Popular science | that little thing about urology

Hello everyone.

I am Dr. Tang Yuzhe from Tsinghua Chang Gung Memorial Hospital in Beijing. Today we have a talk about what diseases urology includes and what treatments are commonly used at present.

First of all, let's briefly introduce what is urology? Urology, as its name implies, can be divided into two parts: urology and surgery. Urology refers to the treatment of the urinary system, and surgery refers to surgery as the main means of treatment to solve the problem. According to the anatomical location, urology mainly includes adrenal gland, kidney, ureter, bladder and urethra, and the male genitourinary system is also combined, so the male urinary system also includes penis, scrotum, testis and prostate. Female urinary system and reproductive system are independent, female urinary system belongs to urology, while female reproductive system belongs to gynecology.

If classified according to the types of diseases, the common diseases in urology can be mainly divided into the following categories:Urinary neoplasms, urinary calculi, urinary trauma, genitourinary infections, genitourinary malformations, adrenal diseases, prostate diseases, andrology.

Healthy kidney (left) and renal tumor (right)

Urinary calculi often cause back pain, hematuria and other symptoms.

Urinary trauma caused by various causes

Deformities of genitourinary system and andrological diseases

Prostate disease

Adrenal gland disease

Urology is the pioneer of minimally invasive surgery, minimally invasive treatment covers almost all diseases of urology, the development of minimally invasive surgery is inseparable from the progress of surgical equipment and instruments in recent years, here we come to a minimally invasive urology surgery "past life and present life".

01

As early as 400 BC, Hippocrates, the famous father of medicine in ancient Greece, gave a detailed description of the diseases of urolithiasis in urology. "the ipsilateral kidney, back, waist and testis felt sharp pain, and the number of urination increased. Then urination decreased. With the discharge of sand and stone, it causes severe pain when passing through the ureter. The sand and stones are discharged and the pain stops. " This is the earliest record of urological diseases in the world. With the development of the times, urology has gradually separated from general surgery into an independent discipline. In the past 200 years, minimally invasive therapy is in the ascendant, which is the golden period for the development of minimally invasive therapy in urology.

In 1804 the German Phillip Bozzini Barzini invented the world's first photoconductor endoscope, which could directly observe in vivo, including urethra, oral cavity, nasal cavity, etc., and tried to overcome the main challenge of endoscopy, the problem of optical treatment. It consists of an optical component, a lighting device and a mechanical part. The head end adapts to different anatomical structures of the body by changing the head end components.

In 1806, in the eleventh year of Jiaqing of the Qing Dynasty, this endoscopic device was first applied to the human body, a professor of the Vienna Academy of Medical surgery.

Cystoscope based on platinum fiber

The appearance of indirect cystoscope with internal light source and optical system in 1879 also represented the birth of modern urological equipment.

In order to record cystoscopic images, Georg Wolf in Germany in 1908 was the first to apply a camera to cystoscope.

Cystoscope with flash color photography and optical fiber lighting was first introduced in 1966. (image above)

But at this time, the endoscope still faces a problem, that is, the light transmittance and image quality of the optical system are very poor, and the minimally invasive surgical endoscope needs a narrow space to provide high quality image quality. at this time, a British physicist Harold Hopkins uses a cylindrical lens instead of the original air to isolate the space, which increases the brightness of the light source by 8 times, at the same time, the image quality is significantly improved, and the field of view of the image is obviously enlarged. Hopkins registered the patent of cylindrical lens system in 1959. Karl Storz bought the patent and produced Hopkins cylindrical lens system endoscope in 1967, which opened the long road of cooperation between Hopkins and Storz. 1967 is the real birth year of modern endoscopic equipment. This is the first milestone in the history of endoscopic system, laying the foundation of contemporary endoscopic imaging system. Until now, the endoscopic equipment used in clinic is hospkins imaging system.

First milestone-Hopkins Cylindrical Lens system

The second milestone of the endoscopic imaging system is the computer processing electronic imaging system. With the advent of the computer era, the situation that only the operator can peep in the traditional endoscope is completely changed. The computer converts the optical signal into an electrical signal and transmits it to the display, which is convenient for the operator and other personnel to watch, which not only improves the accuracy and convenience of the image, but also greatly shortens the learning curve of doctors.

Modern computer processing electronic imaging system

02

Minimally invasive treatment of urology can be divided into two categories, the first category is called intracavitary surgery, Endoscope refers to minimally invasive equipment into the urinary tract for related surgical operations. The second category is laparoscopic surgery, Laparoscope is minimally invasive instruments through the abdominal cavity or retroperitoneal surgery.

First of all, let's take a look at the intracavitary surgery, which mainly includes cystoscopy, ureteroscopy, percutaneous nephroscope and seminal vesicle endoscope. all endoscopic treatments are retrograde through the urethra into the natural cavity of the human body-urethra for related operations.

Cystoscope is placed into the urethra and bladder to examine and treat the lesions of the bladder, urethra and prostate, including cystoscopy, tissue biopsy under cystoscope, extraction of foreign bodies under cystoscope, transurethral resection of prostate, transurethral resection of bladder tumor and transurethral lithotripsy.

The lithotomy position (above) is generally used for cystoscopy, and the above operation is carried out. At the same time, according to whether the head end can be bent, it is divided into hard mirror and soft mirror. The following picture shows the manifestations of various diseases under cystoscope.

Cystoscopic manifestations of the disease

Ureteroscope is similar to cystoscope in that ureteroscopy is placed into the ureter to examine and deal with ureteral lesions, including ureteroscopic exploration, ureteroscopic lithotripsy, ureteroscopic biopsy, electrocautery, and tumor resection.

Similarly, ureteroscopy can be divided into hard lens and soft lens according to whether the head end can be bent or not. the following picture shows the soft ureteroscope and the hard ureteroscope.

Flexible ureteroscope

Rigid ureteroscope

Percutaneous nephroscopic surgery began in the 1940s. In recent years, with the extensive development of radiation, ultrasound and CT technology, the continuous improvement of intracavitary equipment, the invention of ultrasonic lithotripsy, pneumatic lithotripsy, holmium laser lithotripsy and other intracavitary lithotripsy instruments, the continuous improvement of percutaneous renal passage technology and the accumulation of clinical experience have continuously improved the success rate of operation, reduced complications and expanded the scope of operation. In addition to simple renal and upper urinary tract calculi, open surgery is difficult to deal with staghorn calculi, percutaneous ureteropelvic junction stricture and balloon dilatation, percutaneous nephroscopic foreign body extraction, percutaneous renal calyceal tumor treatment, the following picture is a schematic diagram of percutaneous nephrolithotomy.

Diagram of percutaneous nephrolithotomy and lithotripsy

03

Let's talk about the second largest piece of minimally invasive treatment in urology-laparoscopy.

Laparoscopy was first developed and first used by Jacobaeus in Stockholm in 1901. It can be said that laparoscopic technology is a milestone in the history of medicine in the 20th century, from the traditional transabdominal laparoscopic technology in 1990 to retroperitoneal laparoscopic technology in 1994, then to robot-assisted laparoscopic technology in 2004, single-hole laparoscopic technology in 2008, and human natural cavity technology in 2010, it can be said that with the progress of technology and the innovation of ideas, laparoscopic technology has developed by leaps and bounds.

The above picture visually shows the incisions of different surgical methods, from the traditional open surgery with a large incision above 40cm, to three or two cm small incisions with laparoscopic techniques, to single-hole laparoscopic incisions, to single-hole laparoscopic incisions, to non-incisions through the natural cavity, laparoscopic technology greatly reduces the postoperative recovery time of patients, and the following picture is a diagram of laparoscopic surgery.

Finally, let's talk about robotic surgery. Many people have heard of robot surgery, and some people ask me: is this robot safe? I can't trust a robot to operate on me? I still need someone to do it for me? So what exactly is robotic surgery?

Robot-assisted laparoscopy is a technology developed by European and American countries. because the manipulator is flexible, it avoids the problems of dead angle in traditional laparoscopic instruments, and its accuracy is 10 times higher than that of open surgery, which greatly shortens the operation time, improves the accuracy of surgery, and shortens the operator's learning curve. the following picture shows the actual operation of robot-assisted laparoscopic surgery. Doctors can be seen operating robotic arms on the console to perform various surgeries as if they were playing video games.

Real scene of robotic surgery

With regard to the future of minimally invasive surgery, we can expect that in the next 20 years, with the continuous improvement of minimally invasive instruments and robotic arms, we can achieve the single-hole robot surgery shown in the picture. Through a minimally invasive incision to perform complex surgical operations in the limited space of the human body, the capsule robot will be able to perform surgical operations in the human body in the next 100 years to achieve the purpose of treatment. At that time, mankind will certainly overcome the diseases that we cannot conquer at present, and we look forward to the early arrival of that day!