Minimally invasive treatments employ techniques that minimize, and often completely avoid, the larger skin incisions or injury to healthy tissues associated with traditional surgery. Minimally invasive treatments are procedures that have minimal bleeding risk and are performed under local anesthesia or intravenous sedation. Many are performed in an office setting.

Patients with a wide range of urologic problems - from benign prostatic hyperplasia (BPH) to prostate cancer to kidney stones to conditions requiring kidney removal now benefit from minimally invasive techniques. Minimally invasive procedures have many advantages over traditional urologic treatment options, such as less pain, lower costs, fewer side effects, and being able to get back to normal activities more quickly.

Endoscopy

In urology, surgeons approach many diseases of the urinary tract by endoscopic techniques, using fiberoptic telescopes that thread their way through the urethra into all parts of the urinary tract.

Prostate

With about six million American men having Benign Prostatic Hyperplasia, the most commonly used procedure is transurethral resection of the prostate (TURP), which shaves the prostate from within and requires spinal anesthesia and brief hospitalization. Four minimally invasive alternatives are transurethral needle ablation (TUNA), interstitial laser therapy, transurethral microwave therapy, and insertion of Urolme stent. All are performed in an office setting.

Transurethral needle ablation (TUNA) uses a fine needle, which is inserted through the urethra and then into several sites in the prostate to deliver the slow heat energy. Treatment takes about 30 minutes.

Interstitial laser is a laser fiber, which is inserted via the urethra into prostate tissue at several locations, and the laser heats the prostate.  Treatment takes about 30 minutes.

Transurethral microwave therapy (TUMT) uses a catheter that contains a microwave antenna, which is placed through the urethra to apply heat to the prostate. The treatment takes about 1 hour.

Insertion of the Urolome stent. This urinary tract stent is similar to the stents that are used to keep blocked coronary vessels open. This stainless steel wire stent expands in the prostate to keep an open channel. It is used for poor risk patients who have a limited life expectancy or would have problems with anesthesia, invasive prostate surgery, or delayed bleeding.

Kidney stones

Kidney stones are one of the most common disorders of the urinary tract. About one half million stones are reported in the United States each year. Kidney stones affect about 12 percent of men and 5 percent of women by the age of 70 years. The peak age for a stone is between 20 and 40 years old. Caucasians have an increased incidence as compared to African Americans. Stones are more common in hot climates and the peak incidence occurs one or two months after the hottest months.

Most visible stones in the upper urinary tract may be treated with extracorporeal shock wave lithotripsy, which delivers shock waves that fragments the stone with the patient lying on an X-ray table.  However, there may be situations, such as in patients on anticoagulation (blood thinners) therapy, where the stones may also be treated with ureteroscopy using a tiny fiberoptic scope into the ureter to visualize the inside of the kidneys, and employing laser or other forms of energy to break up kidney stones or destroy smaller tumors of the lining of the kidney or ureter. For larger stones that may have several branches or that may be too dense for ureteroscopic treatment, surgery, called percutaneous nephrostolithotomy, through a half-inch puncture in the skin into the kidney is the standard approach, avoiding the painful incision of open surgery.

Laparoscopy

Laparoscopy is the use of scopes and small instruments through small incisions (less than half inch or quarter inch) to perform surgery. While laparoscopy has commonly been used to perform gallbladder surgery, at Emory University it is used as the preferred method for kidney and adrenal surgery and has broad applications for other types of surgery.

The advantages of laparoscopy include smaller incisions to heal, a quicker recovery time, and better visualization with the use of scopes and video, providing a magnified view of the surgical field. Patients require much less pain medication, leave the hospital sooner and return to their daily activities weeks earlier than traditional open surgery.  While the large kidney tumors are still best removed by open surgery, most of the kidney and adrenal disorders are now being treated by laparoscopic techniques. Some of the urinary conditions that are being treated by laparascopic techniques include:

• Poorly functioning or atrophic (shrunken) kidneys
• Chronically infected kidneys
• Large kidney cysts
• Ureteropelvic junction obstruction (blocked kidney)
• Kidney tumors
• Adrenal masses

Some of the common laparoscopic surgeries performed at Emory University include laparoscopic nephrectomy (kidney removal), laparoscopic partial nephrectomy, Laparoscopic kidney tumor ablation, Laparoscopic pyeloplasty, Laparoscopic adrenalectomy, laparoscopic stone surgery and laparoscopic prostate surgery.

Radiofrequency Ablation

Radiofrequency ablation (RFA) of kidney tumors is performed under local anesthesia with sedation through a skin puncture in the back. This procedure is used on a wide spectrum of patients with small, single, or multiple, kidney tumors.  Radiofrequency energy, delivered via a needle probe guided by X-rays, kills the tumor cells at the site of the tumor and spares much of the unaffected kidney.

This is a relatively new procedure, which is seen as an adjunct to cancer treatment after other therapies have been utilized. RFA causes the cellular destruction of soft tissue by heating them. Heat is generated through agitation caused by alternating electrical current (radiofrequency energy) moving through tissue. The heat results in local cells coagulation: coagulated cells die and cannot continue to grow.

Using conventional imaging methods (ultrasound, CT Scan or MRI guidance), a needle electrode is positioned strategically within the area to be treated. The needle is connected to a unique radiofrequency generator and electrical current is delivered into the tissue.  An umbrella-like array of electrodes are deployed into the tumor and the more than 100 degree centigrade heat generated from the current destroys the tumor without damaging other parts of the body. As cells are heated, they are destroyed. RFA is similar to that of a microwave, where the heat is from inside out. Destroyed cells are reabsorbed by the body over time

Cryoablation

Cryobablation of kidney tumors is another minimally invasive approach to spare as much of the normal kidney tissue as possible.  This procedure uses cold to freeze the cancer at the site of the kidney tumor.

Minimally Invasive Open Surgery

Emory University offers minimally invasive surgical approaches to prostate cancer such as Mini-laparotomy, Radical Retropubic Prostatectomy (pdf) and Radical Perineal Prostatectomy. At Emory, more than 1,000 patients have now undergone Mini-lap Radical Retropubic Prostatectomy (RRP) for localized prostate cancer. This small minimally invasive surgical approach to prostate cancer results in hospitalization of two to three days with typically minimal pain following discharge. Patients have excellent continent rates of 90 to 95 percent and sexual potency rates of 66 to 75 per cent.

Brachytherapy

For prostate cancer patients who wish an alternative to surgery or radiation therapy, a popular option is radioactive seed implantation called brachytherapy, which is used most frequently in prostate cancer. This involves placement of radioactive seeds by an urologist and radiation oncologist directly into the prostate using ultrasound guidance under anesthesia as an ambulatory surgery procedure.  Most of the implants are permanent, using low dose radiation sources such as iodine or palladium. Some centers may employ higher energy sources as temporary implants, such as iridium, for the more aggressive tumors. 

At Emory, iodine seeds alone are used for the more favorable tumors, and Emory doctors reserve combination therapy with iodine seeds plus external beam radiation therapy for the more aggressive tumors.