Robot-assisted Prostatectomy With Removal of Prostate Tumor Metastases With a Gamma Probe in European hospitals
Treatment prices are regulated by national law of the corresponding countries, but can also include additional hospital coefficients. In order to receive the individual cost calculation, please send us the request and medical records.
Department of Adult and Pediatric Urology, Andrology
The Department of Adult and Pediatric Urology, Andrology offers the full range of services in the areas of its specialization. Men and boys with diseases of the reproductive system can be diagnosed and treated in the medical facility. Doctors also treat infertility and erectile dysfunction. Medical care is provided to men and women with diseases of the urinary system, namely kidneys, ureters, bladder, and urethra. The department is certified as the Prostate Cancer Center by the German Cancer Society (DKG), which indicates the excellent quality of the services provided in this area. The department's urologists have a perfect command of the innovative treatment methods, including holmium laser enucleation of the prostate (HoLEP), photodynamic therapy, and da Vinci robot-assisted surgery. The department employs comprehensively trained and experienced doctors who apply advanced medical achievements in their practice. Each patient is provided with an individual approach, considering their specific needs and wishes.
Department of Adult and Pediatric Urology
The Department of Adult and Pediatric Urology provides high-precision diagnostic examinations and effective treatment for diseases of the genitourinary system and reproductive system in men and boys. Of particular interest is drug therapy and surgical treatment of prostate, bladder, kidney, testicular, and penile cancers. The department is part of the Comprehensive Cancer Center Ulm (CCCU). For the patient, this means that their clinical case is studied by a multidisciplinary tumor board, which determines the optimal treatment tactics. The department is also certified by the German Cancer Society (DKG), so all therapeutic procedures meet strict national and international standards. The department's team of urologists also has unique clinical experience in the minimally invasive treatment of kidney stone disease, benign prostatic hyperplasia, neuro-urological dysfunction, and all urologic diseases in children. During the surgical treatment, the specialists at the medical facility successfully use minimally traumatic surgical techniques. They perform endoscopic, laser, minimally invasive, and robot-assisted surgery using the innovative Da Vinci system. The department treats about 3,000 inpatients and 9,000 outpatients with clinical cases of varying complexity annually. The number of surgical procedures performed and treatment outcomes are regularly published by the authorized commission of the Initiative Quality in Medicine (IQM).
Department of Urology
According to the Focus magazine, the Department of Urology ranks among the top German medical institutions specializing in prostate cancer treatment! The department offers the full range of high-precision diagnostic studies and effective therapeutic options for men with diseases of the genitourinary system. The doctors of the department specialize in the treatment of prostate cancer, benign prostatic hyperplasia, kidney, testicular cancers, urolithiasis, erectile dysfunction and urinary incontinence. There are also excellent qualifications in the field of reconstructive urology.
Department of Adult and Pediatric Urology
According to the Focus magazine, the Department of Adult and Pediatric Urology ranks among the top German medical facilities specializing in prostate cancer treatment! The department offers all types of modern diagnostic and therapeutic services for patients with urologic diseases. Of particular interest is the treatment of urogenital tumors in men and urogynecological diseases. The department also specializes in kidney transplantation, which is carried out within the specialized center. This center is the largest in Germany and Europe and annually demonstrates high treatment success rates. In addition, the department's competence covers the treatment of urological problems in boys of all age groups.
Department of Adult and Pediatric Urology
According to the Focus magazine, the Department of Adult and Pediatric Urology ranks among the top German departments specializing in prostate cancer treatment! The department offers the full range of diagnostics and treatment of the urinary system in men and boys. The department has a long history, rich traditions, and is also a recognized center of excellence in the treatment of all urological diseases. The department specializes in the treatment of malignant urological diseases, reconstructive surgery, pediatric urology, treatment of urinary tract dysfunction and kidney stone disease.
Department of Adult and Pediatric Urology
According to the Focus magazine, the Department of Adult and Pediatric Urology ranks among the top German medical facilities specializing in prostate cancer treatment! The department offers the full range of advanced methods of diagnostics and treatment of all genitourinary system diseases, including in children. Of particular interest is the treatment of patients with urinary tract and kidney tumors, kidney stone disease, prostate diseases, treatment of urinary incontinence, andrologic disorders and urological problems in young patients. Since 2010, the department has been certified as the Prostate Cancer Center (certified by the German Cancer Society, recertified in 2016).
Department of Adult and Pediatric Urology, Andrology
According to the Focus magazine, the Department of Adult and Pediatric Urology, Andrology is one of the best medical facilities in Germany for prostate cancer treatment! The department provides effective treatment for the entire spectrum of diseases of the urinary tract and male reproductive system in accordance with the highest medical standards. Patients of all ages, from newborns to the elderly, can receive medical care. The department's primary specialty is reconstructive urology: surgeons perform reconstructive urethral plastic surgery, artificial sphincter and synthetic tape (sling) implantation surgery to treat urinary incontinence, reconstructive penile plastic surgery to correct congenital and acquired defects, and penile prosthetics for erectile dysfunction. An equally important focus of the urology team is the surgical treatment of oncologic diseases such as bladder, kidney, adrenal, prostate, testicular, and penile cancer. Almost all surgical procedures to treat cancer are performed using minimally traumatic microsurgical and robot-assisted techniques – the department's urologists have the innovative da Vinci system at their disposal. Tumor drug therapy is provided in cooperation with specialists at the Cancer Center Hamburg. The department is a certified Urologic Oncology Center of the German Cancer Society (DKG). It is also one of the leading centers for pediatric urology in Germany and has the status of a certified training center for physicians of the European Society for Pediatric Urology (ESUP).
Department of Adult and Pediatric Urology, Andrology
According to the Focus magazine, the Department of Adult and Pediatric Urology, Andrology ranks among the best departments in Germany specializing in prostate cancer treatment! The department offers the full range of diagnostic and therapeutic services in the fields of its expertise. The department's medical team specializes in the treatment of diseases of the urinary tract in women and men, as well as in the treatment of pathologies of the reproductive system in adult men and children, andrological diseases in men. The primary focus of the clinical practice of the department's doctors is medical care for patients with kidney, bladder, ureteral, urethral, prostate, testicular and penile cancers. The department's specialists keep pace with medical innovations, so most surgical interventions are performed using sparing laparoscopic techniques that do not require large incisions in the skin and soft tissues. To treat prostate cancer, doctors successfully use robot-assisted prostatectomy with the da Vinci surgical system. This intervention has many advantages over classical surgery and is available only in the best hospitals in the world. In addition, the department's doctors demonstrate excellent results in the treatment of kidney stone disease, urinary incontinence and pelvic organ prolapse. A specially trained team of doctors has been formed for the treatment of urological pathologies in children. Of particular interest is the correction of congenital genitourinary anomalies in young patients.
Department of Urology
The Department of Urology specializes in the diagnosis and treatment of a full range of kidney, bladder, and urethral diseases in both men and women, as well as prostate, testicular, and penile pathologies. The department provides both conservative and surgical treatment. The department successfully practices innovative da Vinci robotic surgery and performs laparoscopic and endoscopic procedures. These operations are classified as minimally traumatic, while their effectiveness is comparable to the results of classical open surgery. Doctors of the department, together with specialists in nephrology and transplantology, perform kidney transplants, including from living donors. It should be noted that the medical facility is one of the few in Germany to perform kidney transplants using the da Vinci robotic technology. The priority focus of the urologists of the department is the treatment of cancers of the urinary system and male genitalia. The department is certified by the German Cancer Society (DKG) as a specialized center for prostate, testicular, kidney, and bladder cancer. The exceptional professionalism of the department's medical team, combined with state-of-the-art equipment, forms a solid basis for providing high-quality medical services to patients with urological diseases.
Department of Adult and Pediatric Urology
The Department of Adult and Pediatric Urology offers the diagnostics and treatment of all diseases of the urinary system organs (kidneys, ureters, bladder, urethra, etc.), as well as of the male reproductive organs in adults and children. The department specializes in the surgical and drug treatment of oncological diseases, correction of complex malformations, and plastic reconstructive urology. The department is the certified Prostate Cancer Centre.
Department of Adult and Pediatric Urology
The Department of Adult and Pediatric Urology provides high-precision diagnostics and effective treatment of the full range of diseases of the kidneys, urinary tract, bladder, prostate, testicles and their appendages, vas deferens and penis. The treatment of urologic cancers is of particular interest. The focus of pediatric urologists is on young patients with congenital and acquired malformations of the genitourinary system. The department has its in-house advanced operating rooms, an X-ray unit, and two stations with 57 beds. The high quality of medical care is confirmed by many prestigious certificates, including the DEKRA certificate and the certificate of the European Board of Urology. As one of the best urologic facilities in Germany and a leading urology clinic in Munich, the department has been offering patients the daVinci robot-assisted surgery since 2009, which has many advantages for patients: minimal pain, speedy recovery, the highest level of precision compared to conventional surgical interventions.
Department of Adult and Pediatric Urology
According to the Focus magazine, the Department of Adult and Pediatric Urology ranks among the top German departments specializing in prostate cancer treatment! The department offers the widest range of modern diagnostic and therapeutic methods for accurate detection and treatment of diseases of the genitourinary system in men and boys. The priority focus of the department is the treatment of prostate cancer (certification of the German Cancer Society).
Department of Adult and Pediatric Urology
According to the Focus magazine, the Department of Adult and Pediatric Urology ranks among the top German medical facilities specializing in prostate cancer treatment! The department offers services for the diagnostics and treatment of diseases of the kidneys, urinary tract and pathologies of the reproductive organs in men. The therapeutic options are complemented by the treatment of urological problems in children. The department's doctors focus on the patients with oncopathologies (prostate cancer, renal cell cancer, bladder cancer, testicular cancer). Of particular interest is minimally invasive therapy of stones in the kidneys, ureters and bladder. The doctors have in their arsenal conventional and the very latest conservative, drug and surgical therapies, which allow them to achieve the best result in clinical cases of varying severity.
Department of Urology
According to the Focus magazine, the Department of Urology is included in the ranking of the top German departments for prostate cancer treatment! The department offers the full range of diagnostics and treatment of diseases of the kidneys, bladder and urinary tract, male genital organs. The department has advanced experience in urologic surgery and is one of the most reputable medical institutions specializing in the treatment of benign and malignant prostate diseases. In 2009, the department was certified by the German Cancer Society as the Prostate Cancer Center.
Department of Adult and Pediatric Urology
According to the Focus magazine, the Department of Adult and Pediatric Urology ranks among the top German departments specializing in prostate cancer treatment! The department deals with the diagnostics, conservative and surgical treatment of diseases of the genitourinary system in men and boys. If necessary, surgical treatment may be provided with the use of sparing minimally invasive techniques, which allows to ensure early recovery for the patient. In the treatment of benign prostatic hyperplasia, kidney stone disease, ultramodern laser technologies are widely used. The department treats more than 1,800 inpatients and about 5,000 outpatients every year.
Department of Adult and Pediatric Urology
According to the Focus magazine, the Department of Adult and Pediatric Urology ranks among the best German medical facilities for prostate cancer treatment! The department offers all diagnostic and therapeutic services in the field of its competence and specializes in the treatment of diseases of the genitourinary system in men of all age groups. The department has 46 beds for inpatient medical care. One of the key focuses is prostate cancer treatment (certification of the German Cancer Society as a Prostate Cancer Center). The doctors of the department are also highly professional in the treatment of diseases of the external genital organs in men, pathologies of the kidneys, adrenal glands, ureters, bladder and urethra in men and women.
Thanks to the development of medicine, most patients with prostate cancer have a favorable prognosis. This disease is successfully treated in Europe. Moreover, in most cases, the doctors from the Departments of Urology remove the prostate using a minimally invasive laparoscopic technique. More and more surgical procedures are performed using robot-assisted surgical systems. They are minimally traumatic, rarely cause complications and reduce the patient's rehabilitation period. Countries with advanced medicine use special methods to detect metastases and determine tumor boundaries using radio navigation. They help reduce the risk of prostate cancer recurrence.
Content
- Who needs a robot-assisted prostatectomy?
- Sentinel lymph node resection
- Robot-assisted prostatectomy and DROP-IN gamma probe
- Additional fluorescence control
- PSMA-targeted radio navigation
- Treatment in Europe with Booking Health
Who needs a robot-assisted prostatectomy?
Prostate cancer patients who require radical treatment can get rid of the disease in one of the following three ways:
- Radiation therapy.
- Brachytherapy.
- Surgery.
A surgical intervention has many advantages: the lowest risk of recurrence, accurate staging due to the examination of removed lymph nodes, instant cure of prostate adenoma. However, the standard surgery is traumatic. It is performed through large incisions, requires long-term recovery, and leads to the development of erectile dysfunction and urinary incontinence in many patients.
In countries with advanced medicine, such surgical procedures are gradually becoming a thing of the past. Most of the interventions in urology are performed laparoscopically – through short incisions. Moreover, 50-70% of prostatectomies in countries with advanced medicine are performed using robot-assisted surgical systems.
Gamma probing is an additional procedure to remove lymph nodes potentially involved in the neoplastic process. It is required to reduce the risk of recurrence. Gamma probing is indicated not for all patients, but only for those who have more than 5% chance of having metastases.
Robot-assisted prostatectomy has the following benefits:
- Doctors have more freedom of action as compared to a conventional laparoscopic intervention, so they can remove lymph nodes even in the most unfavorable location without the risk of complications.
- Surgeons can see the surgical field better.
- Surgeons use additional techniques in order to detect sentinel lymph nodes, metastases, tumor boundaries (fluorescence navigation, radio navigation).
- Perfectly thin and even incisions.
- Instantaneous vascular coagulation that facilitates reduced blood loss.
Key benefits for the patient are:
- Minimal invasiveness of the surgical procedure and rapid recovery.
- Minimum time in the hospital.
- Low risk of erectile dysfunction and urinary incontinence.
- Rapid restoration of control over urination.
- Low risk of cancer recurrence (when using gamma probing).
Sentinel lymph node resection
At the time of diagnosis, prostate cancer may not have metastases in the lymph nodes. However, this is data from clinical trials. The stage is established by the results of CT or MRI scans, which do not reveal enlarged lymph nodes. Radionuclide methods are also sometimes used, but even they can only detect metastases from 1 cm in size.
Thus, if, from a clinical point of view, there are no metastases, this does not mean that they are really absent. There may be foci of metastasis several millimeters in diameter, which are a potential source of recurrence after prostate cancer surgery. To prevent recurrence, these lymph nodes must be removed.
In standard prostate cancer surgery, doctors do not look for metastases. They simply use nomograms and formulas to calculate the risk of tumor metastasis. If the probability is significant, then lymph node dissection (lymph node removal) is performed in a limited, standard or expanded scope. A risk of recurrence of more than 5% is an indication for extended lymphadenectomy. However, even in this case, the return of cancer is not excluded, since some of the lymph nodes, into which tumor cells penetrate, may be located outside the boundaries of standard lymph node dissection.
Radioisotope lymphoscintigraphy is a procedure that solves this problem. Intraoperative examination reveals the lymph nodes into which lymph flows from the tumor. These nodes are considered sentinel nodes – they are the first on the path of movement of cancer cells. Accordingly, if metastases appear somewhere, then first of all in them.
The essence of the diagnostic examination is that several injections of a radioactive substance are made into the patient's prostate before the surgery. Then, a thin long laparoscopic gamma probe is inserted during the operation into the patient's body through one of the ports. It is used to scan for radiation. The doctor detects the lymph nodes, in which the radioactive substance has accumulated, and removes them to prevent cancer recurrence.
Robot-assisted prostatectomy and DROP-IN gamma probe
Prostate cancer surgery in Europe is increasingly performed with the help of robot-assisted surgical systems. In recent years, doctors have begun to use the DROP-IN probe for robots instead of conventional laparoscopic gamma probes.
The problem with the conventional laparoscopic gamma probe is the lack of maneuverability. It has only four degrees of freedom. Some foci of accumulation of the radiopharmaceutical may not be detected, since the signals are muffled by the nearby large accumulations of radionuclide in the injection area. In addition, blocking the trocar with a probe prevents access to other instruments, so tissue aspiration and extraction cannot be performed. To solve this problem, an additional incision has to be made. Finally, in case of robot-assisted surgery, the diagnosis is complicated by the fact that the surgeon is not near the patient, but controls the robot using a remote console. Therefore, he needs the help of a human assistant who will carry out the necessary procedures, following oral instructions.
The DROP-IN probe can be used without an assistant. It has six rather than four degrees of freedom, unlike the laparoscopic probe. This probe can detect and remove more lymph nodes. The first experience with its use has already shown its advantages: patients had an average of more than 30 sentinel lymph nodes beyond the limits of the standard volume of extended lymphodissection. Moreover, 45% of the removed nodes were inaccessible or difficult for conventional laparoscopic gamma tracking.
Additional fluorescence control
Fluorescence diagnostics is an alternative to radio guidance. The doctor injects a substance that accumulates in the cancer cells and makes them glow when the laparoscope is specially illuminated. It also helps the doctors to detect metastases and tumor foci.
The best European hospitals use fluorescence diagnostics not instead of, but in addition to radio navigation. The gamma probe is more accurate, it allows the doctors to detect more sentinel lymph nodes. Its use was limited only by insufficient manipulation of standard laparoscopic probes, but this problem was solved with the development of probes for robot-assisted surgery.
PSMA-targeted radio navigation
The most advanced direction in the treatment for prostate cancer is the PSMA targeting technology, which is used for gamma probing. It involves the use of drugs that accumulate only in cancer cells.
The difference from the standard radio navigation technique is the selectivity of the accumulation of the radionuclide. When carrying out radioisotope lymphoscintigraphy, the radioactive substance simply accumulates in the sentinel lymph nodes, regardless of whether there are cancer metastases in them or not. However, drugs targeting PSMA (prostate-specific membrane antigen) only accumulate where there are cancer cells.
When performing prostatectomy, this type of radio navigation is usually used not only for the detection of metastases, but also for the determination of tumor boundaries. Patients undergoing salvage prostatectomy receive the greatest number of benefits. This is a surgical procedure to remove the prostate in those patients whose cancer has recurred after radiation therapy. Previously, such operations were performed only via open access: through a large incision. However, today the best European centers already perform them with the help of robotic systems. The minimally traumatic variant of the surgery became possible precisely thanks to the development of a probe used during robotic-assisted prostatectomy. This technology makes it possible to determine tumor boundaries, identify all deep tumor foci and metastases in the lymph nodes as effectively as in open surgery.
Treatment in Europe with Booking Health
To undergo prostate cancer treatment in one of the European hospitals, you can use the services of the Booking Health company. On our website, you can see the cost of treatment and compare prices in different hospitals in countries with advanced medicine in order to book a medical care program at a favorable price. The treatment in a European hospital will be easier and faster for you, and the cost of treatment will be lower.
You are welcome to leave your request on the Booking Health website. Our specialist will contact you and provide a free consultation on treatment in Europe. Booking Health will fully organize your trip abroad. We provide the following benefits:
- We will choose the best medical hospital for treatment in Europe, whose doctors have vast experience in robot-assisted prostatectomy using a gamma probe.
- We will help you overcome the language barrier and establish communication with the doctor from the Department of Urology at the European hospital.
- We will reduce the waiting time for the medical care program. You will undergo treatment in the Department of Urology on the most suitable dates for you.
- We will reduce the prices. The cost of treatment in Europe will be lower due to the lack of overpricing and additional coefficients for foreign patients.
- We will take care of any organizational issues: we will issue documents, meet you abroad and take you to the hospital, book a hotel, provide interpreting services.
- We will prepare a program and translate medical records. You do not have to repeat the previously performed diagnostic procedures.
- We will help you keep in touch with the doctors in the Department of Urology after the completion of treatment in Europe.
- We will organize additional examination and treatment in a European hospital, if required.
- We will buy medicines abroad and forward them to your native country.
Your health will be in the safe hands of the world's leading doctors. The Booking Health specialists will help you reduce the cost of treatment, organize your trip to a European hospital, and you will only have to focus on restoring your health.
Authors: Dr. Vadim Zhiliuk, Dr. Sergey Pashchenko
