Surgical Techniques in Urology

Transurethral resection of the prostate (TUR-P) is the gold standard for treating benign prostatic hyperplasia. It removes excess prostate tissue that obstructs urination, while the outer layer of the prostate, the prostatic capsule, the seminal colliculus and the urethral sphincter remain unaffected.

Transurethral resection of the prostate is one of the oldest minimally invasive procedures. As an endoscopic method, it removes diseased prostate tissue without the need to open the urethra. It uses a resectoscope made up of an inner and an outer sheath, with two channels – one for inflow and one for outflow of fluid. The inner sheath contains the working element that moves the resection loop, as well as the optics connected to the light source and camera. Current flowing through the loop resects the tissue in slices and stops bleeding.

In endourology, new methods are becoming increasingly important alongside established treatments for benign prostatic hyperplasia (BPH), and in recent years endoscopic enucleation of the prostate (EEP) has become the new trend. This is also reflected in the current European Association of Urology (EAU) guidelines (2018), which list EEP as the method of choice for treating BPH with prostates larger than 80 mL.

Bipolar enucleation of the prostate significantly improves symptoms and quality of life for patients with benign prostatic hyperplasia. Its results are similar to monopolar TUR-P, but bipolar enucleation carries a lower risk of bleeding-related complications.

Both US and European guidelines strongly recommend holmium laser enucleation of the prostate (HoLEP), a minimally invasive treatment for benign prostatic hyperplasia (BPH). Studies show that HoLEP is as effective as or more effective than other methods, with fewer side effects.

HoLEP is suitable for most BPH patients, regardless of prostate size. Rates of blood loss, incontinence and erectile dysfunction are lower than with other methods. The procedure takes longer, but catheterization and hospital stays are shorter, and recurrence rates are lower too.

In short, HoLEP is a gentle and effective minimally invasive treatment for BPH.

Green light lasers with 80 to 180 watts of power and a wavelength of 532 nm are particularly suitable for ablation and hemostasis in the treatment of benign prostatic hyperplasia. Hemoglobin absorbs the energy, creating a high energy density in the tissue, so the irradiated prostate tissue quickly reaches vaporization temperature. The laser energy is delivered to the prostate through a side-firing fiber. Building on this, experts have developed a technique called "en bloc" enucleation of the prostate: with a green light laser, the prostate can be completely enucleated at a cutting power of 80 watts and a coagulation power of 40 watts.

After careful weighing of the risks, the green light method can be used in patients whose ongoing anticoagulation therapy cannot be reduced.

Cystoscopy is the examination of the bladder with a cystoscope, which can be combined with an examination of the urethra. The cystoscope is inserted into the bladder through the urethra, and integrated optics show the inside of the organ on a screen. Compared with rigid cystoscopy, flexible cystoscopy causes patients less discomfort and pain.

Rigid cystoscopy is one of the most important diagnostic methods in urology. A rigid cystoscope gives a direct view of the urethra, urethral sphincter, prostate, bladder and ureteral orifices. The procedure is relatively simple and can usually be performed on an outpatient basis. For indications such as visible or microscopic hematuria, hematospermia or azoospermia, incontinence, voiding disorders, chronic pelvic floor pain, trauma or suspected foreign bodies, flexible cystoscopy is usually the first choice. Rigid cystoscopy is used for more complex cases that may require further therapeutic intervention, such as transurethral resection of bladder or prostate tumors, urethrotomy or botulinum toxin injections to treat incontinence.

Extracorporeal shockwave lithotripsy is a common treatment for kidney, ureteral and bladder stones. Pressure waves generated outside the body are applied to the patient through a transducer and focused through skin and tissue onto the stone, breaking it into sand-like particles. The fragments can then pass easily out of the body with the urine.

• Piezoelectric technology
• Focal zone
• Positioning and localization

Photodynamic diagnosis, also called fluorescence diagnosis, is used to diagnose epithelial tumors (carcinoma in situ) and precancerous lesions. A photosensitizer accumulates in or around tumor cells and makes them fluoresce after two hours, so that they become visible endoscopically.

Pediatric urology is a highly specialized branch of urology that diagnoses and treats urological conditions in children from birth to adolescence. In recent years, the miniaturization of telescopes and instruments and advances in surgical techniques have made minimally invasive treatment increasingly important.