Advances in Urology, Uro-Oncology and Kidney Transplant

Modern urology is now a technology-led specialty. Lasers, miniature flexible endoscopes and surgical robots allow urologists to treat an enlarged prostate without an incision, clear kidney stones through natural passages, remove kidney tumours while saving the kidney, and transplant a kidney through an 8 to 9 cm wound. These advances in urology, uro-oncology and kidney transplant shorten hospital stays and widen the group of patients who can be treated safely.

That is the central argument Dr. Yajvender Pratap Singh Rana (Dr. Y P S Rana), Senior Director - Urology, Uro-Oncology, Andrology and Kidney Transplant, BLK-Max Super Speciality Hospital, New Delhi, India, made to doctors from Ethiopia, Nigeria, Chad, Kenya and other African countries in November 2025. He has worked at BLK-Max for about 15 years and described his theatres as "full of lasers, mini endoscopes, robots" and other high-end equipment. His session ran from benign prostate disease and stones through sexual medicine to kidney transplant and robotic cancer surgery. This guide sets out the whole map and covers uro-oncology and the technology behind it in depth; the companion articles take the remaining clusters further.

The four problems that fill a urology clinic

Dr. Rana grouped the bulk of his work into four clusters.

1. Urinary symptoms from the prostate, either benign prostatic hyperplasia (BPH, a non-cancerous enlargement of the gland) or prostate cancer.
2. Kidney and ureteric stones, from small stones to a "huge stone load" filling both kidneys.
3. Kidney failure needing transplant, with patients referred from Africa, the Middle East, the CIS countries and as far as Fiji, alongside a large domestic caseload.
4. Urological cancers of the prostate, kidney and bladder, which he treats as a robotic onco-surgeon.

Andrology, the medicine of male sexual function and fertility, runs alongside all four. The day-care prostate procedures, laser stone surgery, shock wave therapy for erectile dysfunction and microsurgery for male infertility are covered in modern treatment of an enlarged prostate, kidney stones and erectile dysfunction. Kidney transplant, the largest part of the session, has two dedicated articles: kidney transplant for international patients, from donor rules to cost and life after a kidney transplant.

Advances in urology: from open surgery to the robot

Dr. Rana described three eras of surgery. In the first, surgeons were known for the size of their incisions. The second was laparoscopy (keyhole surgery with long hand-held instruments). The third, the present, is robotic surgery.

BLK-Max runs three robotic systems: two da Vinci systems and one SSI Mantra, a robot made in India. In his assessment the SSI Mantra is cheaper and "equally good as Da Vinci", though slightly slower.

Benefits of robotic surgery for the surgeon

The change from laparoscopy is ergonomic as much as optical. The surgeon sits at a console rather than standing over the patient, so there is no shoulder strain and no hand tremor, and the surgeon controls the camera directly. The three-dimensional view is magnified about four to five times, so arteries and veins are seen clearly and bleeding points are controlled before they bleed.

Dr. Rana illustrated the point with his own experience. Doing deep pelvic surgery laparoscopically seven or eight years earlier, he stood holding the instruments for hours with heavy strain on his shoulders. Now he operates seated, deep in the pelvis, in comfort. A radical prostatectomy that took six to seven hours laparoscopically is now finished within four hours skin to skin, and in a favourable prostate in two and a half to three hours.

Benefits of robotic surgery for the patient

Surgical accuracy, in his words, "is translated for the better patient outcomes". He listed the benefits plainly: more precise surgery, less blood loss, lower transfusion rates, less pain, a lower infection risk, smaller incisions, a shorter hospital stay and a quicker return to work.

Robotic radical prostatectomy for prostate cancer is the clearest example. Dr. Rana regards it as the best modality for the operation. Blood loss has fallen from the 700 to 800 ml once standard in open prostatectomy to about 100 ml, and most of his patients go home after three days and are free of the catheter after two to three weeks. He covered the operation itself in a later, dedicated masterclass, set out in robotic radical prostatectomy: a complete guide.

Uro-oncology: saving organs that were once removed

Dr. Rana described uro-oncology as "very close to my heart". His theme was that robotic precision lets the surgeon remove the cancer while keeping as much healthy tissue, and function, as possible.

Bladder cancer: radical cystectomy with a neobladder

For bladder tumours that need radical surgery, his team performs radical cystectomy (removal of the bladder) with creation of a neobladder, a new reservoir fashioned from the patient's own bowel so that urine can still be passed through the urethra.

Robotic partial nephrectomy for kidney cancer

Partial nephrectomy removes only the tumour and leaves the rest of the kidney working. Dr. Rana walked the audience through a robotic case step by step.

1. The colon is mobilised to expose the kidney.
2. The renal hilum is dissected: the small lumbar vein, the renal vein, the gonadal vein and the renal artery are identified, and the artery and vein are looped.
3. The renal artery is clamped with a small bulldog clamp so that the tumour can be cut out in a bloodless field.
4. Near-infrared fluorescence imaging (the Firefly mode of the robotic system) shows the tumour's blood supply, which helps define the line of excision.
5. The tumour is excised and the kidney is reconstructed (renorrhaphy), so the whole kidney is preserved.

The tumour in that case measured about 1.5 cm on the surface, with most of its bulk buried inside the kidney: only about a third was visible from outside. Days before the masterclass he had removed a tumour lying at the renal hilum itself, a very difficult location, and the patient had been discharged doing well. Indicative prices for kidney surgery are listed on the nephrectomy cost page.

Tumours in both kidneys: a case labelled incurable

The case Dr. Rana chose to tell in full concerned a man referred from East Africa with tumours in both kidneys and a mass in one adrenal gland. He had been labelled as having metastatic disease and told that immunotherapy alone was the option, with survival of a year at most.

Dr. Rana was not convinced. The kidney tumours were small and the adrenal lesion still looked resectable, so he proposed removing all three in a single operation, accepting that the disease might be metastatic but aiming for cure. At the time of the masterclass the patient was almost five years from surgery, with no tumour in his body. Dr. Rana stressed that this was a single case, but he has operated robotically on several patients with tumours in both kidneys, removing the tumours on both sides in one session and saving both kidneys.

Advanced kidney cancer with tumour thrombus

At the far end of the spectrum, his team performs robotic radical nephrectomy with level IV inferior vena cava (IVC) thrombectomy. Level IV means the tumour has grown as a column of thrombus up the IVC, the body's main vein, above the diaphragm, and has to be extracted along with the kidney.

Day-care urology and the shift away from incisions

Two statements from the session capture how far benign urology has moved. For the prostate, Dr. Rana told the audience that none of their patients should need open surgery "in this era": bipolar transurethral surgery and laser enucleation are the standard of care, and very large glands are handled with laser or robotic surgery. For stones, he has not made an incision for a stone patient in the last 15 years, treating stones of every size with lasers and endoscopes, or with a robot where anatomy demands it.

Kidney transplant at BLK-Max: the scale of the programme

By the data analysed at the start of 2025, the programme at BLK-Max had performed about 1,100 kidney transplants, and the number has grown since. The series includes recipients who were HIV positive, hepatitis B surface antigen positive, hepatitis C positive and positive for two viruses at once, as well as about 25 paediatric transplants.

Dr. Rana was emphatic about children: they do not thrive on dialysis, and a good life comes only after a transplant. Paediatric transplants are more challenging, but he described the long-term outcomes as very rewarding.

He called kidney transplant "not an operation to be taken lightly". Kidneys are precious and hard to come by, surgical accuracy is critical, and deceased-donor donation is the key to closing the gap between supply and demand. He offered an image he uses with families: renal transplant is like a marriage, a blessing for most, a curse for some and a risk for all.

His team has also helped build transplant capacity abroad, mentoring programmes in Dar es Salaam, Ethiopia and other centres by training visiting surgeons, doctors and nurses at BLK-Max and supporting them as their own programmes begin.

The next frontier: xenotransplantation, artificial kidneys and tissue engineering

Asked whether animal kidneys could one day be transplanted into humans (xenotransplantation), Dr. Rana was sceptical. Such transplants are being tried, but problems at the tissue level and the risk of transmitting animal viruses to the recipient leave their success questionable. He sees more promise in engineered artificial kidneys, which he expects to become reality in the near future.

The merger of biology and technology is already reaching the operating theatre. A urethral stricture is a narrowing of the urethra, the tube that carries urine out of the bladder; in men it is about 18 to 20 cm long. Strictures have traditionally been treated by repeated endoscopic incisions or by urethroplasty, an open reconstruction that often uses a graft of buccal mucosa (the lining of the cheek). Urethroplasty remains a good operation, but it is invasive.

For patients with a short stricture, Dr. Rana's team now uses a tissue-engineered buccal mucosa graft. A small piece of tissue is taken from the inside of the cheek and sent to a laboratory, where the cells are grown in tissue culture. The cultured cells are then implanted into the urethra. He described it as the recent advance in urethroplasty technique, and as an example of biotechnologists building practical, technology-driven solutions for patients.

What this means for referring doctors

Dr. Rana closed with a call for closer collaboration with referring doctors, offering to discuss cases with them directly. Much of what a transplant or cancer patient needs happens after surgery, back home. Transplant patients, for instance, are followed by their own nephrologists, who can send biopsy results and discuss early signs of rejection by telephone; the questions doctors raised during the session, from HIV-positive recipients to donor ethics, are collected on the Live Discussion page for this masterclass.

The practical messages for a referring doctor are consistent across the session:

• Prostate: a man with bothersome urinary symptoms who tolerates medicines poorly has minimally invasive options, including day-care procedures that preserve ejaculation.
• Stones: stones are never a silent disease; they grow, obstruct and damage the kidney, so every stone needs assessment, although small stones that cause no symptoms can be watched with periodic imaging.
• Kidney failure: screen early with serum creatinine, a urine examination and an ultrasound, stabilise the patient on haemodialysis, and identify a related donor before travel.
• Cancer: small tumours in both kidneys do not automatically rule out surgery; in selected patients, robotic surgery can remove them in one session and save both kidneys.

Further reading on the specialty is collected on the urology hub.