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Urologija - Wikipedia Idi na sadržaj

Urologija

S Wikipedije, slobodne enciklopedije

Urologija je grana kliničke medicine koja se bavi etiologijom, patogenezom i dijagnostikom oboljenja urinarnog trakta kod muškaraca i kod žena, te reproduktivnim organima kod muškaraca. Ljekar specijalista za ovu oblast naziva se urolog i on je obučen da postavlja dijagnoze i liječi urogenitalna oboljenja. Oboljenja urogenitalnog trakta koja su u nadležnosti urologa su infekcije mokraćnih kanala, bubrega i mokraćnog mjehura raznim bakterijama, kao i upala prostate kod muškaraca, poremećaji izvodnog sistema bubrega kao zaprekama protoka mokraće, urođene anomalije, kamenacem, dobroćudni i zloćudni tumorima bubrega.

  • problemima mokraćnog mjehura
  • problemima mokraćne cijevi i prostate
  • problemima penisa kao što je impotencija, tumori i druge bolesti
  • poremećajima testisa i okolnih struktura
  • sterilizacijom muškaraca
  • neplodnošću muškaraca
  • seksualnim disfunkcijama - traženje organske podloge za impotenciju, preuranjenu ejakulaciju itd.

Pored toga, urologija je često povezana s drugim oblastima medicine poput: andrologije, nefrologije, ginekologije, neurologije, onkologije i hirurgije.

Historija urologije

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Iako je urologija kao samostalna nauka relativno mlada, njeni korjeni idu nazad sve do antike.

Urologija u antici

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Već u starom Egiptu oko 1000. p. n. e. bio je poznat kateter za mokrenje. Ovaj prvobitni kateter je bio sačinjen od bronze. Također su se sprovodile i operacije uklanjanja kamenca iz mokraćnog mjehura. I u staroj Grčkoj su se liječnici bavili urološkim bolestima. Hipokrat je prvi klasificirao poremećaje mokrenja, te razlikovao poremećaje mikcije od disurije (bolnog mokrenja), strangurije (kapanja mokraće) i ishurije. Nadalje, on opisuje nastajanje kamenca u mokraćnom mjehuru, ne savjetujući drugim ljekarima da operativno uklanjaju kamenac. (u čuvenoj Hipokratovoj zakletvi stoji da ljekari ne smiju vaditi kamenac). Hipokrat je proučavao i oboljenja bubrega, a pošto mu iz vjerskih razloga nisu dopustili da vrši anatomske studije ljudskih leševa, sva ispitivanja su bila bazirana na promatranju pacijenata. Prvi anatomski opisi prostate potiču od Herifilosa iz Halkedona 300. p. n. e. Ovi opisi se baziraju na obdukciji leševa. Kasnije, Amonius iz Aleksandrije oko 250. p. n. e. poboljšava tehniku vađenja kamenca putem njegovog drobljenja i vađenja pomoću kliješta. Odatle vodi i njegov nadimak Lithotom (grčki lithos - kamen) Rimski liječnik Celsus je nanovo otkrio učenje Hipokrata, te u svojim djelima opisuje tehnike uklanjanja kamenca iz mokračnog mjehura i postavljanja metalnih katetera. Aretaios iz Kapadokije (81.-138.) je klasificirao različite vrste upala bubrega i preporučuje terapiju putem postavljanja katetera. u kasnijoj antici Oribasios iz Pergamona (325. - 403.) opisuje spajanje mokraćovoda s kateterima napravljenim od cinka i olova, a Paulos iz Aigine u 5. vijeku dalje poboljšava operaciju vađenja kamenca tako što preko anusa dolazi do kamenca i vadi ga preko reza s bočne strane tijela. Ova metoda se održala sve do 17. - 18. vijeka.

Urologija u arapskoj medicini

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Ibn Sina (980 - 1037) u svom djelu Canon medicinae opisuje, na bazi Galenovih učenja, poremećaje u funkcionisanju bubrega i posljedice koje proizilaze iz toga. S tim u vezi, on upotrebljava fine kožne cijevi ojačane olovom kao katetere. Abulkasis iz Kordobe, Španija, u 11. vijeku se bavi operacijama kamenca u mokraćnom mjehuru (mada on sam nije vršio takve operacije) na temelju djela Paulusa iz Aigine. Svoja saznanja je objavio u jednoj medicinskoj enciklopediji od 30 tomova, koja je stoljećima bila hirurško remek-djelo.

Urologija u srednjem vijeku

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Važna urološka i anatomska saznanja otkrio je Leonardo da Vinci, zatim briselski anatom Andreas Vesal (1514 - 1564) i njegov nasljednik Eustachi (1500 - 1574). Iz oblasti anatomije urogenitalnog trakta, opise sjemenika iznio je francuski liječnik Etienne La Riviere, dok je Marcellus Malpighi (1628–1694) pridonijeo nauci svojim otkrićem funkcionisanja bubrega. Lorenzo Bellini (1643–1704) tokom svog istraživanja otkriva nefrone (bubrežne kanaliće). Kao utemeljitelj urologije u obliku kakav danas poznajemo, smatra se italijanski anatom Giovanni Battista Morgagni (1682–1771). Svojim djelom De sedibus et causis morborum (O uzrocima bolesti) u pet tomova 1761. je postavio temelje za naučna istraživanja. Istraživao je i analizirao razne varijante sužavanja mokraćnih kanala i klasificirao tumore mokraćnog mjehura. Pri tom je otkrio hiperplaziju prostate, istraživao kompenzatorno povećanje jednog bubrega zbog gubljenja ili nefunkcionisanja drugog.

Razvoj endoskopije

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Urologija

Najveći razvoj urologije i urološke endoskopije učinio je liječnik iz Frankfurta Phillip Bozzini. On je 1806. godine napravio prvi endoskop koji je koristio svjetlo svijeće. Tek 1826. godine Segalas je pokušao ovo otkriće upotrijebiti u liječenju pacijenata. Koristio se ogledalima za pregled mokraćnog mjehura a svjetlost su davale dvije svijeće. Kasnije je francuski hirurg Antonin Desormeaux (1815-1882), koji je tada radeći u Parizu, u Akademiji za medicinu godine 1853. prezentirao endoskop, koji je koristio smjesu etanola i terpentinskog ulja za osvjetljenje. Također je mnogo istraživao mokraćovode i mokraćni mjehur te je 1865. svoja istraživanja objavio u knjizi Traite de l’endoscopie. Otkriće prvog cistoskopa s električnim osvjetljenjem pripisuje se drezdenskom liječniku Maximilianu Nitzeu (1848-1907) koji ga je prezentirao u Beču 1879. godine. Kasnije je napisao Lehrbuch der Kystoskopie (Priručnik cistoskopije) 1889. te cistografski Atlas 1894. godine. S cistoskopijom počinje tačnije istraživanje i klasifikacija bolesti mokraćnih puteva. Istovremeno se razvija ureter-kateter kojim se sondiraju mokraćni putevi. Pošto je bilo vrlo teško raditi s prvobitnim cistoskopom, Joaquin Albarran (1860-1912) iz Pariza je razvio specijalni cistoskop s mehaničkim pomičnim vrhom.

Upotreba rendgena u urologiji

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Nakon otkrića rendgenskih zraka 1895. godine i začetka radiologije, rendgensko snimanje u urologiji je započelo 1927. godine kada je von Lichtenberg, ubrizgavajući u krvotok posebno sredstvo za pojačavanje kontrasta i vidljivosti mokraćnih puteva, razvio tzv. pijelografiju, pa se time dijagnosticiranje u urologiji još više poboljšalo.

Grane urologije

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  • Neurourologija
  • Pedijatrijska urologija
  • Onkološka urologija
  • Andrologija
  • Ginekološka urologija

Reference

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  • Thomas Gasser i Georg Rutishauser: Basiswissen Urologie, Springer-Verlag, ISBN 3-540-25637-7