00389 2 3091 484
00389 2 3091 484
Medical Services
Urology
Diagnostic urological procedures
Ultrasound examination of the urogenital tract is a detailed examination of the kidneys in order to diagnose urinary stones, malignant and benign changes to the kidneys, and differentiate abnormal kidney related pain. Examination of the bladder to diagnose tumors and bladder stones. Examination of the prostate and testicles in men
ТRUS biopsy in the only method which can prove prostate cancer. It is performed using a transrectal echo-probe. It includes biopsy of the prostate changes, taking samples from the prostate, these samples are then sent to a pathologist who ultimately determines the definitive diagnosis. The procedure is performed under local anesthesia.
Uroflow is the only method that provides an objective indication of the quality of the urinary stream. A device called uroflowmeter provides a graphical representation of the urinary stream, as well as the urine flow rate expressed in milliliters per second (ml/sec). This facilitates complete diagnostics of all diseases, and conditions associated with aggravated urination, as well as diseases of the prostate, urethra, and bladder.
Exploratory cystoscopy: an endoscopic procedure to directly examine the mucosa of the bladder, performed in a short-term general anesthesia (propofol), to detect inflammatory changes, calculi, foreign bodies, and tumors in the bladder. Placement and removal of urethral and J-J probes endoscopically, with an application of short-term anesthesia (propofol) and x—ray control.
Dilatation of the urinary canal – the urethra, is a procedure performed in a day-hospital. Indications for this interventional procedure include any stenosis of the urethra, caused by inflammatory processes, trauma, or postoperative stenoses – strictures of the urethra. It is performed using metal dilators, under local anesthesia. The entire procedure lasts about 20 minutes.
Application (installation through a Nelaton catheter) of medications (BCG – immucyst, Mitomycin) in the bladder – is applied as an additional therapy after transurethral resection of surface tumors on the bladder.
Surgical resolution of stress incontinence and slippage of the bladder
Stress incontinence is a condition where the bladder discharges urine in unpredictable times, such as during physical activity, coughing, sneezing, etc. It occurs when the function of the muscles in the lesser pelvis, that control the act of urination, is damaged.
This muscle function might be damaged from birth, due to a sustained injury in that region, due to some medications, or surgeries in that region (surgical treatment of the prostate in men). It is more common in women.
Diagnostics involves an examination and some tests and interventions, such as cystoscopy, echo diagnostics, postvoid residual measurement, urine culture, x-ray with contrast etc. The treatment can be modulated in accordance with the clinical picture and the severity of the symptoms. Usually, one can begin with a medication treatment with tablets that increase muscle tone and by changing one’s lifestyle habits. The final treatment of this condition is surgery. It may involve the following:
- Reconstruction of the front wall of the vagina
- Placement of an additional sphincter
- Collagen injection
- Retropubic suspension of the bladder and urethra
- Providing support to the bladder and urethra using elastic materials
- Vaginal supports of the urethra
Surgery of the penis, testicles, and pediatric urology
Circumcision
The penis is a male reproductive organ and, like any other organ in the human body it can be afflicted by different diseases, some of which require surgical treatment.
Starting from the early childhood all the way to old age, the diseases of the penis that require surgery are the following:
Phimosis – This is a condition involving difficult or completely impossible retraction of the foreskin over the glans. It can occur in patients of all ages, it can also be a congenital condition or an acquired condition, usually due to poor hygiene.
The surgical treatment of phimosis is circumcision, a procedure that involves the circumcision of the entire foreskin and it is completely removed leaving the glans penis completely free.
Hypospadias
Hypospadias is a congenital anomaly of the male reproductive organ when the urethra opens on the bottom part of the penis and not at the top. It is treated surgically, with a reconstruction of the urethra.
Epispadias
Epispadias is a congenital anomaly of the male reproductive organ when the urethra opens on the upper side of the penis and not at the top. It is treated surgically, with a reconstruction of the urethra.
Curvature of the penis
Curvature of the penis is a condition where the penis curves to one side and is usually recognized in puberty. The penis looks normal, but when erect it curves to one side. It is treated surgically with plication of tunica albuginea.
Removal of the testicle because of a testicular tumor
The removal of a testicle because of a testicular tumor (orchifunicolectomia) Orchiectomy (also called Orchidectomy) is a surgical procedure involving the removal of one or both testicles due to cancer and other reasons, such as reduction of testosterone. This procedure is most commonly applied when treating testicular tumors.
Testicular prostheses
Placement of testicular prostheses as a safe and adequate replacement of lost testicles.
Testicle hydrocele
The hydrocele of the testicle is a physiological accumulation of fluid around the testicle which causes swelling in the scrotum. Hydrocele is common in newborns and usually disappears without any treatment during the first year. Older boys or adult men may develop hydrocele as a result of scrotum inflammation or injury.
Classical surgeries (nephrectomy and transversal prostatectomy)
Nephrectomy
Nephrectomy (kidney removal – in the event of a non-functional kidney or a kidney tumor). The treatment of most types of kidney cancers begins by removing the primary tumor with a surgery called nephrectomy.
The objective of the surgery is to remove the primary tumor and the affected kidney tissue. Even if the cancer has already spread, the body will still benefit from a nephrectomy. There are two basic types of nephrectomy: partial, where the surgeon removes the part of the kidney where the tumor is located, and radical where the surgeon removes the entire kidney and usually includes the removal of the glands, the surrounding fatty tissue, and the lymph nodes around the kidney.
Transvesicular prostatectomy
Transvesicular prostatectomy or open prostatectomy is a surgery performed when there is an enlargement of the prostate, and the prostate is very large (for example more than 80g.) This prostate enlargement is called benign hyperplasia or BHP. In these types of men, transurethral surgery is not safe. The transvesicular prostatectomy is performed in the following cases:
- Repeating or enduring urinary tract infection
- Acute urinary bloating
- Obstructions during urination
- Repeating hematuria (blood in urine)
- Pathological changes on the bladder, urethras, or kidneys because of prostate obstruction
Endoscopic procedures
Endoscopic surgery is a minimally invasive approach where urology surgeons use a small video camera (endoscope) and specialized surgical instruments attached to the endoscope, to work on the bladder, urethras, and kidneys.
Endoscopic surgery of urinary stones
Endoscopic surgery of urinary stones is performed using endoscopic techniques such as cystoscopy, urethroscopy, and percutaneous endoscopy. The ureteroscope is a specialized, very long, thin endoscope that carries a small telescopic camera and specialized surgical tools. To treat the stones, the physicians insert the endoscope through the urethra to the bladder. During the intervention, if the kidney stones have descended into the bladder, then they can be removed.
Endoscopic surgery for bladder cancer
The form of bladder cancer called surface transitional cellular carcinoma, is treated with endoscopic surgery called transurethral resection. Using a specific endoscope called a cystoscope, the surgeons locate the tumor in the bladder and remove it with a small wire loop attached to the cystoscope. This form of cancer typically recurs which requires more frequent regular controls using cystoscopy.
Benign enlargement of the prostate
Benign prostate enlargement usually causes middle aged men and elderly men to experience urination obstructions which occurs when the prostate is enlarged which is also known as a benign prostate hyperplasia (BPH). This is the most common abnormality affecting the prostate. It is an utterly benign condition and is not related to prostate cancer. Moderate symptoms can be treated with medications that relax the prostate muscle. Severe symptoms have to be treated. One treatment is transurethral resection of the prostate using a telescope to remove the enlarged prostate tissue, thereby removing the blockage and facilitating a normal flow of the urine.
Lithotripsy
For the purpose of braking stones in the urogenital tract, Zan Mitrev Clinic has available a laser that can be used to efficiently treat various types and chemical compositions of stones and represents an optimal solution even for stones that are difficult to access. The procedure is done in the hospital by an adequately trained urologist.
This approach is an excellent alternative to traditional lithotripsy because it involves less risk of complications and a higher degree of efficiency and safety, regardless of the stones to be treated. In comparison to other surgical procedures it has the indisputable benefit of minimal hemorrhaging and stone movement (retropulsion) during the surgery.
A few of the many benefits that patients get with this method are:
- Minimally invasive method
- Immediate resolution of the symptoms
- A very short period of recovery and return to the everyday activities
- Minimal side effects
viktor.grujevski@zmc.mk