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Urology is a surgical speciality dealing with diagnosis and treatments of the male and female urinary tract and male reproductive organs. Within the urology speciality at the London Bridge Hospital there is a dedicated treatment programme for prostate cancer and the skills and facilities to carry out laparoscopic (keyhole) surgery wherever possible. The full range of services, available from the urology team includes the following:
SURGICAL PROCEDURES FOR ENLARGED PROSTATE
It’s common for a man’s prostate to get bigger as they get older. Sometimes if the prostate is enlarged it can press on your bladder and your urethra. This can cause problems when you urinate. For example you may strain when you urinate or you may have to pass urine urgently, incomplete emptying and incontinence. You will have urinary flow rate and residual volume scan, a symptom score sheet to fill in, a rectal examination and a PSA (prostate specific antigen) test done when you visit your consultant.
Trans-urethral resection of the prostate. A TURP if suitable can relieve these symptoms.
It involves a surgeon inserting a special tube down your urethra, through which a heated wire loop is used to shave off the overgrown areas of your prostate. Usually have to stay 3-4 days in hospital.
Holmium Laser Therapy is available at the London Bridge Hospital for the treatment of Prostatic Enlargement. This is minimally invasive procedure that utilises the powerful Holmium Laser as a precise cutting instrument to treat enlarged prostates of any size.
- HOLEP – Holmium Laser Enucleation
Holmium Laser Enucleation, HoLEP - Particularly suitable for larger prostates which may be unsuitable for vaporisation.
- HOLAP- Holmium Laser Ablation
Holmium Laser Ablation, HoLAP- Can also be used to vaporise smaller prostates combining the advantages of short stay, minimal bleeding and rapid return to normal activity. Most patients will be discharged within 36 hours.
- GREENLIGHT PVP/HPS
The hospital acquired the GreenLight HPS (High Performance System) prostate laser treatment system from American Medical Systems earlier this year to treat patients affected by Benign Prostatic Hypertrophy (BPH), and who complain of acute urinary symptoms such as frequent trips to the bathroom, a feeling of not having emptied the bladder, a dribbling stream, and in severe cases retention of urine.
This minimally invasive procedure, performed under a light anaesthetic, is relatively painless for the patient; complications appear much lower than with TURP or open surgery.
PROSTATE CANCER DIAGNOSIS AND TREATMENT
Prostate cancer is the most common cancer in men and is increasing in incidence. A comprehensive integrated localised Prostate Cancer treatment programme is essential to ensure that the treatment an individual patient receives is most appropriate for that person and his disease. We offer a dedicated Prostate Cancer Service supported by specialist Radiological and Pathological services, providing a full range of surgical treatments.
The diagnosis is confirmed with a biopsy taken using a Trans-rectal Ultrasound and now at the London Bridge we are currently doing Transperineal Template biopsies.
- TRANSRECTAL ULTRASOUND BIOPSY
Prostatic biopsies are most often carried out under ultrasound guidance. A lubricated sheathed transrectal ultrasound probe is passed into the back passage and the prostate gland examined to identify any obvious abnormalities within the prostate. Local anaesthetic is given and the biopsies of the prostate taken for analyses. This is often an outpatient or day case procedure (if done under a general anaesthetic).
- TRANSPERINEAL TEMPLATE BIOPSY
TRANSPERINEAL TEMPLATE BIOPSY Transperineal Template Biopsy are taken through the perineum (the area between your scrotum and anus) patients do not have rectal bleeding or discomfort, as experienced after trans-rectal biopsies. Taking the biopsies this way through the perineum reduces the risk of sepsis. It allows better sampling of the central and anterior portions of the prostate which are not usually sampled by the trans-rectal biopsy.
- RADICAL PROSTATECTOMY
Radical Prostatectomy - Removal of the entire prostate through an incision in your abdomen. This is done if the cancer has not spread from outside the prostate gland. Suitable for men who are younger rather than older.
- LAPARSCOPIC PROSTATECTOMY
Laparscopic Prostatectomy - Removal of the prostate through keyhole surgery. This procedure is less invasive than a radical prostatectomy.
High Intensity Focused Ultrasound is a form of ultrasound therapy used to treat prostate cancer that has not spread outside of the prostate. The treatment involves inserting an ultrasound probe into your rectum. The probe produces ultrasound waves that pass through the wall of your rectum. The heat destroys the prostate tissue within the specified area. Normally used for smaller prostates.
- PROSTATE BRACHYTHERAPY TREATMENT
Brachytherapy is the treatment of prostate cancer by the implantation of radioactive seeds into the prostate. The delivery of intenstital Brachytherapy is now-days carried out with great precision, utilising trans-rectal ultrasound to visualise the prostate and allow the radioactive seeds to be placed under direct supervision. This procedure is now done as a day case, its minimally invasive with little risk of bleeding. The most common symptoms after Brachytherapy are described as irritative symptoms. Almost all patients find that they have to pass urine more frequently. A medicine called an alpha-blocker is prescribed temporally for 3 months to assist the urinary flow that may be slightly weaker than before. For further information please click here
- HORMONE TREATMENT
Hormone treatment is given to patients with large tumours in the prostate and it has spread to the lymph nodes or bones. Hormonal treatments are designed to reduce the effects of testosterone, which stimulates prostate cancer growth.
- EXTERNAL BEAM RADIOTHERAPY
External Beam Radiotherapy' is normally given as series of short, daily treatments in the radiotherapy department, using equipment similar to a large x-ray. The treatments are usually given from Monday to Friday, leaving patients to rest at the weekend. Each treatment is called a fraction. Giving the treatment in fractions ensures that less damage is done to normal cells than to cancer cells. The damage to normal cells is mainly temporary, but is the radiotherapy has some side effects. The number of treatments you have depends on several factors, including your general health, the type of cancer being treated and where it is in the body, whether or not you have had, or are going to have surgery, chemotherapy or hormonal therapy as part of your treatment. For these reasons, treatment is individually planned for each patient and even people with the same type of cancer may have different types of radiotherapy treatment.
This is the second most common urological cancer. It is 2-3 times more common in men than women and is generally diagnosed in patients aged 60-80 years old. Some urinary symptoms such as blood in the urine or recurrent urinary tract infections, difficulty or pain in passing urine the cause can only be identified by having a look into your bladder. From this your consultant will be able to find out whether the tumour cells are cancerous. This can help decide with future treatment options. At the London bridge we offer a wide range of treatments such as the:
- FLEXIBLE CYSTOSCOPY
A cystoscopy is a procedure that looks at the bladder and the other parts of the urinary system. It involves inserting a special tube, called a cystoscope, into the urethra and then passing it through to the bladder.
- BLUE LIGHT CYSTOSCOPY
Blue Light Cystoscopy is offered to patients with superficial bladder cancer ( cancer that has not invaded the bladder muscle). A special photosensitising agent (Hexvix) is put into the bladder one hour before Cystoscopy. It is then viewed under blue light. It is useful for patients who have suspicious cell in the urine (urine cytology) but no evidence of tumour at cystoscopy.
Please click here to download the Blue Light Cystoscopy leaflet.
A transurethral resection of a bladder tumour (TURBT) is a treatment for bladder tumours. The tumour or tumours are cut away from the bladder wall and sent for examination. From this, your consultant will be able to find out whether the tumour cells are cancerous. This can help decide with future treatment options.
- OPEN RADICAL CYSTECTOMY
Open Radical Cystectomy is the surgical removal of your entire bladder along with surrounding fatty tissue and lymph nodes. This whereby the surgeon uses a large incision approximately 15-18cms in length to carry out the procedure. Because of the nature of open surgery this enables your surgeon to be able to look into your abdomen to perform your surgery.
- LAPARASCOPIC RADICAL CYSTECTOMY
Laparascopic Radical Cystectomy - Translated means removal of the entire bladder. In recent years, it has emerged as the most effective treatment for bladder cancer that has invaded the muscle layer surrounding the bladder. In men the prostate and the seminal vesicles (where the mans semen is stored). Having a cystectomy involves surgery to the bowel as well as the bladder. A small portion of the bowel is used to make the urostomy, this is where the tubes “ureters” that lead down from the kidneys are joined to a piece of bowel that is then brought to the surface of the skin and sutured in place, thus creating a raised pink fleshy area, called a stoma. In future your urine will be collected in a small see through bag that will be attached to your abdomen.
- RADICAL CYSTECTOMY AND NEOBLADDER FORMATION
This is done the same way as the cystectomy only instead of a stoma and bag on the outside of the skin an artifical bladder may be created from a section of bowel, in which case a bag is not necessary. Neobladders are positioned inside your body in the same position as your original bladder. And the kidneys will filter your kidneys as they always did and deposit urine into your neobladder. Most patients are able to learn how to release the urine from the neobladder much like they did with a normal bladder. In some cases the patient may have to insert a catheter multiple times a day to empty the neobladder. Not everyone is a candidate for this type of bladder reconstruction.
Like most cancers, kidney cancer becomes more common as you get older. Two thirds of all kidney cancers occur in people over the age of 60 years. A major risk is smoking, which increases the risk of getting kidney cancer between two and three. Many tumours are found while patients are having an ultrasound scan for other complaints. The diagnosis is usually confirmed by CT scan. The most common symptom, found in about half of all cases is blood in the urine. However only a minority of people with this symptom, actually have cancer. In most cases it is caused by kidney infection or kidney stones. Small tumours may be monitored at first with further scans. The London Bridge Hospital offer a wide range of surgical treatment options:
- PARTIAL NEPHRECTOMY
Removal of part of the kidney which is diseased.
- LAPAROSCOPIC RADICAL NEPHRECTOMY
Removal of the kidney through keyhole surgery.
- OPEN RADICAL NEPHRECTOMY
Removal of the kidney through one large incision.
OVERACTIVE BLADDER TREATMENTS
We offer a range of treatments for urgency, frequency and incontinence problems.
- LIFESTYLE ADVICE
Pelvic floor exercises and bladder retraining with the urology nurse specialist.
- BLADDER INSTILLATIONS
For painful bladder syndrome/ urethral syndrome
- BOTOX INJECTIONS FOR OVERACTIVE BLADDER SYNDROME
Highly effective minimally invasive treatment in patients whose quality of life is effected by urinary frequency, urgency and incontinence.
KIDNEY STONE TREATMENT
Almost everyone knows someone who has had kidney stones. The kidneys filter the blood to remove excess mineral salts and other wastes. Kidney stones form when the urine becomes so saturated with a certain mineral that no more of it can dissolve into the urine, this part then forms crystal’s which grow into hard stones. Kidney stones usually develop in the kidney’s however they can form anywhere in the urinary tract. Stones may cause no symptoms or may present with severe pain and blood in your urine or a urinary tract infection. Many stones pass spontaneously and require no intervention if they are quite small. Larger ones will require some intervention. Treatments available at the London Bridge include:
- EXTRA CORPEAL SHOCK WAVE LITHOTRIPSY (ESWL)
This is a procedure to fragment stones using shock waves generated outside the body and directed on to the stone. This is an effective treatment for treating 80% of kidney stones.
- RIGID AND FLEXIBLE URETERORENOSCOPY
These procedures involve passing a fine telescope up into the ureter and in to the kidney to direct a laser onto a stone. These treatments are effective in treating smaller stones in the ureter and the kidney.
- PERCUTANEOUS NEPHROLITHOTOMY
To prevent kidney stone formation the easiest step to take is to increase hydration and good dietary advice, this applies to suffer’s of all types of kidney stones. Dietary advice is available from your Consultant or from the Clinical Nurse Specialist at The London Bridge.
We offer many more procedures, to find out more click on each individual urologists website.
London Bridge Hospital – A leading Private Hospital in London offering the highest standards of clinical skills and nursing care