A Robotic Radical Prostatectomy for patients who may benefit from bilateral nerve sparing Radical Prostatectomy. David however still offers laparoscopic and open radical prostatectomy depending on the specific cancer. There is very little difference between a robotic and a 3D laparoscopic procedure for prostate cancer although many believe that a robotic procedure makes nerve sparing easier.

A Radical Prostatectomy involves removing the prostate and seminal vesicles to treat localised prostate cancer. Traditionally this is performed through a cut in the lower abdomen. A laparoscopic radical prostatectomy is performed through five key hole incisions in the lower abdomen under a general anaesthetic. The key hole approach to this surgery means that there is less bleeding, less post-operative pain and a rapid return to normal activities. A catheter tube drains the urine from the bladder into a bag for 10-14 days. This tube is removed in the rooms after discharge. Hospital stay is typically 1-2 days and you need to avoid heavy lifting for six weeks to allow the wounds to heal. Return to work is variable and depends on occupation and how physical your job is. If your job is sedentary you may return to work after two weeks. The magnification during surgery also means that a precise nerve sparing procedure can be performed, when appropriate, to preserve erections after surgery. Results for potency are, however, surgeon dependent and you do need to ask your surgeon what his/her results are for erections after surgery. Regardless of how a radical prostatectomy (open or laparoscopic) is performed there is a risk of incontinence (5%) that persists beyond three months and impotence (30%). It is worth noting that every man can be helped to have an erection after surgery using a variety of methods that you can discuss with your surgeon. A laparoscopic radical prostatectomy is a good alternative to a robotic prostatectomy if your insurers will not fund a robotic procedure. 3D laparoscopy has been a major advance in the last three years giving superb vision and depth perception for laparoscopic surgery. For Southern Cross members David Merrilees performs this procedure as an Affiliated Provider with a fixed cost.

Laparoscopic Partial Nephrectomy is now available for selected kidney tumours and allows a minimally invasive approach to remove the tumour/cancer while leaving the rest of the kidney functioning. Traditionally the concern with partial laparoscopic nephrectomy has been the ability to control blood loss, however the development of the sliding clip technique has allowed us to introduce this procedure to Auckland with good results. There is an obvious benefit to overall kidney function if it is possible to remove the kidney tumour and leave the rest of the kidney behind. Laparoscopy or keyhole surgery allows a faster recovery and earlier return to work than open surgery and is therefore, where possible, a good solution to removing a small kidney cancer. Many central kidney tumors however may be best removed with an open partial nephrectomy or a radical nephrectomy.

Traditionally kidney cancer is treated by removing the malignant growth in the kidney via an open operation. David performs key hole or laparoscopic kidney removals for both benign and malignant conditions. This surgery is typically performed using four key hole incisions through the abdomen. The lowest key hole is extended at the end of the surgery to remove the kidney so that it may be analysed in the lab. This means that recovery from surgery is similar to having your appendix removed. Hospital stay is typically 3-4 days and it takes 30 days to return to normal activity on average. Cancer control rates are equivalent to open surgery. All tumours in the kidney up to 10cm in size should be considered for a laparoscopic nephrectomy. As with other key hole surgery there is less pain, bleeding and a faster recover with a laparoscopic nephrectomy compared with open surgery.

Key hole surgery can be performed to correct a congenital blockage to the flow of urine out of the kidney into the tube that drains urine to the bladder (ureter) – traditionally this surgery is performed through the flank above the 12th rib via an open incision. It takes 90-120 minutes to perform and patients are typically discharged on the first or second post-operative day. Four small key holes are used for the surgery. This is now the gold standard operation to treat a PUJ obstruction.

Urinalysis is a test that examines the content of urine for abnormal substances such as protein or signs of infection. This test involves urinating into a special container and leaving the sample to be studied.

This term means protein in the urine and may indicate that there is a problem with your kidneys.

This term means blood in the urine and may be the result of inflammation or other problems with your kidneys, blockages in your ureter, infection or other problems with your bladder or problems with your prostate.

A UTI is caused by an infection in the urinary tract. Women get UTIs more often than men. UTIs are treated with antibiotics. Drinking lots of water also helps by flushing out the bacteria. If the infection is in the bladder it is called cystitis. If the infection is in the kidneys it is called pyelonephritis.

Urinary incontinence or loss of bladder control is the involuntary passage of urine (passing urine without meaning to). There are many causes and types of incontinence, and many treatment options. Treatments range from simple exercises to surgery. Women are affected by urinary incontinence more often than men.

Urinary retention, or abnormal holding of urine in the bladder, is a common urological problem. Possible causes of acute urinary retention (sudden inability to urinate) include a blockage in the urinary system, stress or nerve problems. Chronic urinary retention (some urine is always left in the bladder after emptying) may be caused by bladder muscle failure, nerve damage, or obstructions in the urinary tract. Treatment for urinary retention depends on the cause.

What causes bladder cancer is not always clear, but the risk of developing bladder cancer can be increased by smoking, getting older, long term bladder problems and unsafe exposure to aniline dyes which are used in some industries. Bladder tumours usually form in cells lining the bladder. Once a tumour begins to enlarge, it may stay in the lining or grow into the wall of the bladder. If untreated, the tumour may then grow into other structures such as lymph nodes. If the cancer enters the bloodstream it may spread to other areas of the body (metastasis). Often the first symptom noticed is blood in the urine, other symptoms such as needing to pass urine more often or feeling as if you need to go but can’t affect about 1/3 of people with early bladder cancer. As the tumour grows these symptoms affect more people. The first test to diagnose bladder cancer is usually a urine sample. Sometimes a tube will be inserted through the urethra and the bladder will be washed with liquid to try to wash out some cancer cells for diagnosis. If cancer is suspected, the next step is usually a cytoscopy (a tube to allow the doctor to look inside the bladder). If there is to be a tumour the doctor can take a small sample (biopsy) for testing. CT or MRI scans are also used to scan the body to see if the cancer has spread to other areas. Treatment depends on the size of the tumour and how much it has grown into the bladder wall. Surgery may be considered especially if the tumour is still small. The surgeon can insert a cytoscope through the urethra and cut out the tumour or burn it away. If the tumour has grown more deeply the surgeon may cut open the abdomen and remove some or the entire bladder (a partial or full cystectomy). If the whole bladder is removed an artificial bladder will be created on the inside or a urostomy bag on the outside. Radiotherapy (an x-ray beam) can be used as the main treatment in some people and in others may be used after surgery to remove any remaining cancer cells. In early cancer, drugs (chemotherapy) or another treatment called BCG may be placed directly into the bladder to kill cancer cells (intravesical treatment). Usually though, chemotherapy is used in the later stages where it can attack cancer cells throughout the body (not just the bladder) and help stop the cancer spreading.

This term refers to stones in the urinary system. They form in the kidneys but can be found anywhere in the urinary system. They vary in size and the amount of pain they cause. Many of these stones can pass though without help but some require medical intervention. Extracorporeal shockwave lithotripsy (ESWL) is the most frequently used procedure for the treatment of kidney stones. In ESWL, shock waves that are created outside the body travel through the skin and body tissues until they hit the denser stones. The stones break down into very small particles and are easily passed through the urinary tract in the urine.

Kidney failure occurs when the kidneys cannot remove waste products from the blood or control the amount of water in your body. Acute kidney failure occurs suddenly and may be the result of injury, loss of large amounts of blood, drugs or poisons. Kidneys may return to normal function if they are not too badly damaged. Chronic renal failure means a slow decline in kidney function, which may not be noticed immediately. If renal function continues to deteriorate dialysis may be needed.

This is an enlargement of the prostate gland. In BPH there may be difficulties in passing urine as the enlarged prostate can cause a blockage. Patients with BPH often notice an increased urge to empty the bladder, especially at night. Many men over 60 years of age have some BPH. There are many different treatment options available for people with BPH. Most commonly your doctor can prescribe tablets to improve urinary function.

This is the term used to describe inflammation of the prostate gland. Symptoms can include increased need to pass urine and pain on passing urine as well as perhaps lower back pain. Sometimes this inflammation is due to an infection and an antibiotic will be prescribed, otherwise pain relief medication may be prescribed.

Prostate cancer typically consists of many very small, tumours within the prostate. At this stage, the disease is often curable (rates of 90% or better) with standard treatments such as surgery or radiation. Unfortunately, at this stage the cancer produces few or no symptoms and can be difficult to detect. If untreated and allowed to grow, the cells from these tumours can spread to other parts of the body in a process called metastasis. Once the cancer has spread beyond the prostate, cure rates drop dramatically. In most cases, prostate cancer is a relatively slow-growing cancer, which means that it typically takes a number of years for the disease to become detectable, and even longer to spread beyond the prostate. However, a small percentage of patients experience more aggressive forms of prostate cancer. Treatments options for prostate cancer include surgery, radiation, hormone treatment and chemotherapy. Which treatment is chosen depends on factors such as the stage of the cancer and the patient’s age, other health issues and willingness to undergo certain procedures or therapies – some of which may have side effects.