Urology Staff Utilizing Latest Technology at TBHC By Rajveer Purohit, MD, MPH

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Urology Staff Utilizing Latest Technology at TBHC By Rajveer Purohit, MD, MPH

November 20, 2005

History
Urological diseases are as old as human history. In fact, bladder stones have been found in mummies dating back to over 5,000 years. Kidney and bladder stones were common, but the side effects of surgery were as painful and deadly as the stones themselves. The risks of surgery were so high that Hippocrates, whom some consider the father of medicine, prohibited any treatment for kidney stones over 2,400 years ago. His oath, still taken by student doctors today, urges surgeons to "not use the knife, not even on sufferers from stones" and shy away from "such men as are engaged in this work." Fortunately, technology has progressed, and most urologists are not detested as back-alley stonecutters. During the Renaissance in Europe , surgeons traveled from city to city throughout Europe offering surgeries to remove stones. Although ancient Chinese physicians advised placing onion leaves in the urethra to help open the urinary channel for urination, by the 1700's, Benjamin Franklin had designed an early metal version of the urinary catheter in America to allow his brother and, possibly, himself to urinate. Technological advancement has been critical to the development of modern urology and increasing the comfort of patients.

Modern Times
The critical step into modern medicine in urology began with the creation of special instruments that allowed urologists to visualize the urinary tract. These instruments included lighting and sophisticated lenses to allow urologists to see inside the bladder, and later, the inside of the kidney. One of the next modern breakthroughs was the development of sound shock waves to break apart kidney stones. The technology developed after World War II, when scientists investigated why lung tissue in castaways were damaged from the explosion of water bombs. Over the ensuing decades, researchers were able to harness the power of these sound waves and use them to improve health. In the first machines, patients with kidney stones were submerged in a bathtub while shock waves were targeted at them. Sound waves travel harmlessly through the water and body tissues and focus their destructive energies on the stones. Newer machines are an important part of the urologist arsenal against kidney stones.

Recent developments
In the last few years, lasers have been increasingly used by urologists. Lasers harness energy from light and permit that energy to be directed towards a particular point. There are different types of lasers, and each has unique properties best suited for certain problems. One of the most commonly performed procedures using lasers is laser lithotripsy. In this technique, kidney stones are to be broken up using fine instruments that allow the urologist to get into the kidney and bladder, and pulverize the stones with the laser. Benign prostatic hyperplasia - a condition in which the prostate becomes very large and causes urinary problems in men - is often treated with lasers which allow surgeons to open a wider urinary channel through the prostate by vaporizing tissue. Lasers allow surgeons to decrease blood loss and permit patients to go home the same day as surgery with minimal discomfort. Lasers have also been used to treat skin lesions, strictures of the urethra, and certain types of cancers with minimal side effects and less pain for patients.

Laparoscopy and Robots
Over the last decade, the use of laparoscopy has exploded. Laparoscopy is a technique where a few small incisions are made in the abdomen (rather than one very large one) to allow small instruments, including a camera, to perform complex surgeries. The first purely laparoscopic nephrectomy (kidney removal), nephroureterectomy, and pyeloplasty (using complex laparoscopic suturing techniques) were performed at The Brooklyn Hospital Center during the past year. These techniques have allowed patients to recover much more quickly from their surgeries with less pain and fewer complications.

Recently, robots have increasingly begun to be used to perform urological surgeries. These robots are not quite the same as a human-like machine you may have seen in space movies. The robotic machine uses arms attached to laparoscopic instruments, and sits next to the patients during the operation. The surgeon still controls the robot's arms and instruments, but he can sit in another room and manipulate the robot to perform very detailed surgeries that would be difficult to do by standard laparoscopy alone. Because the lead surgeon does not need to be in the room at the time of surgery, it is not too difficult to imagine a future in which military surgeons in the United States may be able to operate on injured soldiers in distant countries. Another possibility being investigated by NASA is the use of robotic surgery on sick astronauts. Specialized surgeons on earth may be able to direct the movements of the robot to treat sick spacemen. Within the next ten years, the use of robotic surgery is likely to become much more widespread - in the future, you may not think twice about being operated on by a machine!

Prevention
Perhaps some of the most significant gains that will occur in the future will be in prevention and treatment. Researchers are working on vaccines against prostate cancer that would contain benign viruses, which stimulate our bodies' own immune systems against prostate cancer. A lot of recent research has focused on genetically analyzing prostate cancer. With new laboratory techniques using tools such as DNA microarrays, it is possible to analyze over 50,000 genes being expressed at a particular time in one patient. Unlocking the mystery of all these genes may help predict, for example, which patients will form deadly prostate cancers and which will not.

Technological developments have continued to characterize the field of urology and are extensively utilized by The Brooklyn Hospital Center Urology Staff. The future of urology will clearly be one driven by large technological advances, and ultimately, patients will increasingly benefit from these advances.

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