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Kidney Stone

The reason why most kidney stones form is not known. A stone may cause no problems but often it causes pain. Most kidney stones are small and pass out with the urine. Some stones become stuck in a kidney or in the tube draining urine from the kidney. They can then cause persistent symptoms or problems. There are various treatment options to remove a stuck stone. About half of people who have a kidney stone develop another one at a later time in their life. Drinking plenty of water each day may prevent this from happening again.

Large stones and those that cause symptoms

Kidney stones that can't be treated with conservative measures - either because they're too large to pass on their own or because they cause bleeding, kidney damage or ongoing urinary tract infections - may require more extensive treatment.

What are kidney stones?

Kidney stones can form in the kidney, in the tube draining urine from the kidney (the ureter) or in the bladder. They can be many different sizes and shapes. The size of kidney stones ranges from tiny microscopic crystals to stones as large as potatoes.

Penile Cancer Treatment

When you're treated at Tristone Hospital for penile cancer, some of the nation's top specialists focus their expertise on you. They communicate with each other - and with you - to ensure you receive the most advanced treatment with the least impact on your body.

As one of the nation's leading cancer centers, Tristone Hospital sees many more patients with penile cancer than the average oncologist. This means we have a higher level of experience and expertise, which is crucial to your treatment and recovery.


If you are diagnosed with penile cancer, your doctor will discuss the best options to treat it. This depends on several factors, including the type and stage of the cancer and your general health.

Surgery is the most frequent form of treatment for penile cancer, but laser therapy and radiation may be used for smaller tumors. The type of treatment usually depends on how far the cancer has spread.

Your treatment for penile cancer will be customized to your particular needs. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.

Laparoscopic Urology

Many traditional urologic surgical procedures require large incisions with lengthy hospitalization and recovery. Minimally invasive surgery, also often known as laparoscopic or keyhole surgery to patients, has recently been developed in the field of urologic surgery with the advancement of engineering and computer technologies. Using a small telescope with built-in magnification mechanism and a variety of long, thin surgical instruments placed through approximately 3-5 incisions, the surgeon is able to perform minimally invasive surgery for a variety of urologic diseases and problems. Patients who have undergone these procedures have enjoyed not only the same diagnostic and therapeutic benefits of traditional open surgery but also greatly reduced postoperative pain, shorter hospitalization, faster recovery, and better cosmetic results.

Minimally invasive surgery has been applied to a multitude of benign (non-cancerous) and malignant (oncologic or cancerous) urologic problems. Furthermore, it has been applied to conditions affecting a variety of urologic organs (including kidney, adrenal gland, ureter, bladder, prostate, lymph nodes).

One application of minimally invasive surgery/laparoscopy is kidney cancer removal. Using only 3 small puncture holes, the entire kidney may be removed. This is very different from conventional open surgical removal of the kidney, in which a much larger surgical cut is typically needed.

Recently, robotic technology has been used in the field of laparoscopic urologic surgery. Radical prostatectomy for prostate cancer is an area with increasing widespread use of such robotic technology. When robotics are involved, such procedure is often called "robotic-assisted laparoscopic radical prostatectomy" or Robotic surgery has been reported to provide better visualization and greater dexterity to the surgeon, and the clinical data to date appear to be promising and similar to those of the established conventional open surgery. The new generation robotic system is currently available at Stanford, and the robotic laparoscopic surgery is offered to the appropriate patients after thorough evaluation in the Urology Clinic.

Minimally invasive surgery may not be an appropriate option to every patient. At Stanford, individualized evaluation and consultation will provided to all patients interested in this surgical modality.


There are many treatment options for prostate cancer that is confined to the prostate gland. Each option should be considered carefully, balancing the advantages against the disadvantages as they relate to the individual man's age, overall health and personal preferences.

How is the type of prostate cancer treatment decided?

Once a diagnosis of prostate cancer has been made a man and his doctor must decide what steps to take next for management and treatment. The decision will depend on a number of factors including:

  • Gleason score - high (more aggressive), intermediate (Gleason 7), or low grade
  • stage of the cancer - localised in the prostate gland or spread to other parts of the body
  • level of PSA in the blood and the rate of change of PSA over time (velocity)
  • age and general health
  • side-effects of treatment
  • personal preference.

  • To help with making decisions about treatment, patients can be placed into high, intermediate or low risk groups with respect to likely cancer outcome. This is done using a combination of factors.

    How is localised prostate cancer treated?

    If the cancer is localised, that is, only in the prostate gland, the options available include observation monitoring, active surveillance, radical prostatectomy .
    Surgery and radiation therapy both work well in treating localised prostate cancer but they have different side-effects.

    Endoscopic Surgeries

    Surgical Endoscopy represents the surgical aspects of interventional endoscopy, ultrasound, and other techniques in the fields of gastroenterology, obstetrics, gynecology, and urology, as well as in gastroenterologic, thoracic, traumatic, orthopedic, and pediatric surgery. It offers a worldwide forum for discussion of aspects of interventional endoscopy and ultrasound as integral elements of surgical practice. It also affords the international surgical community a focal point for the exchange of information on practice, theory, and research in various medical and surgical disciplines.

    What is Endoscopic Surgery?

    Endoscopic surgery uses scopes going through small incisions or natural body openings in order to diagnose and treat disease. Another popular term is minimally invasive surgery (MIS), which emphasizes that diagnosis and treatments can be done with reduced body cavity invasion. Radical Surgeries

    VVF, UVF Female Surgeries

    What Is VVF?

    Urinary fistulas arising in a women is a complex and multi faceted problem. Apart from a cause of grave concern and psychosocial issues in the women herself, it can cause tension and emotional distress to the family, including the newborn if it is a case after child birth.

    Urinary fistulas present as continuous urinary leakage in women. This chronic incessant leakage causes wetting, bad smell, skin soiling infections and may lead to the woman becoming a social outcast, either by choice or by societal pressure. Female urinary fistulas is a pertinent cause of incontinence or urinary leakage in women. Most women decline treatment because of embarrassment or shame.

    But, female urinary fistulas are eminently treatable and their management though difficult and controversial, once successful, provide long lasting relief to patients and their families.

    There are many types of female gynecological urinary fistulas, most common of which is the Vesico vaginal fistula or the VVF. But the other varieties are –

  • Vesico Vaginal Fistula - VVF
  • Uretero Vaginal Fistula – UVF

  • A vesicovaginal fistula is an abnormal passageway between the bladder and the vagina that causes incontinence, allowing urine to drain directly into the vagina rather than through the urethra. The condition can be congenital or acquired through surgery or other physical trauma (e.g. childbirth). In developed countries, one of the most common causes is tissue damage from gynecological surgeries, such as a hysterectomy or urinary tract procedure. Treatment depends on fistula size and location.

    Conservative Treatment for Vesicovaginal Fistula

    The most common symptom of a vesicovaginal fistula is loss of bladder control or urinary incontinence. Conservative treatments of vesicovaginal fistula promote closure of the fistula and prevent urine from flowing through. These include:

  • Foley catheter: A one-to-two month catheterization of the bladder ensures that urine is drained from the bladder through the urethra and gives the fistula time to close.
  • Estrogen therapy: Estrogen therapy-via pill, patch, injection, vaginal cream, or ring-may help strengthen the vaginal wall and close the fistula.

  • Conservative treatment options are best for patients with a fistula smaller than 3mm in diameter. If these aren't successful, patients can move on to more invasive procedures.

    Minimally Invasive Procedures for Vesicovaginal Fistula

    Minimally invasive procedures for vesicovaginal fistula treatment destroy the lining of the fistula to try and block or occlude it. This can be done a number of different ways, including the use of electrocautery (burning), lasers, or occlusive agents such as fibrin glue. In these procedures, a cystoscope (thin tube with a camera) is inserted through the urethra and up to the bladder to get a visual of the fistula. Then, tools can be inserted through the tube and used to close the fistula.

    Occlusion can be effective for fistulas smaller than 3mm. It is typically used when conservative treatment doesn't work. Occlusion can sometimes initially be effective but then fail later, necessitating additional procedures.

    Pediatric Urology

    Abnormal conditions of the urinary tract, male reproductive system and vagina are among the most common pediatric health concerns in the United States, affecting millions of children each year.

    Pediatric Urology Services at Tristone Kidney Hospital provides diagnostic and treatment options for pediatric patients with conditions that affect the urinary tract, male reproductive system and vagina. These conditions include:

  • Ambiguous genitalia
  • Bladder Exstrophy
  • Hematuria
  • Hernias and hydroceles
  • Hypospadias
  • Incontinence
  • Kidney stones
  • Megaureter
  • Neurogenic bladder
  • Undescended testes
  • Ureteropelvic junction obstruction
  • Urinary stones
  • Urinary tract infection
  • Vesicoureteral reflux

  • Diagnosis

    Symptoms of serious conditions of the urinary tract or kidneys vary but are commonly indicated by frequent, uncontrolled or painful urination. Pediatric Urology Services strives to offer state-of-the-art diagnostic techniques for accurately identifying urologic diseases and disorders in infants, children and adolescents. Physicians at Cedars-Sinai are currently investigating ways to diagnose problems in the fetus so that potentially life-threatening conditions can be corrected before they fully develop.


    Andrology is the branch of medicine concerned with male health, particularly focused on the problems of the male reproductive system. The Andrology Laboratory Department at Harvard Vanguard Kenmore provides a wide range of services for the accurate diagnosis of male infertility and works closely with the Fertility and Reproductive Health Department to help identify the best treatment options for each individual or couple.

    Andrology tests and services include:

  • Semen analysis
  • IUI (Intrauterine insemination) sperm preparation
  • Other specialized tests as needed
  • Reconstructive Urethral Surgeries

    The severely damaged female urethra is a rare occurrence that has two main causes - obstetric injury and surgical trauma. Obstetric injuries are exceedingly uncommon in industrial countries but not so in the Third World. Damage to the trigone, vesical neck, and urethra during delivery is thought to be the result of prolonged and neglected labor, most often associated with maternal–fetal disproportion wherein the fetal head compresses these structures against the pubis, causing pressure necrosis. Surgical damage may occur during any of the Peyrera - type bladder neck suspension procedures, anterior colporrhaphy, urethral diverticulectomy, and, much less commonly, vaginal hysterectomy.

    In our experience, urethral diverticulectomy is the most common cause of extensive urethral damage. This most likely results from failure to obtain a tension-free closure of the urethral defect that results from excision of the diverticulum. During bladder neck suspension, inadvertent injury to the bladder or urethra may occur, or an errant suture may result in fistula formation or tissue necrosis. We have also seen several patients who sustained extensive tissue loss after a seemingly simple Kelly plication. It is postulated that the plication sutures were tied too tightly around a urethral catheter, resulting in pressure necrosis.

    Rarely, indwelling urethral catheters may cause pressure necrosis of the urethra, and even more rarely, trauma to the pelvis may result in fracture or separation of the symphysis pubis, which lacerates the urethra and/or vesical neck. Finally, there may be local invasion of these tissues from carcinoma of the cervix or damage from radiation treatment.