Urology

Prostate cancer 

Early diagnosis is vital also for prostate cancer and involves a PSA test, an examination and ultrasonography. This enables us to tackle the cancer with a less aggressive procedure and fewer complications. In many cases, the Unit recommends removal of the entire prostate gland (radical prostatectomy), preserving the erectile nerves by using the “nerve sparing” technique. We use a non-surgical, minimally invasive system, called EchoLaser therapy to treat focal lesions of the prostate 

Bladder cancer 

Bleeding (haematuria) is the hallmark of bladder cancer: it is important to identify bladder cancer early and to remove the tumour as soon as possible for examination. The procedure is performed endoscopically. For cancers that penetrate the muscular wall, removal of the whole bladder (cystectomy) is indicated, with the creation of a neobladder (orthotopic) in selected cases.

Kidney cancer 

Kidney cancer is often diagnosed by chance, as a result of tests carried out for other reasons (incidental tumour). It is operated on through complete removal of the organ (nephrectomy) or, where possible, partial resection (tumourectomy). The procedure is usually done through minimally invasive laparoscopy (keyhole surgery), with substantial benefits for the patient, thanks to fewer complications, shorter hospital stays and less post-operative pain.

Urological oncological surgery involves the use of da Vinci robotic surgery, which enables an even more conservative approach, subsequently reducing operative complications, with speedier recovery after surgical treatment. 
 

Benign prostatic hypertrophy (BPH) [benign prostatic enlargement (BPE)] disorders are usually kept under control with drug treatment that may continue over many years. If drug treatment fails, surgery is the best solution. The operation can be performed:

• endoscopically, using thulium laser, monopolar technique, bipolar technique or plasma vapourisation
• with a minimally invasive technique, using EchoLaser therapy, a revolutionary non-surgical transperineal system

Kidney stones affect at least 10% of the overall population, and in particular people over 50. In typical cases, onset is sudden, with acute pain. Admission to the emergency department is often required for initial treatment and testing. Admission to hospital is sometimes necessary for the performance of specific additional tests, to start pharmacological “expulsion” therapy of the stone or to remove the stone by means of an endoscopic surgical procedure. The Unit treats urinary stones in all their possible locations, with state-of-the-art endoscopic and minimally invasive methods:

• Kidney stones with percutaneous treatment (PERC, mini-PERC), or retrograde endoscopic treatment (retrograde intrarenal surgery - RIRS)
• Ureteral stones with laser or ultrasound ureterolithotripsy (ULT)
• Bladder stones with endoscopic laser or ultrasound cystolithotripsy

The main treatments carried out concern: 

• Erectile dysfunction, treated surgically by inserting a penile prosthesis;
• Penile curvature may be congenital or acquired (by sclerosis or after an injury) and is resolved by gentle corrective surgery.
• Testicular cancers have a peak incidence in young men (< 40 years) and show hereditary predisposition. Treatment to remove the testicle (orchidectomy) is usually followed by the placement of a testicular prosthesis.
• Penile cancers have a higher incidence in older age. Recurrent local infections may predispose individuals to and even cause the onset of this disease. The least invasive treatment is laser therapy.
• Varicocele is nearly always asymptomatic. It is treated by stopping the altered flow in the spermatic vein by open or laparoscopic (keyhole) surgery (vein ligation) or embolisation

EchoLaser is a revolutionary non-surgical minimally invasive system that uses laser thermal ablation to treat benign prostatic hypertrophy (BPH) and prostate cancer. 
Laser thermal ablation induces coagulative necrosis of the cells in the area treated, by elevating the temperature of the affected tissue. The combined action of heat and exposure time gives rise to an irreversible change in the structure of the cells targeted, with the loss of vital functions in these cells. Cell necrosis continues for 72 hours after the end of the procedure. 

The surgeon uses transperineal percutaneous laser ablation on the affected area, with no need for general anaesthesia, no scarring and without involving the urinary tract. The procedure consists of the use of a beam of laser light that is directed into the tissue to be treated thanks to optical fibres, which are in turn introduced using ultra-thin needles. When the laser light is released into the tissue, the rise in temperature induces coagulative necrosis.

The advantages of this treatment are: 

• short patient recovery times (outpatient treatment); 
• full preservation of male biological functions, such as erection, ejaculation and urination;
• short procedure; 
• lower risk of complications and infections;
• the catheter only needs to be in place for a very short period of time.