State-of-the-Art, Minimally Invasive Urologic Treatments
Patients with a wide range of urologic problems, from benign prostatic hyperplasia (BPH) to kidney stones to conditions requiring kidney removal, now benefit from minimally invasive techniques offered at The George Washington University Medical Faculty Associates.
Minimally invasive procedures have many advantages over traditional urologic treatment options. Patients undergoing minimally invasive procedures generally have less pain and lower costs. Plus, they can usually get back to normal activities more quickly.
New Option for Men with an Enlarged Prostate
An estimated six million American men have an enlarged prostate, also called benign prostatic hyperplasia (BPH). Symptoms include difficulty starting urination, getting out of bed frequently at night to urinate, and frequent urination with urgency. Traditionally men with moderate to severe symptoms have had two choices, expensive, lifelong medication with potential side effects or surgery to remove the obstructing prostate tissue, which required about a six-week recovery.
More than two years ago, GW MFA began offering another option, microwave heat therapy with the Urologix Targis System.
Putting heat into the prostate destroys prostate cells. This shrinks the size of the prostate, which reduces the obstruction that causes the symptoms. The elegance of the Targis System is that it is an outpatient procedure that requires little anesthesia. In this treatment, a specially designed catheter is inserted through the urethra. The obstructing prostate tissue is heated, but the surrounding tissues are not affected.
New Kidney Removal Procedure Much Easier on Patients
Because of its vital functions such as filtering wastes and fluids from the bloodstream, kidneys are essential for human survival. Yet more than 30,000 Americans suffer from kidney cancer each year and many more have suspicious growths on their kidneys requiring surgical removal or biopsy, known as nephrectomy.
The traditional kidney removal surgery was a difficult one for patients. Nephrectomy historically required making a 10- to 12-inch incision in the patient’s side and sometimes removing a rib. “Patients typically were back to work in 4 to 6 weeks. However, it took months for many patients to recover completely from the incision,” says Jason D. Engel, MD, Assistant Clinical Professor of Urology at GW MFA.
Now there is a new, minimally invasive option for patients who need a kidney removed. The procedure, called hand-assisted laparoscopic nephrectomy, allows the surgeon to view, cut and remove the kidney with much smaller incisions. The physician makes four ¼- to ½-inch incisions in the abdomen. A flexible videoscope is inserted in one of the incisions providing the surgeon with a magnified view of the kidney and surrounding tissue. Other specially designed surgical instruments on long, narrow rods are placed through the other incisions. A fifth incision of 2- to 3-inches is made to provide access for the surgeon’s hand.
“Reducing pain and getting patients back to normal activities quickly are pluses of hand-assisted laparoscopic nephrectomy,” says Dr. Engel. “Patients are back to every day activities in two weeks, maybe even sooner.” This procedure also results in shorter hospital stays, fewer infections, and significantly reduced scarring.
“For patients fighting kidney cancer, this is a welcomed shortcut on their road to recovery,” says Dr. Engel.
Advances in Treating Kidney Stones
In the past, patients with kidney stones too large to pass faced a major surgery to remove the stones. Even when stones were smaller, passing kidney stones was painful and not always possible.
GW urologists use several minimally invasive techniques when stones are large or the patient cannot pass them easily.
Extracorporeal shockwave lithotripsy (ESWL) uses high-frequency ultrasound delivered from outside the body to smash the stones into a passable dust-like material. ESWL is a major advance in the ability to deal with kidney stones.
Even if smashed, larger stones create too much debris to pass through the ureter. In this case, urologic surgeons at GW Hospital use a procedure called percutaneous nephrostolithotomy to access the kidneys with endoscopic instruments inserted through the patient’s back. The stones are then broken up with a laser or other tools and removed.
“Open surgery for kidney stones is almost obsolete," says Dr. Engel. “Now, there are a lot of different ways to deal with stones.”
