More Urologic Conditions Are Being Treated with Minimally Invasive Procedures

November 5, 2010

The latest urologic procedures bring patients all the advantages of being highly effective without requiring major surgery. Skilled Urologists Richard Medley, MD, and Dennis Smith, MD, describe several of these procedures available at Floyd Memorial and the benefits they provide.

Leading-Edge Cancer Surgery Preserves Healthy Kidney Tissue

Until recently, a diagnosis of kidney cancer meant the entire kidney had to be removed. But major advances in cancer staging, imaging technology and surgical techniques now allow surgeons to remove only the abnormal portion in many cases. As Urologist Dennis Smith, MD, explained, “By using a procedure called a partial nephrectomy for cancer that is localized, we can maintain more of the patient’s kidney tissue and help preserve renal function.”

“Urology often involves very important quality of life issues. For example, when a man has an enlarged prostate that keeps him running to the bathroom, or a woman has incontinence that causes her embarrassment, it can keep them from leading a normal, active life. The advanced treatments at Floyd Memorial can help them get back to doing the things they enjoy.”

Dennis N. Smith, MD
Board Certified Urologist
Allied Urology, PSC

During the procedure, three or four incisions less than half-an-inch long are made. A tiny camera is placed inside the body so the surgeon can view the area. The other incisions are used to position the instruments the surgeon uses to remove the tumor along with enough surrounding tissue to make sure the cancer is eliminated.

Dr. Smith added, “Floyd Memorial has the technology that allows us to use minimally invasive laparoscopic or hand-assisted laparoscopic techniques rather than open surgery for the procedure. That reduces the likelihood of complications and helps patients heal faster with less pain.”

Advanced Surgical Treatment for Kidney Stones

Anyone who has had a kidney stone knows that the pain is almost unbearable. And this area of the country has a higher than average incidence. “Fortunately, at Floyd Memorial we have a wide range of non-invasive and minimally invasive ways to treat kidney stones,” said Urologist Richard Medley, MD.

“Tremendous advances in urologic procedures mean that many treatments are now minimally invasive. It is very rare today for anyone to need major open surgery for kidney stone disease. And surgical treatment for incontinence in women that once required open surgery and weeks of recovery can now be done on an outpatient basis – without any visible scars.”

Richard N. Medley, MD
Board Certified Urologist
Metropolitan Urology

The least invasive way to treat kidney stones is shock wave lithotripsy, in which shock waves precisely target the stone and break it up into pieces small enough to be flushed out in the urine. This works best for relatively small stones. The urologist must consider the size and location of the stone as well as the condition of the patient to determine if this is the best solution. When it is not, Floyd Memorial offers patients additional effective options.

Ureteroscopy – an Incision Free Treatment for Stones and Other Blockages

“Ureteroscopy is an outpatient procedure that requires no incisions, and may be the preferred option for the patient,” said Dr. Smith. “Recovery is generally quick and there is very little discomfort.”

During the procedure the surgeon inserts a tiny instrument called a ureteroscope into the urethra, through the bladder and into the ureter. The scope allows the surgeon to see into the urinary tract. When the stone is located, the surgeon then inserts a flexible wire with a basket through a channel in the ureteroscope. The surgeon can then grab the stone and remove it. Or, the surgeon may choose to extend a flexible fiber through the scope into the stone, and use a laser to break it up.

In addition to removing stones, the procedure may be used for patients who have a blockage caused by a narrowing or abnormal growth in the ureter.

Percutaneous Nephrostoliphostomy – a Minimally Invasive Option for Removing the Largest Stones

If a kidney stone is very large or irregularly shaped, or the patient is not a good candidate for other procedures, percutaneous nephrostoliphostomy may be used. According to Dr. Smith, “A urologist and interventional radiologist usually work together for the procedure. The surgeon reaches the kidney through a small incision in the patient’s back. A nephroscope, which is a tiny fiberoptic camera, and other instruments are threaded in through the incision. The stone can then be removed through the tube.”

Outpatient Treatment for Incontinence Requires No External Incisions

Stress incontinence affects millions of women, and can keep them from doing many of the things they enjoy most. As Dr. Medley explained, “Stress incontinence is the involuntary leakage of urine that can occur with even a minor strain like laughing or sneezing. It results from weakness in the tissues that support the urethra, which carries urine out of the bladder. This weakness is often the result of pregnancies. And today, we have a procedure that can correct this pelvic floor weakness on an outpatient basis with no external incisions at all.”

The procedure uses the Gynecare TVT Secur™ System. “We position a tiny mesh sling under the urethra to give it support so when the patient stresses her abdomen by jumping or coughing, everything doesn’t drop down and cause leakage,” said Dr. Medley. “It is performed entirely through the vagina. There is no cutting through the abdominal wall,” he said. The procedure offers significant benefits over earlier surgical methods:

  • It’s less invasive so there is less potential for complications
  • There is less post-operative pain
  • The actual procedure takes just 15 minutes
  • Patients go home the same day without a catheter

Minimally invasive surgeries are also available for more complex problems with the pelvic floor, including the protrusion of the bladder through the vagina, which is called a cystocele. “This is actually a type of hernia,” explained Dr. Medley. “One technique we use involves the anterior Pinnacle kit, which streamlines and simplifies the surgery and provides reliable, long-lasting results for the woman.”

When To See a Urologist

Urologists diagnose, treat and manage disorders of the urinary tract in men, women and children. The organs that make up the urinary tract include the kidneys, ureters (the tubes that connect the kidneys to the bladder), urinary bladder and the urethra (the tube that carries urine to the outside of the body). In men, it also includes the reproductive organs. There are many situations in which you should contact a urologist, or when your primary care physician may refer you to one. Among them are:

  • Enlargement of the prostate in men
  • Elevated levels of PSA (Prostate Specific Antigen) shown in a blood test
  • Incontinence, or the involuntary leakage of urine
  • Weakening of the pelvic floor in women
  • Passing blood in the urine
  • Cancer or tumor in the urinary tract
  • Kidney stones, or stones in the ureter or bladder
  • Certain sexual and fertility problems in men

Kentuckiana’s Only Prostate MRI

Floyd Memorial Hospital is the only hospital in this region to bring patients the advantages of the iCAD MRI Prostate Imaging System. It is an exciting new tool for the early and accurate diagnosis of prostate cancer.

As Dr. Smith explained, “When a PSA test and digital rectal exam indicate that prostate cancer is a possibility, we perform a routine biopsy, taking several tissue samples from various areas of the prostate gland. Sometimes, however, the cancer can be in a difficult to- access location and the biopsy may come back negative. If we still believe there is a high likelihood that the patient has cancer, a prostate MRI provides a simple, non-invasive way to find very subtle differences in blood flow. It can help us pinpoint the suspicious area so that we can do a biopsy on a very specific area.”

The new system can also improve the accuracy of treatment if cancer is found. Using prostate MRI results as a guide, Radiation Oncologists can aim a higher dose of radiation exactly where the MRI indicates the cancer is located, and avoid harming healthy surrounding tissue.

For more information on Floyd Memorial’s network of urologists, call 1-800-4-SOURCE (1-800-476-8723).