DR STEPHAN HRUBY

Essential expertise / performing operations / treatments:

Prostate carcinoma

• Targeted diagnostics using MRI and targeted tissue samples (TRUS/MRI fusion biopsy)
• “Liquid biopsy” – “Select MDx” test for prostate cancer: urine genetic test for risk assessment in cases of elevated PSA level
• Personalised, robot-assisted radical prostate removal (Da Vinci prostatectomy) with individual nerve protection
• Robot-assisted fluorescence-targeted lymph node removal
• Entire spectrum of drug therapy for advanced prostate cancer as well as palliative treatment and care

Prostate enlargement

• Transurethral resection of the prostate TURP (the so-called “scraping out”): the classic operation for benign prostate enlargement is performed through the urethra in a circulatory-sparing irrigation solution and, depending on the individual constitution, can also be performed in a way that preserves ejaculation
• Robot-assisted enucleation – for particularly large glands of more than 100 grams, the adenoma is removed through the abdomen with the help of the Da Vinci system using laparoscopy. This means that the ureteric orifices and the urethral sphincter can be protected as much as possible.
• In patients with a very high risk of anaesthesia and/or bleeding:
  transurethral vaporisation of the prostate – this involves vaporising part of the prostate through the urethra with a plasma probe.
  REZUM method – this shrinks the prostate using steam without the risk of bleeding. As a result, the need for permanent urinary diversion by means of a permanent catheter can be avoided or reversed even in a large number of patients who have so far refrained from surgical rehabilitation due to the risk of anaesthesia. In special cases, this method is also an alternative for very young patients.

Chronic prostatitis

• Detailed diagnostics: the diagnosis of CPS/CPPS is ultimately a diagnosis of exclusion and involves extensive clinical, laboratory and imaging investigations.
• Drug therapy: symptomatic and supportive therapy individually adapted to the stage and symptoms.
• Shock wave therapy: one of the few therapeutic approaches that has led to a significant improvement in pain symptoms and quality of life after a few weeks in placebo-controlled studies. The treatment is painless, but sometimes produces a slight tingling sensation in the treated area. A treatment cycle comprises at least six treatments over a period of three to six weeks. First effects are usually seen after four treatments.
• Interdisciplinary cooperation with psychologists & physiotherapists: an individual stretching and exercise programme as well as accompanying psychotherapy can effectively support the healing process in individual cases.

Kidney tumours & kidney cysts

• Robot-assisted & kidney-preserving tumour removal – “partial kidney resection” (“Da-Vinci-partial nephrectomy”): – Thanks to the possibilities of the Da Vinci robot, 10-fold magnification and angled instruments as well as the use of intraoperative ultrasound, up to 70 % of kidney tumours can now be operated on in an organ-preserving manner.
• Robot-assisted laparoscopic or traditional open surgery radical kidney removal – depending on the location and extent of the tumour
• Drug therapy for advanced renal tumour disease

Adrenal tumours

• Robot-assisted or laparoscopic adrenalectomy
• Organ-preserving tumour removal in selected cases

Reconstructive urology

• Robot-assisted renal pelvoplasty for renal pelvic outlet stenosis
• Robot-assisted ureteral end-to-end anastomosis or ureteric reimplantation (“Psoas Hitch” or “Boari” surgery) for ureteric stenosis
• Robotic assisted bladder diverticulotomy for symptomatic outpouchings of the bladder wall
• Robot-assisted V-Y bladder neck plasty for stubborn bladder neck stenosis that cannot be managed endoscopically
• Ureteric stents (internal splints – “DJ stents” or “metal stents”) – as temporary or permanent solution
• Palliative urinary diversion

Urinary stones

• Endoscopic stone disintegration using laser or lithoclasts
• Ureteroscopy (state-of-the-art flexible digital HD endoscopes)
• Percutaneous procedures for larger kidney stones (mini PCNL or traditional PCNL)
• Laparoscopic stone removal
• Long-term care for frequent stone patterns such as cysteinuria

Urothelial tumours (bladder)

• Diagnostics using state-of-the-art HD endoscopy: fluorescence and NBI imaging can significantly increase the detection rate.
• Bipolar (circulation-sparing) transurethral resection of bladder tumours: around 90 % of tumours are superficial and can be treated minimally invasively.
• Radical bladder removal (minimally invasive or open surgery) with individual urinary diversion (neobladder, ileum conduit, ureteric fistula)
• Robot-assisted kidney and ureter removal for urothelial tumours in the area of the renal pelvis or ureters
• Laser therapy for tumours in the initial stage in the ureter or renal pelvis
• Bladder irrigation therapy with BCG or mitomycin for treatment of early-stage tumours with a high risk of progression – this therapy enables bladder preservation in many cases, but must be considered carefully.
• Drug therapy in cases of advanced urothelial tumours

Erectile dysfunction

• PDE-5 inhibitors: these drugs are an important pillar of treatment. However, since up to 30% of all patients do not respond or respond little to this therapy, I am also happy to advise you on alternative treatment methods.
• Corpus cavernosum auto-injection therapy (SKAT): this is an effective form of therapy when the erectile tissue and blood flow to the penis are intact and drug treatment has no effect.
• Shockwave therapy: one of the few therapies for which a regenerative effect on erectile tissue vessels & nerves has been proven in placebo-controlled studies. The treatment is painless, but sometimes produces a slight tingling sensation in the treated area. A treatment cycle comprises at least six treatments over a period of three to six weeks. One treatment takes around 15 – 25 minutes. First effects are usually seen after approx. four treatments. Of course, this therapy does not work miracles, but it can make the use of PDE-5 inhibitors unnecessary in patients with mild ED and significantly improve the response to medication in patients with more severe forms, thus leading to more fulfilling sexual function.
• Interdisciplinary cooperation with psychologists: accompanying psychotherapy can effectively support the healing process in individual cases.

Premature ejaculation

• Medication & counselling can lead to improvement here in many cases.
• Here, too, I am in close interdisciplinary exchange with sex therapists and psychologists.

Curvature of the penis

• Drug therapy with PDE-5 inhibitors: a low-dose PDE-5 inhibitor is the basic therapy for conservative treatment, as it increases blood flow in the penis during the day and night and thus supports healing.
• Treatment with penile extender: a good complementary option to conservative therapy as well as preparation for surgery. However, these are only suitable for the acquired curvature.
• Shock wave therapy: shock wave therapy has revolutionised the treatment of penile curvature in recent years. Especially as part of a combined treatment with PDE-5 inhibitors and/or remedies, significant improvements in symptoms are achieved with this method.
• Surgical rehabilitation: I only recommend surgical rehabilitation if no conservative therapy shows a significant improvement. Furthermore, surgery should only take place when the disease has stabilised for at least 9 – 12 months.

Hormonal changes

• Detailed history-taking & laboratory diagnostics
• Sonography of the testicles
• Testosterone replacement therapy: tablets, gel or 3-month depot injection