Recent innovations in urology have enabled clinicians to preserve the kidney and, with it, kidney function for their patients.
Memorial Sloan Kettering researchers showed that kidney-sparing operations can have similar oncologic outcomes as the radical procedures performed in the past for certain types of renal masses.
Metastatic clear cell renal cancer (ccRCC) with bone metastases, however, requires complete surgical removal of the affected kidney and often other organs.
Partial Nephrectomy
Many kidney tumors are best treated with a procedure called partial nephrectomy. In this minimally invasive surgery, the urologist removes only the diseased portion of your kidney. It is also known as kidney-sparing surgery and nephron-preserving surgery.
During the surgery, the urologist will make an incision in your flank, the fleshy area on the side of your body between your hip and ribs. Then, they will temporarily block blood vessels that carry kidney-related fluids. They may also place a small tube inside, called a drain, to collect fluid from around the kidney. This will help to reduce the amount of fluid that accumulates after your operation.
Laparoscopic and robotic partial nephrectomy helped as an effective kidney cancer treatment Melbourne for patients with small (4 cm) renal tumors while sparing the remainder of their healthy kidneys. It has become the standard of care at most major centers. However, for larger kidney tumors or those that extend into the renal vein, vena cava, and/or surrounding structures, open surgery is often necessary.
Most patients with small kidney tumors who can tolerate the surgery will be candidates for a laparoscopic or robotic procedure. This minimally invasive approach offers patients shorter hospital stays, reduced pain after the operation, and a faster recovery. It is especially beneficial for patients who are not good candidates for traditional open surgery due to advanced age, poor health, or other medical conditions.
Radical Nephrectomy
Recent innovations in surgical techniques have allowed us to preserve kidney function during surgery for many patients with renal cell carcinoma.
When the cancer is localized, doctors may recommend removing only the diseased portion of the kidney (partial nephrectomy) or the entire kidney along with the tube that leads to the bladder (ureter), the gland that sits on top of the kidney (adrenal gland), and a portion of the fat around the kidney. If the tumor is near a rib, the surgeon may also remove that rib.
A surgical team performs the procedure while you’re asleep and pain-free with medicine (general anesthesia). Your surgeon will make a cut on your side, usually below or over your lowest ribs. Then they’ll remove the kidney, part of the ureter, the adrenal gland, and some of the surrounding fat.
For stage 2 cCRC, the goal of radical nephrectomy is to remove as much of the cancer as possible to increase the effectiveness of subsequent radiation therapy or chemotherapy. The team may also give you the drug pembrolizumab (Keytruda) to shrink or destroy any remaining cancer cells that surgery might miss.
Transurethral Resection of the Ureter (TURU)
TURU is used to treat cancers that affect the kidney through the ureter. The procedure is performed under local anesthesia through a small incision near the affected area. During the procedure, a thin tube called a cystoscope is inserted into the ureter. The urologist then uses a small tool called a ureteroscope to cut the tumor and remove it from the body.
The success of this treatment depends on the size of the tumor, where it is located in the ureter, and whether or not it has spread to other tissues. Patients with large tumors may require a longer surgery time than those with smaller ones. During the surgery, the urologist may also need to use a urinary diversion device to drain urine from the bladder.
PET scanning has unique characteristics that make it an important tool for assessing renal function and diagnosing kidney diseases. Its superior sensitivity enables the detection of tracer uptake by the kidneys and allows for dynamic three-dimensional imaging. In addition, PET images can be co-registered with CT scans for better visualization of the underlying anatomy.
A recent study found that patients who received simple dismissal instructions after robot-assisted radical prostatectomy were less likely to call with questions or visit the emergency department. The research team hopes that these results will help inform the future care of prostate cancer patients.
Transurethral Resection of the Prostate (TURP)
Men with a large prostate experience symptoms of benign prostatic hyperplasia (BPH). The symptoms include burning sensations during urination, blood in the urine, and the need to urinate frequently. These symptoms may increase as the prostate enlarges with age.
The prostate gland is a walnut-sized organ that surrounds the urethra, which carries urine from the bladder to the penis. It also makes some of the fluid that mixes with sperm to make semen. The prostate is located just below the bladder and behind the testicles, and the urethra passes through it. If the prostate gets too big, it can press on the urethra and block the flow of urine.
To perform TURP, the urologist inserts a soft, flexible tube into the urethra. The resectoscope is attached to an electrical loop that can cut or chip away overgrown prostate tissue.
When performing a TURP, the surgeon should avoid removing tissue more distal than the verumontanum, or “very.” This is the area closest to the external sphincter muscle and can be easily injured. This could result in a bladder tamponade that requires evacuation or even a blood transfusion.
In conclusion, advancements in urological techniques, particularly kidney-sparing operations like partial nephrectomy, have revolutionized kidney cancer treatment. These minimally invasive procedures yield comparable outcomes to traditional radical surgeries, preserving kidney function and expediting patient recovery. In cases of metastatic clear cell renal cancer (ccRCC) with bone metastases, comprehensive surgical approaches remain essential.
Innovative treatments such as transurethral resections target kidney-related issues affecting the ureter, while precision surgeries like transurethral resection of the prostate (TURP) benefit men with benign prostatic hyperplasia (BPH), improving urinary functions. If you reside near Melbourne, visit the website www.pereraurology.com and learn more about these.
The integration of PET scanning enhances diagnostic accuracy, aiding in personalized care. Recent research highlights the significance of postoperative guidance in optimizing patient outcomes.
These advancements in urology underscore a promising path in kidney cancer treatment, offering more effective and minimally invasive solutions while prioritizing patient well-being and improved care.
