Kidney stones are clusters of crystals that accumulate in the urine. By accumulating there, they can form stones or stones that can reach a size of a few millimeters to several centimeters. Then these stones formed in the kidneys can then move and move down into the ureters and bladder.

Epidemiology

Urinary stones are common and affect around one in ten people in India. However, this frequency varies by country, mainly due to dietary habits.

Types of calculations

There are several types of urinary stones, the most common being calcium oxalate stones and uric acid stones.

How are the calculations manifested?

The best known and most painful manifestation of stones is the attack of renal colic. Thus, this crisis, sometimes extremely painful, is due to the migration of a kidney stone into the ureter. As a result, there is obstruction and tensioning of the ureter by urine under pressure. It is this obstruction and the resulting distention that causes the pain.

Some kidney stones cause no pain. Consequently, they are sometimes discovered fortuitously during radiological or ultrasound examinations carried out for another reason: abdominal ultrasound, scanner, X-ray of the abdomen.

What causes kidney stones?

The  lithiasic disease  responsible for their formation is  favored by insufficient water intake  (less than 1.5 to 2 liters per day),  certain trades or climates exposing them to dehydration.

Diet also plays a role, especially  excess animal protein, salt or, conversely, insufficient calcium intake.

Symptoms of Kidney Stones

Kidney stones do not always cause symptoms or pain in the kidneys. Moreover, many people are carriers without knowing it. On the other hand, when the stone migrates and becomes blocked in the urinary tract, the pain is very sharp.

Other symptoms may also occur:

• The presence of blood in the urine (visible to the naked eye, the urine being red from the beginning to the end of urination, or detected during a Cyto-Bacteriological Examination of Urine ECBU );
• A urinary tract infection responsible for cystitis , pyelonephritis or even sepsis ;
• A discreet or frank, violent lumbar pain , typical of an attack of renal colic, so intense that one does not know what position to take to calm it;
• Very rarely anuria : this exceptional total absence of urine can be observed, in a patient with a single kidney, if the calculation involves a complete obstacle of a ureter or even more rarely in the event of simultaneous migration of calculations in the two ureters.

Fever is an unusual symptom that should lead to urgent consultation.

What are the risk factors?

Kidney stones can be very different in nature. However, there are some risk factors:

• Insufficient hydration: urinary salts increase, which promotes their crystallization;
• A diet too rich in salt and/or protein;
• A diet that is too low in calcium;
• Sedentary lifestyle: calcium is released in too low a quantity due to a decrease in bone quantity linked to a lack of physical activity;
• Taking certain medications.

What exams are performed?

Imaging exams

The imaging examinations most often requested are renal ultrasound, abdominal X-ray without preparation ( ASP ) and uroscanner.

Ultrasound and ASP are often requested in first intention or in emergency or during monitoring after an intervention.

Uroscanner can be performed with or without intravenous injection of contrast product. In fact, it is today the most accurate examination to assess the size, location and impact of a urinary stone.

Biological examinations

The most frequently requested biological tests are:

• The ECBU, cytobacteriological examination of urine, which is used to look for a possible urinary tract infection.
• The study of renal function (creatinine, MDRD or CKD-EPI) in particular before a CT scan with intravenous injection of contrast product.
• Analysis of the calculus or its fragments after spontaneous elimination or surgical removal. Indeed, this analysis is very useful because it makes it possible to know precisely the chemical nature of the stone and to draw practical consequences from it to avoid recurrences.
• The biological assessment, in search of a phospho-calcic anomaly, a hormonal imbalance (parathormone) which can explain the formation of kidney stones.

Kidney stone treatments

Once past the crisis, it remains to eliminate the stone, which occurs spontaneously in more than 60% of cases when the stone is less than or equal to 6 mm.

In other cases, it is necessary to carry out an intervention to destroy or extract the calculation. Finally, some stones can be dissolved (see below).

Medical treatments

Medical treatments include treatments used during renal colic attack, such as anti-inflammatories.

On the other hand, when it comes to uric acid stones, one can use the property that these stones have of being soluble in an alkaline medium. These stones can thus be dissolved by alkalizing the urine. The alkalinization of the urine can be obtained by drinking Vichy water or by taking a medicine based on citric acid. However, this alkalinization acts slowly and it often takes several weeks to completely dissolve a stone. But the result is sometimes surprising, since it is possible to completely dissolve certain uric acid stones of more than one centimeter. Unfortunately, this does not work in 100% of cases.

Surgical treatments

The majority of stones that do not pass on their own can be removed or destroyed using minimally invasive techniques. These include extracorporeal lithotripsy, ureteroscopy (flexible or rigid, with or without the use of a laser) or percutaneous surgery.

Dr. Pawan has at his clinic all the technologies indicated above and in particular:

• An extracorporeal lithotripsy device (a device used to break up stones from outside the body, using shock waves, formerly called a “bathtub”). This machine is permanently present at the Archette clinic, which allows rapid care and treatment of stones.
• A latest generation laser to break certain stones in the ureter or kidney by endoscopic means, called flexible ureteroscopy (flexible camera introduced into the urinary tract).

However, the choice of the technique to use depends on the characteristics of the calculation to be treated and not on the availability or not of one technique or another.

Prevention of kidney stones

In all types of stones, diet measures are the basis of preventive treatments for kidney stones.

The main recommended elements are:

• increasing fluid intake (drinking more water),
• reduced
• consumption of certain foods (salt, foods rich in oxalates, foods rich in calcium).

This prevention is as far as possible adapted according to the type of calculation in question. The analysis of stones or their fragments is therefore desirable, at least during a first episode.

Urinary incontinence is a condition where an individual has involuntary urine leakage. This can be a very embarrassing and uncomfortable problem, and it can significantly affect a person’s quality of life. There are different types of urinary incontinence, and each has its unique causes and symptoms.

Types of Urinary Incontinence:

1. Stress incontinence: This type of incontinence is caused by pressure or stress on the bladder, such as during sneezing, coughing, laughing, or physical activities like running or jumping. It is more common in women and is often caused by weakened pelvic muscles or damage to the urinary sphincter.
2. Urge incontinence: This type of incontinence is characterized by a sudden, intense urge to urinate, followed by involuntary urine leakage. It is often caused by an overactive bladder, which can be a result of nerve damage or muscle problems.
3. Overflow incontinence: This type of incontinence occurs when the bladder doesn’t empty completely, causing urine to leak out unexpectedly. It is often caused by an obstruction or blockage in the urinary tract, such as an enlarged prostate in men or a pelvic organ prolapse in women.
4. Functional incontinence: This type of incontinence is caused by physical or mental limitations that prevent a person from getting to the bathroom in time. It is often seen in elderly or disabled individuals who may have difficulty moving quickly or using the toilet independently.

Causes of Urinary Incontinence:

There are several factors that can contribute to the development of urinary incontinence, including:

1. Weak pelvic muscles due to pregnancy, childbirth, or ageing.
2. Hormonal changes during menopause.
3. Certain medications can cause bladder irritation or relaxation of the bladder muscles.
4. Medical conditions that affect the nervous system, such as Parkinson’s disease or multiple sclerosis.
5. Obesity or a sedentary lifestyle.
6. Certain types of surgery, such as prostate surgery or hysterectomy.

Treatment of Urinary Incontinence:

The treatment of urinary incontinence depends on the type and severity of the condition. Some treatment options may include:

1. Pelvic floor exercises: Also known as Kegel exercises, these exercises help to strengthen the muscles that support the bladder and urethra.
2. Medications: There are several medications that can be used to treat urinary incontinence, such as anticholinergics or beta-3 agonists.
3. Bladder training: This involves scheduling regular bathroom breaks and gradually increasing the time between trips to the bathroom to help improve bladder control.
4. Minimally invasive procedures: Some procedures, such as the injection of bulking agents or placement of a sling, can help to improve bladder control.
5. Surgery: In some cases, surgery may be necessary to correct an underlying condition that is causing urinary incontinence, such as a prolapsed bladder or prostate enlargement.

Conclusion

Urinary incontinence is a common condition that can significantly impact a person’s quality of life. It is important to seek medical attention if you are experiencing any symptoms of urinary incontinence, as there are several treatment options available that can help improve bladder control and reduce the frequency of urine leakage. With proper treatment and management, many people with urinary incontinence can improve their symptoms and regain their quality of life.

Testicular hydrocele is a medical condition characterized by an accumulation of fluid in the sac that surrounds the testicles. It is a relatively common condition, especially in males over the age of 40, and can cause discomfort and swelling in the affected area.

Symptoms

The most common symptoms of testicular hydrocele include swelling in the scrotum, discomfort or pain in the affected area, and a feeling of heaviness or pressure. In some cases, the swelling may be more noticeable after physical activity or standing for extended periods of time. The condition may affect one or both testicles.

Causes

There are several potential causes of testicular hydrocele, including injury or trauma to the scrotum, infections in the scrotal area, or inflammation of the epididymis. In some cases, the condition may be due to an underlying medical condition, such as testicular cancer or cirrhosis of the liver.

Diagnosis

To diagnose testicular hydrocele, a doctor will typically perform a physical examination of the affected area, as well as a medical history review. Additional tests, such as an ultrasound or blood tests, may also be necessary to rule out other potential causes of the swelling and discomfort.

Treatment

In many cases, testicular hydrocele will resolve on its own without medical intervention. However, if the swelling and discomfort are causing significant discomfort or affecting daily activities, treatment options may include medication to reduce inflammation, aspiration to remove the excess fluid, or surgery to repair the underlying issue causing the hydrocele.

Prevention

There are no specific measures that can be taken to prevent testicular hydrocele, but taking steps to maintain good overall health and wellness may help reduce the risk of developing the condition. This includes maintaining a healthy diet and exercise routine, avoiding activities that could lead to injury or trauma in the scrotal area, and seeking prompt medical attention for any scrotal infections or injuries.

Overall, testicular hydrocele is a common condition that can cause discomfort and swelling in the scrotal area. While it may resolve on its own without treatment, medical intervention may be necessary in some cases. By understanding the symptoms, causes, and treatment options for this condition, individuals can take steps to manage their symptoms and reduce the risk of long-term complications.

An enlarged prostate, also known as benign prostatic hyperplasia (BPH), is a common condition that affects many men as they age. It occurs when the prostate gland, which is located just below the bladder, grows in size and presses against the urethra, the tube that carries urine from the bladder out of the body. This can cause a range of uncomfortable symptoms that can impact a man’s quality of life. Here is a detailed look at enlarged prostate, including its causes, symptoms, and treatment options.

Causes of Enlarged Prostate

The exact cause of an enlarged prostate is not fully understood. However, it is believed to be related to changes in hormone levels that occur as men age. Specifically, as men get older, their bodies produce less testosterone, which can lead to an increase in the amount of a hormone called dihydrotestosterone (DHT). DHT is known to stimulate the growth of the prostate gland, which can lead to BPH.

Other factors that may contribute to an enlarged prostate include a family history of the condition, obesity, and certain medical conditions such as diabetes and heart disease.

Symptoms of Enlarged Prostate

The symptoms of an enlarged prostate can vary from person to person, but they typically involve problems with urination. Some common symptoms of BPH include:

• A weak or slow urinary stream
• Difficulty starting urination
• Frequent urination, especially at night (nocturia)
• Urgency to urinate
• Inability to completely empty the bladder
• Dribbling at the end of urination
• Urinary tract infections

In some cases, an enlarged prostate can lead to complications such as bladder stones, urinary tract infections, or even kidney damage.

Treatment Options for Enlarged Prostate

There are several treatment options available for an enlarged prostate, depending on the severity of the symptoms and the patient’s overall health. Some common treatment options include:

• Medications: There are several medications available that can help relieve the symptoms of an enlarged prostate. These include alpha blockers, which help relax the muscles in the prostate and bladder, and 5-alpha reductase inhibitors, which can help reduce the size of the prostate gland.
• Minimally invasive procedures: For men with more severe symptoms, minimally invasive procedures may be recommended. These include transurethral resection of the prostate (TURP), which involves removing portions of the prostate gland that are blocking the urethra, and laser therapy, which uses a high-powered laser to shrink the prostate gland.
• Surgery: In rare cases, surgery may be recommended to remove the entire prostate gland. This is typically only recommended for men with severe symptoms or complications from BPH.

Conclusion

An enlarged prostate can be a frustrating and uncomfortable condition, but there are many treatment options available to help relieve the symptoms. If you are experiencing symptoms of BPH, it is important to speak with a qualified urologist who can help determine the best course of treatment for your individual needs.

Urological reconstructive surgery is a specialized field of surgery that aims to restore function and quality of life for patients with urological conditions. This type of surgery can involve the reconstruction or repair of the urinary tract, genitalia, or other structures in the pelvic region. Here is a detailed breakdown of the different types of urological reconstructive surgery:

1. Urinary tract reconstruction: This type of surgery involves the reconstruction or repair of the urinary tract, which includes the kidneys, ureters, bladder, and urethra. Urinary tract reconstruction can be necessary in cases of bladder cancer, bladder exstrophy, ureteropelvic junction obstruction, or urethral stricture. The goal of urinary tract reconstruction is to restore normal urinary function and prevent complications such as infection, urinary incontinence, or kidney damage.
2. Genitalia reconstruction: Genitalia reconstruction is a type of surgery that is performed to repair or reconstruct the external genitalia. This can include procedures such as hypospadias repair, in which the urethral opening is repositioned, or phalloplasty, which is a surgery to construct a penis. Genitalia reconstruction can be necessary due to congenital abnormalities, injury, or cancer.
3. Pelvic organ prolapse repair: Pelvic organ prolapse is a condition in which the pelvic organs, such as the uterus or bladder, descend into the vaginal canal. Pelvic organ prolapse repair involves surgical procedures to reposition or remove the prolapsed organs, and can be performed using minimally invasive techniques.
4. Penile prosthesis implantation: A penile prosthesis is a medical device that is implanted into the penis to treat erectile dysfunction. The prosthesis can be inflatable or non-inflatable, and is designed to help patients achieve and maintain an erection for sexual intercourse.

Urological reconstructive surgery can be performed using traditional open surgery or minimally invasive techniques, depending on the condition being treated and the patient’s needs. In general, minimally invasive techniques are preferred, as they offer faster recovery times, less pain, and fewer complications compared to traditional open surgery.

If you are experiencing urological problems, it is important to seek out a qualified urological surgeon who specializes in reconstructive surgery. With the right treatment, you can restore function and quality of life and get back to living your life to the fullest.

Kidney cancer is a type of cancer that develops in the kidneys, the bean-shaped organs that filter waste products from the blood and produce urine. The most common type of kidney cancer is renal cell carcinoma, which accounts for about 90% of all kidney cancer cases. Other types of kidney cancer include transitional cell carcinoma, renal sarcoma, and Wilms tumor, which is most commonly found in children. Kidney cancer can be difficult to detect in its early stages because it often does not cause any symptoms, but as the cancer progresses, symptoms such as blood in the urine, pain in the side or back, and weight loss may develop. In this article, we will discuss the various treatments available for kidney cancer.

Diagnosis of Kidney Cancer

The first step in treating kidney cancer is to diagnose the disease. Your doctor may order various tests to determine whether you have kidney cancer. These tests may include:

• Imaging tests, such as ultrasound, CT scans, or MRI scans, to get a detailed picture of the kidneys and surrounding tissues
• Biopsy, a procedure in which a small sample of kidney tissue is removed and examined under a microscope to determine if cancer cells are present
• Blood tests, which may be used to detect certain proteins or other substances that are produced by kidney cancer cells

Once kidney cancer is diagnosed, your doctor will determine the stage of the cancer to determine the appropriate treatment options.

Treatment Options for Kidney Cancer

The treatment options for kidney cancer depend on several factors, including the stage and location of cancer, the patient’s overall health, and the patient’s preferences. The main treatments for kidney cancer include:

Surgery

Surgery is the most common treatment for kidney cancer, especially if the cancer is confined to the kidney. In many cases, the entire kidney may be removed, which is called a nephrectomy. In some cases, only part of the kidney may be removed, which is called a partial nephrectomy. After surgery, patients may need to stay in the hospital for a few days and may need to take pain medication to manage their discomfort.

Radiation Therapy

Radiation therapy uses high-energy radiation to kill cancer cells. It is not often used as the main treatment for kidney cancer, but may be used in certain cases, such as when the cancer has spread to other parts of the body or when surgery is not an option. Radiation therapy can cause side effects such as fatigue, skin irritation, and nausea.

Immunotherapy

Immunotherapy is a type of cancer treatment that works by boosting the immune system’s ability to fight cancer. There are several types of immunotherapy drugs that may be used to treat kidney cancer, including checkpoint inhibitors and cytokines. Immunotherapy can cause side effects such as fatigue, fever, and muscle aches.

Targeted Therapy

Targeted therapy is a type of cancer treatment that uses drugs to target specific molecules or proteins that are involved in the growth and spread of cancer cells. There are several targeted therapy drugs that may be used to treat kidney cancer, such as sunitinib, sorafenib, and pazopanib. Targeted therapy can cause side effects such as nausea, diarrhea, and fatigue.

Conclusion

Kidney cancer is a serious disease that requires prompt diagnosis and treatment. The most common treatment options for kidney cancer include surgery, radiation therapy, immunotherapy, targeted

Bladder cancer is a type of cancer that begins in the cells lining the bladder. It is the sixth most common cancer in the United States, with an estimated 83,000 new cases diagnosed each year. The treatment options for bladder cancer depend on several factors, including the stage of the cancer, the location of the tumor, and the patient’s overall health. In this article, we will discuss the various bladder cancer treatment options in detail.

Surgery

Surgery is the most common treatment for bladder cancer. The type of surgery depends on the stage and location of the cancer. The options include:

Transurethral resection of bladder tumor (TURBT): This is a minimally invasive surgery used to remove the tumor from the bladder lining. During this procedure, a cystoscope (a thin tube with a light and camera) is inserted into the bladder through the urethra. The surgeon uses a tool to remove the tumor and cauterize any bleeding.

Radical cystectomy: This is a more extensive surgery in which the entire bladder is removed. In men, the prostate gland and seminal vesicles may also be removed. In women, the uterus, ovaries, and part of the vagina may also be removed.

Partial cystectomy: This surgery removes only part of the bladder if the tumor is located in a specific area and has not spread.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. It may be used in combination with surgery or radiation therapy or as the primary treatment for bladder cancer. Chemotherapy drugs can be given intravenously or inserted directly into the bladder through a catheter.

Radiation Therapy

Radiation therapy uses high-energy beams to kill cancer cells. It is often used in combination with chemotherapy or surgery. There are two types of radiation therapy:

External beam radiation therapy: This type of radiation is delivered from outside the body using a machine.

Internal radiation therapy (brachytherapy): This type of radiation involves placing a radioactive source directly into the bladder. The radiation source is inserted through the urethra and is removed after a few minutes.

Immunotherapy

Immunotherapy helps the body’s immune system fight cancer. It works by stimulating the immune system to attack cancer cells. One type of immunotherapy used for bladder cancer is called Bacillus Calmette-Guerin (BCG). BCG is a bacteria that is used to stimulate the immune system to attack cancer cells in the bladder. It is inserted into the bladder through a catheter.

Conclusion

The treatment options for bladder cancer depend on several factors, including the stage and location of the cancer, as well as the patient’s overall health. Surgery is the most common treatment for bladder cancer, but chemotherapy, radiation therapy, immunotherapy, and clinical trials are also options. The choice of treatment will be determined by your doctor and will depend on several factors, including the type of bladder cancer, the stage of the cancer, and your overall health. It is important to discuss all of your treatment options with your doctor to determine the best course of action for you.

What is Prostate Cancer?

Prostate cancer is characterized by the uncontrolled growth of abnormal cells in the prostate gland. Prostate cancerIn many cases, the disease progresses slowly and may cause no symptoms for several years. In other cases, prostatic neoplasms can evolve aggressively and give rise to metastases. Symptoms occur in more advanced stages of the disease and can be similar to conditions other than cancer, such as prostatitis and benign prostatic hyperplasia.

The onset of prostate cancer correlates to some risk factors, which can favor the neoplastic transformation of cells; first of all the age over 50 years. The extreme prevalence of prostate cancer after this age, and the excellent chances of eradication in the early stages, underline the importance of early diagnosis.

Diagnosis

Digital rectal examination (DRE)

Rectal exploration is the simplest diagnostic procedure to check the state of health of the prostate and identify any alterations by touch. With a gloved, lubricated finger, the doctor palpates the prostate and surrounding tissue through the wall of the rectum.

The exam allows you to evaluate:

• Size, firmness and texture of the prostate gland;
• Any pain caused by touching or pressing on the prostate;
• Hard areas or lumps, which may suggest the presence of one or more tumors.

However, it should be emphasized that the tumor could cause alterations that are difficult to detect by palpation. For this reason, prostate specific antigen (PSA) blood level determination is a complementary test to digital rectal examination.

PSA (prostate specific antigen) test

PSA is an enzyme produced by the prostate gland, whose function is to keep the sperm flowing after ejaculation. Normally present in low concentrations, it can be determined in the blood through a common blood test.

Cancer cells produce large amounts of prostate specific antigen; therefore, determining the levels of PSA in the blood increases the chances of detecting the presence of the tumor, even in the early stages. After treatment, the PSA test is often used to check for any signs of recurrence.

Prostate ultrasound

If a clinical suspicion of prostate cancer emerges from the urological examination and PSA values, it is likely that the doctor will request a transrectal prostate ultrasound. This examination allows to obtain more precise data on the morphology of the prostate, but once again it cannot be considered a completely reliable diagnostic test. The last word, in this sense, belongs to the prostate biopsy, the only tool currently validated for the diagnosis of cancer.

Prostate biopsy

If symptoms and test results raise the suspicion of cancer, a urologist may perform a biopsy of the prostate. This investigation is able to determine with certainty the presence of cancer cells in the prostate tissue. The procedure, performed under local anesthesia, consists in taking small samples (at least 12), coming from different areas of the prostate gland. The ultrasound guide is inserted into the rectum and transrectal or transperineal blood samples are taken with a special needle (the region between the rectum and the scrotum). The pathologist analyzes the biopsy samples under a microscope to look for any cancer cells and determine the grade of the tumor.

Staging

Doctors analyze the results of rectal examination, biopsy, and imaging to determine the stage of the tumor. This relatively complex system reflects the many varieties of prostate cancer and helps determine which type of treatment is most appropriate.

The staging of prostate cancer mainly depends on:

• Ability of the tumor to invade nearby tissues, such as the bladder or rectum;
• Ability of the tumor to metastasize to lymph nodes or other parts of the body, such as bones;
• Grade (Gleason score);
• PSA level.

Doctors identify the stage of prostate cancer using the TNM system (tumor, lymph nodes, and metastases):

• “T” describes the characteristics of the tumor;
• “N” indicates whether the cancer has spread to regional lymph nodes (they are located next to the prostate in the pelvic region).
• “M” refers to the spread of the tumor to other parts of the body (metastases).

The set of these parameters (TNM, Gleason and PSA) allows the disease to be assigned three different risk classes: low, intermediate and high risk.

Sometimes, a simpler staging number system is used.

The stages of prostate cancer are:

• Stage I – early stage tumor, very small and completely within the prostate gland; may not be found during a digital rectal exam.
• Stage II – the neoplastic mass is larger, but remains confined within the prostate.
• Stage III – the tumor extends beyond the prostate, may have invaded the seminal vesicles or other nearby tissues, but the cancer cells have not yet metastasized to the lymph nodes.
• Stage IV – advanced cancer, which has spread to lymph nodes or other parts of the body, including the bladder, rectum, bones, lungs or other organs (about 20-30% of cases are diagnosed at this stage).

If prostate cancer is diagnosed at an early stage, the chances of survival are generally good. About 90% of patients in stages I and II will live at least five more years, and 65-90% will live for at least 10 more years. Stage III correlates with a 70-80% chance of living for at least another five years. However, if prostate cancer is diagnosed when it has reached stage IV, the patient has a 30% chance of living for at least another five years.

Treatment

Treatment for prostate cancer depends on individual circumstances, in particular: tumor stage (I to IV), Gleason score, PSA level, symptoms, patient age and general health conditions. For many cases of prostate cancer, treatment may not be needed right away.

The aim of therapy is to cure or control the tumor, so as not to reduce the patient’s life expectancy.

Active surveillance

If prostate cancer is very early, growing very slowly and causing no symptoms, the patient may decide to delay treatment. Active surveillance involves an observation period, which aims to avoid unnecessary treatment of harmless cancers (and its complications), while still providing timely intervention for men who need it. Active surveillance involves regular follow-up tests to monitor prostate cancer progression: blood tests, rectal exams and biopsies. When evidence shows that the disease is progressing, treatment, such as surgery or radiation therapy, may be opted for.

Radical prostatectomy

Radical prostatectomy involves the surgical removal of the prostate gland, some surrounding tissue and some lymph nodes (for this reason, the correct name of the procedure is radical prostatectomy and bilateral pelvic lymphadenectomy). This treatment is an option for the treatment of localized prostate cancer and locally advanced cancer.
The radical prostatectomy procedure can be performed by:

• Robotic laparoscopic surgery: Instruments are attached to a mechanical device (robot) and inserted into the abdomen through small incisions. The surgeon sits at a console and uses hand controls to drive the robot, which allows for more precise movements with surgical instruments.
• Retropubic surgery: The prostate is removed through an incision in the lower abdomen. Compared to other types of surgery, it correlates with a lower risk of nerve damage, which could lead to bladder control problems and erectile dysfunction.
• Perineal surgery: To access the prostate, an incision is made between the anus and the scrotum. The perineal approach to surgery may allow for faster recovery times, but it is more difficult to avoid nerve damage.
• Laparoscopic prostatectomy: Your doctor performs surgery through small incisions in your abdomen, with the assistance of a laparoscope.

Radical prostatectomy, like any operation, carries some risks and side effects, including urinary incontinence and erectile dysfunction. In extremely rare cases, post-operative problems can lead to patient death.

Having completely removed the prostate and seminal vesicles, the patient will become sterile and will have an orgasm without ejaculations, but – in the absence of complications – he will be able to resume an almost normal sex life. The reduction or absence of an erection are common side effects of the intervention, for which there are however appropriate pharmacological solutions.

In many cases, radical prostatectomy eliminates the neoplastic cells. However, prostate cancer can come back after the operation.

Radiotherapy

Radiation therapy involves the use of radiation to kill cancer cells. The radiation source can be external or can be inserted directly into the prostate of the suitably anesthetized patient. In the latter case we speak of brachytherapy, an intervention indicated above all in patients in the low or intermediate-risk class.

Radiation therapy is an option for the treatment of localized prostate cancer and locally advanced prostate cancer. Radiation therapy can also be used to slow the progression of metastatic prostate cancer and relieve symptoms.

Radiation therapy is usually given on an outpatient basis, in short sessions five days a week, for 1-2 months. Side effects of radiation therapy can include tiredness, painful and frequent urination, urinary incontinence, erectile dysfunction, diarrhea, and pain when defecating. As with radical prostatectomy, there is a chance that the cancer could come back.

Brachytherapy

Brachytherapy is a form of “internal” radiation therapy, in which a number of small sources of radiation are surgically implanted into the prostate tissue . This method has the advantage of delivering a dose of radiation directly to the tumor, reducing damage to other tissues. However, the risk of sexual dysfunction and urinary problems is the same as with radiation therapy, although bowel complications are minor.

Hormone therapy

Hormone therapy is often used in combination with radiation therapy, to increase the chances of treatment success or to reduce the risk of recurrence. It can also be used in men with advanced prostate cancer to relieve symptoms, shrink the tumor size and slow down the proliferation of cancer cells.

Hormones control the growth of prostate cells. Specifically, the tumor needs testosterone to grow. Hormone therapy can:

• Shut down testosterone production with luteinizing hormone releasing hormone (LH-RH) agonists;
• Block the effects of testosterone, preventing the hormone from reaching the cancer cells, using antiandrogen drugs (e.g. cyproterone).

Limiting the availability of hormones can cause cancer cells to die or proliferate more slowly. The main side effects of hormone therapy are caused by their effects on testosterone and include decreased sex drive and erectile dysfunction. Other possible side effects include: hot flashes, sweating, weight gain and swelling of the breasts.

Orchidectomy

Alternatively, it is possible to opt for surgical removal of the testicles (orchiectomy).

The efficacy of orchiectomy in reducing testosterone levels is similar to that of the drug approach, but the surgery can lower testosterone levels more rapidly.

Cryotherapy and High Intensity Focused Ultrasound (HIFU)

Cryotherapy (or cryoablation) involves freezing prostate tissue to kill cancer cells: It involves inserting tiny probes into the prostate through the wall of the rectum, then cycles of freezing and thawing allow it to kill the cancer cells and some surrounding healthy tissue. Similarly, HIFU involves the use of high-intensity ultrasound focused to heat specific points in the prostate.

These procedures are used on some occasions, mainly to treat patients with localized prostate cancer. However, HIFU treatment and cryotherapy are still being evaluated and their long-term efficacy has not yet been proven.

Chemotherapy

Chemotherapy is mainly used to treat metastatic cancer and tumors that do not respond to hormone therapy. The treatment destroys cancer cells, interfering with the way they multiply. The main side effects of chemotherapy are caused by their effects on healthy cells and include: infections, fatigue, hair loss, sore throat, loss of appetite, nausea and vomiting. Sometimes, if prostate cancer has already spread, the goal is not to cure it, but to control and reduce symptoms (such as pain), as well as prolong the patient’s life expectancy.

Pediatric urologists are surgeons who can diagnose, treat, and manage urinary and genital (genitourinary) problems in children.

If your child has a disease or condition of the genitals or urinary system (kidneys, urethra, bladder), a pediatric urologist has the experience and training to treat your child.

Conditions Treated

The Pediatric Urology Service of the Mass General for Children is capable of diagnosing and treating all diseases included in the broad clinical spectrum of Pediatric Urology and the genital tract.

• Vesicoureteral reflux and urinary tract infection, including minimally invasive surgery for the treatment of reflux by injection of Dx/HA (Deflux)
• Diagnosis and treatment of voiding dysfunction, enuresis, urinary incontinence
• Neurogenic bladder
• Surgical treatment of tumors and malignant diseases of the kidney, bladder and testicles.
• Obstructive uropathy: congenital hydronephrosis, congenital megaureter, ureteral duplication/ureterocele, posterior urethral leaflets
• Prenatal evaluation of congenital hydronephrosis and other obstructive uropathy
• Hypospadias
• Sexual ambiguity (intersex). Reconstruction of the genitals in both sexes
• Bladder exstrophy, epispadias, cloacal exstrophy
• Complex reconstructions of the urinary tract: bladder exstrophy, cloacal exstrophy, persistent cloaca, imperforate anus and associated urological anomalies, urinary diversions and reversal of urinary diversions, urinary incontinence
• Prune Belly Syndrome
• Renal ectopia, horseshoe kidney, crossed renal ectopia, and associated anomalies
• Inguinoscrotal pathology: inguinal hernia, hydrocele, undescended testicle (including laparoscopy for cases of undescended and non-palpable testicles), varicocele (including minimally invasive surgery), acute scrotum (testicular torsion)
• Tumours
• Trauma
• Kidney transplants including minimally invasive surgery for donor nephrectomy

Urethroplasty is a surgical procedure that is used to repair and reconstruct the urethra, which is the tube that carries urine from the bladder to the outside of the body. This procedure is typically used to treat urethral strictures, which are narrow sections of the urethra that can cause difficulty in urination, pain, and urinary tract infections. Here is a detailed guide to urethroplasty:

Urethroplasty Overview

Urethroplasty is a surgical procedure that involves the reconstruction or repair of the urethra. This procedure is typically used to treat urethral strictures, which are caused by scar tissue or injury to the urethra. The goal of urethroplasty is to restore the normal function of the urethra and allow for normal urination.

Urethral Strictures

Urethral strictures are narrow sections of the urethra that can cause difficulty in urination, pain, and urinary tract infections. They can be caused by a variety of factors, including trauma, infection, radiation therapy, or previous urethral surgery. Urethral strictures can be treated with a variety of techniques, including dilation, urethrotomy, and urethroplasty.

Types of Urethroplasty

There are several types of urethroplasty, including:

• Buccal mucosa urethroplasty: This procedure involves using tissue from the lining of the inside of the cheek to reconstruct the urethra.
• Penile skin flap urethroplasty: This procedure involves using skin from the penis to reconstruct the urethra.
• Urethral advancement and anastomosis: This procedure involves moving the urethral opening to a new location and connecting the two ends of the urethra.
• Dorsal onlay urethroplasty: This procedure involves placing a graft of tissue over the urethral stricture to widen the urethra.

Urethroplasty Procedure

Urethroplasty is typically performed under general anesthesia. During the procedure, the surgeon will make an incision in the area of the urethra that needs to be repaired or reconstructed. The type of incision and the specific technique used will depend on the location and severity of the urethral stricture. The surgeon will then repair or reconstruct the urethra using tissue from other parts of the body or a synthetic graft. The incision will be closed with sutures or staples, and a catheter may be inserted to allow for drainage.

Recovery and Follow-Up

After the urethroplasty procedure, the patient will need to stay in the hospital for a few days to allow for monitoring and recovery. The catheter will typically be removed after a few days, and the patient will need to avoid strenuous activity and sexual activity for several weeks. The patient will also need to come in for follow-up appointments to monitor their progress and ensure that the urethra is healing properly.

In conclusion, urethroplasty is a surgical procedure that is used to repair and reconstruct the urethra, typically to treat urethral strictures. There are several types of urethroplasty, and the specific technique used will depend on the location and severity of the stricture. Recovery and follow-up will involve monitoring and avoiding strenuous activity, as well as regular appointments to ensure that the urethra is healing properly. If you are experiencing difficulty in urination or other symptoms of a urethral stricture, consult with a urologist to determine if urethroplasty is a suitable treatment option for you.