Uro-oncology deals with tumours of the kidney, bladder, prostate, testis and upper urinary tract. When a tumour is confined to the organ, the main treatment is most often surgical removal, and the precision of the operation determines both control of the disease and quality of life afterwards.
Modern uro-oncological surgery is largely minimally invasive: in a laparoscopic operation the surgeon works through several incisions about a centimetre long, using a video camera and thin instruments. The tumour is removed according to the same oncological principles – completely and with a margin of healthy tissue – but blood loss, pain and the hospital stay are reduced, and recovery is faster.
Dr Penev has completed a laparoscopic course in urology and uro-oncology in Pilsen, Czech Republic, certification training in working with a robotic surgical system, and courses in endoscopic and laparoscopic uro-oncology. Since 2017 he has been part of the team at the Department of Urology at Kaspela University Hospital (UMBAL Kaspela), Plovdiv, where both conventional and laparoscopic operations for cancer are performed.
When it is recommended
Surgery is considered for:
- a kidney tumour – depending on its size and position, either only the tumour or the whole kidney is removed;
- prostate cancer confined to the gland – radical prostatectomy is one of the options for a cure, alongside radiotherapy and, in low-risk disease, active surveillance;
- a bladder tumour – endoscopic resection (TURBT) for superficial tumours and, when the tumour grows into the muscle layer, removal of the bladder;
- a testicular tumour – removal of the testis through an incision in the groin, scheduled within days.
The choice between surgery, monitoring, radiotherapy and drug treatment depends on the stage of the tumour, your age, any other conditions and your own priorities, and it is made at a multidisciplinary tumour board with an oncologist, a radiation oncologist, a pathologist and a radiologist. Dr Penev presents the options to you, together with their benefits and risks.
Do not put off a consultation if you have blood in the urine without pain or a firm, painless lump in a testicle. Heavy bleeding with clots, being unable to pass urine, or sudden severe pain in a testicle are emergencies – go to an emergency department or call 112 (the European emergency number) instead of waiting for a scheduled appointment.
How it is done
Main operations
- Radical nephrectomy – removal of the whole kidney with the surrounding fatty tissue, for larger or centrally located tumours.
- Partial nephrectomy – removal of only the tumour with a thin layer of healthy tissue, for smaller tumours (most often up to about 4 cm, or larger if they are in a suitable position), in order to preserve kidney function.
- Radical prostatectomy – removal of the prostate and the seminal vesicles and, when indicated, the pelvic lymph nodes; when it is oncologically safe, the nerves responsible for erections are spared.
- TURBT (transurethral resection of a bladder tumour) – the tumour is removed through the urethra with an endoscope, without an incision; the histology determines whether treatment inside the bladder (intravesical treatment) is needed and how you will be followed up.
In the operating theatre
The operations are performed under general anaesthesia and take approximately two to four hours. The removed organ is always sent for histological examination. With very large tumours, growth into neighbouring organs or many previous abdominal operations, open surgery remains the safer choice – the goal is complete removal of the tumour, not the size of the incision.
Preparation
The diagnosis and stage are established with ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) and, depending on the tumour, with PSA and a biopsy, cystoscopy or tumour markers; blood tests and a consultation with an anaesthetist follow. Tell Dr Penev about all the medicines you take, especially blood thinners – these are stopped only on a doctor’s instructions. Before a radical prostatectomy you will discuss what to expect regarding continence and erections, and before an orchidectomy, if you wish to have children, sperm banking is offered.
After the operation and results
After a laparoscopic operation on the kidney or prostate, the hospital stay is usually three to five days, after TURBT one to three days, and after a cystectomy (removal of the bladder) about two weeks. Heavy lifting and sport are possible after four to six weeks.
The histology result is usually ready within two weeks and determines the final stage; on that basis the tumour board decides whether follow-up is enough or further treatment is needed. After a radical prostatectomy your PSA is monitored regularly, and after kidney surgery your blood pressure and kidney function.
No operation can guarantee the result, but when a tumour is confined to the organ, removing it completely is the foundation of treatment aimed at a cure. Seek help immediately if, after you have been discharged, you develop a temperature above 38 °C, heavy bleeding, severe pain, a swollen leg or are unable to pass urine.
Where it is done
The operations are performed at the Department of Urology at Kaspela University Hospital, Plovdiv, 64 Sofia St, Block 3, which has a high-tech operating suite. The pre-operative consultation and follow-up take place at Dr Penev’s practice in Plovdiv, 5 Anri Barbyus St, and at Vita Med Medical Centre, Karlovo, by appointment.
Price
Initial consultation €50, follow-up consultation €30. The cost of the operation and hospital treatment is confirmed at the consultation, depending on the type of procedure.
If you have been found to have a tumour of the kidney, prostate, bladder or testis, book a consultation with Dr Penev – you will get a clear explanation of the findings and of the treatment options.
Frequently asked questions
What happens if a laparoscopic operation has to be converted to open surgery?
This is a planned-for possibility, not a complication. If the anatomy, adhesions or bleeding require it, the surgeon continues through a conventional incision in order to complete the operation safely and in full. This possibility is discussed in advance and is part of informed consent.
What does nerve-sparing prostatectomy mean and who is it suitable for?
It is a technique in which the nerve bundles that run alongside the prostate and are responsible for erections are separated and preserved. It is suitable when the tumour does not reach them – in localised, lower-risk disease. With a more advanced tumour, removing it completely takes priority over preserving the nerves.
Is a biopsy needed before surgery for a kidney tumour?
Usually not. Unlike the prostate, for the kidney a contrast scan is in most cases enough to plan surgery, and the final diagnosis is made from the histology of the removed tumour. A biopsy is considered in individual cases – for example with a small tumour when monitoring is preferred.
Will I leak urine after my prostate is removed?
In the first weeks after the catheter is removed, mild leakage when coughing or straining is common, and in most men it gradually settles with pelvic floor exercises. Lasting significant incontinence is rare and can also be treated.
The information on this website is for general education and does not replace an examination and consultation with a doctor. If you have urgent symptoms, seek medical help immediately or call 112.