Urology

In the specialty area of Urology, we primarily work with the Karolinska University Hospital. The Department of Urology at Karolinska University Hospital is a major academic centre for urological diseases and conducts specialized and highly specialized urology with focus on surgery. Here the team of exceptional experts will customize your treatment to ensure the best possible outcomes.

The clinic has been a pioneer in Robotic surgery and the technique was initiated at the department already 2002. Today the Urology Clinic is one of the world´s leading clinics in urological surgery with a very high volume of robot assisted surgeries. Highly specialized surgeons perform more than 600 prostatectomies and about 100 cystectomies a year, always at the cutting edge to increases precision and minimize side effects. The clinic is in the research frontline of prostate cancer and bladder cancer and collaborates with major international urological centres.

In addition to the surgeons, the team includes oncologists, pathologists and radiologists as well as specially trained support staff. The all cooperate closely to provide you with comprehensive but personalized care, from counselling and treatment to end of recovery, even after leaving the hospital.

Robot assisted radical prostatectomy

If you are diagnosed with prostate cancer and surgery is a treatment option, one of the most important factors to consider is the skill and experience of your surgeon. Both oncological and functional outcomes following radical prostatectomy are related to surgical experience.

Karolinska University Hospital has pioneered robotic-assisted radical prostatectomy and robotic-assisted radical cystectomy and is one of the highest volume robotic surgery centers in Europe. The Urology clinic performs about 600 prostatectomies every year.

With the radical prostatectomy or nerve-sparing surgery performed at the Urology clinic at Karolinska University hospital, a great number of patients retain their potency and their continence. Surgeons from around the world regularly visit Karolinska to learn more about robotic surgery. Karolinska is also leading research in the potential benefits of robotic-assisted radical prostatectomy in patients previously not considered for surgery, such as:

  • Patients with limited metastatic disease,
  • Patients with a history of failed treatment from radiotherapy or other treatment modalities
  • Patients with significant co-morbidities.

Robot-assisted radical cystectomy

Cystectomy is a surgical procedure to remove the bladder completely or partially. Cystectomy is usually used to treat bladder cancer. It is a complex procedure and surgeons may use different surgical techniques, such as:

  • Open surgery, which requires one long incision to access the bladder
  • Robot assisted minimally invasive surgery, which involves several small incisions where special surgical tools are inserted to access the bladder. The surgeon sits in a console and remotely operates the surgical tools. If your bladder is removed completely, surgeons work to reconstruct the urinary tract in order to ensure that you will be able to urinate in one way or another. Several options exist:
  • Orthotopic continent urinary diversion (neobladder). During this procedure the surgeon uses a piece of your intestine to create a tube that runs from your kidneys to a small reservoir that allows you to urinate through your urethra in a relatively normal way.
  • Urinary conduit (ileal conduit or urostomy). During this procedure, the surgeon uses a piece of your intestine to create a tube that runs from your kidneys to your abdominal wall. A bag you wear on your abdomen collects the urine.

The Urology Clinic at Karolinska University Hospital has been pioneer in developing a method of totally minimal invasive approach for cystectomies where the whole procedure is done inside the body, intracorporeal.

The Urology Clinic has long experience of performing Robot assisted radical cystectomies, (RARC), and is the leading clinic today when it comes to this minimal invasive method with totally intracorporeal urinary reconstruction for patients with clinically high-risk or muscle-invasive bladder cancer.

The potential advantages of a complete intracorporeal procedure are:

  • Less intraoperative blood loss,
  • Decreased bowel manipulation and exposure,
  • Reduced insensible losses,
  • Decreased morbidity from smaller incisions,
  • Reduced postoperative analgesic requirements,
  • Shorter hospital stay
  • Earlier return to normal activities.

The procedure has demonstrated good oncological outcomes and encouraging long-term cancer specific survival rates.

The procedure has also shown good functional outcomes with intracorporeal continent diversion and high levels of quality of life after surgery.

What type of cystectomy and reconstruction you undergo depends on several factors, such as the reason for your surgery, your overall health and your preferences. Discuss your options with your surgeon to determine which procedures are appropriate for you.

In order to give you the best possible recovery, the clinic has developed an enhanced recovery program that starts directly after the surgical treatment. Once you have returned home, the staff will continue to support you through out the whole recovery process.

Nephrolithiasis

Most people get their first kidney stone before the age of 50. The lifetime risk of having a renal colic is one in ten and once you have had a stone the risk of having one more is almost 50 per cent. The most prominent symptom is intense pain, along with urgency and difficulty to void. Treatment options for renal colic include medication and placement of a urethral stent or a nephrostomy in the urinary tract. These interventions reduce the risk of having a new colic and kidney failure.

Most stones in the urinary tract resolve on their own. However, when the stones are too big or if there are anatomical abnormalities, the stones will not pass. At that stage, active treatment is necessary.

 

There are three treatment modalities for urolithiasis; extracorporeal shock-wave lithotripsy (ESWL), endoluminal laser lithotripsy with an ureteroscope (URS and RIRS) and percutaneous nephrolithotomy (PCNL). ESWL is the most common and is used for smaller stones (<20 mm) in the urethra and the kidney. URS and RIRS have the same indications while PCNL is used for bigger stones (>20 mm) in the kidney. ESWL, URS and RIRS are performed in daytime care. PCNL most often requires an overnight stay in the hospital.

The Department of Urology at Karolinska University Hospital is an academic centre for urological diseases and conducts specialized and highly specialized urological treatment with a focus on surgery. Here the team of exceptional experts will customize your treatment to ensure the best possible outcomes.

The clinic has been a pioneer in extracorporeal shock-wave (ESWL) treatment of kidney stones. Under the former professor Hans-Göran Tiselius the Kidney Stone department of Karolinska University Hospital Huddinge developed into one of the world’s leading centres for this treatment modality. In addition to ESWL we offer endoluminal and percutaneous surgery of stones in the kidney and the ureter as well as metabolic evaluation and pharmacologic treatment of patients with recurrent kidney stone disease.

Urinary Incontinence

Treatment for urinary incontinence depends on the type of incontinence, its severity and the underlying cause. A combination of treatments may be needed. We offer a wide range of surgical and medical treatments for urinary incontinence. The treatment for the patient is customized to give the best results and it is therefore of great importance that the pre-treatment investigations for urinary incontinence is meticulous. The pre-treatment work up includes an assessment of the bladder and sphincter function through cystoscopy and urodynamics.

Our surgical treatment options include slings, ProACT ™, ATOMS and the artificial urinary sphincter AMS 800™. For those having severe urinary incontinence where these surgical options may not be feasible we can also offer more extensive surgical treatments such as urinary diversions and bladder augmentations.

We mainly treat male incontinence following surgery or radiation therapy but also patients with neurological disorders causing urinary incontinence. For women with incontinence we may offer treatment options for those having already undergone incontinence surgery without improvement and for women with incontinence following surgery or radiation therapy.

Erectile Dysfunction

Erectile dysfunction (impotence) is the inability to get and keep an erection firm enough for sex. The causes for erectile dysfunction are many and they can be divided into

  • Vascular causes
  • Neurological causes
  • Hormonal causes
  • Structural causes
  • Psychological causes
  • Medications, drugs and alcohol

Patients that has undergone surgery or radiation for prostate cancer have a high risk for erectile dysfunction caused by damage to the erectile nerves.

Depending on the cause and severity of your erectile dysfunction and any underlying health conditions, you might have various treatment options, the most common being treatment with oral PDE5-inhibitors. There are also medical treatments with urethral suppositories and self-injections into the corporal bodies of the penis.

If medical therapy is not sufficient or contraindicated an erectile implant may be an option. There are different types of implants with the simplest type consisting in a pair of malleable rods surgically implanted within the corporal bodies of the penis. With this type of implant the penis is always semi-rigid and merely needs to be lifted or adjusted into the erect position to initiate sex. This type of implant is a good choice for men with limited dexterity or high risk of developing infection after surgery. Today, it is more common to choose a hydraulic, inflatable implant. The implant consists of two inflatable cylinders placed in the corporal body, a pump placed in the scrotum and a fluid reservoir placed under the muscles of the abdominal wall. This implant gives a more natural look and feeling, both in the erect and flaccid state.

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