Indications for endoscopic surgery

Abstract

The indications for endoscopic surgery vary within wide limits, depending chiefly upon the surgeon who is to perform the operation. If he has had adequate training and extensive experience in endoscopic surgery, the indications for him will include the removal of prostates weighing up to 150 to 200 grams, the resection of bladder tumors as large as 4 to 5 cm. in diameter, the crushing of stones up to 3 to 4 cm. in diameter and other procedures which are technically difficult. Surgeons who have not had this extensive training and experience, or who are unequipped in other ways to perform the more difficult endoscopic procedures, will limit the use of this approach to the small sized lesions. If a surgeon has had no training or experience in endoscopic surgery, there is no indication for its use by him; it is better for him not to attempt it. For the average urologist, endoscopic surgery is indicated for relief of bladder neck obstruction due to prostatic carcinoma which does not respond to hormone therapy and for removal of bladder neck contractures, median bars and the smaller prostatic adenomas. Small bladder tumors, small stones and sometimes Hunner ulcers and other intravesical lesions can usually be removed more successfully by the average urologist through the endoscopic approach than by open surgery. The ultimate factor determining the approach best suited to a given case is the operator himself. If he has established proficiency at removing large prostates and other lesions endoscopically, there is no contraindication to continuance of this method in his hands.