Urologic Surgery
When medication and other non-surgical treatments are either unavailable or cannot relieve symptoms, surgery is the accepted treatment for a broad range of conditions that affect the male reproductive organs and the organs of the urinary tract. These conditions include, but are not limited to, prostate cancer, ureteropelvic junction (UPJ) obstruction, bladder and kidney cancer and vesicoureteral reflux.
Facing any kind of urologic surgery creates a great deal of anxiety for most men. Among your concerns is: “Will my body function normally following surgery?” Traditional open urologic surgery – in which large incisions are made to access the pelvic organs – has been the standard approach when surgery is warranted. Yet common drawbacks of this procedure include significant post-surgical pain, a lengthy recovery and an unpredictable, potentially long-term impact on continence and sexual function.
Fortunately, less invasive surgical options are available to many patients facing urologic surgery. The most common of these is laparoscopy, which uses small incisions. While laparoscopy can be very effective for many routine procedures, limitations of this technology prevent its use for more complex urologic surgeries.
A new category of surgery, introduced with the development of the da Vinci® Surgical System, is being used by an increasing number of surgeons worldwide for prostatectomy and other urologic procedures. This minimally invasive approach, utilizing the latest in surgical and robotics technologies, is ideal for delicate urologic surgery. This includes prostatectomy, in which the target site is not only tightly confined but also surrounded by nerves affecting urinary control and sexual function. Using da Vinci, your surgeon has a better tool to spare surrounding nerves, which may enhance both your recovery experience and clinical outcomes.
Prostate Cancer & Treatment
The prostate is a male reproductive gland that produces a fluid found in semen. Located below the bladder and in front of the rectum, the prostate surrounds the urethra — the tube that empties urine from the bladder.
Prostate cancer affects the prostate gland and may spread to surrounding structures. While most men with prostate cancer have no symptoms, physician can find prostate cancer during a regular checkup, using a combination of a blood test called a PSA and a digital rectal exam (DRE).
Nearly one in six American men will be diagnosed with prostate cancer during his lifetime.1 With greater awareness, prostate cancer detection is on the rise and mortality is declining. Moreover, better treatments are allowing more men to return to active and productive lives after treatment.
Treatment Options
If the you have an early diagnosis of prostate cancer, there is usually a range of treatment options. These may include conservative management, radiation therapy with either external bream or brachytherapy therapy, cryosurgery and prostatectomy – surgical removal of the prostate. Your treatment options will depend on a number of factors, including the stage of the disease, your age and health or personal preference.
Prostatectomy
The gold standard treatment option for men under 70 with early-stage, organ-confined cancer is surgical removal of the prostate using nerve-sparing radical prostatectomy. Prostatectomy is also the most widely used treatment for prostate cancer today in the US.1
The primary goal of prostatectomy is removal of the cancer. A secondary goal is to preserve urinary function and -- when applicable -- erectile function. Preservation of the nerves necessary for erections can be an extremely important goal for patients. These nerves run alongside the prostate and are often damaged when removing the prostate. A nerve-sparing prostatectomy attempts to preserve these nerves so that the patient may be able to return to his prior erectile function.
Types of Prostatectomy
Approaches to this procedure include traditional open surgery, conventional laparoscopic surgery or da Vinci ® Prostatectomy, which is a robot-assisted laparoscopic surgery.
With a traditional open procedure, your surgeon uses an 8-10 inch incision to access the prostate. This approach often results in substantial blood loss, a lengthy, uncomfortable recovery and a risk of impotence and incontinence.
Conventional laparoscopy uses a specialized surgical camera and rigid instruments to access and remove the prostate using a series of small incisions. This approach provides your surgeon with better visualization than an open approach. In addition, it provides patients the benefits of a minimally invasive procedure.
Despite these advantages, conventional laparoscopy relies on rigid instruments and standard 2D video, technical limitations that can be challenging for the surgeon. Because of these drawbacks, conventional laparoscopy doesn’t lend itself well to complex procedures like prostatectomy. Therefore, very few urologists use this approach for prostatectomy. Moreover, neither laparoscopy nor open surgery can provide adequate visualization for a very precise, nerve-sparing prostatectomy.
da Vinci Prostatectomy (dVP)
Referred to by many as robotic surgery for prostate cancer or robotic prostatectomy, da Vinci® Prostatectomy is more accurately a robot-assisted, minimally invasive surgery that is quickly becoming the preferred treatment for removal of the prostate following early diagnosis of prostate cancer. In fact, studies suggest that da Vinci Prostatectomy may be the most effective, least invasive prostate surgery performed today.1
Though any diagnosis of cancer can be traumatic, the good news is that if your doctor recommends prostate surgery, the cancer was probably caught early. And, with da Vinci Prostatectomy, the likelihood of a complete recovery from prostate cancer without long-term side effects is, for most patients, better than it has ever been.
da Vinci Prostatectomy is performed with the assistance of the da Vinci Surgical System – the latest evolution in robotics technology. The da Vinci Surgical System enables surgeons to operate with unmatched precision and control using only a few small incisions. Recent studies suggest that da Vinci Prostatectomy may offer improved cancer control and a faster return to potency and continence.1 da Vinci Prostatectomy also offers these potential benefits:
- Significantly less pain
- Less blood loss
- Fewer complications
- Less scarring
- A shorter hospital stay
- And a faster return to normal daily activities
If you are a candidate for prostate surgery, talk to a surgeon who performs da Vinci Prostatectomy.
Kidney Cancer
Overview
Kidney Cancer can form in the small tubes inside the kidney. Those tubes located in the center of the kidney where urine collects, are used to filter blood. Each year in the United States , kidney cancer is diagnosed in about 54,000 Americans and more than 13,000 do not survive the disease. 1 Kidney cancer is slightly more common in men and is usually diagnosed between the ages of 50 and 70 years. The most common kidney cancer is called renal cell carcinoma.
It is important to realize that with early diagnosis and treatment, kidney cancer can be cured. If found early, the survival rate for patients with kidney cancer ranges from 79 to 100 percent. 2
Treatment Options
Kidney cancer is fairly resistant to radiation and chemotherapy. As a result, the gold standard treatment for localized kidney cancer is removal of the kidney or kidney tumors.
Kidney surgery is traditionally performed using an open approach, meaning doctors must make a large incision in the abdomen. Another approach is conventional laparoscopy. It is less invasive, but limits the doctor's dexterity, vision and control, compared to open surgery.
da Vinci ® for Kidney Conditions
If your doctor recommends surgery for kidney cancer, you may be a candidate for a new, minimally invasive approach — da Vinci® Surgery. da Vinci Surgery uses state-of-the-art technology to help your doctor perform a more precise operation than conventional surgery. It offers several potential benefits over conventional open surgery, including:
- Significantly less pain
- Less blood loss
- Fewer transfusions
- Less risk of infection
- Less scarring
- Shorter hospital stay
- Shorter recovery time
- Increased potential for kidney preservation in certain prescribed cancer operations
- Better clinical outcomes, in many cases
da Vinci Surgery for kidney cancer incorporates the best techniques of open surgery and applies them to a robotic-assisted, minimally invasive approach.
The precision and dexterity of the da Vinci Surgical System's advanced instrumentation facilitates a minimally invasive approach for treating kidney cancer.
As with any surgery, these benefits cannot be guaranteed, as surgery is patient and procedure specific.
Kidney Disorders
The kidneys are two small fist-sized organs located behind the abdomen on each side of the spine above your waist. By producing urine, kidneys remove toxic by-products and excess fluids from the body to help maintain a critical balance of salt, potassium and acid.
Diseases of the kidney are found more often in racial and ethnic minority populations in the United States than in the Caucasian population. African Americans, Asian Americans, Hispanics/Latinos, and Pacific Islander Americans are three times more likely to suffer from kidney failure than Americans of European descent.
Blockage of the Ureter
One of the most common conditions affecting the kidneys is blockage of the ureter - the tubes that transport urine from the kidneys to the bladder. This condition is found in adults, but more commonly diagnosed in children.
Normally, a single ureter drains a single kidney but sometimes there may be two ureters draining one kidney. One ureter drains the upper part of the kidney and the second ureter drains the lower part. As long as they both enter the bladder normally, this "duplicated collecting system" is not a problem.
In rare cases, a child may be born with an ectopic (abnormally positioned) ureter. This is a ureter that fails to connect properly to the bladder and drains somewhere outside the bladder. In girls, the ectopic ureter usually drains into the urethra or even the vagina. In boys, it usually drains into the urethra near the prostate or into the genital duct system . The urethra is a canal that carries the urine from the bladder and in males also serves as a passageway for semen
The most common cause of blockage in the urinary tract in children is a congenital obstruction at the point where the ureter joins the renal pelvis — the ureteropelvic junction (UPJ) - the area at the center of the kidney where urine collects and is funneled into the ureter. This problem occurs in roughly one in 1,500 children. 1 These obstructions develop prenatally as the kidney is forming and today most are diagnosed on prenatal ultrasound screening. In UPJ obstruction, the kidney produces urine at a rate that exceeds the amount of urine able to drain out of the renal pelvis into the ureter. This causes an accumulation of urine in the kidney. This accumulation, also called hydronephrosis , is visible on ultrasound and often allows the doctor to predict the presence of UPJ obstruction before the baby is born.
Although less common in adults, UPJ obstruction can occur as a result of kidney stones , previous surgery or disorders that can cause inflammation of the upper urinary tract.
Blockages of the ureter can create serious side effects like infections and kidney stones. If left untreated, blockages can cause chronic pain and may damage the kidney over time.
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