Treatment and Surgery Restoration of 3rd Age Diseases

• Urethrotomy – Urethral Stent insertion
  Urethrotomy is an endoscopic technique which is considered as a minimally invasive procedure for the treatment of the anterior and posterior urethral strictures. The operation takes a short time and is carried out with local anaesthesia or light sedation and the proper endoscopic equipment. During this procedure, and with the aid of the optical urethrotome of only a few millimitres in diameter, we are capable of checking the urethra width, access the narrowing and, with proper handling achieve restoration of the narrowing to its normal diameter. In some cases, the surgeon may need to insert a URETHRAL STENT for a few weeks, in order for the normal diameter to be maintained. After urethrotomy, the patient may experience mild nuisance (burning sensation) during urination, as well as frequent urge to urinate. These problems do not last more than 2-4 hours and are treated with common painkillers. video

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• Female Incontinence - T.V.T. insertion
  The treatment of a problem such as incontinence, which is intensely experienced by millions of women all over the world who worry about their socialization and hygiene, is a very sensitive and important field of research.
  A relatively new method for the treatment of female incontinence is the insertion of a special support tape in the urethra (tension-free trans-vaginal tape), which reinforces the capability of the urethral sphincter to prevent involuntary loss of urine. The tape consists of a thin polypropylene mesh. It is surgically inserted through a small (2cm) incision in the vagina underneath the urethra, thus lifting it and giving it a steady supportive sling by improving its involuntary convergence, which results to perfect impermeability. The procedure lasts approximately 20 minutes, is carried out with local or epidural anaesthesia. After insertion of the tape, the patient may experience mild nuisance (burning sensation) during urination, as well as frequent urge to urinate. These problems do not last more than 2-4 hours and are treated with common painkillers.  The patient must remain in hospital for one day, while morbidity is minimal. The patient may return to her normal sexual activity in a month’s period. video

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• Male Incontinence – Artificial Sphincter Implantation
  Male incontinence is a pathological condition that can occur to men as a post-operative complication. For people with urine incontinence who do not respond to any pharmaceutical treatment or want a rapid and permanent result, the artificial sphincter implantation is the permanent solution to the problem. There are several types of sphincters among which the interested patient can select after discussion with the Surgeon Urologist. The surgery lasts for approximately 3 hours and is carried out with spinal or epidural anaesthesia.
  Making a small surgical cut (incision) at the base of the penis, the posterior urethra is identified and prepared, which is where the artificial sphincter is implanted. This is a hydraulically inflating elastic cylinder which snares the posterior urethra, is connected with a small fluid tank and a pump mechanism placed in the scrotum. By applying slight pressure on the pump mechanism, the cylinder empties the fluid and urination is possible. When urination ends, by applying slight pressure again, the predetermined fluid quantity is gathered in the elastic cylinder from the tank, thus restoring the impermeability of the urethra. One-day hospitalization is required, while there is very small post-operative morbidity. Further complications either to the patient or the prosthetic device are statistically minimum.

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• Cystocele – Vaginal Mesh Suspension Placement
  The methods for the restoration of damages in the vaginal wall due to prolapse of the internal pelvic organs, after a major surgery or due to old age are a great challenge, as regression and reappearance of symptoms is frequent.
  A new method for the treatment of cystocele is the placement of a special support – suspension mesh, which reinforces the support capability of the pelvic ground at the vaginal area, which, when weakened, allows the urinary bladder to prolapse through the vagina. The tape consists of a thin polypropylene mesh. It is surgically inserted through a small (4cm) incision in the vagina underneath the urethra, thus lifting the posterior bladder wall which prolapses and is supported in four spots at the side walls of the pelvic ground, providing steady support and improving the involuntary prolapse of the urinary bladder. The procedure lasts approximately 1 hour, is carried out with local or epidural anaesthesia. After insertion of the vaginal mesh suspension, the patient may experience mild nuisance (burning sensation) during urination, as well as frequent urge to urinate. These problems do not last more than 2-4 hours and are treated with common painkillers. The patient must remain in hospital for one day, while morbidity is minimal. The patient may return to her normal sexual activity in a month’s period.

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• Hydrocele – Surgical Restoration
  Hydrocele is the collection of fluid between the petals of the tunica albuginea of the testicle (pre-formed fibrous capsule covering the testes), and is called idiopathically elytroid. The accumulation of fluid is progressive and painless. A small incision is made in the scrotum to open the cavity of the elytroid tunica of the testis. Then the fluid is removed and the elytroid tunica is reversed and firmly fixed in order to efface the already existent cavity so as not to recur. The operation is carried out with general or spinal anaesthesia. One-day hospitalization is required, while morbidity is minimal. Possible nuisance in the scrotum area do not last more than 2-4 hours and are treated with common painkillers.

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• Ligature and Excision of the Spermatic Chord – Unilateral or Bilateral
  This operation is performed to patients with extended or recurrent infections of the testes and to men who want a permanent contraceptive method. In the latter case, however, a written consent by both the patient and his wife is required. The operation is carried out with local anaesthesia or sedation and by opening a small, 1cm incision in the inguinal area. The operation lasts approximately 30 minutes, is safe and the nuisance that may be experienced by the patient is minimum and can be treated with common painkillers. After the operation the patient must remain in hospital for a few hours for observation.  

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• Spermatocele – Surgical Restoration
  It is a small, soft cyst which contains accumulated fluid (mostly sperm) on the upper and rear part of the testis. This operation is performed by making a small incision in the scrotum in order to open the cavity of the elytroid tunica, and then identify and remove the cyst. Usually, specimen of the cyst is sent for biopsy. The operation is carried out with general or spinal anaesthesia. One-day hospitalization is required, while morbidity is minimum. Possible nuisance in the scrotal area do not last more than 2-4 hours and is treated with common painkillers.

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• Fournier Disease (Fulminating gangrene of the scrotum) – Surgical Treatment
  It is an acute infection and occurs in the external male genitalia. Surgical treatment must be immediate and consists of the surgical excision of the entire pathologic – infected tissue of the scrotum. During the operation, the testes and the spermatic chord remain intact due to the fact that the pathology concerns only the scrotal skin and are covered with vaseline compresses for a long time. The plastic-repairing restoration of the scrotum is performed after a long time period (weeks), as the main cause of the infection must first be treated pharmaceutically. The operation is performed with general anaesthesia. The hospitalization required is unknown and depends of the size of the damage and the post-operative course of the patient, while morbidity is increased.

   

  Penile Prostheses
  Among the main factors that create problems in the sexual life and the self-confidence of a man are the erectile dysfunction and the size of the penis, which sometimes affect the family and social environment of the person, creating serious psychological disorders. Further to the fact that this “problem” can be congenital, there is also a number of reasons that cause reduction of the erectile capability, such as hormonal disorders, bent penis, Peyronie’s disease, complete prostatectomy in cases of cancer and the administration of certain medications.
  Men with erectile dysfunction who do not respond to any pharmaceutical treatment, or want a rapid and permanent result, the penile prosthesis implant is the solution to the problem. There are several prosthesis types and the interested person will decide which one he will select after discussion with the Urologist Surgeon. The operation takes approximately one hour and is carried out with spinal or epidural anaesthesia.
  Making two small (approximately 2cm) incisions in the scrotum near the base of the penis (the incisions cannot be seen or noticed by the sexual partner), two hydraulically inflating elastic cylinders are implanted which are connected with a small fluid tank and a pump mechanism placed in the scrotum. By applying slight pressure on the pump mechanism the cylinders fill with fluid and penile inflation – erection is achieved. When sexual intercourse ends, by applying slight pressure again, the fluid quantity is removed from the elastic cylinders back to the tank, thus causing the penis to flaccid. One-day hospitalization is required, while there is very small post-operative morbidity. Further complications either to the patient or the prosthetic device are statistically minimum.  Despite the fact that the prosthetic implant is synthetic, the aesthetic result is excellent and cannot be noticed when the penis is either erected or flaccid. After a month’s period from the operation, the patient can achieve a normal sexual life. video

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• Penis Lengthening – Penis Enlargement Interventions
  One of the main factors that create problems in the sexual life and the self-confidence of a man is the size of the penis, which sometimes affects the family and social environment of the person, creating serious psychological disorders.
  Microphallus can occur at birth due to hormonal disorders of after traumatic injuries. In some cases the male perception on “their insufficient, small-sized penis” does not comply with medical evaluation. There is no rule defining the normal size of the penis. Great attention must be paid, by both the surgeon and the patient, to pointing out the crucial difference between the psychogenic-psychosomatic cause and the medically considered as really existing.
  With this operation, the inner part (the base) of the organ becomes visible. The incisions are not performed on the penis but in the pubic area, without any intervention to the vessels and nerves of the penis. The operation takes approximately one hour and is carried out with spinal or epidural anaesthesia. There can be no prediction regarding the penile lengthening preoperatively. It usually ranges between 2 to 4cm, and the result is permanent. One-day hospitalization is required, while morbidity is minimal.
  This operation does not only achieve repair and a good result on the aesthetic level, but the main goal is to give a solution to the functional part of the problem. For these reasons the patient must consult the special Urologist-Andrologist in order to have a correct diagnosis and the proper results.

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• Penis Widening – Penis Enlargement Interventions
  One of the main factors that create problems in the sexual life and the self-confidence of a man is the size of the penis, which sometimes affects the family and social environment of the person, creating serious psychological disorders.
  Microphallus can occur at birth due to hormonal disorders of after traumatic injuries. In some cases the male perception on “their insufficient, small-sized penis” does not comply with medical evaluation. There is no rule defining the normal size of the penis. Great attention must be paid, by both the surgeon and the patient, to pointing out the crucial difference between the psychogenic-psychosomatic cause and the medically considered as really existing.
  This operation increases the penile diameter by injecting material between the Bucks fascia and the superficial (Dartos) fascia achieving 30%-40% widening. The operation takes approximately one hour and is carried out with spinal or epidural anaesthesia. The permanence of the result depends of the injected material. One-day hospitalization while morbidity is minimal.
  This operation does not only achieve repair and a good result on the aesthetic level, but the main goal is to give a solution to the functional part of the problem. For these reasons the patient must consult the special Urologist-Andrologist in order to have a correct diagnosis and the proper results. 

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• Peyronie’s Disease – Corpora Cavernosa Plastic Surgery
  A basic anatomic element in the penile structure are the two chambers running the length of the penis called corpora cavernosa. Diseases such as Peyronie’s disease, with causes mostly unknown, cause disfiguration and bending of the penis and many times hardening of the corpora cavernosa. Thepenilecurvatures are congenital or acquired and can be caused also by injury. Sometimes the damages in the corpora cavernosa can be such than the only solution is surgery. Thetreatmentofsuchconditiondepends on the size and type of the problem.
  With this operation, the surgeon reveals the corpora cavernosa where he identifies and prepares the damage (cicatricial plaque). Depending on the location and size of the damage as well as the penile curvature, the surgeon will decide upon his further surgical approach:

  • -NESBIT I – II.
  • -Damage removal and replacement by a flexible autologous or heterologous implant.
  • -Penile Prostheses placement

   The operation takes approximately one hour and is carried out with spinal or epidural anaesthesia. One-day hospitalization is required while morbidity is minimal.
  This operation does not only achieve repair and a good result on the aesthetic level, but the main goal is to give a solution to the functional part of the problem. For these reasons the patient must consult the special Urologist-Andrologist in order to have a correct diagnosis and the proper results. 

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  Priapism - Restoration
  It is the involuntary, painful and prolonged erection which persists after ejaculation despite the absence of sexual stimulation. The cause is inability of the corpora cavernosa to empty the blood that was accumulated in them in order to achieve erection. Surgical treatment must be sought immediately (within 6 hours), if the administered medication is ineffective. The surgical repair is performed immediately in the urologist’s office, with the blood discharge through 2 Trocars (medium calibre needles) which are inserted in the penis base for quick discharge and patient’s relief. The operation does not last longer than 20 minutes and is carried out with local anaesthesia. Full recovery occurs after 2-4 days, when the patient can return to his normal sexual activities.

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• Prostate T.R.U.S. Guided Biopsy
  The Transrectal Ultrasound Guided Biopsy of the Prostate (T.R.U.S. – BIOPSY) is a diagnostic test which can achieve timely and reliable diagnosis of prostate cancer. With a thin ultrasound transducer we can have a reliable and complete image of the prostatic gland. Also with the transducer’s guidance small tissue samples are collected with a special biopsy needle. The operation takes approximately 20 minutes and is carried out with topical anaesthesia or sedation. The test is safe and the nuisance that may be experienced by the patient during and after the operation is minimal and can be treated with common painkillers. video

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• Transurethral Resection of the Prostate (TURP)
  This operation uses a special instrument, the resectoscope, which consists of a cold light lense system, faucets for the liquid flow control, and an electric loop which cuts or cauterizes the tissues performing haemostasis. We approach the prostate through the urethra. With the resectoscope the prostatic tissue is cut in small pieces. The liquid which is infused carries the pieces along into the bladder, from where they are removed. The operation is carried out with general or spinal anaesthesia, does not last longer than 1 hour and the patient remains in hospital for 2 days.

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• Transurethral Photoselective Vaporization of the Prostate – Green Light Laser
  This method is used in cases of benign prostatic hyperplasia. This is because it performs vaporization of the removed part of the prostate and there is no sample for biopsy. The operation is carried out through the urethra with an instrument similar to resectoscope, with which we insert a flexible optic fibre, the Green Light PV, which vaporizes the specific part of the prostate that we want to remove. Also, this instrument performs suction of the remaining parts of the prostate, and at the same time the tissues are cauterized and haemostasis is achieved. The operation is carried out with general or spinal anaesthesia, does not last longer than 1 hour and the patient remains 24 hours in hospital for observation. video

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