The Urological Surgery unit at Paideia International Hospital offers procedures ranging from traditional open surgery to the most innovative minimally invasive techniques: robotic, endoscopic, laparoscopic.
Robot-assisted surgery
Robot-assisted surgery represents the very latest development in minimally invasive surgery. It is not a surgery performed by a robot, but a minimally invasive laparoscopic surgery performed and directed by experienced surgeons. The da Vinci Xi Robot gives the surgical gesture a precision that cannot be compared with other techniques.
The advantages of robot-assisted surgery in urology are:
- Smaller incisions
- Less bleeding
- Shorter hospital stay and quicker return to work
- Cosmetic improvements
- Low incidence of certain surgical complications
The main results of radical prostatectomy with the Da Vinci Xi are:
- Biochemical recurrence-free survival rates (BCR) after surgery
- Urinary continence
- Power
Benign prostatic hyperplasia
Benign prostatic hypertrophy (BPH) is one of the urological conditions with the highest incidence and prevalence in men, and its incidence increases with age. It is estimated that around 70% of men between the ages of 60 and 69 suffer from the condition, rising to 80% of men over 70.
Diagnostic-therapeutic framework:
- Uroflowmetry with RPM evaluation
- Ultrasound of the urinary tract
- Comprehensive urodynamic test
- Assessment by UDM video (optional)
- Specialist-patient counselling for shared treatment programme
- “Tailored” therapeutic choice (tailoring treatment) in relation to prostate size, age of the patient, patient's wishes, ejaculation sparing techniques
Therapeutic management:
The team offers all possible therapies that are available today, with a focus on minimally invasive techniques that preserve antegrade ejaculation:
- Aquablation
- Rezum
- Elesta
- HOLEP, ThuLEP
- BiTURP, BiTUIP (bipolar energy)
- Robot-assisted prostate adenomectomy (RASP)
Aquabeam
The AquaBeam system is a robotic device designed for the ablation and removal of prostate tissue in individuals with lower urinary tract symptoms caused by benign prostatic hyperplasia (BPH). This system works by combining three principles of action:
- Real-time image acquisition: intra-operative ultrasound guidance
- Robot-assisted procedure: planned and accurate removal of tissue performed robotically
- Water jet: hydrodissection of the target tissue without using thermal energy
Aquabeam ensures a high rate of preservation of ejaculatory function. With prostate sizes between 30g and 80g (85% of cases), a sexual dysfunction rate of 0% after three years is observed in the literature In prostates between 80g and 150g, 2% ejaculatory dysfunction and 1% erectile dysfunction is observed at two years.
Rezum
Rezum is another recent development that uses water vapour for the minimally invasive treatment of BPH, Rezum is performed as an outpatient procedure. The procedure takes only a few minutes (about 8 mins) and can be performed under locoregional anaesthesia/sedation, without the need for general anaesthesia. Within a few weeks, the thermal effect produces a significant reduction in prostate size, with a permanent de-constructive effect. In 87% of the cases, the intervention allows the preservation of antegrade ejaculation. Benefits of Rezum therapy include:
- Minimally-invasive
- Simplicity and speed of execution
- Performed in day hospital with minimal sedation or under local anaesthesia
- Rapid return to normal daily activities
- Effective reduction of symptoms and preservation of sexual function
Percutaneous transperineal laser ablation
Percutaneous transperineal laser ablation (TPLA) can be considered a viable alternative to traditional surgery with the advantages of reduced invasiveness, no intra- and post-operative bleeding, no post-surgical infections and preservation of antegrade ejaculation.
This procedure is performed on an outpatientbasis, under local anaesthesia and as an outpatient, eliminating hospitalisation time and rapidly returning the patient to social and working life.
The percutaneous transperineal approach to this procedure eliminates all the complications that TURP entails, thus making it a possibility even for patients with comorbidities and a high anaesthesiological risk.
Transperineal laser ablation of the prostate reported an ejaculation retention rate of over 90%. This makes TPLA even more attractive for young, sexually active patients.
Enucleation of the prostate
Enucleation of the prostate by holmium/tullium laser (HOLEP/ThuLEP) allows the complete enucleation by transurethral laser energy of any size of prostate adenoma (≧ 120 ml), reducing intraoperative bleeding, post-operative hospital stay, earlier removal of the bladder catheter and rapid return to working life, social life and an early resumption of sexual activity.
Adenomectomy of the prostate
Finally, adenomectomy of the prostate with the Da Vinci Robot enables the treatment of voluminous prostate adenomas (≧ 180 ml) with preservation of the aesthetic and cosmetic result (absence of surgical scars), shorter hospitalisation time and earlier removal of the bladder catheter, rapid return to working and social life and resumption of sexual activity.
This procedure is performed on an outpatientbasis, under local anaesthesia and as an outpatient, eliminating hospitalisation time and rapidly returning the patient to social and working life.
The percutaneous transperineal approach to this procedure eliminates all the complications that TURP entails, thus making even patients with comorbidities and a high anaesthesiological risk eligible.
Transperineal laser ablation of the prostate reported an ejaculation retention rate of over 90%. This makes TPLA even more attractive for young, sexually active patients.
Renal calculi
Urinary calculi is a condition caused by the accumulation in the excretory cavities of poorly soluble constituents of urine with the formation of crystalline clusters of varying size and chemical composition.
Endoscopic treatment of renal calculi (kidney stones) is performed with the aid of a flexible instrument called a uretero nephroscope. The end of this instrument, with a diameter no bigger than 4 mm, is flexible in the different spatial directions, thus exploring each renal calyx in detail.
This surgical technique is the gold standard in treating kidney stones up to 2 cm. This is a purely endoscopic procedure, in which no traditional or laparoscopic surgical access is required. The average hospital stay is about 12-24 hours and the procedure is usually performed under general anaesthesia. In cases of complex and large calculi, a ureteral stent (JJ stent) is placed and removed in an outpatient clinic after 7-14 days.
TLU (Transperitoneal laparoscopic ureterolithotomy )
Semi-rigid ureteroscopy is an endourological procedure that is used exclusively in treating ureteric calculi. The instrument allows upward travel along the course of the ureter, where a 300 micron diameter laser fibre is used to pulverise the calculus. The procedure is performed under general anaesthesia and the average hospital stay is 12-24 hours. In cases of complex and large calculi, a ureteral stent (double J stent) is placed and removed in an outpatient clinic after 7-14 days.
PCNL (percutaneous nephrolithotripsy)
Percutaneous nephrolithotomy (PCNL) is recommended for kidney stones, kidney stones >2 cm in size (especially if located at the level of the inferior calyx group) and to treat cystine kidney stones. Percutaneous lithotripsy is performed under general anaesthesia.
The Mini-Perc is a development of the percutaneous lithotripsy technique, which involves inserting instruments, in this case miniaturised (14-20 Fr), directly into the kidney.
The procedure involves creating a nephrostomy access point, dilating the pathway and introducing f the nephroscope into the urinary tract: the stone is located, it is crushed and the residue is removed. At the end of the procedure, a nephrostomy is placed in the urinary tract for urine drainage and possibly a ureteral stent (JJ stent) to be removed after 14-21 days. In some cases, a nephrostomy probe can be placed in preparation for surgical access under local anaesthesia before performing nephrolithotomy surgery.
Robot-assisted pyelolithotomy
Robot-assisted surgery may prove to be a viable treatment option in cases of larger calculi in relation to the possibility of solving the problem in a single treatment.
The postoperative hospital stay is usually 48-72 hours. At the end of the procedure, a double J ureteral stent is inserted and removed in an outpatient clinic after 14-21 days.
