UROLOGIC OPERATION 7 cystectomy

Cystectomy

Objective

In cases of cancer of the bladder

•   Removal of the urinary bladder in part or whole.

Position

Supine.

Anesthesia

Procedure

   1.  A cystoscopy is performed.

   2.  A midline or low transverse incision is made.

   3.  The operative field explored.

   4.  The bladder is dissected from its vascular supply.

   5.  The prostate and seminal vesicles are included in the specimen.

   6.  The distal ureters, urethra, and vas are divided and ligated.

   7.  Urinary diversion.

   8.  A closed-system wound drain may be employed.

   9.  Wound drain may be employed.

10.  Wound is closed in layers.

Instruments

•   General set

•   Deep instruments set

•   Kidney procedures set

•   Gastrointestinal procedures set (Available)

•   Abdominal hysterectomy set (Available)

•   Self-retaining retractor (e.g. Balfour, O’Connor O’Sullivan) (Fig. 8.87)

•   Hemoclip appliers (assorted sizes and lengths) (Fig. 11.11)

•   Drain (e.g., Hemovac, Jackson-Pratt, Penrose).

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UROLOGIC OPERATION 6 Cystostomy

Cystostomy

Objective

In case of urinary obstruction

•   An opening is made direct into the bladder to overcome the obstruction.

Position

Supine.

Anesthesia

Local.

Procedure

1.  A low vertical or transverse anterior abdominal incision.

2.  Bladder may be distended.

3.  Dome of the bladder is incised.

4.  de Pezzer or Malecot catheter is inserted and secured with absorbable sutures through the bladder wall to obtain a watertight closure.

5.  The catheter exits the main incision or a stab wound.

6.  Secured to the skin with a stitch.

7.  Wound is closed.

8.  Urethral catheter may be placed to minimize leakage.

Instruments

•   General set

•   Urethral sounds 

•   Catheter stylet 

•   Trocar (available) 

•   Foley catheter and sealed drainage unit (

•   Catheter for cystotomy (e.g. de Pezzer, Malecot) 

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UROLOGIC OPERATION 5 Cystoscopy

Cystoscopy

Objective

In case of:

•   Hematuria and urinary infection.

•   Interior of the urethra, the bladder and the ureteral orifices are viewed.

Position

Lithostomy.

Anesthesia

Local, spinal or general.

Procedure

1.  Urethra may be dilated initially with a sound.

2.  Lubricated cystoscope is inserted in the urethra.

3.  Urethra is inspected as the cystoscope is advanced into the bladder.

4.  The obturator is removed.

5.  Bladder is filled with irrigation fluid, and under direct visualization the bladder, ureteral orifices, bladder neck, and urethra are examined.

Instruments and Supplies

•   Urethral sounds (Fig. 11.3)

•   Cystoscope (telescope, obturator and sheath) (Fig. 8.138)

•   Fiberoptic light cord

•   Stopeock

•   Hemostat

•   Syringe (30 ml)

•   Medicine glass, syringe (10 ml), penile clamp (for topical anesthetic instillation)

•   Graduated pitcher (to measure residual urine)

•   Topical anesthetic, e.g. lidocaine (Anestacon)

•   Lubricant (KY jelly).

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UROLOGIC OPERATION 4 spermatocelectomy

Spermatocelectomy

Objective

In cases of:

•   Cyst in the epididymis.

•   Excision of a cystic swelling.

Position

Supine.

Anesthesia

Epidural or general.

Procedure

1.  A scrotal incision and the condition assessed.

2.  The cystic mass is excised.

3.  Anastomosis is performed using fine absorbable sutures with the aid of loupes or a microscope.

4.  The anastomosis may be tested for patency using a blunt needle (e.g. 20 gauge), syringe, and methylene blue die.

5.  The incision is closed.

Instruments

Vasectomy set

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archives for access & review.

Visitors that follow may post contributions to the site,please write to address above.

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