Operative procedures in urology

In urology, surgical procedures include measures that address diseases of the kidneys, ureters, bladder, urethra, as well as the male reproductive organs. Urological surgical procedures are aimed at curing, alleviating, or diagnosing various diseases.

Phimose

Phimosis, a foreskin constriction, occurs not only in childhood but can also affect adults. It usually results from chronic inflammation. Typical symptoms are pain during urination and/or sexual intercourse, accompanied by redness and swelling. The surgical treatment is performed through circumcision, that is, the complete removal of the foreskin under local or general anesthesia.

Benign prostatic hyperplasia

Among the most common benign diseases is so-called benign prostatic hyperplasia (BPH), an age-related, hormonally-induced benign enlargement of the prostate. It causes typical symptoms during urination, such as a weakened urine stream, nocturnal urgency, and the feeling of incomplete bladder emptying. Diagnosis is usually performed through a digital rectal examination, transrectal ultrasound, and urine flow measurement. Surgical procedures are used for treatment, where excess prostate tissue is removed with a wire loop or laser.

Nephrectomy

Nephrectomy, the surgical removal of a kidney, is one of the established standard procedures in urological surgery. It becomes necessary in malignant diseases like kidney cancer, in severe injuries, or non-functional kidneys due to chronic kidney inflammation. Depending on the extent of the procedure, a distinction is made between radical and partial nephrectomy. In a radical nephrectomy, the entire kidney along with surrounding fatty tissue and lymph nodes are removed. In some cases, the adrenal glands are also removed. In a partial nephrectomy, only the diseased part of the kidney is removed, while healthy tissue is preserved.

Cystectomy

Cystectomy, the surgical removal of the bladder, is one of the most complex procedures in urology. It is usually performed in advanced bladder carcinoma, a malignant tumor that has invaded beyond the superficial mucosa into the bladder muscle. In some cases, it may also be required for chronic recurrent bladder infections or radiation damage when other treatment options are exhausted. The development of bladder carcinoma is often linked to risk factors such as smoking, chronic infections, or certain medications. The most common symptoms include visible blood in the urine, frequent urination, pain during urination, or recurrent urinary tract infections. Diagnosis is confirmed, among other things, by cystoscopy and imaging procedures like CT or MRI.

Vasectomy

A vasectomy is a surgical procedure for male sterilization as a permanent method of contraception. During the procedure, the vas deferens, which carry sperm from the testicles to the urethra, are cut and sealed. The goal is to make ejaculation infertile without affecting hormone production, potency, or sexual sensation. The vasectomy is considered one of the safest and most reliable contraceptive methods and is generally regarded as permanent, although, in rare cases, reversal is possible. The procedure is usually performed on an outpatient basis under local anesthesia. Small incisions in the skin or a special "no-scalpel" technique are used to find each vas deferens, which is then cut and either cauterized or closed with clips. Afterwards, the skin is stitched or glued. The entire procedure usually takes about 20 to 30 minutes.

Urinary incontinence

The surgical treatment of urinary incontinence depends on the type of incontinence, the severity of symptoms, and the individual's anatomical conditions. Urinary incontinence is the involuntary loss of urine, especially during physical exertion, coughing, or laughing, and can significantly impair the quality of life.

The most common form is stress incontinence, which usually occurs in women, often due to connective tissue weakness, postnatal changes, or gynecological surgeries such as hysterectomy. It is usually caused by pelvic floor weakness or insufficient support of the urethra. When conservative measures such as pelvic floor training or electrostimulation are no longer effective, surgical procedures are used. The standard today is the implantation of a tension-free vaginal tape. This involves placing a narrow strip of plastic under the mid-urethra through the vagina. It supports the urethra and prevents it from descending under pressure. The operation is minimally invasive, usually takes less than an hour, and has a very high success rate.

In men, typically after prostate surgery, stress incontinence can occur due to a weakened internal sphincter muscle. In such cases, artificial sphincter systems are used. A cuff is placed around the urethra and opened with a button when the patient wishes to urinate, otherwise, it prevents urine flow. For milder forms of incontinence, a so-called male urethral sling offers an alternative. This functions similarly to the tape in women and stabilizes the urethra.