Uro-oncology
Uro-oncologic surgery is one of the doctor’s core areas of expertise. The approach rests on two principles: step-by-step, accurate diagnosis and organ-sparing surgery whenever possible.
Last updated:
Step-by-step diagnosis
1. Initial assessment
Symptoms, risk factors, physical examination, urinalysis and ultrasound. Blood in the urine is always taken seriously.
2. Imaging
Computed tomography (CT), MRI and, if needed, contrast urography are used to determine the precise location and extent of the tumor.
3. Confirmation
If doubt remains, an endoscopic examination or a biopsy is performed. For the prostate, MRI–ultrasound fusion biopsy offers higher diagnostic accuracy.
Surgical areas
Kidney tumors
When the size and location of the tumor allow, removing only the tumor (resection) is preferred; when that is not possible, a laparoscopic or robotic radical nephrectomy is performed.
Prostate cancer
Treatment depends on the stage and risk group: active surveillance for low-risk disease; radical prostatectomy (laparoscopic or robotic) or radiation therapy for non-metastatic disease; and drug therapy for disease that has spread. The decision is made individually, together with the patient.
Bladder cancer
Visible blood in the urine — even if it is painless and happens only once — always requires a urological evaluation. The first steps are a urine test and an ultrasound, but these two tests alone cannot rule out bladder cancer: cystoscopy (a camera examination of the inside of the bladder) and imaging of the upper urinary tract (CT urography) may be required. Treatment depends on how deeply the tumor has grown and on its stage. If the tumor has not grown into the muscle layer of the bladder, a transurethral resection of the bladder tumor (TURBT) is performed endoscopically; depending on the risk group, it may be followed by placing medication directly into the bladder (instillation), and regular follow-up is needed because the tumor can recur. If it has grown into the muscle layer, more extensive treatment is usually required, such as radical cystectomy (complete removal of the bladder). The treatment plan is tailored to the stage and to the patient’s overall condition.
Upper urinary tract tumors
Tumors of the ureter and renal pelvis are rare, but they can present with blood in the urine and require the same principles of evaluation and follow-up.
A cancer treatment plan requires a multidisciplinary decision, and no text on the internet can replace an individual treatment plan. If a tumor is suspected, see a doctor without delay.