Endoscopy/Endourology In-Depth Study

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The Simple Endoscopy/Endourology Unit, within the Complex Urology Unit, is mainly dedicated to the treatment of:

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This branch of urology is characterized by operating within the urinary tract, including the uppermost urinary tracts, such as the renal calyces, with instruments inserted through the urethra (the natural canal through which we urinate) or, less frequently, through a small incision made in the side and deeper into the kidney. Transurethral procedures are used in the former, while percutaneous procedures are used in the latter. Postoperative pain is minimal, and hospital stays are significantly short. Miniaturization of instruments has enabled endoscopic/endourological procedures that were once unthinkable. For example, the "flexible" ureteropyeloscope, which is inserted through the urethra and with which it is possible to reach and operate on the ureter (the natural canal, a few mm in diameter, that carries urine from the kidney to the bladder) and from there further up into the calyceal cavities of the kidney, has an external diameter of just over 3 mm, contains optical fibers for endoscopic vision and one or two operating channels through which LASER fibers with a diameter of less than half a millimeter, forceps, baskets and anything else necessary for the planned treatment are introduced.

These procedures employ a wide variety of modern technologies, including the Holmium Laser, which is particularly effective in the treatment of urinary stones, prostatic hypertrophy (HoLEP) in patients for whom traditional endoscopic approaches are inadvisable (coagulation defects, large adenomas), and upper urinary tract tumors that do not warrant more aggressive treatments. Other technologies used include ballistic (Lithoclast) and ultrasound.

I bladder tumors, which are the most common among urinary tract tumors, undergo endoscopic resection and are sent for histological examination. This examination provides information on the type of tumor, its degree of malignancy, and the extent of infiltration of the various layers of the bladder wall. This information influences the subsequent clinical workup (whether or not complementary drug therapies such as topical immunotherapy or topical chemotherapy are necessary, whether or not bladder removal is indicated, and whether or not the patient is placed on a program of endoscopic follow-up only).

I tumors of the “upper urinary tract”When indicated, they are treated endourologically using miniaturized instruments such as the "semi-rigid" or "flexible" ureteropyeloscope described above, introduced transurethrically. They can be biopsied with forceps and immediately subjected to holmium laser vaporization or endoscopic resection. Percutaneous treatment of this pathology is rare.

La urinary stones It is subjected to endoscopic/endourological treatment when extracorporeal shock wave lithotripsy is not indicated or has been ineffective. For upper urinary tract stones (calyces, pelvis, ureters), transurethral treatment is preferred over percutaneous treatment, using a semi-rigid and/or flexible ureteropyeloscope, similar to that described for upper urinary tract tumors. Stones are removed intact, when possible, or after being crushed with a Holmium laser or ballistic energy. For large kidney stones, a percutaneous approach is used, which involves accessing the urinary tract through a hole made in the side of the kidney, deeper into the kidney, through which endoscopic instruments are inserted, the diameter of which may be no larger than a pencil. In this case, too, stones can be removed intact or after being crushed with ultrasound, a Holmium laser, or Lithoclast (ballistic energy).

La complex calculosis Treatment of the upper urinary tract may involve a combined transurethral and percutaneous approach, with two teams working simultaneously. The transurethral approach is also preferred for bladder stones, while the percutaneous, suprapubic approach is reserved for larger stones. Patients with urinary stones are also studied from a metabolic perspective to identify any factors that predispose them to stone formation and to establish effective dietary/pharmacological prophylaxis.

In accordance with the recommendations of the International Guidelines, the prevalent treatment ofprostatic hypertrophy It is the endoscopic resection “TURP”, reserving the possibility, in selected cases (for example in the presence of coagulation defects), of using alternative techniques such as laser enucleation of the prostate (HoLEP) or minimally invasive techniques aimed at vaporizing the obstructing prostatic adenoma (REZUM, greenlight laser).

When indicated, endoscopic treatment of the “bladder neck disease or dyskinesia" is performed via the "transurethral" route through an incision in the neck and prostate (cervicoprostatic incision or TUIP). If performed correctly it eliminates
obstruction of bladder emptying and minimizes the risk of retrospermia (sperm rising into the bladder during orgasm), which is of significant importance considering that the pathology is predominantly juvenile.