6- Technology in urology Quiz

Technology in Urology

• Urology utilizes various technologies for treatments.
• Key technologies include ESWL, Ureteroscopy, PCNL, open/laparoscopic surgery, lasers, and robotic surgery.
• ESWL is an extracorporeal shockwave lithotripsy treatment. It uses shockwaves to break kidney stones. It is non-invasive.
• Ureteroscopy involves inserting a small scope into the ureter or kidney. Various instruments like baskets, loops, or snares are used to remove stones. Lasers can break stones, too. A stent, at the surgeon's discretion, might be placed afterward.
• PCNL is percutaneous nephrolithotomy. It is used for large stones (>2 cm). Stones that are more likely struvite and those with difficult anatomy, such as calyceal diverticulums, often require PCNL. It is a procedure for accessing larger stones in the kidney through a small incision. The procedure often involves using a hollow tube to remove stones and other related procedures.
• Open surgery involves larger incisions, more significant blood loss, and likely longer hospital stays and catheterization periods compared to minimally invasive approaches.
• Conventional Laparoscopy utilizes smaller incisions, reduced blood loss, and shorter hospital stays compared to open surgery. However, it has drawbacks in the form of instruments that are rigid and controlled at a distance, which creates a limited range of motion and precision.
• The da Vinci Surgical System addresses these drawbacks by using robotic technology, 3D visualization, and intuitive movement and increased dexterity. It facilitates less traumatic procedures, reduced blood loss, and faster recovery time in comparison to other more invasive methods.
• HIFU (High Intensity Focused Ultrasound) is a minimally invasive technique utilizing sound waves generated by an ultrasound transducer. these low-power waves are focused into a small area to cause localized heating to kill the affected tissues. The technique is employed to target specific tissues without affecting surrounding areas.

Contraindications to ESWL

• Pregnancy
• Coagulopathy
• Urinary Tract Infection (UTI)
• Intrarenal vascular calcifications
• Renal artery aneurysm or AAA (abdominal aortic aneurysm)

Complications of ESWL

• Retroperitoneal hematoma (hemorrhage in the area behind the peritoneum). It occurs in about 25% of imaging cases but only in 0.5% are clinically significant.

Complications of URS (Ureteroscopy)

• Ureteral Perforation (occurs in about 5% of cases). Treatment involves stenting for approximately 6 weeks. Can lead to strictures in the long term (1% of all URS cases).
• Ureteral Stricture (caused by stone or URS).
• Ureteral Avulsion (rare but severe).

Stents

• Polymer tubes placed from the kidney to the bladder, acting to keep the ureter open during the healing process.
• Potential side effects of using stents include bladder spasms, flank pain, and hematuria (blood in the urine).

PCNL

• Different lithotripsy methods like ultrasonic, pneumatic, and laser lithotripsies can be used in conjunction with PCNL.

Complications of PCNL

• Bleeding: The kidney is highly vascular, so bleeding is a common complication.
• Sepsis: Infection of urinary stones (particularly struvite stones) presents a high risk for sepsis.
• Pneumothorax/Hydrothorax: Upper pole puncture carries the highest risk for pneumo- or hydrothorax (air or fluid accumulation in the pleural space).
• Colon/Spleen injury: Injury to these organs occurs in very rare cases.

Open Surgery

• Longer incision.
• Increased blood loss (typically about 900ml or 2 units).
• Longer hospital stay (about 3.5 days).
• Longer catheterization (about 15 days).

Conventional Laparoscopy

• Smaller incisions.
• Reduced blood loss (typical less than one unit at 380ml).
• Shorter hospital stay (about 1.3 days).
• Less risk of infections.
• Shorter catheterization (7-10 days).

Conventional Laparoscopy Drawbacks

• Instruments controlled at a distance.
• 2-Dimensional image.
• Rigid instruments with reduced range of motion.
• Surgeon's decreased precision and dexterity.
• Surgeon fatigue and increased difficulty with complex operations.

How to Overcome Conventional Laparoscopy Drawbacks

• Use of robotic technology (da Vinci Surgical System).
• 3D visualization system.
• Intuitive movement,
• Improved Dexterity.

HIFU

• Uses high-intensity focused ultrasound.
• Sound waves are generated by an ultrasound transducer.
• Low power waves are focused into target tissues.
• Precise tissue targeting.
• Allows for finer tuning of the procedure.
• Kills tissue through thermal (80-100°C), cavitation, and mechanical (shearing force) effects.

Procedure Overview Using HIFU

• Minimally invasive procedure.
• Transrectal approach for imaging and treatment.
• No incisions or stab wounds.
• Procedure duration of 2-4 hours.
• Spinal or epidural anesthesia.

Sonablate 500

• HIFU device used in prostate treatments.
• This procedure is employed to treat prostatic tissues affected by cancer in a minimally invasive manner.

Ablatherm

• Another HIFU device.
• High power focused ultrasound to treat a target region for a specific type of medical issue.

Subtotal Ablation Procedure

• Removal of some but not all prostatic tissues using HIFU.
• No damage to the rectum or prostate capsule.