Urology

Kidney Cancer Treatment

The treatment of a kidney tumor is determined according to the patient’s age, general health condition, and the extent (stage) of the cancer’s spread. Surgery is the standard method in the treatment of kidney cancers. Depending on the stage, size, and number of the cancer, either the kidney, the adrenal gland, and the surrounding membrane and fatty tissue are completely removed through a radical nephrectomy, or only the tumor is removed through a partial nephrectomy.

The surgical technique, whether open surgery or the method called laparoscopic (closed surgery), is decided by the surgeon. If the remaining kidney is normal, removing the diseased kidney does not cause any problems regarding kidney functions. Depending on the surgical technique, the patient can usually be discharged from the hospital shortly after the surgery (3–4 days). After being discharged, it is possible to return comfortably to normal daily activities. According to your doctor’s recommendation, you should return to the hospital later for reassessment of your condition. This follow-up is absolutely necessary in order to evaluate your general condition after the surgery and to plan the future course of your disease. This follow-up examination is also the most appropriate time to share all the details of your illness with your doctor.

The removed specimens are examined using the histopathology method to determine the type, character, and extent of the tumor. This both confirms the diagnosis and provides information about the spread.

If the cancer is inside the Gerota’s fascia, in most patients no additional treatment is required. If the tumor has spread outside the fascia or is present in another location, additional treatment will be necessary after surgery.

Kidney Stones

A kidney stone, medically known as nephrolithiasis or urolithiasis, refers to hard mineral deposits that accumulate in the kidneys.
If substances such as calcium oxalate or uric acid are found in urine at higher-than-normal concentrations, kidney stones may form. These substances can crystallize in the kidney, and over time, the crystals grow to form a stone. Stones can move or travel down the urinary tract and be expelled from the body. However, if a stone becomes lodged anywhere along the urinary tract and blocks the flow of urine, it often causes severe, typical kidney pain, which is widely feared.

Risk Factors

Certain medical conditions and lifestyle habits can trigger the risk of kidney stone formation.
People who have previously had calcium stones are at a higher risk of recurrence. The likelihood of forming another stone after the first episode is about 15% within one year and 80% within 10 years.

Patients with gout or high uric acid levels in their urine have an increased risk of kidney stones. Some medications that promote crystal formation can also raise the risk. Frequent or persistent diarrhea or dehydration, leading to concentrated, acidic urine, can contribute to stone development.

Other risk factors include:

• Urinary tract infections

• Structural abnormalities of the kidney

• Kidney diseases (e.g., renal tubular acidosis, polycystic kidney disease)

• Dietary habits

• Insufficient fluid intake

• Living in hot climates

• Hypercalciuria, cystinuria, hyperoxaluria, hyperuricosuria

• Certain medications (e.g., acetazolamide, some antiviral drugs)

• Some intestinal diseases (e.g., inflammatory bowel disease)

• Genetic factors

• History of bowel surgery (e.g., jejunoileal bypass)

• Metabolic disorders (e.g., hyperparathyroidism, gout)

Prevention:

• Drink plenty of fluids, especially water (at least 2.5 liters daily).

Symptoms

Pain is the most common symptom of kidney stones. For some people, kidney pain may be a mild, barely noticeable ache, while in others, it can be extremely severe, excruciating, and intense enough to require hospitalization.

Pain attacks are caused by the movement of the stone within the ureter and the associated spasms. Severe pain episodes typically last between 20 and 60 minutes. Kidney pain occurs on the same side of the body as the stone.

• Stones in the kidney or upper ureter cause flank pain between the ribs and hips.

• Stones in the lower ureter or near the bladder cause pain in the lower abdomen, sometimes radiating to the genital area.

Other symptoms may include:

• Blood in the urine

• Nausea and vomiting

• Burning sensation during urination

• Frequent urge to urinate

• Occasionally, kidney stones may cause no symptoms and are discovered incidentally during routine check-ups or imaging for other reasons.

How Can I Prevent It?

Dietary habits play a major role in stone formation. By paying attention to your diet, it is possible to significantly reduce the risk of kidney stones:

• Avoid consuming acidic beverages such as cola and soda whenever possible.

• Reduce tea and coffee intake.

• Grapefruit juice and apple juice may increase the risk of kidney stones; on the other hand, pure lemon juice can be protective.

• Completely avoiding milk and dairy products increases the risk of stone formation. Diets lacking calcium should not be followed. Consume milk, yogurt, and cheese in moderation.

• Choose high-fiber foods.

• Limit excessive intake of high-oxalate foods such as beetroot, soy, black tea, chocolate, cocoa, dried figs, black pepper, hazelnuts, parsley, poppy seeds, spinach, strawberries, blackberries, etc.

• People with a history of kidney stones should limit the consumption of beer and other alcoholic drinks, anchovies, sardines, organ meats, legumes, mushrooms, spinach, asparagus, cauliflower, and meat.

• Reduce salt intake.

• Engage in regular physical activity without putting strain on the body.

• Lead a stress-free lifestyle.

Kidney Stone Treatment Options

1- Flexible Ureterorenoscopy (Flexible URS), Retrograde Intrarenal Surgery (RIRS, RIRC)
One of the latest technologies in the treatment of kidney stones is the Flexible URS method, which allows complete removal of stones in the kidney entirely endoscopically (without any incision). In this method, once the kidney is reached endoscopically, the stones are visualized via camera and fragmented using a laser. This technique has a very high success rate, and another advantage is that the hospital stay is limited to just one day.

2- ESWL (Extracorporeal Shock Wave Lithotripsy)
Shock waves originating from a focal point are directed at the stone to break it down. Devices are available that focus using X-ray or ultrasound. The broken stone fragments are passed out of the body through the urinary tract. ESWL cannot achieve success in all stones. Success depends on the type, hardness, size, and location of the stone in the urinary tract. While some stones can be broken in a single session, others may require repeated sessions. Discomfort and pain may be felt during the ESWL session, so painkillers are administered before treatment. In most cases, hospital admission is not necessary after the procedure. This is one of the main methods applicable to most patients requiring interventional treatment. It is considered a good treatment option especially for stones located within the kidney and in the upper ureter. However, it is not suitable for stones larger than 2 cm, very hard stones, or those completely filling the kidney. In this method, high-energy shock waves are directed precisely to the stone, progressing without damaging the skin or internal organs, and causing fragmentation at the stone’s surface. The stone is then broken into small pieces, allowing for easy passage through the urinary tract.

3- Percutaneous Nephrolithotomy (PCNL)
In endoscopic kidney stone surgery, a 0.5–1 cm incision is made in the back area at the level of the kidney. Under X-ray guidance, a thin tube open at both ends is placed into the kidney. Using an optical device inserted through this tube, the stone is visualized on a monitor and removed with special instruments. The most significant advantage of percutaneous surgery is the preservation of the normal structure of body tissues, resulting in a faster recovery process. Patients experience a much more comfortable postoperative period compared to open surgery and are generally discharged within 2–3 days, quickly resuming daily activities. This is a much shorter period compared to open kidney stone surgery. Particularly in stones located in the lower calyces of the kidney and in large stones, ESWL success rates decrease significantly. In such cases, PCNL is a minimally invasive procedure with a high success rate. During surgery, pneumatic lithotripsy and laser lithotripsy are used to break the stones. With these technologies, even the hardest stones can be broken easily. This technique can also be applied to stones covering the entire kidney, known as staghorn stones.

4- Ureterolithotripsy
Ureteral stones can be removed by intervention with ureterorenoscopy (URS). In URS, no incision is made. A special endoscopic instrument is passed through the urinary tract to visualize and remove the stone in the ureter. Most patients can return home the same day and resume normal activities the next day. The success rate is especially high in stones located in the lower and middle ureter (96–100% success). Ureteroscopy is used to remove stones that cause obstruction in the lower and middle parts of the ureter. In ureteroscopic procedures, a very thin telescopic instrument is inserted through the urethra and bladder into the ureter. With this thin and flexible endoscope, the stone causing the obstruction is reached and removed. One year after the first stone episode, patients are checked with ultrasound and direct imaging. During this period, to prevent recurrence, patients must pay particular attention to fluid intake.

Dear Patient,
All of these treatment options are available at our hospital. For more detailed information, please contact us.

Infertility Treatment – Microtese

Infertility in men accounts for approximately half of couples who are unable to have children in today’s society. In other words, in half of the couples with infertility, there is also a male factor. In addition to male-related causes such as azoospermia (absence of sperm cells in men) and retrograde ejaculation (backward release of sperm cells), treatment should be initiated without waiting for factors related to the woman, such as age. The ICSI (Intracytoplasmic Sperm Injection) method has made it possible for men who have no sperm in their semen (the whitish, sticky fluid containing male reproductive cells released from the penis during ejaculation) to have children. However, for this procedure to be performed, the man must produce at least a small amount of sperm cells in the testicles. In other words, the sperm must be obtained from the person himself.

Obtaining sperm cells from the testicles is done by different methods depending on the patient’s condition. In men whose semen analysis (male fluid without sperm cells) shows no sperm cells, a testicular biopsy can be performed. This procedure aims to determine the cause of the absence of sperm cells — whether it is due to the inability to produce sperm cells, a blockage, or another reason for the absence of sperm cells in the semen.

TESE (Testicular Sperm Extraction) is a procedure performed to find small areas in the testicles where sperm cells are produced in patients with severe sperm production disorders. Tiny tissue samples of millimeter size are taken from several sites within the testicles, and the presence of sperm cells is checked. Micro TESE is the process of finding sperm cells within the sperm-producing tubules of the testicles using a microscope. In men with sperm production disorders not caused by a blockage, this procedure offers a 36% to 68% chance of finding sperm cells.

With the Micro TESE procedure, the chance of finding sperm cells during each biopsy increases while removing less testicular tissue. Compared to conventional TESE, the Micro TESE method has a higher sperm retrieval rate. Another advantage is that during the biopsy, damage to blood vessels and nerves in the testicular area is minimized, and the embryologist can more easily locate sperm cells in small tissue samples. After Micro TESE, the patient is kept under observation for 2 to 3 hours due to the general anesthesia and can be discharged home. For 7 days, heavy physical activities, long journeys, and prolonged driving should be avoided.

In Micro TESE, since the patient must remain still for a long period, general anesthesia is preferred over local anesthesia. Under the microscope, testicular structures are examined in detail at 20x magnification, and samples are taken from areas where sperm production is present. During the testicular incision (surgical cut), areas with fewer blood vessels are chosen under the microscope, which minimizes bleeding during the procedure. This also allows preservation of the vessels that provide blood supply to the testicles. Since very small amounts of tissue are removed (70 times less than multiple-site biopsies), there is no decrease in testosterone (male hormone) levels in the blood.

Retrieving sperm cells from the testicles can be performed under general or local anesthesia. In procedures performed under local anesthesia, sperm cells can be obtained by needle aspiration from the testicles or by removing a small sample of testicular tissue via a minor incision. These methods are chosen when sperm production within the testicles is certain or when the absence of sperm cells in semen is due to a blockage.

In addition to Micro TESE, in men with sperm production disorders and no sperm cells in semen, sperm retrieval under a microscope from the testicles (Microdissection TESE) can be performed. This method also uses general anesthesia.

Bladder Cancer

Uncontrolled growth of the cells that make up the bladder is called bladder cancer. Bladder cancer originates from the layer of cells lining the inside of the bladder. If this cell growth is limited only to the superficial layer of the bladder, it is called superficial bladder cancer. If the cell growth deepens and extends into the muscle and fat layer, it is called invasive bladder cancer.

Bladder cancer that has reached the muscle layer can spread to surrounding tissues. Through the bloodstream, it can reach other tissues and cause distant metastases, potentially spreading to organs such as the lungs or liver.

Bladder Cancer – Symptoms and Risk Groups

Although the exact cause of this disease has not been determined, it can occur at any age. However, since it is mostly seen in individuals over the age of 60, it can be considered a disease of older age. It is three times more common in men than in women, and the most significant risk factor is smoking.

Compared to non-smokers, smokers are 10 times more likely to develop this cancer. It is also frequently observed in individuals with a genetic predisposition and those exposed to chemicals for long periods (such as workers in the paint, rubber, and leather industries).

The risk of bladder cancer increases in individuals with recurrent urinary tract infections, those with kidney stones, and those who need to use a catheter for extended periods.

Symptoms of Bladder Cancer

• Visible blood in the urine

• Burning sensation during urination

• Pain during urination and frequent urge to urinate

Since these complaints are similar to those of a simple urinary tract infection, they are often not taken seriously. However, especially in individuals in the risk group, these symptoms should prompt an immediate visit to the doctor.

Examinations Required for Diagnosis

• Urinalysis, urine culture

• Ultrasound examination

• Kidney X-ray (IVP or CT scan)

• Cystoscopy (procedure to examine the bladder using a lighted camera system)

Treatment of Bladder Cancer

Surgery is a treatment method used in many patients with bladder cancer. Surgical alternatives are listed below:

Transurethral Resection (TUR):

In stage 0 and 1 bladder cancer, the tumor can be removed with the help of a cystoscope under general or spinal anesthesia. Using the cystoscope, a cutting instrument is sent into the bladder to remove the tumor. TUR surgery can be repeated, and chemotherapy or biological therapy may be applied after this type of surgery. For a few days after TUR, blood in the urine and pain during urination may be observed.

Open Surgery:

A urological surgeon removes part or all of the bladder through an incision in the body.

Partial Cystectomy:

If there is a single and small tumor in the bladder, the surgeon may not need to remove the entire bladder, and only a portion of the bladder is removed. After this type of surgery, there may be issues with urinary control, but they can improve over time.

Radical Cystectomy:

This is the removal of the entire bladder. In stage II and III bladder cancers, the entire bladder is removed. The surgeon removes the bladder, surrounding lymph nodes, and part of the urethra. Additionally, in male patients, the prostate is removed, and in female patients, the uterus is removed. Since the bladder is removed, the surgeon either creates a new bladder from a section of the intestine or connects the urinary tract to an external bag for urine collection.

Urinary Incontinence

The bladder is an organ located behind the muscles below the navel, in front of the intestines in men, and below the uterus in women. It is a pouch where urine coming from the kidneys is stored.

When urine from the kidneys starts to fill the bladder, signals are sent to the brain through the nerves. In response, the brain sends signals to both prevent the bladder from contracting and to keep the muscles responsible for holding urine contracted. However, when the accumulated urine in the bladder starts to approach capacity, the signals sent to the brain increase, prompting the brain to direct the person to the toilet and release the pressure. As a result, the bladder muscle contracts, the muscles holding the urine relax, and the person urinates. In a normal adult, the bladder (urinary pouch) can hold about 350–500 ml of urine.

As urine accumulates, the bladder expands due to its elasticity, preventing an increase in internal pressure, which allows urine to flow freely from the kidneys into the bladder. Additionally, muscles located just below the bladder, which are continuously contracted, prevent the stored urine from leaking. In women, the urethra (urinary tract) is anatomically shorter than in men, and certain hormones provide additional support to the urethra.

There are many causes of urinary incontinence. These include bladder infections (cystitis in women), vaginal infections, bladder stones, tumors, difficult childbirth, hormonal changes after menopause, radiation therapy to the abdominal area, neurological diseases, and bladder outlet obstructions caused by conditions such as prostate enlargement in men.

Other causes of continuous urinary incontinence in women may include connections (fistulas) between the bladder and vagina or between the ureter (urine tube connecting the kidney to the bladder) and the vagina. Urinary incontinence can also be seen in uncontrolled diabetes and alcoholism.

Past surgeries in both men and women can lead to urinary incontinence. In men, surgeries for prostate cancer, other prostate surgeries, bladder neck surgeries, and operations around the bladder and urinary control mechanisms may cause this problem.

Certain medications can also cause or contribute to urinary incontinence. These include muscle relaxants, antihypertensive drugs, diuretics, sedatives, antidepressants, and allergy medications.

Diseases that cause a slowdown in brain function (such as dementia, Alzheimer’s, and vascular diseases) can also lead to urinary incontinence.

Urinary Incontinence After Vaginal Delivery

The muscles that hold the bladder in place may tear or become damaged during vaginal delivery. Normally, when coughing or sneezing, the bladder moves downward slightly. The supporting muscle tissue underneath prevents further movement, thus preventing urine leakage. However, damage or tearing of these surrounding muscles may prevent adequate support, causing the bladder to descend more than normal during coughing or sneezing, which leads to urine leakage.

Diagnosis:

Diagnosis involves taking a detailed medical history, performing a physical examination, using a daily urinary diary, conducting a pad test to measure the amount of urine leakage, and, if necessary, performing urodynamic tests to evaluate bladder function.

Urodynamics is particularly used for patients who continue to have urinary incontinence despite previous surgery and for those who will undergo surgery. During this procedure, a catheter is placed into the bladder, allowing valuable information to be obtained about how the bladder functions and the causes of urinary incontinence.

Surgical Treatment:

Surgical treatment is applied to patients who do not benefit from medical therapy or exercise-based methods.

In recent years, understanding that stress incontinence (urine leakage during coughing or sneezing) is mainly due to insufficient pelvic floor support has led to the abandonment of bladder-lifting techniques. Instead, a special material is surgically placed under the bladder base like a hammock to prevent further downward movement. This method, called TVT (Trans Vaginal Tape), is a very simple, same-day procedure that does not require hospitalization and can even be performed under local anesthesia.

This technique has been a significant advancement in urinary incontinence treatment. Scientific studies have shown that its long-term results are highly satisfactory. The success rate is over 90% in the early period, and even five years after surgery, the success rate remains above 80%.

Prostate Enlargement

BPH (Benign Prostatic Hyperplasia) is one of the most common conditions affecting middle-aged and older men. Its incidence increases with age. Approximately 20% of patients require surgical intervention, while 80% are recommended monitoring and medical treatment.

BPH symptoms include frequent urination, nighttime urination, and incomplete bladder emptying, which cause a gradual decline in quality of life. Under the influence of testosterone, known as the male hormone, the prostate enlarges and narrows the section of the urethra passing through it, leading to intermittent urination and weakened urine flow.

Symptoms

In BPH, a group of complaints known as lower urinary tract symptoms (LUTS) may occur:

• Weak urine stream

• Intermittent urination

• Straining to urinate

• Prolonged urination time

• Difficulty emptying the bladder

• Urgency to urinate

• Frequent urination

• Nocturia (waking at night to urinate)

• Urinary incontinence

Evaluation

Patient complaints are assessed using the IPSS (International Prostate Symptom Score). Digital rectal examination, blood PSA (Prostate-Specific Antigen) measurement, and urinalysis are essential evaluations. Digital rectal examination and PSA testing help urologists distinguish between benign and malignant prostate enlargements.

Treatment Options

Surgical treatment is applied to patients who have complications due to prostate enlargement, show no improvement despite medical treatment, or prefer a more effective treatment option. The choice of surgical method depends on factors such as prostate size, the patient’s overall health condition, presence of other diseases, medications used for these conditions, and other relevant considerations. Based on this evaluation, either open or minimally invasive surgical procedures are performed. In 90% of patients, minimally invasive methods can be used. These operations can be performed under spinal, epidural, or general anesthesia.

Depending on the patient’s condition, the endoscopic (minimally invasive) prostate surgery technologies used include:

• Monopolar (conventional) TUR

• Bipolar (plasma kinetic) TUR

• Greenlight laser

MRI Fusion

Early detection through regular prostate screenings plays a crucial role in preventing prostate cancer. MRI Fusion Biopsy, a more sensitive method in prostate cancer screening, can detect cases that standard biopsy may miss, eliminate suspicion of cancer, and prevent the need for repeated biopsies.