A comprehensive offering of urological procedures including minimally invasive surgeries & robotic techniques.

Urodynamic Assessment

A urodynamic assessment is a series of tests that help evaluate how well your bladder and urethra function, particularly if you're experiencing symptoms like urinary incontinence or difficulty urinating. The procedure typically takes about 45 minutes and is done in the office.

During the test, a small catheter is gently inserted into the bladder to fill it with sterile fluid. You’ll be asked to inform us when you feel the urge to urinate. We then assess your bladder's pressure and ability to store and release urine. An ultrasound bladder scan will be used. You’ll also be asked to urinate into a special device to measure flow and bladder emptying.

The results of the test guides us in diagnosing any issues and creating a treatment plan to improve your bladder function. The procedure is generally well tolerated, and any discomfort is usually mild.

Flexible Cystoscopy

A minimally invasive procedure that uses a flexible tube with a camera to examine the bladder, urethra and prostate, helping diagnose conditions like infections, tumours or bladder stones.  In office, this is performed with a gel local anaesthetic however it can also be performed under a light sedation in hospital.  The procedure takes minutes to perform. This is usually well tolerated and any discomfort is usually mild.  Occasionally there will be burning, frequency or blood in the urine initially, less commonly a UTI can occur which requires treatment with antibiotics.

Minimally invasive surgery refers to procedures that require only small incisions or no incisions at all, offering quicker recovery, less pain and reduced scarring compared to traditional open surgery. These techniques utilise advanced technology such as robotic systems, laparoscopic instruments and endoscopes to perform precise surgeries with minimal disruption to surrounding tissues.  Dr Basto aims to provide all surgeries by minimally invasive techniques wherever possible.

Robotic-assisted surgery is a minimally invasive technique where a surgeon uses a robotic system to perform precise procedures with enhanced control and vision. This approach allows for smaller incisions, reduced pain and faster recovery compared to traditional open surgery.

Robotic surgery is an extension of laparoscopic (“keyhole”) surgery, where the robotic system is attached to the standard laparoscopic setup of instruments.  The surgeon remains in the room seated at a console, where they control the robotic arms using intuitive hand and foot controls. The console provides a 3D high-definition view of the surgical site, enhancing the surgeon’s ability to perform precise movements.

While the robot assists with precise instrument manipulation, it does not control the operation autonomously. The surgeon is in full control, making all decisions and guiding the robotic arms throughout the procedure, ensuring patient safety and optimal outcomes.  The robotic system allows for greater surgeon dexterity and improved visualization of intricate areas, making it ideal for urological procedures in hard to access locations such as the pelvis. Dr Basto has the expertise and accreditation to perform robotic assisted surgeries.

Endoscopic surgery is a minimally invasive technique that allows for the diagnosis and treatment of urological conditions without the need for external cuts or incisions. Instead, the procedure is performed through natural body openings such as the urethra, using specialised instruments and a camera (endoscope).

Access to the bladder, kidneys or ureters is achieved by gently inserting the endoscope through the urethra, offering direct visualisation of the urinary tract. This approach is often used for treating conditions like stones, bladder tumours and prostate enlargement.

Since no external cuts are necessary, endoscopic surgery typically results in less pain, a quicker recovery, and minimal scarring. This technique provides a safe and effective solution for many urological issues, with the added benefit of shorter hospital stays and faster return to normal activities.

Prosthetics in urology are devices designed to restore function and improve quality of life for individuals experiencing urinary or erectile dysfunction. These devices can provide significant relief for patients who may not benefit from other treatments.

For urinary incontinence, an Artificial Urinary Sphincter (AUS) is commonly used. This device helps control urine flow by using a cuff around the urethra that can be inflated and deflated to prevent leakage. It's most often used in men who have incontinence following prostate surgery.  There is a new but growing indication for women with severe stress urinary incontinence, often where other continence procedures have failed, to have an AUS device implanted utilising robotic assisted surgery.

For erectile dysfunction, an Inflatable Penile Prosthesis (IPP) offers a reliable solution where all other management has failed. The device is implanted into the penis and allows the patient to achieve an erection through a pump mechanism, restoring sexual function and confidence.  This device may also be suitable for select patients with the combination of Peyronie’s penile curvature and erectile dysfunction.  Additionally, there are alternative penile implants that do not require inflation.

Urethral Slings are used to treat stress urinary incontinence in both men and women. For men, slings are often placed after prostate surgery to support the urethra and prevent leakage. For women, slings are inserted to provide additional support to the  urethra, addressing stress incontinence commonly caused by a weakening of the supporting muscles.

These prosthetic solutions offer life-changing benefits and are tailored to meet the unique needs of each patient.

Neuromodulation involves the use of electrical stimulation to regulate nerve activity, often for treating urinary issues.  Sacral neuromodulation and posterior tibial nerve stimulation work by a similar mechanism to augment the S3 sacral nerve and optimise the communication between the bladder and the brain.

Sacral Neuromodulation (SNM)

Sacral neuromodulation is a minimally invasive treatment that uses electrical impulses to stimulate the sacral nerves, which play a key role in controlling bladder function. This therapy is particularly effective for patients with conditions like overactive bladder, urge incontinence and urinary retention, as well as certain cases of faecal incontinence.

The procedure involves implanting a small, TGA-approved device (similar to a pacemaker) under the skin in the lower back/upper buttock, with a lead positioned near the sacral nerves. Before committing to the full implant, patients undergo a trial phase where a temporary lead is placed to assess how well the stimulation works. This "try before you buy" approach allows for an evaluation of symptom improvement, ensuring that SNM is the right treatment choice for you.

During the trial phase, there is a small external battery that can be carried in a pouch on the body. You will follow up to assess the response at week one and week two.  At the first appointment modifications can be made to tweak and hopefully improve the response. At the second appointment the leads will be simply removed and nothing will remain attached to your body.

Many patients find significant relief from symptoms, improving their quality of life.  If there is greater than 50% improvement in symptoms it is suitable to proceed to the full implant. Most patients experience minimal discomfort and high satisfaction with the long-term results. The trial phase significantly reduces risk by allowing patients to evaluate the benefits firsthand.

Posterior Tibial Nerve Stimulation (PTNS)

Posterior Tibial Nerve Stimulation is a non-invasive treatment used to manage overactive bladder symptoms and urge incontinence. This therapy involves delivering mild electrical pulses to the posterior tibial nerve, located near the ankle, through a small, thin needle electrode. These pulses stimulate the nerves that control bladder function, helping to restore normal urinary control. The procedure is typically performed in-office and requires no surgery or anaesthesia.

PTNS is often used when other treatments, like medications, are not effective. The therapy is typically administered in a series of weekly sessions, with patients often experiencing gradual improvement in symptoms. It's a well-tolerated procedure, with few side effects, and can be a great alternative for those seeking a less invasive option.