1st Urology Clinic

At the 1st Urology Clinic, robotic surgical management of urological diseases is applied. In principle, all urological conditions treated laparoscopically can also be managed robotically. However, the conditions most commonly treated robotically, with the greatest benefits for the patient, include: prostate cancer, bladder cancer, benign conditions of the prostate and bladder (large prostatic adenoma, bladder diverticulum, vesicovaginal fistula), benign conditions of the renal pelvis and ureter (pyeloplasty, ureteroneocystostomy), as well as benign and malignant kidney diseases (renal cancer, large renal cysts).

Procedures that may also be performed robotically include robotic varicocele repair and robotic inguinal hernia repair.

Additionally, the 1st Urology Clinic includes a Urinary Incontinence Unit and an Andrology Unit.

• Robotic Radical Prostatectomy
• Robotic Radical Nephrectomy
• Robotic Partial Nephrectomy
• Robotic Cystectomy
• Robotic Pyeloplasty
• Robotic Simple Prostatectomy

• Flexible laser lithotripsy of kidney and ureteral stones
• Percutaneous laser lithotripsy
• HoLEP, Holmium Laser Enucleation of the Prostate
• Laser resection of bladder and ureteral tumours
• Laser incision of ureteral strictures

The Urinary Incontinence Unit provides comprehensive diagnostic evaluation and definitive management of urinary incontinence in both men and women. Following the initial diagnostic assessment, which determines the type of incontinence, the appropriate therapeutic options are proposed:

• Simple medical advice involving lifestyle modifications (diet, weight control, specialized pelvic floor muscle strengthening exercises, etc.)
• Targeted pharmacological treatment (anticholinergics)
• Minimally invasive surgical treatments, without incisions, performed either transvaginally or perineally, with short hospital stay and relatively rapid recovery
• Tension-free incontinence sling placement

Staffed by specially trained Urologists–Andrologists with extensive experience in the management of male infertility and sexual dysfunction.

The most effective diagnostic and therapeutic methods are applied for the management of male infertility conditions (varicocele, prostatitis, obstruction of the seminal or ejaculatory ducts, etc.).

Diagnosis of male infertility is usually initially established through semen analysis and subsequently through more specialized investigations performed at Metropolitan General, such as urine and semen cultures, hormonal, biochemical and immunological testing of semen and blood, as well as specialized imaging studies, including penile Doppler ultrasound (Triplex).

All test results are evaluated by the Urologist–Andrologist, determining the final diagnosis of the underlying cause of infertility and the appropriate treatment plan.

Treatment

Pharmacological therapy

Microsurgical procedures for all surgically correctable causes of male infertility (varicocele, testicular biopsy for tissue cryopreservation, obstruction of the seminal ducts or epididymis)

Focuses on the diagnosis and treatment of sexual dysfunction (ejaculatory disorders, decreased libido, erectile dysfunction such as weak erection or inability to maintain erection during intercourse, anatomical abnormalities/penile curvature, etc.). Initially, the underlying cause is identified, which may be psychogenic, organic, or a combination of both, and appropriate management is then proposed.

Etiological diagnosis

This is achieved through detailed medical history, clinical examination for the diagnosis of anatomical abnormalities or inflammatory conditions, and specialized laboratory and imaging tests.

Blood tests help determine whether the condition is neurogenic, endocrine (e.g., hyperprolactinemia, low testosterone), vascular (e.g., hypertension), or related to renal, hepatic, or thyroid disorders, as well as undiagnosed diabetes mellitus or dyslipidemia. Additionally, penile Doppler ultrasound (Triplex) is available at Metropolitan General for the diagnosis of vascular causes (arterial or venous) of erectile dysfunction.

Treatment

There are several effective treatment options, with success rates approaching 95% in the majority of cases:

Pharmacological treatment, alone or in combination with specialized psychotherapy when required. A wide range of medications with different clinical profiles is available, allowing individualized treatment selection

Vacuum devices: an alternative option for patients who wish to avoid pharmacological treatment and have occasional sexual activity

Surgical correction of penile curvature: penile curvature may be congenital or acquired (Peyronie’s disease). Treatment is performed at Metropolitan General with specialized reconstructive procedures, requiring only one day of hospitalization

Intracavernosal injection therapy: administration of specialized pharmacological agents following strict individualization, directly into the corpora cavernosa. Patients are trained to self-administer the injections prior to intercourse

Penile prosthesis implantation: the optimal solution for patients who do not respond to other treatments. The procedure is performed surgically with a one-day hospital stay, and modern implants come with a lifetime manufacturer’s warranty in case of mechanical failure