Benign Prostatic Hyperplasia:

“Benign prostatic hyperplasia affects about 65% of men over the age of 50. Among these men, approximately 30% will need to undergo surgical intervention not only to address the symptoms but primarily to manage the complications arising from the inability to properly void urine due to prostate enlargement.

The availability of ultrasound and uroflowmetry devices in every organized urology clinic today allows for the proper selection of patients who should undergo surgery, avoiding unnecessary interventions based solely on the size of the prostate.

In the past, the removal of significantly enlarged prostates required an ‘open’ surgical procedure, which was taxing and resulted in substantial bleeding for the patient.

Later on, the open surgery was largely replaced by ‘transurethral’ prostatectomy, which, however, particularly for large adenomas, was not without complications.

In recent years, ‘transurethral vaporization’ of the prostate using the ‘green’ Laser and plasma techniques has been applied in Greece as well. These methods achieve the same results as the previous techniques, with minimal bleeding and short hospital stays, rarely exceeding one day. Moreover, these methods can be employed for patients under anticoagulant or antiplatelet therapy.”

Urinary Tract Lithiasis

“Until the mid-1980s, ‘open’ surgical treatment for urinary lithiasis accounted for 50% of urologists’ surgical workload. For a condition where surgery did not address the cause but the manifestation of the disease, the lack of alternative methods had catastrophic consequences for unfortunate patients who had a tendency to form stones.

The availability of extracorporeal shock wave lithotripsy (ESWL) and endoscopic techniques today has practically eliminated the need for classical surgical interventions. As a result, younger urologists are essentially untrained in ‘open’ techniques.

Modern approaches to lithiasis management are as follows:

Endoscopic Lithotripsy

Successfully applied in almost 100% of cases for urinary bladder stones, using either Holmium Laser or pneumatic lithotripters that function as compressors.

For ureteral stones or managing calculi fragments after ESWL, the success rate with ureteroscopy is around 95%. The availability of flexible ureteroscopes and thin fibers for Holmium Laser now allows for the treatment of stones in the upper ureter and inside the kidney using the technique called Retrograde Intra-Renal Surgery (RIRS).

Percutaneous Lithotripsy:

Performed under general anesthesia for renal stones larger than 2 cm, such as lower pole kidney stones. The success rate of percutaneous lithotripsy is 97% compared to only 37% for ESWL. Despite not requiring a surgical incision, it is a specialized surgical procedure that demands corresponding expertise.

Extracorporeal Lithotripsy:

Performed without anesthesia on an outpatient basis. Primarily suitable for kidney stones up to 2 cm in size. The success rate is up to 90% for selected cases. For larger stones, the success rate drops to 50%. An indwelling ureteral stent (pigtail catheter) is often placed to prevent obstruction.

In cases of ureteral stones, the effectiveness of lithotripsy seems to depend on the stone’s location, with success rates ranging from 65-81% for stones in the upper part and 58-67% for stones in the lower part of the ureter.

CAUTION: Extracorporeal lithotripsy should be performed by a specialized urologist, not a technologist, as the specialized knowledge achieves high success rates through proper machine settings and prevents complications that can occasionally have catastrophic consequences.

“Open” Surgery:

Primarily applied in coral-like kidney stones, although the combination of extracorporeal and percutaneous methods can also successfully remove these stones.

In conclusion, for the majority of lithiasis cases, the solution lies either in extracorporeal lithotripsy or minimally invasive endoscopic techniques, with hospital stays rarely exceeding 24 hours.”

Bladder Cancer

“The bladder cancer is the fourth most common cancer in males and the tenth in females. In developed countries, 90% of cases involve transitional cell carcinoma of the bladder epithelium, and the median age at diagnosis is 68 years. The disease typically manifests with painless hematuria, and diagnosis is easily achieved with the availability of imaging and endoscopic techniques.

After diagnosis, the next step is tumor resection, which is performed using a suitable instrument via the urethra. It’s important for the transurethral resection of the tumor to be conducted by an experienced urologist, ensuring that the excised material includes a portion of the muscular layer of the bladder. Given that the bladder wall is only a few millimeters thick, the risk of bladder perforation is evident, especially when necessary expertise is lacking.

When the cancer is superficial and hasn’t invaded the bladder wall, it is treated with transurethral resection combined with intravesical instillations of chemotherapeutic or immunostimulatory agents. Bipolar diathermy is the preferred technique for the procedure, offering significant advantages: it ensures excellent hemostasis, making the procedure nearly bloodless, while minimizing the risk of trigone nerve stimulation and preventing possible bladder perforation.

Depending on the disease characteristics, it’s now possible to predict the chances of recurrence or progression of the cancer and recommend appropriate treatment. The European Association of Urology, after studying thousands of cases, has developed relevant tables that record the likelihood of cancer recurrence or progression to muscle-invasive disease within one year and five years. Additionally, recommended follow-up methods are outlined to detect recurrences in their early stages. It’s important to convey the message that patients should maintain a lifelong relationship with their urologist and undergo regular follow-up.

In cases of muscle-invasive disease, the removal of the bladder and its replacement with a neobladder made from intestine is necessary. Fortunately, modern techniques allow the construction of an “orthotopic” neobladder, freeing the patient from the need for a urinary pouch, while also preserving erectile nerves.”

Upper Urinary Tract Cancer

Cancer of the upper urinary tract (meaning the renal pelvis and ureter) accounts for 5% of urinary tract cancers. In contrast to bladder cancer, which can be easily detected with the help of ultrasound and cystoscopy, cancer of the upper urinary tract is difficult to diagnose, and often the decision for surgery is made without sufficient preoperative evidence of the disease.

In 50% of cases, the examination is conducted as part of hematuria investigation and includes imaging, cytology, and endoscopic methods.

The availability of axial pyelography in recent years, but especially the advancements in endoscopic methods, particularly ureteroscopy, now allow us not only to diagnose but also, where feasible, to conservatively manage the disease without removing the kidney.

Kidney Cancer

Kidney cancer represents about 3% of adult neoplasms and is characterized by the lack of early clinical manifestations, as well as resistance to radiation therapy and chemotherapy.

Fortunately, the availability of modern imaging methods and especially the presence of ultrasound in every organized urological clinic now allows for the detection of cancer in increasingly early stages, usually in patients who have no symptoms.

Surgical intervention is the only known effective treatment, with a 94% cure rate for first-stage disease and 79% for second-stage disease.

It is important for the kidney removal to be done “radically,” including all the perinephric fat and Gerota’s fascia, which is the thin fibrous capsule surrounding the kidney and its fat. This technique, which maximizes the chance of negative surgical margins, is best achieved through a transabdominal approach.

Laparoscopic nephrectomy is a less invasive technique with lower morbidity and a faster recovery time. For tumors up to 4 cm, partial nephrectomy is suitable, yielding oncological outcomes that are comparable to those of radical nephrectomy. Therefore, it’s important to preserve the kidney where possible, removing only the tumor with a thin margin of renal parenchyma. This is because patients with a single kidney have been shown to experience significant long-term renal dysfunction problems.

Prostate Cancer

Usually, cancer doesn’t cause symptoms, and its diagnosis is based on the PSA (Prostate-Specific Antigen) level in the blood and digital rectal examination of the prostate through the rectum. PSA is a protein produced by the prostate, and its levels increase when there’s cancer, but it can also be elevated in benign conditions like benign prostatic hyperplasia and prostate inflammations. Thus, the absolute PSA level is not the only factor, as other data guide us in deciding to recommend a biopsy, such as the size of the prostate, the age of the patient, the rate of PSA increase over time, and the ratio of total PSA to free PSA.

The availability of these tests today, along with the awareness of the need for preventive screening among the general population, has resulted in the diagnosis of cancer at much earlier stages, leading to a 30% reduction in mortality.

After diagnosing cancer, the key question to answer is whether the cancer is localized in the prostate and potentially curable or if it’s already metastatic. Studies have shown that if the PSA is less than 10 and the Gleason score is 6 or lower, the imaging tests available to us today, such as CT scans and bone scans, are always negative. Thus, their performance is unnecessary.

Moreover, the use of the Partin and Hahn tables allows us to predict the probability of localized or metastatic cancer and recommend appropriate treatment using specific criteria. These researchers from Johns Hopkins University analyzed thousands of patients and developed these tables, estimating the clinical stage of the disease, PSA levels, and the “aggressiveness” of cancer as determined by the Gleason score.

In the case of localized disease, the goal is to achieve a cure rather than mere maintenance. This is currently accomplished through three methods: surgery, short-term treatment with radioactive seeds implantation, and external beam radiotherapy. Studies indicate that for the same stage of the disease, outcomes in the first decade are similar regardless of the chosen method. However, after the first decade, surgery seems to be more advantageous.

Radical prostatectomy can be performed either through the classic “open” method or laparoscopically, with or without robotic assistance. Extensive post-analysis has shown that both oncological and functional outcomes (urinary continence and preservation of erectile function) are the same, regardless of the method used. The difference seems to lie in the surgeon’s experience, as recently emphasized at the Urological Forum held in Davos in February 2011: “Patients should choose the surgeon, not the method.”

In cases of metastatic disease, the treatment aims to deprive the prostate of its nourishment, which is the male hormone testosterone. The realization that prostate cancer is hormone-dependent earned Huggins the Nobel Prize in Medicine in 1966 and has given millions of cancer patients many additional years of good life.


Services related to male infertility and sexual dysfunction are offered in close collaboration with the Assisted Reproduction Department of the “Mother” Hospital.

Male Infertility

Around 15-20% of couples fail when attempting to conceive. In roughly half of these cases, the “culprit” for the failure is the male partner. A systematic diagnostic approach leads to identifying the causes of the problem and providing appropriate treatment.

Therapeutic approaches include:

– Pharmacological treatment for hormonal dysfunction
– Addressing infections of the genitourinary system
– Microsurgical treatment of varicoceles (dilation of veins in the scrotum)
– Surgical treatment for the obstruction of ejaculatory ducts
– Microsurgical sperm retrieval through aspiration (MESA, TESE)
– Genetic investigation of “unexplained” cases of male infertility.

Microsurgical Treatment of Varicoceles

Varicoceles are present in about 15% of men and are the most reversible cause of male infertility. 35% of men with primary infertility and 75-80% with infertility after the first child exhibit varicoceles. However, most surgical techniques have a significant recurrence rate. Microsurgical restoration provides the highest chance of success with conception rates of 43% in the first and 69% in the second year.

Microsurgical Sperm Retrieval through Aspiration (MESA, TESE)

This procedure involves aspiration from the epididymis (MESA) or retrieval from the testicle (TESE) and urethral excision of the spermatic lump. These techniques, all performed on an outpatient basis, in combination with in vitro fertilization, enable conception even for men with complete absence of sperm.

Male Contraception

De-ligation procedures of the spermatic ducts (vasectomy) are performed for men who desire a permanent method of contraception. The procedure is conducted under local anesthesia on an outpatient basis.

Sexual Dysfunction

The primary emphasis is on erectile dysfunction. Additionally, Peyronie’s disease and premature ejaculation are addressed.

Around 5% of men experience erectile dysfunction at 50, 20% at 60, and 47% at 70 years of age. Regardless of age, all cases of erectile dysfunction can be successfully managed.

Although psychological factors often contribute to the problem, most cases involve an underlying organic issue. Our approach aims to precisely identify the problem and provide causal treatment.

With the availability of highly effective medications and techniques such as intracavernous injections and prosthetic surgery, solutions are provided for all cases.

Peyronie’s Disease

Peyronie’s disease affects about 4% of men between 30 and 80 years of age. It is characterized by the development of a hard “plaque,” usually on the dorsal surface of the penis, causing curvature during erection. Today, this otherwise benign condition is successfully managed through surgical interventions in cases where conservative treatment is ineffective.

Premature Ejaculation

Premature ejaculation is the most common male sexual dysfunction. Most studies report it affecting 25-30% of men, while some researchers believe the prevalence can reach up to 75%. The disorder is managed after appropriate diagnostic evaluation, either through local therapies or medications.

Urinary Incontinence

Ανδρική ακράτεια

Η διαγνωστική διερεύνηση του προβλήματος απαιτεί συνήθως την διενέργεια ενδοσκοπικού ελέγχου για να εκτιμηθεί η ακεραιότητα του σφιγκτηριακού μηχανισμού και την εκτέλεση ουροδυναμικής μελέτης για να αξιολογηθεί η συμπεριφορά της ουροδόχου κύστης. Μετά την συλλογή των πληροφοριών από τις παραπάνω εξετάσεις επιτρέπεται η εξαγωγή συμπερασμάτων για την θεραπευτική αγωγή που χρειάζεται.

Η αγωγή μπορεί να περιλαμβάνει χάπια που είτε «σφίγγουν» την ουρήθρα, είτε «χαλαρώνουν» την κύστη, σε πιο σοβαρές μορφές ακράτειας όμως απαιτείται χειρουργική παρέμβαση. Μέχρι πρόσφατα η μόνη διαθέσιμη θεραπεία ήταν η εμφύτευση τεχνητού σφιγκτήρα, επιλογή που και σήμερα εφαρμόζεται σε πλήρη ακράτεια.

Τα τελευταία χρόνια επίσης εφαρμόζεται με μεγάλη επιτυχία, ιδιαίτερα σε περιπτώσεις μικρής και μέτριας ακράτειας, η τοποθέτηση ταινιών που συμπιέζουν αλλά και επανατοποθετούν την ουρήθρα και δίνουν λύση στο πρόβλημα.

Robotic Surgery

Robotic Radical Prostatectomy
Robotic Radical Cystectomy
Robotic Joint Urology - Gynecology Endometriosis

*Collaborating with Robotic Gynecology Consultant for complex Deep endometriosis patients requiring joined procedures