Urology is a subspecialty of surgery. Kidney disorders that cannot be treated surgically fall under nephrology, a subspecialty of internal medicine. Common procedures are: removal of stones from the renal pelvis, ureter and bladder; the removal of a kidney or part of it; implanting the ureters in an intestinal loop; kidney transplant; the removal of growths, and the removal of an enlarged anterior gland.
Urology includes surgery of the urinary system (kidneys, ureters, bladder, prostate and urethra) and of the male genitalia.
For the recognition of diseases of the kidneys which qualify for surgical treatment, a number of investigations are necessary, namely the chemical, bacteriological and microscopic examination of the urine, the chemical examination and the checking of the functioning of each kidney separately. Of utmost importance, however, is the X-ray examination. One starts with a regular recording, which shows the presence of kidney stones and the size of the kidney. Then the excretory urography is performed: the contrast agent abrodil is injected into the blood, which is excreted by the kidneys. The X-ray, the pyelogram, then gives an image of the renal pelvis and at the same time the rate of excretion† In this way, the shape and size of the renal pelvis as well as the time of excretion are known, because a new picture is taken every time after some time. Normal kidneys provide a picture of the renal pelvis after just a few minutes.
If no excretion pyelogram is visible after 20 minutes, then there is certainly a serious disturbance in the functioning of the kidneys. v An image of the renal pelvis can also be obtained in another way, namely by cystoscopic examination (cystoscopy b). The cystoscope is inserted through the urethra into the bladder and allows us to view the interior of the bladder. Abnormalities of the bladder wall ( growths, inflammation-like changes), enlargement of the prostate, bladder stones or foreign bodies in the bladder, pathological changes of the ureters are now beautifully recognizable. Thin tubes (catheters) are introduced into the ureters through the cystoscope and, if there are no constrictions or blockages (by stones) of the ureters, they can be pushed into the renal pelvis. In this way, the urine from each kidney can be collected and examined separately and the functioning of each kidney can be checked separately. To this end, a dye (indigo carmine) is injected under the skin, which after some time (with normal kidneys within 10 minutes) is excreted by the kidneys and the urine turns blue.
The appearance of the blue color in the urine thus gives an impression of the excretory capacity of each kidney. Finally, the contrast agent can now be injected directly through the tubes into the renal pelvis. By immediately taking an X-ray, one can in this way get a nice picture of the renal pelvis, which is even sharper than the excretion pyelogram and possible deviations in shape and size of the renal pelvis and so-called filling defects due to tumors (fig. 19 opposite p. 489) or because of tuberculosis excellent visibility. The urological examination table can be used, thereby avoiding the time-consuming and inconvenient transfer of the patient from the cystoscopy table to the X-ray table. The cystoscopy requires strict asepsis to prevent bacteria from being introduced into the bladder with the cystoscope.
The investigation of the functioning of each kidney is therefore so important, because it not only determines which one the diseased kidney is, but also reveals the functioning of the other kidney. When one wants to remove one kidney, it is still necessary to know whether the other kidney is capable of doing the work of both.
Urology belongs to surgery of the abdominal organs and accidental surgery among the principal parts of surgery. It is not possible here to mention the many diseases of the urinary system, which are treated surgically. The suppuration of the kidneys caused by infections, renal tuberculosis, the enormous expansion of the renal pelvis with simultaneous destruction of the renal tissue by blockage of the outlet (by a wedged stone or by a blood vessel that presses abnormally on the outlet, which prevents the drainage of the urine is prevented) and kidney tumors are diseases that can only be cured by removing the diseased kidney. Especially in renal tuberculosis, early recognition and surgical treatment can prevent further progress of the inflammatory process on the ureter, bladder and even the other kidney. That is why, for any longer lasting pus discharge in the urine, the bacteriological examination of this, supplemented by a special examination for tuberculosis by culture or animal experiment, is of such great importance. In the case of malignant kidney tumors , as is the case with all malignant tumors, the help of the radiologist is indispensable.
Radiation can make a large kidney tumor smaller and more suitable for surgery, while after the removal of the kidney, radiation can render harmless any residual tumor cells in the surgical area. X-ray radiation before and after surgery is a powerful tool in the treatment of tumors that are susceptible to this.
In kidney stone diseasethe removal of the kidney is only necessary in the case of extensive ossification or suppuration of a no longer functioning kidney. Usually the stones can be removed from the kidney or renal pelvis while preserving the kidney. An X-ray examination to determine the exact location of the stone is indispensable for this operation. A stone wedged in the ureter can be moved into the bladder by cystoscopic treatment (stretching the ureter and, if necessary, grasping the stone in instruments specially made for this purpose) and then continue to emerge naturally. Otherwise, the stone must be surgically removed from the ureter.
It is sometimes necessary to have a prolapsed kidney ( walking kidney )normal position by suspension from the ribs, and sometimes an inflammation swollen kidney that no longer secretes urine may, in certain cases, by the removal of the renal capsule have a — albeit very small — chance of to recover.
In the bladder conditions, the inflammations are treated with bladder irrigations, while the bladder is opened to remove a bulge in the bladder wall (diverticula ), which can cause serious problems, or to remove a stone, foreign object or tumor. The longer the less, however, for the latter cases the bladder has to be opened surgically, due to the improvement in the technique of the so-called endovesical operations,surgical treatments, which are performed using a surgical cystoscope. Thus, under constant eye control, one can crush a stone in the bladder and flush out the grit; a bladder tumor is electro-surgically euthanized and destroyed in a few sessions by coagulation.
Among the diseases of the urethra we mention the congenital malformations of the tip of the penis and the urethra, the injuries of the urethra (when someone falls astride the tips of a fence), the strictures after an accident or as the final state of a gonorrhoeic infection , the stones and the growths. The narrowing of the urethra ( stricture) often requires long-term treatment, whereby the tube must be stretched periodically with metal or other spark plugs (rods of different thickness).
When the testis, which in embryonic life lies in the abdomen, during its descent to the scrotum, has become stuck somewhere in its way, usually in the groin, and it has not been possible to control the further descent of the testis by the administration of hormones. the organ is surgically moved to its normal position. The tuberculosis of the epididymis and the growths of the testis are treated with removal of the affected organs. Common disorders are the water fracture and the varicose vein,neither of which, however, are a fraction. The hydrocele ( hydrocele ) is an accumulation of fluid between the membranes surrounding the testis, and the varicose hernia consists of dilated veins in the spermatic cord. Both conditions can be easily cured by surgery. The malignant tumor of the penis, which necessitates the removal of the organ, is very serious. The end of the urethra is then sutured to the skin in front of or even better behind the scrotum.
Of the various diseases of the prostate, the most important is the enlargement of the prostate caused by benign or malignant neoplasms in old age, which makes the emptying of the bladder more difficult and eventually even impossible. Because the bladder cannot empty itself properly, urine is congested in both renal pelvises, so that the functioning of the kidneys is damaged in the long run to such an extent that the patient dies of urine poisoning ( uraemia ). When treating prostate disease, the functioning of the kidneys must therefore first be checked with the aid of the research methods already described and if this proves to be insufficient, regular emptying of the bladder ( catheterism )) combat the effects of urination, before proceeding to the actual treatment of the prostate disease. Only when the kidneys are working normally again can the enlarged prostate be surgically removed ( prostatectomy ) from the bladder opened in the abdomen, from the perineum through an incision behind the scrotum or by the latest method in front of the bladder (retropubic). In addition to prostatectomy, the urologist is increasingly making use of endovesical operations, whereby the prostate enlargement is reduced by electro-surgical treatment by means of a specific surgical cystoscope (electroresection of the prostate). The electrical heating ( diathermy ) of the prostate is recommended by our compatriot Remijnse.
Especially in prostate cancer, which usually soon becomes unsuitable for surgery, electroresection, combined with hormonal therapy ( menostilbene ), can remove the objections for a considerable time or reduce them to bearable dimensions. Since an annoying inflammation of the epididymis often develops after the operative treatment, many surgeons have decided to interrupt the seminal duct in the spermatic cord on both sides before prostatectomy by cutting a piece in between to prevent the progression of the often unavoidable infection from the surgical site along the vas deferens to prevent the epididymis.
List of Acronyms Related to Urology