UROLOGY

UROLOGY

Urology is responsible for the care of all problems involving the male and female urinary organs including the kidneys, ureters, urinary bladder, prostate, and urethra; the urinary tract from the kidney to the urethra, which carries the urine from the bladder to the exterior as well as management of adrenal or suprarenal problems. Urology is also responsible for care of the male reproductive organs, including the testis and penis and other surrounding organs. Kidney failure requiring transplantation is also a problem that is handled by the Urologist. Sometimes corrective surgery could take care of obstruction that is responsible for kidney failure.

Urology Practice in Kelina Hospital handles the following:

1. Kidney Stones

Laser lithotripsy, ultrasonic lithotripsy, Pneumatic lithotripsy, lithotripsy using the Swiss Lithoclast Master, which combines ultrasonic and pneumatic technology are done using the standard nephroscope (Percutaneous Nephrolithotomy or PCNL), mini-percutaneous nephrolithotomy (mini-perc), flexible ureteronephroscopes also called ureterorenoscopes or videoscopes, semi-rigid uretero-renoscopes. Kelina has several flexible scopes from several of the best companies in the world, including flexible nephroscope and flexible cystoscope. Kidney stones can be taken out without any wound on the body. More than half of our patients go home the same day.

2. Enlarged Prostate

We do only minimal access (endoscopic) surgery for prostate, include bipolar TURP and laser vaporization. Recently, we acquired the most powerful laser in the world for Holmium laser enucleation of the prostate. Before now, we have done several Diode laser vaporization in the past. The holmium laser is the best for prostate surgery, especially because the prostate can be removed and sent for histology to confirm that there is no cancer. Bipolar TURP is still regarded as the Gold Standard for prostate surgery. Here in Kelina, we have multiple technologies for dealing with the prostate. None of them requires cutting the body open or creating any wound at all on the body. We hardly do open surgery for prostate in Kelina Hospital. Sometimes enlarged prostate is due to prostate cancer. Sometimes there is no cancer. Whether or not there is cancer would definitely affect choice of treatment or surgery.

  1. Prostatitis, Prostatodynia and other problems with the Prostate gland.
  2. Male Infertility, due to watery sperm or any other problem. The commonest cause of watery sperm is low sperm count. The commonest cause of low sperm count is varicocoeles.
  3. Passage of blood in urine, also called haematuria.
  4. Painful urination, or dysuria, sometimes due to urethritis.
  5. Pain in the Scrotum or testis. Patients, especially young boys, need to come to the hospital as an emergency because pain could be due to torsion. If surgery is not done within a matter of minutes, the testis turns black and is damaged irreversibly.
  6. Intersex or problems hermaphroditism or ambiguous genitalia.
  7. Inability to pass urine after birth, sometimes due to posterior urethral valves.
  8. Kidney cancer.
  9. Bladder cancer.
  10. Cancer of the testis, scrotum or penis.
  11. Genital anomalies from birth, such as hypospadias or epispadias.
  12. Abnormalities of the urinary organs from birth, such as ectopia vesicae, where the urinary bladder is completely exposed to the outside, without any skin cover
  13. Pain in the flank, on the side of the ribs towards the back. This is where the kidneys are located.
  14. Urinary retention or failure to pass urine
  15. Kidney swelling as in hydronephrosis, from obstruction or some other cause, even if there is no cancer.

Achievement

Kelina Hospital was the first hospital in Africa (according to Lumenis) to acquire the 120 Watts Holmium Laser, P120, Moses Technology. That was in 2018. In one year, we did over 50 Holmium Laser Enucleation of the Prostate(HoLEP) surgeries, all successfully. In West Africa, we were the first hospital to start doing HoLEP.

OUR CONSULTANT UROLOGIST

Dr Celsus U. Undie
MB;BS, FWACS, FICS, Dip Lap Surg.
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HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HoLEP)

Kelina Hospital also offers Holmium Laser Enucleation of the Prostate (HoLEP). HoLEP is the most advanced form of prostate surgery. Laser removes the prostate with the least bleeding compared to all other methods. Patients can go home the same day or next day after their surgery. Transurethral Resection of the Prostate (TURP) is recommended only for prostates less than 80g, according to the European Association of Urology. For prostates bigger than 80g, the recommendations on the current guidelines is that TURP should  not be done. Only HoLEP should be done. We have 2 lasers  suitable for HoLEP. We have 3 lasers in all.

HoLEP has advantage over all other methods of prostate surgery in the following sense:

  1. It can take out prostates of any size, compared to TURP.
  2. There is minimal blood loss compared to TURP and open surgery.
  3. There is no external wound compared to open surgery
  4. Patients spend very little time on admission, compared to TURP and Open surgery. Patients can go home same day after surgery.
  5. Patients can go back to work a day after discharge.
  6. Catheterization time after surgery is lower than with TURP or open surgery.

Between October 2018 and November 2019, we performed 46 HoLEP procedures and all of them were carried out successfully. In 2 years, we have done about 100 prostate surgeries. Typically, patients leave the hospital within 24 hours of surgery.

Kelina Hospital Lagos HoLEP

HOLMIUM LASER FOR LITHOTRIPSY.

Lithotripsy is a process by which kidney stones or stones formed naturally in any part of the urinary tract can be pulverized into powder, and the particles flushed out without the need for open surgical operation.  Holmium laser is capable of breaking up any type of stone in the urinary tract. Apart from lasers, we have other types of lithotripsy machines for different applications in stone treatment. These include ultrasonic, pneumatic and combined-energy machines, such as the Swiss Lithoclast Master. Kelina was the first hospital in Nigeria to acquire this technology. The first Laser we acquired was from Karl Storz in 2010.

Kelina Hospital Lagos surgery

ULTRASONIC LITHOTRIPSY

Ultrasonic lithotripsy is most useful for Percutaneous Nephrolithotomy (PCNL). The stones suitable for PCNL are usually very large, above 2cm in diameter, and equipment dissipating minimal energy like the Ultrasonic lithotripsy is most useful for Percutaneous Nephrolithotomy (PCNL). Kelina was the first hospital in Nigeria to acquire the Swiss Lithoclast Master.

Kelina Hospital Lagos stones
These kidney stones were removed here in Kelina Hospital by ultrasonic Lithotripsy

PNEUMATIC LITHOTRIPSY

This can be used for stones in the urinary tract where semi-rigid rather than flexible scopes can reach. Acquiring the 4  lithotripters simultaneously made us stand out as a complete centre for kidney stone treatment in Nigeria.

Kelina Hospital Lagos stones
These kidney stones were removed in Kelina Hospital by Pneumatic Lithotripsy

PERCUTANEOUS NEPHROLITHOTOMY

The first PCNL in Nigeria was done here in Kelina Hospital. This is used for very huge stones in the kidney. Some of them are called Staghorn calculi. When the stones are so big, breaking them up into powder without picking up the particles is fraught with complications and delayed or failed passage (when you pour sand into a funnel, it may not necessarily pass). A direct straight line small puncture gaining access to the kidney using PCNL will afford the opportunity to take out the stone directly. Ultrasonic lithotripter can be used to break the stone up into manageable pieces, and the pieces could be picked up one at a time or flushed out through the nephroscope, which is a part of the equipment used for this procedure. Kelina Hospital has 3 different types of nephroscopes for different types of stones (the standard 26F, the Dresden Nephroscope and Miniperc).

Kelina Hospital Lagos stones
These stones were removed from the kidney of a widow, completely free of charge during our annual charity programme in 2011, inconjunction with Surgical Aid Foundation. This was the first PCNL to be done in Nigeria.