Urological surgeries are surgical methods used to address problems arising in the urinary tract and reproductive organs. These surgeries are generally performed after evaluating the patients medical history and health status. Conditions such as urinary tract infections, stones, cancers, prostate diseases, reproductive system and sexual health issues, and urinary incontinence may require urological surgery. Various operations are performed in the fields of prostate surgery, stone treatment, cancer surgery, infertility interventions, and pediatric urology. This article will closely examine the types of urological surgeries and the conditions in which they are applied.

1. Prostate Surgeries: Open Prostatectomy, Endoscopic Prostate Surgery (TUR)
2. Stone Surgeries: Kidney Stone Surgeries, Bladder Stone Surgeries, Ureter Stone Surgeries
3. Cancer Surgeries: Radical Cystectomy for Bladder Cancer, Radical Prostatectomy for Prostate Cancer, Endoscopic Bladder Tumor Surgery for Bladder Cancer, Testicular Tumor Surgeries, Renal Tumor Surgeries
4. Infertility (Reproductive): Varicocele Surgery
5. Pediatric Urology: Surgery for Vesicoureteral Reflux (VUR), Undescended Testis Surgery, Circumcision
6. Kidney Surgeries: Nephrectomy (Kidney Removal), Renal Cyst Surgery, Surgery for Ureteropelvic Junction Obstruction

These surgeries target a range of conditions from urinary tract infections and stone disease to cancer and reproductive health. Prostate surgeries are performed to resolve issues in the prostate gland, while stone surgeries aim to remove stones located in the kidney, ureter, or bladder. Cancer surgeries are used in the treatment of various cancer types, and infertility surgeries offer solutions for reproductive problems. Pediatric urology addresses specific conditions seen in children. These surgeries, utilizing modern medical techniques, aim to improve patients quality of life and extend life expectancy.

Prostate Surgeries

Prostate surgeries are performed to resolve problems related to the prostate gland in men. Open prostatectomy and endoscopic prostate surgery (TUR) are among the methods used to treat benign prostatic hyperplasia.

Open prostatectomy is a traditional surgical approach. In this procedure, the surgeon removes the enlarged portion of the prostate gland that is obstructing the urinary tract. It may be preferred when the prostate weighs over 80-100 grams. This method is usually performed under general anesthesia and takes about 60 minutes. The hospital stay is typically 2 days, and the recovery period may be somewhat longer.

Endoscopic prostate surgery (TUR) is a less invasive option and is also used for benign prostatic hyperplasia. In this procedure, an endoscope (camera) is inserted through the urethra to remove prostate tissue. TUR offers a faster recovery since it is performed through the urinary tract. It can be performed with standard techniques or with Holmium or Thulium laser methods. It is especially preferred when urinary flow is obstructed due to prostate enlargement.

Both methods are chosen based on the physicians assessment and the patients condition. The choice of method depends on the type and size of the prostate problem and the patients overall health status.

Stone Surgeries

Stone surgeries are surgical methods used to treat stone formations frequently encountered in urology. Kidney stone surgeries are performed with different techniques depending on the size and location of the stones. Open surgery is now rarely used, as most stones can be treated with endoscopic (minimally invasive) methods. Large kidney stones can be removed using a camera inserted through a small incision in the back (Percutaneous Nephrolithotomy), while smaller stones can be fragmented and expelled through the urinary tract using endoscopic methods (Retrograde Intrarenal Surgery, RIRS).

The ureter is a thin tube connecting the kidney to the bladder, measuring about 25-28 cm in adults. All ureteral stone surgeries today can be performed with a thin device called a Ureterorenoscope (URS) inserted through the urinary tract. Stones are fragmented with a laser and expelled through the urinary tract. Depending on the course of the surgery and the surgeons preference, a stent is usually placed and removed after about 4 weeks.

Bladder stone surgeries aim to remove stones formed in the bladder. These surgeries are generally performed endoscopically. Endoscopic instruments are used to access the bladder and fragment and remove the stones.

These surgeries require specialized approaches based on the size, location of the stones, and the patients health status. The most appropriate treatment option is determined after evaluation by a specialist urologist, aiming for the patients recovery.

Cancer Surgeries

Cancer surgeries in urology involve the surgical treatment of various types of cancer.

In bladder cancer, it is important to determine whether the cancer is superficial or has invaded the deep muscle layer of the bladder. The first step is to perform an endoscopic TUR surgery to understand the pathology. If the cancer is superficial and not widespread, it can be followed endoscopically. However, if it is very widespread or has invaded the muscle layer, a radical cystectomy is performed. This operation involves complete removal of the bladder and regional lymph nodes. Subsequently, a new bladder is constructed from the small intestine and connected either to the abdominal wall or, in suitable patients, to the original urinary channel.

For prostate cancer, the surgical procedure is radical prostatectomy. In this operation, the prostate gland and surrounding seminal vesicles are removed. The surgery can be performed with open, laparoscopic, or robotic (minimally invasive) techniques. Although the methods differ, the goal and procedure are the same, and there is no difference in cancer control between the techniques.

Renal tumors are also common in urology. Today, most kidney tumors are detected incidentally during ultrasound, CT, or MRI performed for other reasons. Less commonly, they are found in patients presenting with severe flank pain or hematuria. The treatment of kidney tumors is surgical. In elderly patients with very small tumors, comorbidities, or high anesthesia risk, observation or alternative treatments may be considered. Depending on the location and size of the tumor, either the entire kidney is removed (Radical Nephrectomy) or only the tumor tissue is excised (Partial Nephrectomy).

Testicular tumors mainly affect young men and present as a growing mass in the testis. After appropriate evaluation, the affected testis is removed (Orchiectomy) and sent for pathological examination. Sometimes, testicular tumors may metastasize to abdominal lymph nodes, and if they do not regress after chemotherapy, surgical removal may be necessary. This surgery should be performed by highly experienced urologists.

Infertility (Reproductive)

Varicocele surgery is a promising solution for couples facing infertility and is a common intervention in urology. This surgery treats varicocele, which is the enlargement of veins around the testicles and can negatively affect sperm production. During the operation, these dilated veins are ligated to improve sperm quality, thereby increasing the chances of conception. Varicocele surgery is usually performed with microsurgical techniques, making it a less invasive procedure. It is an important option for men with infertility issues.

Pediatric Urology

Pediatric urology addresses specific urological conditions seen in children. Among the surgeries performed in this field, operations for vesicoureteral reflux (VUR) are significant. VUR is the backward flow of urine from the bladder to the kidney, which can cause urinary tract infections and, in the long term, lead to kidney failure. These surgeries aim to correct problems in the urinary tract.

Another pediatric urology surgery is for undescended testis. In this condition, one or both testes are not located in their normal position. Surgery is performed to bring the testes into the correct position, as undescended testes increase the risk of testicular cancer in later life and, if not corrected early, can cause permanent damage and future fertility problems. Early diagnosis and treatment are therefore important.

Circumcision is also a common pediatric urology procedure. In this procedure, the foreskin of the penis is surgically removed. Circumcision is performed for various cultural and religious reasons, as well as for hygiene and health benefits.

Kidney Surgeries

Kidney surgeries hold an important place in urology and are used to treat various conditions. Apart from surgeries for kidney cancer, simple nephrectomy involves the complete or partial removal of the kidney. This surgery is generally performed when the kidney loses function due to stones, reflux, or ureteropelvic junction obstruction. Sometimes, nephrectomy may also be necessary in cases of trauma.

Renal cysts are fluid-filled sacs, most of which are benign. Usually, follow-up is sufficient, but if they grow large and compress the kidney, causing pain, laparoscopic cyst removal may be performed. Occasionally, renal cysts may be a variant of renal tumors, and in cases of suspected malignancy, surgical removal is required.

Ureteropelvic junction obstruction can cause hydronephrosis, pain, and eventually loss of kidney function. When such a condition is detected, surgical correction is necessary.

References:

https://www.klinikhaus.com/en/branch/urology

https://www.mayoclinic.org/departments-centers/urology/sections/tests-procedures/orc-20336022