The article in brief
This article details the main surgical indications in urology, covering common pathologies and recent advances. Here are the key points to remember :
- La prostate surgery is being considered for treatment-resistant benign hypertrophy and certain localised cancers
- The urinary stones sometimes require surgery, particularly if they are large or painful
- L'severe urinary incontinence can be treated surgically when other options fail
- The minimally invasive techniques such as laparoscopy, improve post-operative recovery
- The decision to operate depends on individual factors and requires a personalised assessment
As an experienced urologist, I am often faced with patients who ask when it is necessary to consider urological surgery. It's an important question that deserves a detailed answer. The decision to operate is never taken lightly and depends on many factors. Allow me to guide you through the main indications that may lead to urological surgery.
Surgical indications for prostate pathology
Prostate problems are one of the most frequent reasons for consulting a urologist. Two major pathologies may require surgery: benign prostatic hyperplasia (BPH) and prostate cancer.
When should benign prostatic hyperplasia be operated on?
BPH is a very common condition in men over the age of 50. In most cases, treatment with medication is sufficient. However, the problem is urological surgery may be necessary in the following situations:
- Failure or intolerance to drug treatments
- Complications such as acute urinary retention
- Very troublesome urinary symptoms affecting quality of life
- Large prostate (over 80-100g) where drugs are less effective
I remember a 65-year-old patient who suffered terribly from frequent urination, even at night. After trying several treatments to no avail, we opted for an operation that considerably improved his quality of life.
Prostate cancer surgery: when should it be considered?
Prostate cancer is another common condition that may require surgery. Radical prostatectomy is considered in the following cases:
- Localised cancers, where it is the treatment of choice
- Alternative to radiotherapy for certain localised cancers
- Intermediate-stage or high-risk cancers
- Recurrence after radiotherapy (salvage surgery)
It is essential to consult a urologist at the very first suspicious signs to ensure early diagnosis and optimum treatment.
Surgery for urinary stones and incontinence
Urinary calculi and urinary incontinence are two other common urological problems that may require surgery in some cases.
Surgical treatment of urinary calculi
Urinary calculi, also known as lithiasis, can sometimes require surgery. Here are the main indications:
- Calculi too large to be eliminated spontaneously (generally larger than 6-7mm)
- Intense or persistent pain
- Urinary tract obstruction
- Associated urinary tract infection
Modern techniques such as extracorporeal lithotripsy or ureteroscopy often allow these stones to be treated minimally invasively. However, in some complex cases, more extensive surgery may be required.
Urinary incontinence surgery
Urinary incontinence can have a major impact on quality of life. When conservative treatments such as perineal re-education or medication fail, surgery may be considered. The main indications are :
- Severe stress incontinence (fitting of a suburethral band or artificial sphincter)
- Some urge incontinence refractory to conventional treatments (sacral neuromodulation)
I recently operated on a 55-year-old patient who had been suffering from severe stress incontinence for years. The installation of a suburethral sling radically transformed her life, enabling her to resume her sporting activities without fear.
Other indications for urological surgery
Although less frequent, other urological pathologies may require surgery. Here is an overview of these situations:
| Pathology | Surgical indication |
|---|---|
| Bladder tumours | Cancers infiltrating the bladder muscle, high-risk superficial tumours |
| Kidney cancer | Localised tumours, certain locally advanced cancers that are operable |
| Urethral strictures | Severe or recurrent forms |
| Congenital pathologies | Vesico-ureteral reflux, various malformations |
| Erectile dysfunction | Cases refractory to medical treatment (penile prosthesis) |
It is essential to note that the decision to operate depends on many individual factors such as the patient's age, general condition, co-morbidities and personal preferences. As a urological surgeon, I always strive to offer the most appropriate solution for each patient, favouring minimally invasive techniques where possible.
Developments and prospects in urological surgery
Urological surgery has undergone spectacular advances in recent years. Minimally invasive techniques such as laparoscopy and robot-assisted surgery have revolutionised our practice. They mean faster recovery and shorter hospital stays for our patients.
In addition, the development of enhanced rehabilitation after surgery (ARAS) protocols has considerably improved post-operative comfort. These protocols aim to reduce surgical stress and accelerate the patient's functional recovery.
The future of urological surgery looks promising, with the development of new technologies such as focal surgery for prostate cancer and the use of artificial intelligence to improve the precision of our gestures.
In conclusion, consider urological surgery is an important decision that must be taken in consultation between the patient and his urologist. Each case is unique and deserves a personalised assessment. Don't hesitate to consult a specialist if you have any concerns about your urological health. Early diagnosis and appropriate management are the keys to successful treatment.
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