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Urology: A historical perspective
In
the late 19th century, medical specialists were considered "quacks."
Reputable physicians were "generalists" who possessed a broad range of
medical knowledge. It wasn't until the early part of the twentieth century that
the concept of specialization began to take hold. In urology, one of the
Cleveland Clinic's founding physicians helped to develop and legitimize the
emerging field. Dr. William Lower began a tradition of pioneering new treatment
techniques and new approaches to urological health care that remains a calling
card at the Cleveland Clinic to this day.
From Dr. Lower's performance of the first suprapubic prostatectomy to Dr.
Charles Higgins groundbreaking and lifesaving surgery for babies with exstrophy
of the bladder to the first kidney transplants in the world, the Cleveland
Clinic has been at the forefront of many medical breakthroughs in urological
medicine. Currently, urology has become so complex that many subspecialties have
emerged. With eleven distinct subspecialties, the Clinic's Urological Institute
is once again playing a major role in shaping and standardizing urological
medicine.
Treating urological diseases with minimally invasive procedures
One
of the most recent trends in urological medicine is the development of minimally
invasive procedures for the treatment of many different types of urological
diseases.
Kidney cancer
Treatment for the most
common form of kidney cancer, renal cell carcinoma in stage I or II is total
nephrectomy (removal of entire kidney). This procedure is now being performed
laparoscopically in many patients. This technique eliminates the need for a major surgical
incision which equates to less postoperative pain, a shorter hospital stay and a
quicker recovery time. Cure rates are equivalent to the open surgical procedure.
Partial nephrectomy (removal of tumor only) for renal cell carcinoma is a
relatively new approach for treating the disease at stage I or II. This surgery
is primarily an open surgical procedure but is being performed minimally
invasively on a limited basis. Usually reserved for patients with only one
kidney or tumors in both kidneys, results of partial nephrectomy procedures have
been excellent. Survival rates free of cancer are identical to those receiving
radical nephrectomy. Of 1500 partial nephrectomy surgeries performed at the
Clinic, the survival rate after 5 years is 93% while only 8% of the patients had
a recurrence of the cancer.
Another new technique for small, localized cases of renal cell carcinoma is
laparoscopic renal cryoablation. This is a minimally invasive form of
cryoablation (the removal of cancerous tissue through freezing). The frozen
cancerous renal tissue will die and separate from healthy renal tissue. The
hospital stay is less than 23 hours and complete recovery averages two weeks. Of
80 cases performed at the Cleveland Clinic, renal function was preserved in all
cases and there has been no return of tumor in any case after three years. While
the results are promising, laparoscopic renal cryoablation is still in the
developmental stages and long-term follow-up statistics are needed to validate
the success of this approach.
The most promising treatment approaches for patients with stage IV renal cell
carcinoma (metastatic disease) are immunobiologic therapies. The objective of
immunotherapy is to boost the body's immune system to fight cancer cells.
Multi-modality approaches, including immunobiologic therapy and surgery, are
proving to be the most effective treatment methods. Still, much research remains
to be done in this promising approach to treating kidney cancer.
Prostate cancer
Prostate cancer is one
of the most common cancers affecting American males. Often, the treatment for
prostate cancer is radical prostatectomy (removal of prostate). The Cleveland
Clinic now removes the cancerous prostate using a technique called laparoscopic
radical prostatectomy. This minimally invasive technique lowers operative blood
loss, limits post-operative pain, shortens the hospital stay and allows for
earlier removal of urethral catheters. Results of the procedure are comparable
to results achieved from the conventional open prostatectomy procedure.
Currently, the Cleveland Clinic is the only major institution in the United
States routinely performing this procedure.
Incontinence
A relatively new
minimally invasive technique to treat stress urinary incontinence is gaining
popularity among urologists, tension-free vaginal taping (TVT). The technique is
performed in 30 minutes and requires a small vaginal incision. Advantages to
this procedure are a return to full activity within two weeks, there is less
bleeding and pain and the procedure is cost-effective and complications are very
rare. To date, treatment with this procedure at the Clinic has been 100%
effective.
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