Urology Services

UTI’s occur when pathogenic microorganisms enter the urinary tract and produce inflammation. Types of UTI’s include urethritis (urethra infection), cystitis (bladder infection) and Pyelonephritis (kidney infection).

Renal Calculus or often known as kidney stone is considered the third most common urologic condition. The cause of this condition is unknown but most stones originate in the kidneys. Most of the stones are believed to pass through the urinary system spontaneously. The location of the stone can be found in other parts of the urinary tract, not only the kidneys.

At St George Private we have the ability to comprehensively treat stones anywhere in the urinary tract utilizing minimally invasive techniques – our specialists use the latest laser, shock-wave lithotripsy (ESWL) and percutaneous access techniques.

Urinary tract obstruction usually occurs due to pelvic tumors, calculi, urethral strictures, neoplasms, benign prostatic hypertrophy (BPH) and urinary tract trauma.

All levels of obstruction can be managed at St George Private – we have access to all types of specially designed stents to relieve obstruction, as well as interventional radiology if required.

A urinary diversion is created when the bladder must be bypassed or is removed. The most common reason why this technique is done is for bladder cancer. Other reasons include radiation damage to the bladder, neurogenic bladder, interstitial cystitis and urinary incontinence that cannot be conservatively managed. In most cases urinary diversions are permanent, however, can be temporary in few cases and can be reversed is the patient’s condition changes.

Our surgeons are experienced in all forms of bladder re-construction, in which a “neo-bladder” is constructed from the small bowel, thus allowing the patient to avoid a stoma (“wearing a bag”). These advanced techniques can now also utilize robotic techniques.

BPH is a benign, or non-cancerous, growth or enlargement of the prostate gland. The prostate gland surrounds surrounds the urethra, which is the tube that allows urine to flow from the bladder out of the body.

Problems can occur with excreting urine if the prostate becomes larger as it tightens the urethra.

Exciting developments in minimally invasive techniques for treating benign prostate disease have become available over recent years – e.g. laser therapy, the Urolift® procedure. All are available at St George Private.

Our specialists treat all forms of urological cancers – prostate, kidney, bladder, testis and penis. There are many advanced treatments for these cancers that can be accessed at St George Private Hospital.

There are numerous benign swellings and lumps that can occur in the scrotum. They are non-cancerous but can occasionally cause discomfort that requires treatment. Common scrotal swellings include hydrocoeles (a fluid collection around the testis) and epididymal cysts.

If surgery is required, it is usually a day-surgical case, the wound closed with dissolving sutures allowing early return to normal activities.

Surgery to remove the foreskin from the penis. This is usually performed when the foreskin is too tight (phimosis) or is susceptible to recurrent infections (balanitis).

A flexible cystoscopy is a procedure to check for any problems in your bladder using a flexible fibre-optic telescope (flexible cystoscope)

A rigid cystoscopy is a procedure to check for any problems in your bladder using a rigid telescope (cystoscope)

Rigid cystoscopy allows various treatments and procedures to be undertaken at the same time. It is introduced through the vagina (site of the female urethra) or the penis (site of the male urethra). No incision is required, and there are few, if any, significant possible complications. Some people may experience mild burning or bleeding when passing urine for 48-72 hours after the procedure.

Tests to assess the bladder function and urine flow.

An optical urethrotomy is an operation to treat a stricture (a narrowing of the urethra – the tube that carries urine from the bladder to the penis).

This procedure is performed through a special cystoscope introduced through the penis. It is mostly a day procedure though occasionally overnight admission is required. A catheter (a tube in the penis to allow bladder drainage) is also sometimes required. Your surgeon will discuss this with you.

This is a type of surgical procedure where the males tubes (vas) that carry sperm from the testicles are tied or sealed to prevent sperm joining the seminal stream, therefore preventing fertilisation - a permanent form of male contraception.

One or two small incision are made in the scrotum to allow the procedure to be performed. They are dissolving sutures, so there is no need for them to be formally removed. It is most important you do have the sperm count your surgeon will have arranged for you, so as to ensure sufficient time has passed from the vasectomy for the “store of sperm” within a man to be adequately depleted.

Reversing a vasectomy is a procedure to rejoin the tubes that were or sealed cut during a vasectomy.

Renal Calculi or more commonly known as kidney stones are the third most common urologic condition. The cause of this condition is unknown, but most stones originate in the kidneys. Most of the stones are believed to pass through the urinary system spontaneously. The location of the stone can be found in other parts of the urinary tract, not only in the kidneys. CT Scan is the most and reliable common way of identifying both a stone and its position in the urinary tract.

There are a number of techniques utilized to remove urinary tract stones no matter their position. It is very unusual these days to require formal surgery to remove the stones – most therapies are regarded as minimally-invasive. In any of the techniques described below a JJ stent is sometimes required. This is an inert (non-reactive in humans) tube that extends from the kidney to the bladder that prevents obstruction to the kidney whilst healing occurs. Think of it a bit like the need for a dressing or “plaster” after other surgical procedures, only it is entirely internal.

ESWL = Extra Corporeal Shock Wave Lithotripsy

• Uses an shock-wave to break the stone into powder or small pieces allowing it to pass from the kidney in the urine
• Performed as a day procedure
• Not suitable for all stones

Pyeloscopy & Laser Lithotripsy

• A pyeloscope is a flexible telescope that can be passed from the bladder to the kidney
• This allows the stone to be directly visualized and laser energy applied directly to its surface
• The pieces can usually be removed immediately (using an instrument known as a basket) or a technique known as “dusting” can be used to turn the stone to powder
• Your surgeon will discuss the best technique for your stone with you before your surgery

Ureteroscopy

• If the stone is in the lower part of the ureter then an instrument known as a “semi-rigid” ureteroscope is used to gain access to the stone (in a similar manner to the pyeloscope)
• Different energy sources may be utilised to fragment the stone to facilitate its removal, though on occasions the stone can be directly removed utilizing a “basket”.

A nephrectomy is most commonly performed to treat kidney tumours, the most common which are Renal Cell Carcinoma (RCC) and adenocarcinomas (often of the adrenal). The cause of kidney tumours is unknown. A Radical Nephrectomy is the most common surgical treatment of renal carcinoma. This refers to the removal of the kidney which includes the adrenal gland and the retroperitoneal lymph nodes – the term radical is a general medical descriptor used to name an operation or procedure that is used as a treatment for a cancer.

Surgery on the kidney is most commonly performed laparoscopically (see below). This decreases hospital stay and time for complete recovery.

TURBT is considered the first line of surgical treatment for bladder cancer. Medically known as urothelial cancer or transitional cell carcinoma (TCC), bladder cancer is relatively common in smokers and often presents with blood in the urine (known as haematuria). The majority of bladder cancers can be treated by TURBT alone, but the critical issue is how deep the tumour has grown into the bladder wall. If it has not grown into the muscle then TURBT is usually sufficient.

If the bladder cancer has grown deep enough to reach the muscle, your surgeon may need to discuss cystectomy (surgical removal of the bladder), chemotherapy or radiotherapy with you. Each case is quite unique, but most importantly expert help is required – St George Private has surgeons who are widely-known for their expertise in this area.

TURP is a type of surgical intervention done to relieve symptoms caused by an enlarged prostate commonly known as BPH. A surgical instrument is inserted through the penis to allow access to the prostate.

Commonly known as a ”re-bore”, there are actually quite a few energy sources used to achieve relief from the obstruction caused by the prostate – these range from different types of laser (there are many) as well as “bi-polar” techniques and standard electro-cautery. Every patient has a different need and you should discuss with your urologist, which technique suits your particular situation best.

Whilst there are no incisions with TURP, typical hospital stay is 2-3 days with a catheter remaining in the penis for 12-48 hours. Return to normal activities is quite rapid.

This is an operation to remove the prostate gland and some of the tissue around it. It is done to treat prostate cancer. The main complications following this surgery are erectile dysfunction (up to 50%) and incontinence (1-5%), therefore it is not a procedure usually undertaken lightly. It has been determined that experienced surgeons, urological departments and hospitals have a much lower incidence of complications than those without a similar level of expertise. St George Private Hospital has a number of surgeons who are recognized as being at the forefront of this type of surgery

This operation may be done by open surgery (a regular incision below the navel) or laparoscopic surgery (through small incisions allowing “key-hole” surgery). Different men will benefit from the various approaches and you should discuss this with your surgeon – for most men the various techniques are inter-changeable and mostly depend on an individual’s choice of technique.

St George Private Hospital has the latest da Vinci® robot (see below) that allows the laparoscopic approach for this surgery to be performed at the highest level.