It is the part of urology in charge of the diagnosis and treatment of cancer in the urinary system.
Bladder cancer
Bladder cancer refers to any of the many types of malignant tumours located in the urinary bladder.
We distinguish superficial bladder cancer and invasive or infiltrating cancer. If the cancer is superficial, it is resolved with transurethral resection of the bladder and chemotherapy or intravesical immunotherapy, a strict follow-up is imperative since it has a high tendency to recur. If the cancer is infiltrating, it is much more serious and requires aggressive treatment, if staging allows it, radical cystectomy (removal of the bladder) must be indicated, creating an ileal conduit (Bricker) that involves carrying a bag through, which the urine goes through, attached to the abdomen or to make a neobladder using the intestine, in this case the urine continues to flow through the urethra.
The most common form is hematuria, namely urinating blood, voiding syndrome (itching stinging when urinating). For the diagnosis we use ultrasound, cystoscopy and cytologies.
Prostate Cancer
Prostate Cancer is a disease in which cancer develops in the prostate gland.
It develops more frequently in men starting from their fifties. In most cases it is diagnosed through physical examination or by analysis, such as the PSA test (Prostate Specific Antigen). Suspicions of prostate cancer are confirmed by removing a sample from the prostate (prostate biopsy). Sometimes it is necessary to perform several biopsies on the same individual over time, in order to rule out being affected by this pathology. The members of Urologia Girona have dedicated their efforts and participated in various investigations to perfect less invasive techniques that help diagnose prostate cancer. Currently, before performing a biopsy, a multiparametric Magnetic resonance imaging is performed (which combines morphological, dynamic and functional sequences) for a better characterization of the prostate and possible lesions.
At Urología Girona we perform biopsies via fusion. This technique allows us to perform ultrasound-guided prostate biopsies with a real-time correlation to the images obtained from the previous MRI. This technology increases the diagnostic precision of the technique, avoiding the need for new biopsies in the future.
Treatment
The treatment of prostate cancer is highly individualized, many factors must be considered: Age and life expectancy, the patient’s preferences regarding the side effects associated with each treatment, the stage and grade of the cancer.
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- Expectant management: Because prostate cancer often grows very slowly, if the patient is older or has other serious illnesses, it is not necessary to treat the prostate cancer. Normally, PSA determinations in blood and digital rectal examination are carried out periodically.
- Surgery: radical prostatectomy is surgery done with the intent to cure prostate cancer.
- Radical Retropubic Prostatectomy: Open Wound Surgery.
- Laparoscopic Radical Prostatectomy: Trocar Wound Surgery.
- Side Effects: Urine incontinence, erectile dysfunction.
- Da Vinci robotic radical prostatectomy.
- Radiation therapy: Radiation treats low-grade cancer that is confined to the prostate or has only invaded neighbouring tissue. There are several external and internal techniques. Side effects are the same surgery and radiation own neighbouring tissues, such as: actinic proctitis, and radiation cystitis.
- * Other techniques: HIFU, Cryotherapy: they are not yet accepted as first line treatment for most national and international urological associations.
Hormonal treatment: it is aimed at those patients who are not subject to radical treatment and allows us, through the administration of hormones, to slow down the evolution of the disease for a certain time. Lately, new hormonal treatments have appeared that allow us to increase the survival of patients with disseminated prostate tumour, that is, with metastasis.
Kidney Cancer or Renal Cancer
It develops in the kidney. There are two sources depending on the region that affects the kidney. If it affects the collecting system (pelvis, calyces, ureter) it is from the bladder cancer family. If its root is in the renal parenchyma, it is of another type.
Usually, if the staging of the disease allows, the treatment of choice is radical surgery through a nephrectomy, which can be performed via open surgery, laparoscopic or robotic. Depending on the type of tumour it is, there are other rescue treatments. There is a growing tendency to be as less aggressive as possible and to conserve as much healthy parenchyma as possible adjacent to the tumour. This procedure is called partial nephrectomy, it is usually performed laparoscopically or robotically.
Testicular cancer
It is located in the testicles. This type of cancer may develop in the chest and abdomen. It is the most common type of malignant tumour among young people, between the ages of fifteen and forty.
Removal of the testicle is often enough to cure the patient (orchiectomy). This disease has a fairly high cure rate, around 90%. Sometimes and depending on the staging, chemotherapy, radiotherapy and more complex operations are required to achieve healing of the patient.
Renal lithiasis is a disorder that affects the urinary system where kidney stones form (stones in the kidney or in the urinary tract, due to the crystallization and precipitation of compounds from the urine). This can remain in the kidney or it can detach and go down the ureter, producing renal colic. There are various of different composition: calcium oxalate, uric acid, struvite, cystine.
