eISSN: 1896-9151
ISSN: 1734-1922
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vol. 2

What is new in medicine
What is new in urology?

Dirk P.J. Michielsen
Johan G. Braeckman

Arch Med Sci 2006; 2, 1: 66-67
Online publish date: 2006/03/23
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Though surgery remains the major activity of most urologists, in 2005 most of the progress in urology was obtained in the field of diagnosis and medical treatment. To create a comprehensible picture, we divided urology in smaller subspecialties like kidney stones, urological oncology, incontinence, other voiding disorders and erectile dysfunction. Obvious improvements in the diagnostic approach and therapeutic planning are presented.
Kidney stones
CT scanning has become an important tool for the diagnostic work-up of renal and ureteral stones. Today, intravenous urography is stepping out of the picture. The switch from IVU to CT goes with some benefit and some disadvantages. The CT images of the urinary tract (URO-CT) are created without the use of contrast agents, an important advantage for patients with contrast- -allergy. As the whole abdomen is scanned, concomitant or extra urological pathology may also be demonstrated. This is also a big advantage in cases of obscure diagnosis like patients with renal colic or other type of pain in the emergency department. But there are also some problems. First of all, there is a logistic problem as CT machines are not always available. Furthermore, good interpretation of the images is difficult and most of the time the assistance of a radiologist is appreciated. Some information with particular interest for the urologist, like the possibility of percutaneous access to the renal calyx or the exact location of a stone, may be missed. However, 3D-reconstruction can solve this problem and one should ask for this computed image reconstruction whenever necessary.
In the therapeutic area, a tendency towards minimal invasive surgery persisted. Kidney stones are treated by extracorporal shock wave lithotripsy (ESWL) or percutaneous litholapaxia, both valuable techniques with an indication depending upon the exact location and the size of the stones. Smaller stones may also be treated through the ureterorenoscope with the help of Laser destructive energy. Ureteral stones are more frequently treated by ureterorenoscopy rather than ESWL. With ureterorenoscopy one needs general anaesthesia, but the cured rate in one intention to treat is quite higher and there are fewer postoperative problems.

Urological oncology
Most urologists agree that oncology is their most important subspecialty, with prostate cancer lonely at the top. Rectal examination and PSA are “golden...

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