Urological Cancers

Urological cancers refer to malignant tumors that develop in urinary system organs such as the kidney, bladder, prostate, and testis, and treatment success increases significantly with early diagnosis. Although clinical findings vary according to the tumor type, hematuria, changes in urinary habits, and pain are prominent.

Symptoms and treatment methods of kidney cancer generally follow an insidious course and may not produce symptoms until advanced stages; they are detected by imaging techniques, and surgery is the main treatment approach. Targeted therapies and immunotherapy are important options that increase survival in metastatic cases.

Bladder cancer risk factors and the diagnostic process show a strong relationship with smoking and chemical exposure; cystoscopy and urine cytology are used in diagnosis. While intravesical treatments are applied in superficial tumors, radical surgery and systemic treatments are preferred in invasive disease.

Early diagnosis and prognosis of prostate and testicular cancer are evaluated with prostate-specific antigen levels and physical examination; testicular cancer is common in young men and has a high cure rate in the early stage. A multidisciplinary approach is essential in individualized treatment planning.

Laparoscopic and Robotic Surgery in Turkey

Bladder Cancer Surgery in Turkey

MRI Fusion Biopsy in Turkey

Prostate Cancer Surgery in Turkey

Testicular Cancer Surgery in Turkey

Adrenal Tumor Surgery in Turkey

Kidney Cancer Surgery in Turkey

What Are Urological Cancers and Why Is a Modern Approach Needed?

The word cancer understandably creates great concern whenever it is heard. However, in the field of urological diseases, a one-size-fits-all treatment approach has now been completely left behind. Each person’s anatomical structure, the cellular character of their disease, and their personal expectations from life are completely different from one another. The modern approach aims to offer the right treatment to the right person at the right time by taking these differences into account. Whereas in the past quite aggressive surgical interventions were applied as a standard procedure in every suspicious case, much more detailed preliminary examinations are performed today. Thanks to these in-depth examinations, tumors aggressive enough to truly threaten the patient’s life are clearly distinguished from slow-progressing tumors that may remain silently in the body for years without causing any harm. This distinction is extremely critical; because it greatly protects the individual from unnecessary surgeries, heavy drug treatments, and the permanent side effects they may cause. This modern medical approach blended with advanced technology aims not only to defeat the disease; but also to preserve very valuable mechanisms such as urinary continence control and sexual functions that ensure the normal flow of human life.

What Is Prostate Cancer and Why Is Early Diagnosis of Vital Importance?

The prostate is a walnut-sized gland found only in the male body, located just below the bladder and through which the urinary canal passes. Its main function is to produce vital fluids necessary for reproductive functions. Prostate cancer is known as one of the most common types of cancer in the male population worldwide and holds an extremely serious place in terms of public health. The most distinctive and at the same time most dangerous feature of this disease is that it progresses completely silently in its early stages. Cancer cells generally begin to develop in the outer parts of the prostate gland that are far from the urinary canal, namely in the peripheral region. Due to this anatomical location, until the tumor reaches a fairly large size and physically compresses the urinary canal, the patient does not experience any symptoms such as difficulty urinating, frequent urination, or pain. While the disease progresses silently, the chance of complete recovery is almost close to one hundred percent if it is caught at an early stage. This great contrast makes the value of regular screening tests priceless. Without waiting for any complaints, following individuals with a similar family history from the age of forty-five onward, and all other men from the age of fifty onward, with regular blood tests and medical examination is the most important life-saving step.

What Is the PSA Test in Prostate Cancer and In Which Situations Can It Be Misleading?

PSA, also known as Prostate Specific Antigen, is a special enzyme produced by the cells in the prostate gland and enables the liquefaction of semen. Under normal conditions, a very small amount of this enzyme passes into the blood. In screening tests, the level of this enzyme in the blood is measured sensitively with a simple blood sample taken from the arm. However, there is a very fine line here; this substance is specific to prostate tissue, not specific to cancer. A high value in the blood does not mean that the condition is definitely malignant. Any benign or physical change occurring in the prostate tissue may suddenly raise this value. This situation can sometimes cause unnecessary panic among people. For a correct diagnosis, instead of focusing on a single laboratory value, ancillary parameters such as free and bound ratios in the blood, density calculated according to the organ’s volume, and genetic markers evaluated in the urine are examined in detail and a general conclusion is reached.

The factors that can temporarily or permanently increase the level of this enzyme in blood tests are as follows:

• Benign prostate enlargement
• Prostate inflammation
• Urinary tract infections
• Sexual activity
• Heavy physical exercise
• Urinary catheter insertion
• Cycling

What Is Multiparametric MRI and the PI-RADS Score in Prostate Cancer?

In the past, when a suspicious situation was seen in blood tests, the procedure of sample collection directly under ultrasound guidance would be initiated. However, ordinary ultrasound devices cannot visually distinguish diseased tissue from healthy tissue inside the organ. The technology that completely eliminates this problem and creates a real breakthrough in diagnostic processes is Multiparametric Magnetic Resonance Imaging (MRI). This highly advanced imaging method examines the tissue in detail not only by its external appearance but also by its cellular structure. Thanks to different technological sequences applied during the scan, how densely packed the cells in the tissue are, how water molecules move, and the vascular pattern of the capillaries in the area are mapped with millimetric precision.

The data obtained as a result of this detailed mapping are carefully reported using the PI-RADS grading system, which is an international standard. This system scores from one to five the possibility that a suspicious area seen on imaging is clinically dangerous. While scores of one and two show that the risk is almost negligible, scores of four and five indicate a high-risk suspicion. A score of three is a gray area in between; it requires an individualized roadmap to be drawn by taking into account the person’s other tests and lifestyle. Thanks to these smart imaging standards, people are protected from unnecessary interventions.

What Is MRI-Fusion Biopsy in Prostate Cancer and What Are Its Differences from Standard Biopsy?

In standard methods, the procedure of imaging the organ with an ultrasound device and taking random tissue samples from anatomically predetermined standard regions is applied. Since the suspicious area cannot be clearly identified on the screen, this procedure is somewhat like trying to find a target in the dark. In this old method, cells with an aggressive structure may be missed because they correspond to spaces where the needles do not enter, or extremely slow-progressing cells that require no intervention at all may be caught coincidentally and initiate unnecessary psychological pressure in the person.

MRI-Fusion technology, on the other hand, is an advanced navigation system that completely eliminates this randomness. Suspicious foci marked on detailed images obtained beforehand are superimposed with live ultrasound images at the time of the procedure through special computer software. This technological integration works just like an advanced vehicle navigation system. By directing toward target points, pinpoint samples are taken only from the diseased area with millimetric precision.

The main advantages this new-generation application offers to the patient are as follows:

• High diagnostic sensitivity
• Accurate staging
• Prevention of unnecessary repetition
• Low risk of infection
• Targeted pinpoint sampling

How Do Kidney Cancers Develop and How Is the Decision for Surgery Made?

Our kidneys are vital organs that filter hundreds of liters of blood every day, allowing our body to be purified from harmful substances and maintaining the overall fluid balance. Kidney cancers occur as a result of the uncontrolled proliferation of the cells that form the internal tissue of this marvelous filter. The most common type is clear cell tumors, named because of the special appearance of the cells under laboratory examination. A very large portion of these tumors do not create symptoms such as pain, bleeding in the urine, or unexplained fatigue in the individual in the early stages. Today, most of these masses are detected incidentally during a simple abdominal ultrasonography performed for a completely different health problem or for routine health screenings.

By their nature, these cellular structures show quite strong resistance to drug therapies or radiation applications. Therefore, the most effective, permanent, and reliable treatment method in this case is the safe surgical removal of the mass from the body. When the decision for the procedure is made, the size of the mass in centimeters, where it is located in the kidney, its proximity to the surrounding vital main vessels, and special grading systems showing how aggressive the cells are are examined with great care, and a roadmap is drawn accordingly.

What Is Nephron-Sparing Surgery in Kidney Tumors?

In older surgical approaches, when a mass was detected, the entire organ together with the surrounding fatty tissue would be removed from the body as a whole regardless of its size or location. However, continuing life with a single filtration system may lay the groundwork for serious health problems such as high blood pressure, heart and vascular diseases, and chronic failure in advancing age. This may lead to consequences that deeply affect quality of life and may even progress to the need for dialysis. The point modern medicine has reached today is protective surgery that aims to save the organ at all costs instead of sacrificing it.

In this innovative method, only the diseased part of the organ is carefully shaved off together with a few millimeters of safety margin around it. The remaining healthy tissue is aesthetically repaired so that it can continue its function in the body. Since it is necessary to temporarily stop the blood flow going to the organ during the procedure, it is of vital importance that the operation be performed very quickly and flawlessly without damaging the organ tissue.

The main surgical methods applied are as follows:

• Open partial nephrectomy
• Laparoscopic partial nephrectomy
• Robotic partial nephrectomy
• Radical nephrectomy
• Cryotherapy applications

What Is Bladder Cancer and What Are Its Symptoms?

The bladder, known among the public as the urinary bladder, is a highly flexible organ that stores the fluids produced by the kidneys and, when the time comes, contracts and safely expels them from the body. Bladder cancer begins precisely in the delicate layer of cells lining the inner surface of this flexible structure. One of its most striking features is its very strong and proven link with inhaled environmental toxins, especially tobacco products. After these harmful chemicals that mix into the blood are filtered, they come to this reservoir together with the fluid and, while waiting there, gradually disrupt the structure of the cells on the inner surface and cause permanent damage.

The most typical, most common, and most warning first sign of the disease is the painless presence of blood. This condition, which can be clearly noticed by the naked eye, may sometimes also appear only at the microscopic level in laboratory analyses. While it may remain in a superficial layer of the membrane, it also has the potential to progress over time toward the deeper muscle layers. Formations that reach the deep layers require an urgent and much more comprehensive approach because they carry the risk of spreading to different parts of the body through the blood or lymph.

The main risk factors that play a role in the development process are as follows:

• Tobacco use
• Industrial chemical exposure
• Advanced age
• Chronic bladder infections
• Genetic predisposition

How Are Radical Cystectomy and Neobladder Surgery Performed in Bladder Cancer?

If the harmful cells have passed beyond the inner lining and progressed to the deep muscle layer, superficially applied local treatments unfortunately remain insufficient. At this critical stage, the most solid step to be taken to protect life is a large-scale procedure in which the organ and the suspicious lymph nodes around it are completely removed from the body. After the structure inside is removed, it is mandatory to build an entirely new reservoir system so that the fluid filtered from the kidneys can be expelled from the body in a healthy way. The most comfortable method applied in technologically advanced centers is to take a small piece from the person’s own small intestine, make a new pouch in the shape of a sphere, and connect this structure to the natural anatomical pathway.

This extremely delicate operation is performed in a very narrow and deep cavity inside the pelvic bone. The use of robotic systems in this field is in the nature of a technical revolution. The entire process of creating a new reservoir from the intestine is completed in a closed manner through technological arms in the body’s safe internal environment without opening a large incision from the outside. The fact that the intestines do not come into contact with the air of the external environment prevents them from losing their functions and accelerates the healing process in a miraculous way.

The advantages of this application performed with advanced technology are as follows:

• Rapid bowel motility
• Short hospital stay
• Low amount of bleeding
• Reduced wound site pain
• Fast return to daily life

What Are Adrenal Masses (Adrenal Gland Tumors) and When Is Surgery Necessary?

These glands, located like small caps on the very top of each of our kidneys, are responsible for producing extremely critical hormones that enable our body to cope with sudden stress, regulate blood pressure second by second, and control metabolic rate. Essential substances for our daily lives such as adrenaline and cortisol are synthesized in these centers and released into the blood. From time to time, benign enlargements or nodules may form within these glands due to age or genetics. In the management of these structures, which are often noticed incidentally in radiological scans, attention is paid to two main and indispensable rules: whether this structure is secretly producing excessive hormones to a degree that will harm the person and its physical size on a millimetric scale.

If the structure is small in size and remains completely silent in terms of hormone production, it is generally followed safely with imaging at certain intervals without panic. However, when the physical size exceeds a certain limit, especially above six centimeters, surgical removal is strongly recommended because the statistical risk of the structure harboring malignant cells increases very seriously. Since these organs, by virtue of their anatomical structure, are almost adherent to the widest blood vessels of the body, operations in this region require millimetric mastery. Today, this procedure is successfully performed with minimal damage and in a short time by minimally invasive methods using high-resolution cameras and fine instruments with high maneuverability.

What Is Testicular Cancer and How Is It Detected in Young Men?

Although malignant diseases are generally known as conditions that arise due to the cellular fatigue of advanced ages, this condition is a completely different exception. Contrary to general statistics, this disorder mainly targets the young, extremely active, and dynamic male population between the ages of fifteen and thirty-five. It is even the most common type of solid mass encountered in this age group. Structural delays such as the organ not descending naturally to its place on time in infancy and childhood may raise the risk of developing this problem quite markedly in later years. From a medical perspective, the most reassuring and motivating aspect is that when it is noticed early and the right steps are taken, it is one of the rare conditions in which medicine can reach the highest cure rates.

Since the problem is usually located in a visibly noticeable area, it immediately reveals itself as a painless, firm swelling or deformity that can be felt from the outside. For this reason, the high personal awareness of young individuals and their occasional simple self-checks are the strongest link in the early diagnosis chain. When a suspicious firmness is felt, the situation is quickly clarified by detailed examination with sound waves and biochemical markers measured in the blood, and planning for treatment begins without losing time.

What Are the Treatment Methods in Testicular Cancer?

The first and most critical step of this process is definitely surgery. In order to completely prevent the harmful cells from leaking into the body’s lymphatic network or blood circulation, the problematic area is removed intact not through it directly, but through a small and hidden aesthetic incision made in the groin region. This removed structure is examined in great depth in special laboratories; the microscopic type of the cell is clarified and the full picture of the condition is obtained. According to the laboratory results, individuals may be advised only to come for regular check-ups, or supportive drug or radiation sessions most appropriate to the cellular nature of the disease may also be added.

Especially in cases required by the cellular type, or if suspicious cellular remnants are seen in the lymph nodes on the posterior wall inside the abdomen after drug support, complete surgical cleaning of this region is not an option but a vital necessity. This difficult lymph node cleaning operation, which in past years was performed through large and quite demanding abdominal incisions from top to bottom, can now be performed extremely comfortably with closed methods by entering through small openings thanks to today’s technological infrastructure and advanced optical systems.

The main stages planned according to the condition are as follows:

• Radical inguinal orchiectomy
• Chemotherapy
• Radiotherapy
• Retroperitoneal lymph node dissection
• Close clinical follow-up

Minimally Invasive Methods in Urological Cancers: What Are the Differences Between Laparoscopy and Robotic Surgery?

Whereas in traditional open operations it was a physical necessity to create large wounds cutting muscle tissues in the body in order to reach the internal organs, in modern minimally invasive systems only small incisions are created in the body. The process inside is managed with great precision using advanced high-resolution cameras and special long hand instruments sent through these entry points. Both the laparoscopic approach and robot-assisted technology are based on this philosophy, but in the background they contain very serious differences in terms of technological equipment and capability.

In laparoscopic systems, the physician performs the procedure while standing at the head of the table and directs rigid instruments shaped like straight rods by looking at a two-dimensional flat screen in front of them. In robot-assisted technology, the physician sits at an extremely comfortable special control center away from the operating table. Without wearing any glasses, they see an extraordinarily clear field with three dimensions, real depth, and magnified up to ten times completely with the naked eye. The fine tips of the smart device used are more flexible than a human wrist can be; they can rotate around themselves and make perfect bending maneuvers at angles so narrow that the human hand cannot reach them. In addition, the computer system instantly detects and filters the very natural physiological tremors in the physician’s fingers and absolutely does not reflect them to the tips of the instruments. Thanks to this miraculous filtering, smart technology provides an indisputable technical and functional superiority in procedures where sutures must be placed in millimetric vessels, a new organ is built inside, or the preservation of nerve networks is essential.