What is Urology?

Urology: Urinary & Reproductive Disease Diagnosis & Treatment

Urology treats urinary tract diseases in all genders and male reproductive issues, covering the kidneys, bladder, prostate, urethra, from infections to complex cancers.

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Management of Non-Muscle Invasive Bladder Cancer (NMIBC)

The majority (75%) of bladder cancers are diagnosed at this early stage. The goal is to remove the tumor and prevent it from coming back or progressing.

  • TURBT (Transurethral Resection): The primary treatment is the endoscopic removal of all visible tumors.
  • Intravesical Chemotherapy: Immediately after TURBT, a single dose of chemotherapy (Mitomycin or Gemcitabine) is instilled into the bladder to kill any floating cancer cells, preventing them from re-implanting.
  • Intravesical Immunotherapy (BCG): For high-risk tumors (high-grade or T1), simple removal isn’t enough. We use Bacillus Calmette-Guérin (BCG), a live, weakened bacterium related to tuberculosis. When placed in the bladder via a catheter, it triggers a massive immune response. The body’s immune cells attack the bacteria and, in the process, destroy the cancer cells. This is one of the most successful cancer immunotherapies in history.
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Management of Muscle-Invasive Bladder Cancer (MIBC)

Management of Muscle-Invasive Bladder Cancer (MIBC)

When cancer invades the muscle, the bladder itself becomes a threat to life. Treatment must be aggressive.

  • Neoadjuvant Chemotherapy: High-level evidence suggests that giving systemic chemotherapy (cisplatin-based) before surgery shrinks microscopic spread and improves overall survival.
  • Radical Cystectomy: This is the removal of the entire bladder. In men, this includes the prostate and seminal vesicles. In women, it often consists of the uterus, fallopian tubes, ovaries, and part of the vagina.
  • Robotic-Assisted Radical Cystectomy: At Liv Hospital, we utilize the Da Vinci Xi Robotic System. This allows for 3D magnification and precise dissection. The benefits include significantly less blood loss, less pain, and a faster return to bowel function compared to open surgery. Crucially, the robot allows for “Nerve-Sparing” techniques, preserving sexual function in eligible patients.
  • Trimodal Therapy (Bladder Preservation): For patients who are too frail for surgery or firmly refuse it, we offer a combination of maximal TURBT (scraping everything possible) followed by simultaneous Chemotherapy and Radiation.
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Urinary Diversion: Reconstructing the Tract

Urinary Diversion: Reconstructing the Tract

If the bladder is removed, the urine needs a new way to exit the body. Liv Hospital surgeons are experts in all three forms of diversion:

  • Ileal Conduit (Urostomy): A small piece of small intestine is isolated. The ureters are sewn into one end, and the other end is brought out through the skin of the abdomen to form a stoma. Urine drains continuously into a bag worn on the outside. This is the simplest and safest technique.
  • Orthotopic Neobladder: A new bladder is fashioned out of a long segment of the intestine. It is spherical and sewn back to the patient’s native urethra. This allows the patient to urinate “normally” without a bag. It requires a motivated patient who can perform pelvic floor rehabilitation.
  • Continent Cutaneous Diversion (Indiana Pouch): An internal reservoir is made, but it is connected to the skin via a small continent valve. The patient does not wear a bag; instead, they must insert a catheter into the stoma every 4-6 hours to drain urine.

Treatment of Functional Disorders

For conditions like Overactive Bladder (OAB) and Incontinence, we follow a stepped approach.

  • Behavioral Therapy: Fluid management, timed voiding, and pelvic floor physical therapy.
  • Pharmacotherapy: Anticholinergics (solifenacin, oxybutynin) or Beta-3 agonists (mirabegron) to relax the bladder muscle.
  • Intravesical Botox: Just like for wrinkles, Botox paralyzes the bladder muscle. It is injected via cystoscopy to treat severe urgency and urge incontinence. The effect lasts 6-9 months.
  • Sacral Neuromodulation (Interstim): A “bladder pacemaker.” A small wire is placed near the sacral nerves in the lower back. It sends mild electrical pulses that correct the misfiring signals between the bladder and brain.
  • Sling Surgery: For Stress Incontinence (leaking with cough), a small mesh tape is placed under the urethra to provide support (like a hammock).
Treatment of Functional Disorders

Treatment of Interstitial Cystitis (BPS)

This is a chronic pain condition managed multimodally. Treatments include oral medications (Amitriptyline, Pentosan Polysulfate), bladder instillations (cocktails of heparin and lidocaine to coat the lining), and hydrodistention (stretching the bladder under anesthesia).

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FREQUENTLY ASKED QUESTIONS

What are the side effects of BCG therapy?

BCG stimulates the immune system, which can cause “flu-like” symptoms. Patients often experience fever, chills, fatigue, and burning with urination for 24-48 hours after each treatment. Serious complications, such as systemic infection, are rare but possible.

Absolutely. Modern urostomy appliances are discreet, odor-proof, and secure. Patients with stomas swim, exercise, travel, and have intimate relationships. Specialized stoma nurses at Liv Hospital help patients learn to care for their appliances.

A Neobladder doesn’t have a muscle to squeeze like a real bladder. Instead, the patient relaxes their sphincter and uses their abdominal muscles (Valsalva maneuver) to expel urine. It requires learning a new way to void.

 No. The effects of Botox wear off over time as the nerve endings regenerate. Most patients need repeat injections every 6 to 9 months. The procedure is quick and can be done under local anesthesia.

 Studies show that robotic surgery provides oncological equivalence to open surgery—meaning the cancer cure rates are the same. The advantage of robotics lies in its benefits for recovery: less bleeding, smaller incisions, and faster hospital discharge.

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