Surgical Procedures

Percutaneous Nephrolithotomy (PCNL)

PCNL is used to remove large or complex kidney stones that cannot be treated with simpler procedures. It is especially helpful for stones that fill a large part of the kidney or are resistant to other treatments.

A small incision is made in your back to access the kidney directly. Through this channel, a telescope-like instrument is inserted to locate and break the stone using ultrasound or laser energy. The pieces are then suctioned out.

PCNL allows for the complete removal of large stones in one session. It is more effective for complex or stubborn stones than non-invasive methods. With modern techniques, the risks are low and recovery is quicker than traditional open surgery.

You’ll be under general anesthesia and may stay in the hospital for 1–2 nights. A small tube may be left in place to drain the kidney for a short period. Most people are back to light activities within a week or two.

Large kidney stones can cause serious problems like infection, bleeding, or loss of kidney function. PCNL provides a long-term solution by removing the source of these issues, protecting your kidneys and your health.

Retrograde Intrarenal Surgery (RIRS)

RIRS is used to treat kidney stones that are small to moderate in size, especially those in areas that are difficult to reach. It is often recommended when other methods, like shockwave therapy, aren’t suitable.

A very thin, flexible scope is passed through your urinary tract — from the urethra, through the bladder and ureter, and into the kidney. A laser is then used to break the stone into very fine dust that can pass naturally in your urine.

RIRS is completely incision-free and very gentle on the body. It can treat stones in almost any part of the kidney. Recovery is fast, and the procedure is safe and highly effective.

The procedure is usually done under general anesthesia and may be completed as a day surgery. A small stent may be placed in the ureter temporarily to help with healing. You might feel mild discomfort for a few days while passing stone fragments.

By offering a minimally invasive way to treat stones, RIRS helps prevent pain, infections, and kidney damage. It’s an excellent option for patients seeking a quick and comfortable solution with lasting results. Dr. Sahabudin has more than 20 years of experience performing RIRS and continues to carry out the procedure regularly, offering patients skilled and consistent care.

Extracorporeal Shock Wave Lithotripsy (ESWL)

ESWL is a non-invasive treatment for kidney or ureteric stones. It is typically used for smaller stones that are located in the upper part of the urinary system.

Focused sound waves are directed at the stone from outside your body. These waves break the stone into smaller fragments, which can then pass out naturally through your urine over time.

ESWL does not involve any surgery, scopes, or cuts. It is painless for most people and can be done without staying in the hospital. It’s ideal for patients who want a simple, low-risk option.

The procedure takes about 30 to 60 minutes and is usually done under light sedation or anesthesia. You can go home the same day. You may need to drink extra water to help pass the fragments, and some mild discomfort is normal.

Untreated stones can cause repeated pain, infection, or kidney damage. ESWL offers a gentle, effective solution that helps you clear the stone naturally and avoid more invasive treatments. Dr. Sahabudin has been performing ESWL since the 1990s and brings more than 25 years of experience to this field. He continues to perform the procedure regularly and has helped hundreds of patients safely and effectively clear urinary stones using this non-invasive technique.

Robotic Assisted Radical Prostatectomy

This surgery is done to treat prostate cancer that is confined to the prostate gland. It involves removing the prostate before the cancer has a chance to spread.

The procedure is performed using robotic-assisted technology. Through a few small incisions in the abdomen, robotic instruments are inserted and controlled by the surgeon at a console. The robot offers better precision and visualization, allowing careful removal of the prostate while protecting surrounding nerves.

Robotic surgery typically leads to less blood loss, smaller scars, and faster healing compared to open surgery. It also improves the chances of preserving urinary control and sexual function. Many patients experience shorter hospital stays and return to normal activities sooner.

The operation is done under general anesthesia and usually requires a 1–2 night hospital stay. A urinary catheter is placed for about a week during healing. Follow-up appointments include lab tests and recovery check-ins.

Prostate cancer can be life-threatening if left untreated. Robotic prostatectomy offers a minimally invasive, modern, effective, and safe way to remove cancer early — giving patients the best chance for a cure and a quick return to everyday life. Dr. Sahabudin was a pioneer of robotic-assisted radical prostatectomy in Malaysia. He has been performing this surgery since 2003 — for more than 22 years — and has successfully completed over 500 cases.

Transurethral Resection of Prostate (TURP)

TURP is used to relieve urinary symptoms caused by benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate. Common issues include slow urine flow, frequent urination, and incomplete bladder emptying.

A resectoscope, which is a thin tube with a camera and cutting loop, is passed through the urethra to trim away the part of the prostate that is blocking urine flow. No external cuts are made.

TURP is very effective in relieving urinary symptoms and improving quality of life. Most men notice a strong urine flow and reduced frequency within days. It’s considered the gold standard for treating BPH.

The procedure is done under spinal or general anesthesia. After TURP, a catheter is inserted to help with urine drainage. Some patients may stay in the hospital for one night and go home with the catheter in place, which is usually removed after 1–2 days during a follow-up visit. Others may stay in the hospital until the catheter is removed. Some mild burning or bleeding during urination may occur temporarily.

If left untreated, BPH can lead to bladder damage, infections, bleeding, incontinence, kidney failure, or complete blockage of urine flow. TURP safely restores normal urine flow and helps prevent complications, letting you live more comfortably and confidently. Dr. Sahabudin has over 35 years of experience and has performed more than 2,000 TURP procedures, with excellent results in both routine and complex cases.

Transurethral Resection of Bladder Tumour (TURBT)

TURBT is performed to remove bladder tumors and confirm a diagnosis of bladder cancer. It is the first and most important step in managing early-stage bladder cancer.

A thin telescope (cystoscope) is inserted through the urethra into the bladder. Using a small loop, the surgeon removes the tumor layer by layer. The removed tissue is sent to the lab to determine whether it is cancerous and what type of follow-up is needed.

TURBT helps diagnose and treat tumors with no external cuts. It can remove small tumors completely and allows for early, effective treatment of bladder cancer.

The procedure is usually done under spinal or general anesthesia. Patients may go home the same day or after an overnight stay. A catheter may be placed temporarily, and some blood in the urine is normal for a few days.

Bladder cancer is treatable if caught early. TURBT allows for fast diagnosis and immediate removal of the tumor, increasing the chance of cure and reducing long-term risks.

Laser Prostatectomy

Laser prostatectomy is used to treat an enlarged prostate (BPH) that causes difficulty urinating. It is often preferred for patients at higher risk of bleeding or who are on blood-thinning medications.

A laser is delivered through a scope inserted via the urethra. The laser either vaporizes the extra prostate tissue or cuts it away, clearing the blockage and improving urine flow.

Laser surgery is highly effective, with less bleeding and a shorter hospital stay compared to traditional surgery. It allows quicker return to normal activities and may result in fewer complications.

The procedure is done under anesthesia, usually as a day surgery or with one overnight stay. A urinary catheter is often used for a short period. You may notice improvement in urine flow within a few days.

Untreated prostate enlargement can lead to bladder or kidney problems. Laser prostatectomy offers a gentle, modern solution that restores comfort and improves long-term urinary health.

Nephrectomy

A nephrectomy is the surgical removal of a kidney. It is most commonly performed to treat kidney cancer, severe infections, or a non-functioning kidney. It is also done for healthy kidney donation in transplant cases.

There are two main types: partial nephrectomy (removing just the diseased part of the kidney) and radical nephrectomy (removing the entire kidney). The surgery can be done through open, laparoscopic, or robotic-assisted techniques, depending on the condition and size of the tumor.

Removing the damaged or cancerous kidney can prevent the spread of disease and reduce pain or infection. Most people live healthy lives with one functioning kidney. Minimally invasive options also mean faster recovery and less post-operative discomfort.

The surgery is done under general anesthesia and usually involves a hospital stay of 2–4 days. Recovery can take a few weeks, depending on the type of procedure. Patients will be monitored regularly to ensure the remaining kidney stays healthy.

A nephrectomy can be life-saving, especially in cases of cancer or severe kidney damage. It restores health and prevents further complications, giving patients a stronger and safer path forward.

Pyeloplasty – Open and Robotic

Pyeloplasty is a surgical procedure to correct a blockage at the point where the kidney connects to the ureter (the ureteropelvic junction). This blockage may be present from birth or develop due to scarring or stones.

The surgeon removes the narrowed or damaged segment and reconnects the healthy ends. This can be done through open surgery or minimally invasive robotic-assisted surgery, which offers greater precision and faster healing.

Pyeloplasty relieves symptoms such as pain, infections, and reduced kidney function. It allows urine to flow properly from the kidney to the bladder. Robotic surgery provides smaller incisions and shorter recovery time.

The procedure is performed under general anesthesia, with most patients staying 1–3 nights in the hospital. A stent is often placed in the ureter temporarily to support healing. Full recovery usually takes a few weeks.

Untreated blockages can lead to repeated infections and permanent kidney damage. Pyeloplasty offers a lasting solution that restores kidney drainage and helps protect long-term kidney health.

All Laparoscopic Urologic Procedures

Laparoscopic urologic surgery is used to treat a wide range of conditions, including kidney tumors, adrenal growths, ureteral blockages, and other urinary system problems. It offers a minimally invasive alternative to open surgery.

Small incisions are made in the abdomen through which a camera and thin instruments are inserted. The surgeon performs the procedure by watching a magnified image on a screen. Robotic assistance may also be used for added precision.

Laparoscopic surgery causes less pain, fewer complications, and faster healing than traditional open surgery. Patients usually have shorter hospital stays, smaller scars, and quicker returns to normal life.

These surgeries are performed under general anesthesia, and most patients go home within 1–2 days. Recovery time varies by procedure but is generally shorter than with open surgery. Follow-up care focuses on wound healing and organ function.

Minimally invasive surgery offers safe, effective treatment with less physical and emotional stress. It’s now widely used for many urological conditions, helping patients heal faster and feel better sooner.

Open Radical Prostatectomy

Open radical prostatectomy is a surgery to remove the entire prostate gland in men with prostate cancer. It is often chosen when robotic or laparoscopic surgery is not suitable or available.

A single incision is made in the lower abdomen or between the scrotum and anus. The surgeon carefully removes the prostate and reconnects the bladder to the urethra. This traditional method allows direct access for complex cases.

Open surgery is a well-established treatment with reliable cancer control. It may be more suitable for patients with large tumors or prior abdominal surgeries. The approach offers long-term results similar to robotic surgery.

The procedure requires general anesthesia and a hospital stay of 2–4 days. A urinary catheter is placed for about 2 weeks. Recovery may take several weeks, with follow-up to monitor healing and cancer outcomes.

Removing the prostate in early-stage cancer can be curative. Open surgery remains a trusted and effective option, especially in more advanced or complicated cases, offering patients peace of mind and a path

Cystectomy with Ileal Conduit or Continent Diversion

Cystectomy is the surgical removal of the bladder, usually done to treat muscle-invasive bladder cancer. After removing the bladder, a new way to store and pass urine must be created using a diversion technique.

There are two main types of urinary diversion. In an ileal conduit, a small piece of the intestine is used to create a channel for urine to drain through an opening in the abdomen into a bag. In a continent diversion, an internal pouch is made from intestine and connected to a stoma or urethra, allowing urine to be drained at intervals.

Removing the bladder stops the spread of cancer and relieves symptoms like bleeding or painful urination. With diversion, patients can still pass urine — either continuously through a stoma bag or by catheterizing a new internal pouch. Many patients return to active, independent lives after adjusting to the changes.

The surgery is done under general anesthesia and usually requires a hospital stay of 7–10 days. Recovery includes learning to care for the stoma or pouch, managing fluid intake, and gradually resuming normal activity. Ongoing follow-up is important to monitor kidney function and detect any cancer recurrence.

For patients with aggressive bladder cancer, cystectomy provides the best chance of long-term survival. With the right support and training, patients adapt well to the new urinary system and regain a good quality of life.

Reconstructive, Access & Minor Urology Procedures

These procedures help repair, maintain, or improve parts of the urinary system affected by blockages, injuries, birth defects, or previous surgeries. They also include minor interventions that make daily life easier or prepare for other treatments.

• Urethroplasty - a narrowed or scarred segment (traumatic or acquired) of the urethra is surgically removed or repaired using grafts or flaps from buccal mucosa or skin to restore normal urine flow.
• Urethral dilation or stricture repair to open a narrowed urinary passage.
• Fistula repair to close abnormal openings between the bladder and other organs.
• Access surgery for dialysis catheters or long-term urinary drainage.

These are usually done using minimally invasive tools through the natural urinary tract or small incisions.

Even small procedures can greatly improve comfort, reduce infections, and protect kidney function. They restore normal urinary flow or create reliable access for essential treatments like dialysis or long-term catheterization.

Most procedures are done under local or general anesthesia and require only a short hospital stay or same-day discharge. Recovery is usually quick, and follow-up visits ensure proper healing and function.

While often considered “minor,” these procedures are vital in preserving health, improving daily life, and preventing serious complications. They offer real relief and better long-term outcomes, especially for patients with chronic conditions. Dr Sahabudin’s extensive experience ensures these procedures are handled with precision, safety, and compassion.

Ureteral Reimplantation

Ureteral reimplantation is a procedure done to correct problems with the way the ureter connects to the bladder. It is often used to treat vesicoureteral reflux (VUR), where urine flows backward from the bladder into the ureters, or to repair damage from injury or previous surgery.

The surgeon creates a new connection between the ureter and bladder in a position that prevents urine from flowing backward. This is usually done through a small abdominal incision or using a minimally invasive approach, depending on the patient’s condition.

The procedure significantly reduces the risk of urinary tract infections and prevents further kidney damage. It can also relieve symptoms like urinary incontinence or pain caused by reflux.

The surgery is done under general anesthesia. A catheter is placed temporarily to help the bladder heal, and hospital stay is usually one to two days. Recovery takes one to two weeks, and patients may need a follow-up scan to check ureter function.

By correcting abnormal urine flow, ureteral reimplantation can prevent repeated infections and safeguard kidney health, especially important in children and young adults with VUR.

Penile Reconstruction Surgery

Penile reconstruction surgery is performed to rebuild or restore the penis in patients who have congenital abnormalities, trauma, cancer, or as part of gender-affirming surgery. It aims to restore both function and appearance.

Depending on the cause, the surgery may involve using tissue from other parts of the body (often from the arm or thigh) to create a new penile structure. Additional procedures may include urethral reconstruction and implantation of devices to support urinary and sexual function.

This surgery improves both physical and psychological well-being. It restores the ability to urinate standing up, allows for sexual function in many cases, and greatly improves body image and confidence.

The procedure is complex and may involve multiple stages. It requires general anesthesia and a hospital stay of several days. Recovery includes wound care, possible use of a catheter, and follow-up visits for monitoring. Some patients may need further surgeries for refinements.

Penile reconstruction is a life-changing procedure for many individuals. It restores essential bodily functions and helps patients regain a sense of wholeness and dignity.

Robotic Vesicovaginal Fistula (VVF) Repair

Robotic VVF repair is used to correct an abnormal connection (fistula) between the bladder and vagina, which causes continuous urinary leakage. This condition can result from childbirth complications, surgery, radiation, or injury.

Using robotic-assisted surgery, the fistula is carefully closed and the surrounding tissue is reconstructed to ensure proper healing. The robotic tools allow for better visualization and precise movements, leading to improved outcomes.

This approach offers a high success rate with less pain, minimal scarring, and faster recovery than traditional open surgery. It helps patients regain control over urination and prevents infections and social embarrassment.

The surgery is done under general anesthesia. A catheter is placed temporarily to allow the area to heal. Hospital stay is usually short, and recovery at home lasts about two to three weeks. Patients may require follow-up imaging or exams.

VVF can severely impact quality of life. Robotic repair restores normal function, allowing patients to return to daily life with confidence and dignity.

Robotic Cystoprostatectomy

Robotic cystoprostatectomy is the surgical removal of the bladder and prostate, usually done to treat invasive bladder cancer in men. It’s often followed by urinary diversion, where a new way to store and pass urine is created.

Using robotic tools, the surgeon removes the bladder and prostate through small incisions. A urinary diversion (like an ileal conduit or neobladder) is then created. The robotic approach enhances precision and reduces trauma to surrounding tissues.

This procedure effectively treats aggressive bladder cancer while offering benefits of minimally invasive surgery — less blood loss, shorter hospital stays, and faster recovery. Robotic precision also improves cancer control and reduces complications.

Performed under general anesthesia, the surgery may take several hours. A catheter and drainage tubes are placed, and hospital stay is typically 5–7 days. Full recovery may take several weeks. Patients will be educated on managing their new urinary system.

Robotic cystoprostatectomy provides a powerful tool against advanced bladder cancer. It offers a chance for cure, better functional outcomes, and a return to meaningful daily life after cancer treatment.

Prostate Biopsy - Transrectal and Transperineal

A prostate biopsy is a procedure done to check for prostate cancer or other abnormalities. It is usually recommended if a blood test (PSA) is elevated or if a doctor feels a lump or hardness during a rectal exam. It helps confirm whether prostate cancer is present and how aggressive it may be.

Small tissue samples are taken from different areas of the prostate using a needle. This is usually guided by imaging and can be done in two ways:

• Transrectal biopsy: A probe is inserted into the rectum to guide the needle using ultrasound.
• Transperineal biopsy: A more precise approach where both MRI and ultrasound images are fused, and a special grid-based device is used to accurately target areas of concern through the skin between the scrotum and anus. This allows for highly targeted sampling and improved cancer detection.

The tissue is then examined under a microscope to confirm the presence and grade of cancer (Gleason score).

A prostate biopsy provides the most accurate way to diagnose prostate cancer. The transperineal approach, in particular, reduces the risk of infection and improves accuracy by targeting suspicious areas seen on MRI.

The procedure is usually done under local anesthesia in a clinic or day surgery setting. You may feel pressure or mild discomfort during the biopsy. Some blood in the urine, semen, or stool is common for a few days afterward. Most patients go home the same day and can return to normal activities within 24–48 hours. Antibiotics are usually given to prevent infection, and follow-up is arranged to discuss the results.

Early and accurate detection of prostate cancer can save lives. A biopsy helps avoid unnecessary worry when results are normal, and it ensures timely treatment when cancer is present. When performed by a skilled and experienced urologist like Dr. Sahabudin, who has done thousands of prostate biopsies over his career, patients can feel reassured that they are in expert hands. This is one of the most common procedures he performs, ensuring both confidence and safety in the process.