UROLOGY FOR WOMEN

Urology is a medical specialty which treats the diseases of the urinary appliance of both sexes and genital masculine organs. This specialty attends children and adults of both sexes. The organs covered by urology include: Adrenal gland, kidney, urethers, bladder, prostate, seminal gall bladders, penis and bag scrotal with testicles and epididymis.

Click on the link below to know each organ in details.

Adrenal

The adrenal glands, also known as adrenal, are located in the retroperitoneum, attached to the upper and medial portions of the renal poles. The gland is divided into the cortex and medulla, which are woven of great activity of hormones, peptide-producing endocrine and neurotransmitters.

The most common diseases that affect the adrenal glands include cortical and medullary tumors.

Cortex tumors are classified as functional and non-functional, depending on whether or not there’s endocrine manifestation. Non-functioning tumors enshrined the term incidentaloma (found casual). The engines are manifested as expansive processes or masses, discovered in the clinical investigation of symptoms and signs peculiar to each type of basic disease due to the secretion of hormones by the cortical layer, or incidentally from imaging scans made with other objectives. The clinical expression of abnormal hormone production stems from the type of hormone produced, what, ultimately, is the product of the histological layer involved in tumoral process.

Aldosterone-producing tumor (hormone produced by the suprarenal) comes from the outer layer of the cortex, the zona glomerulosa, which gives the synthesis of mineralocorticoids. The clinical manifestation is the increase in the circulating blood volume (hypervolemia), arterial hypertension with low Renin, potassium low high, aldosterone, known as primary hyperaldosteronism.

Other tumors of the adrenal cortex are producers of corticosteroids that translate clinically by classic Cushing Syndrome, those producers of sex hormones, which cause virilization or feminization.

There are centripetal obesity (face and torso) face full moon, giba, violaceous streaks, acne, menstrual irregularity, muscle atrophy, sexual impotence, hypertension and diabetes mellitus.

There's usually a urologist's integration with the endocrinologist in the conduct of these patients.

Tumors of the adrenal Medulla are the pheochromocytoma, neuroblastome and ganglioneuroblastome ganglioneuroma.

There are Stromal Tumors, vessels and nerves, cortical hyperplasia, cysts and pseudocysts, infections and abscesses and metastatic tumors.

The most appropriate and effective way of treatment of adrenal tumors is surgical removal.

Laparoscopy can be used successfully to excision and today is the technique used by most of the developed world.

· Kidney

Kidney diseases are divided into benign and malignant.

Obstructive diseases, malformations, diseases of forming kidney stones, urinary tract infectious diseases are benign and can be handled in certain situations with remedies and other surgeries. These are designed to correct the malformations, unblock and remove the stones. Each situation must be examined by a urologist and treated individually.

Sometimes, even in benign disease is necessary the removal of the kidney by surgery. The laparoscopic technique is much used today because it is a minimally invasive technique. There are clinical benign diseases that compromise the renal function and, in these cases, often the treatment is done in teams between a nephrologist (a specialist who treats the clinical diseases of the kidneys) and an urologist. The best example of this is the situation that occurs when a patient loses kidney function and requires replacement of the kidney. The nephrologist does the clinical treatment, uses the artificial kidney (haemodialysis or peritoneal dialysis), prepares the patient for a transplant and the urologist does renal transplant surgery. Again the nephrologist takes sick and makes the patient monitoring transplanted.

Malignant diseases are represented by neoplasms.

Currently are diagnosed more than 200,000 new cases of kidney cancer with index of lethality over 100,000 deaths, the majority attributed to renal cell carcinoma, one of the most aggressive tumors in urological area. Cases diagnosed early, with tumors confined to the kidney, disease-free survival has in 5 years 80-90%, falling to 50-60% in cases of locally advanced disease. Your prognosis is dependent on the stage of disease at diagnosis. The radical nephrectomy is the classic form of treatment of this neoplasia.

In the last two decades, the widespread use of imaging studies of the abdomen-ultrasonography, computed tomography and magnetic resonance imaging-has been responsible for the increase in the diagnosis of renal cell carcinoma. As a result, the incidental detection of renal tumors 4 cm only early-stage, metastatic potential, increased significantly. In this way, the majority of 76%, injuries that present themselves to surgical treatment is ≤ the 4 cm and 86% are T1 stage at diagnosis. Early diagnosis translates into greater survival of patients with kidney cancer and lower rate of disease progression.

During the past decade, the management of these small tumors underwent a major evolution with saving surgery of nephrons, i.e., retires just the tumor and if it preserves the good part of the kidney. This technique achieves survival rates between 90-100% in 10 years.

Some renal cysts can be malignant. There is a classification known as Bosniak which goes from I to IV. The cysts Bosniak type I and II are the only observation. On the other hand, the cysts classified as Bosnisk IV may be cancer and should be treated as such.

Ureters

The ureters start at what we know with funnel or renal pelvis and end in the bladder. The joint of the pelvis with the ureter known as JUP can present malformation causing difficulty in emptying of urine and needs often a plastic correction, pyeloplasty.

By being an organ of transit in the urine, is in the ureter that have the main causes of urinary tract pain known as renal colic. A calculation can cause a lot of pain to be expelled. 75% of the calculations are eliminated spontaneously and 25% require some type of treatment.

Today it is widely used to power sources and ureteroscopy for fragmentation and subsequent withdrawal of these calculations. The energy source considered most effective is the Laser. Reflux disease, defect in the bladder input that allows urine to the rim at the time of urination, is treated in a clinic and also, depending on the degree of surgical way. Currently this treatment is done, most of the time, endoscopically visualized.

Urothelial cancer can have location within the collector system within the kidney, ureter and bladder. When the tumor is located in the ureter often becomes necessary to remove the entire unit of the affected side.

The urologist requires removing the kidney to the ureter and bladder part where the ureter to deploy.

Bladder

The urinary bladder is the organ that collects urine excreted by the kidneys before disposal by urination. Benign bladder diseases are more common in women: the urinary infections, anatomical changes known as prolapse or drooping bladder, and urinary incontinence. The non-complicated urinary tract infections usually respond well to medical treatment, as well as changes of function known as neurological disorders of the bladder.

Worldwide the bedwetting is a common problem that affects up to 45% of adult women by reflecting often on deterioration of social life. The most common form is stress urinary incontinence, followed in frequency by urgency incontinence caused by overactive bladder. Because of the shame, the taboo and ignorance of the existence of possible treatments, only a women minority who suffer from incontinence, seek a professional. The World Health Organization defines health not only as the absence of disease but also as well being physical, emotional and social.

The incontinence and urinary prolapse are normally treated by minimally invasive, calls surgeries with use of synthetic fabrics: urinary incontinence by urethral hypermobility with slings and prolapses by minimally invasive approach through high. The screens through vaginas are falling into disuse.

Malignant diseases of the bladder are very difficult to treat, because there is a reservoir in lieu of optimally. Sometimes, one can make a scraping and using vaccines such as BCG, Onco-other times, however, it is required the surgical removal of the bladder. As we need to give a target for urine, we call "deriving incontinence".

Urethra

The urethra is a tube that connects the urinary bladder to the outside of the body.

In males, the urethra is the conduit for semen during sexual intercourse. It also serves as a passage for urine to flow. In females, the urethra is shorter and emerges above the vaginal opening.

The external urethral sphincter is a striated muscle that allows voluntary control over urination.

Urethra diseases

  • Hypospadias and epispadias are forms of abnormal development of the urethra in the male, where the meatus is not located at the distal end of the penis (it occurs lower than normal with hypospadias, and higher with epispadias). In a severe chordee, the urethra can develop between the penis and the scrotum;
  • Infection of the urethra is urethritis, said to be more common in females than males. Urethritis is a common cause of dysuria (pain when urinating);
  • Related to urethritis is so called urethral syndrome;
  • Passage of kidney stones through the urethra can be painful, which can lead to urethral strictures;
  • Cancer of the urethra.

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ROBOTIC SURGERY

Na década de 1980 as cirurgias endoscópicas e laparoscópicas deram um grande salto com o advento das microcâmeras.

Surgiram os primeiros robôs médicos, como o braço robótico PUMA 560, que em 1985 auxiliou uma biópsia durante uma neurocirurgia.

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MIRANDOLINO'S TECHNIQUE

Em 1999 o Dr. Mirandolino Mariano faz a primeira cirurgia por laparoscopia, publicando o relato de caso da técnica pioneira em 2002, no Journal of American Urological Association.

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