Abdul Seckam*, PhD and Stephen Mitchell**, MA MB FRCS(Urol) PhD
*Head of Research and Academia, Healthcare Business Solutions UK. email – Abdul.Seckam@hbsuk.co.uk
**Consultant Urological Surgeon, Cancer Lead for Urology, Buckinghamshire Hospitals Trust
 

Introduction


Over the past few decades, advances in technology have revolutionised the field of urology. From diagnostic tools to surgical techniques, these innovations have greatly improved the way urological conditions are diagnosed and treated. The integration of technology into urology services has revolutionised diagnosis, treatment and patient care. From advanced imaging techniques to minimally invasive surgical procedures, technology plays a crucial role in improving outcomes and enhancing patient experience in urological care. This article discusses a number of these innovations and looks at how they are influencing urology practice.
 

Robotic-assisted surgery


One of the most significant technological advances in urology is the development of robotic-assisted surgery systems. These allow surgeons to perform minimally invasive procedures with greater precision and control, leading to faster recovery times and better outcomes for patients. Robotic-assisted surgery is now commonly used for procedures such as prostatectomies, kidney surgeries and bladder surgeries. Robotic-assisted systems, such as the da Vinci surgical system, enable urologists to perform complex procedures with enhanced precision and dexterity. This minimally invasive approach reduces postoperative pain, blood loss and recovery time compared to traditional open surgery (Rivero-Moreno et al, 2023).
 

Imaging technologies


Advances in imaging technologies, such as MRI (magnetic resonance imaging), CT (computed tomography) scans and ultrasound, have greatly improved the ability of urologists to diagnose and monitor urological conditions. These imaging techniques allow more accurate and detailed visualisation of the urinary tract and surrounding structures, helping urologists to make better informed decisions about treatment options.

High-resolution imaging techniques such as multiparametric MRI and PET (positron emission tomography) provide detailed visualisation of the urinary tract, helping with the diagnosis and staging of urological conditions, including prostate cancer. These modalities enhance the accuracy of disease detection and treatment planning (Turkbey et al, 2019).
 

Flexible endoscopy


Endoscopic examination of body cavities has a long history, with relatively complex rectoscopes discovered in the ruins of the Roman city of Pompeii, destroyed by the eruption of Vesuvius in AD79 (Sircus, 2003). However, it was not until the 1970s that flexible cystoscopes were developed, and the 1990s that flexible ureteroscopes with a working channel were developed. Flexible cystoscopy is now a routine outpatient diagnostic procedure and has almost completely replaced diagnostic rigid cystoscopy. Surgery for renal stones has been revolutionised by the development of flexible ureteroscopes with ‘chip on the tip’ technology.

Although digital ureteroscopes only came into clinical use around 15–20 years ago (Mitchell et al, 2008), technology has progressed such that single use disposable flexible ureteroscopes are now commonplace in clinical practice. As a consequence, open surgery for renal stones, a common procedure 50 years ago, is now very rarely used.
 

Telemedicine


Telemedicine has become increasingly important in urology, allowing patients to consult with urologists remotely and receive care without having to travel to a medical facility. This has been especially beneficial for patients in rural areas or those with limited access to urological care. Telemedicine has also been instrumental in providing follow-up care and monitoring for patients with chronic urological conditions, enhancing access to specialised care. Remote monitoring of patients with urinary incontinence or benign prostatic hyperplasia allows timely intervention and personalised treatment adjustments (Glaser et al, 2024). Barriers like digital literacy, internet access, technology acceptance, and accessibility must be addressed for effective telemedicine use (Seckam, 2023). Resolving these issues enables greater patient engagement in telemedicine and digital healthcare.
 

Laser technology


Laser technology has revolutionised the treatment of urological conditions such as enlarged prostates and kidney stones. Laser ablation techniques have been developed for the treatment of enlarged prostates, providing a safer and more precise option for patients.
 
Laser lithotripsy is now a common and highly effective treatment for kidney stones, offering a less invasive alternative to traditional surgical methods. Laser lithotripsy uses holmium or thulium lasers for the fragmentation of urinary stones. However, treatment options are often based on stone size, location, and patient factors, with lithotripsy and ureteroscopy being the primary approaches, while open surgery is now rare. Laser technology offers precise targeting of stones, minimising damage to surrounding tissues and improving stone clearance rates compared to traditional methods (Bhanot et al, 2021; Kronenberg et al, 2021). Further research is needed to establish the safety and efficacy when using such technological advances (Bhanot et al, 2021).
 

Three-dimensional printing 


Three-dimensional (3D) printing technology is increasingly used for preoperative planning, surgical simulation, and the creation of patient-specific anatomical models in urological surgery (Wake et al, 2019). These models aid surgical decision-making, enhance surgical accuracy and improve patient outcomes (Wake et al, 2019).

Conclusions 


These findings demonstrate the diverse applications of technology in urology services, ranging from surgical interventions to diagnostic imaging and telemedicine. Continued research and technological advances hold promise for further improving the efficiency, safety and quality of urological care. In addition, the shift towards greater use of technology in urology has greatly improved patient outcomes and quality of care. As technology continues to evolve, urologists can expect to have even more advanced tools and techniques at their disposal, further enhancing their ability to diagnose and treat urological conditions.
 

References

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Glaser AP, Smith AR, Maglaque D et al (2024) Enhanced clinical decisions for management of benign prostatic hyperplasia using patient-reported outcomes: protocol for a prospective observational study. BMC Urol 24:110. https://doi.org/10.1186/s12894-024-01500-0 

Kronenberg P, Hameed BZ, Somani B (2021) Outcomes of thulium fibre laser for treatment of urinary tract stones: results of a systematic review. Curr Opin Urol 31(2):80-86. https://doi.org/10.1097/MOU.0000000000000853  

Mitchell S, Havranek E, Patel A (2008) First digital flexible ureterorenoscope: initial experience. J Endourol 22(1):47-50. https://doi.org/10.1089/end.2007.0046 

Rivero-Moreno Y, Echevarria S, Vidal-Valderrama C et al (2023) Robotic surgery: a comprehensive review of the literature and current trends. Cureus 15(7):e42370. https://doi.org/10.7759/cureus.42370 

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Sircus W (2003) Milestones in the evolution of endoscopy: a short history. J R Coll Physicians Edinb 33(2):124-34 

Turkbey B, Rosenkrantz AB, Haider MA (2019) Prostate imaging reporting and data system version 2.1: 2019 update of prostate imaging reporting and data system version 2. Eur Urol 76(3):340–351. https://doi.org/10.1016/j.eururo.2019.02.033 

Wake N, Rosenkrantz AB, Huang R et al (2019) Patient-specific 3D printed and augmented reality kidney and prostate cancer models: impact on patient education. 3D Print Med 5(1):4. https://doi.org/10.1186/s41205-019-0041-3 


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