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Endourology refers to a specific specialty area in urology in which small internal endoscopes and instrumentation are used to see into the urinary tract and perform surgery. Urology is a surgical specialty which deals with diseases of the male and female urinary tract and the male reproductive organs. The purpose of endourology is to develop minimally invasive techniques that can equal or surpass the results of classical open surgery.
What distinguishes endourology from traditional urology is that all procedures are done internally, without any extensive incisions. Endourology is also known as minimally invasive urologic surgery or laparoscopic surgery.
Stones may be taken out or fragmented using tiny instruments inserted into the body through such areas the urethra, bladder, and ureter. In addition to treatment, doctors can help determine what is causing the kidney stones and help identify ways to prevent further stones from forming. Thin, flexible instruments including lasers, graspers, miniature stone retrieval baskets, special scalpels, and cautery, can be used to perform surgery without creating any incisions at all. Nearly all endoscopic procedures can be done on an outpatient basis.
Endourological procedures differ from the traditional urological procedures as they are minimally invasive. The different types include the following:
✓ Urethroscopy – If you have pain when you pee or possibly kidney stones, your doctor may want you to have a ureteroscopy. It’s a procedure to find and fix problems in your urinary tract. This is performed if the surgeon needs to have a thorough look at the urethra or the bladder and needs to take sample tissues from the lining of either area to clarify the problem. The procedure is used to treat strictures of blockages of the urethra. During ureteroscopy, your doctor inserts a thin, flexible scope into your bladder and ureter (the tube that carries urine from your kidneys to your bladder). This way she can look for kidney stones or other signs of trouble.
✓ Cystoscopy – used to look inside the bladder using a thin camera called a cystoscope. It is inserted into the urethra and passed into the bladder to allow a doctor to see inside. Small instruments can be passed down the cystoscope to treat bladder problems. Cystoscopy is most often done as an outpatient procedure. Before the procedure you will empty your bladder. Then you will be placed on an exam table. A liquid or gel local anesthetic may be used on your urethra. The average cystoscopy takes about 5 to 10 minutes.
✓ Ureteroscopy – it is an effective way for the urologist to get a clear view of the urinary tract, remove or break up stones and remove suspicious-looking tissue. Doctors sometimes use this procedure as part of shock wave lithotripsy, a treatment to break up kidney stones. Ureteroscopy is used to treat a urine blockage and tumours of the ureter. Ureteroscopes are precision instruments used for surgical procedures within these structures. At times an ureteroscope may also be used to traverse the length of the ureter in order to perform a procedure in the kidney.
✓ Nephroscopy – Nephroscopy is an endoscopic diagnostic and therapeutic procedure to check the interior of the kidney -renal calyces and pelvis in particular. Renal calyces are the exit point of the urine that has been produced in the renal parenchyma. Renal pelvis is the spot of the kidney where the urine accumulates before transferring to the bladder through the ureter. There are two different nephroscopic techniques, which differ a lot one from the other: Flexible Nephroscopy (with the use of flexible ureteroscope) and Percutaneous Nephroscopy (approaching the pyelocalyceal system percutaneously).
✓ Extracorporeal Shock Wave Lithotripsy - This minimally invasive technique for the disintegration of stones involves the administration of shock waves that are generated by a machine called a lithotriptor. After the machine is calibrated, and the stone has been targeted, shock waves are focused and passed through the body in such a manner that their maximum energy is dispersed at the locale of the stone, with the intent of stone disintegration. The pulverized fragments then pass in the patient’s urine. The procedure works best for smaller stones. Other
determinants for success with this treatment technique include stone composition and the specific anatomic location of the stone within the urinary tract.
Endourology can be extremely useful for many patients, however, an evaluation with an endourologist or laparoscopist is first essential. Your medical condition and your particular condition will be evaluated, before the right procedure is selected. Conditions that may be benefited from Endourology include:
✓ Kidney stones and tumours
✓ Bladder stones and tumours
✓ Blockages of the urethra and the ureter
✓ Enlarged prostate in males
If you have any questions regarding Endourology procedures be sure to contact a specialist.
Whether or not a patient is a suitable candidate for an endourological procedure depends on the result of an evaluation by an endourologist or laparoscopist. The patient’s medical history and the nature of the disease are taken into consideration.
So how do you know if you are a candidate for endourology? Well first, you will need to meet and be evaluated by an endourologist or laparoscopist. The physician will take into account your specific medical history and the particular nature of your disease.
The specialty of urology is constantly advancing. Many urologic operations that were once done by open surgery can now be performed through the laparoscope. Much of this change has been due to improved technology. It will become increasingly important for urologists to be able to have the skill and experience using the surgical microscope.
Dr Rahul Yadav is the best Endourologist for all these procedures for patients where it is indicated.