and reduced postoperative discomfort. Patients can recover their mobility early, and postoperative complications are reduced. Integration into society is significantly faster and more efficient after surgical procedures performed by applying the minimally invasive approach. The patient’s general condition becomes better in a much shorter time, postoperative pain is decreased, and the use of painkillers is reduced.
Also, the efficacy of these procedures is at least equal to that of traditional surgery. The cure rate of pathologies remains the same.
The operating unit of EndoPlus Clinic is equipped mainly with devices and instruments designed for minimally invasive surgery:
– equipment for 3D HD laparoscopy (Einstein – Aesculap system) used mainly in urological oncologic pathologies (partial or radical nephrectomy, nephroureterectomy with perimeatic cystectomy, radical cystectomy, radical prostatectomy, adrenalectomy), but also in malformative urological pathologies (hydronephrosis, reflux, etc.)
– Flexible equipment for LASER Holmium intrarenal surgery for kidney stones and urothelial tumours
– Plasma vaporisation for benign prostatic hyperplasia
– Endoscopic resections for bladder tumours
– Endoscopic interventions for urethral strictures