UROLOGIC OPERATION 12

Ureterolithotomy, Pyelolithotomy and Nephrolithotomy

Objective

In case of:

•   Stones in the upper urinary tract

•   Removal of calculi from

     a.  Ureter

     b.  Renal pelvis

     c.  Kidney.

Position

•   Lateral (upper ureter)

•   Supine (lower ureter, kidney).

Anesthesia

General.

Procedure

   1.  Flank incision is made with rib resection (twelfth) optional.

   2.  For stones within the renal parenchyma (nephrolithotomy).

   3.  Temporary interruption of the renal circulation.

   4.  Parenchyma incised and the calculus removed.

   5.  Fatty tissues may be used to bolster the suture line.

   6.  Stones in the renal pelvis (pyelolithotomy) or in the proximal ureter (ureterolithotomy).

   7.  Extracted through incisions overlying the stones.

   8.  Collecting system is irrigated and sutured closed.

   9.  Calculi in the distal ureters are approached retroperito­neally.

10.  Inguinal, lower midline abdominal, or transverse oblique incision.

11.  The stone is palpated, noting that the ureter proximal to it may be dilated.

12.  Control of the ureter proximal and distal to the stone is achieved with vessel loops or atraumatic clamps.

13.  The ureter is opened and the stone retrieved.

14.  Irrigation may be employed and the ureter is closed.

Instruments

•   General set

•   Deep instruments set

•   Kidney set

•   Thoracotomy tray, vascular procedures tray, and gastro­intestinal procedures tray (available)

•   Hemoclip appliers (assorted sizes and lengths)

•   Asepto syringe

•   Vessel loops and umbilical tapes

•   Dissectors (e.g. peanut)

•   Penrose drain 1" (retraction)

•   Gil-Vernets sinus hooks (Fig. 11.16).

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archives for access and review

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

To reate consumer/provider engagement visit www.surginstruatlas.blogspot.com

www.drmmkapur.blogspot.com      www.surgseminar.blogspot.com

Urologic operation 11 transuretral prostatectomy

Transurethral Prostatectomy

Objective

In case of prostatic enlargement. The prostate tissue is removed with the help of a resectoscope.

Position

Lithotomy.

Anesthesia

Epidural or General.

Procedure

1.  Neutral electrode applied to thigh.

2.  Urethra dilated.

3.  Resectoscope introduced.

4.  Prostate removed using diathermy loop.

5.  Bleeding coagulated.

6.  Resectoscope removed.

7.  Self-retaining catheter.

Instruments

•   Bladder sounds or bougies set

•   Supply of sterile water or 1.5 glycine, etc. for irrigation

•   Connecting tubing and nozzles for resectoscope

•   Electro-resectoscope or ‘cold punch’ or laser hot yag instru­ment

•   Fiber light or electric cable and light or low voltage source

•   Electric cable and batteries

•   Diathermy leads, lead anchoring forceps and diathermy apparatus

•   Urethral catheter, 3 way self-retaining (Foley size 18, 20 or 22 Charriere gauge)

•   20 ml syringe and sterile water for inflating cuff of catheter.

Any questions be sent to drmmkapur@gmail.com

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

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

To create consumer/provider engagement visit www.surginstruatlas.blogspot.com

www.drmmkapur.blogspot.com     www.surgseminar.blogspot.com

UROLOGIC OPERATION 10 pereneal prostatectomy

Perineal Prostatectomy

Objective

In case of:

•   Malignancy of prostate

•   Excision of the prostate gland through the perineum.

Procedures

1.  Curvilinear incision is made in the perineum.

2.  For malignancy the entire gland, its capsule, the seminal vesicle, and distal portion of the vasa are excised.

3.  Care is taken to avoid injury to the rectum.

4.  A urethrovesical anastomosis is performed after a trans­urethral Foley catheter is placed.

5.  The wound is drained and the incision is closed.

Instruments

•   General set

•   Hemoclip appliers (assorted) (Fig. 11.11)

•   Perineal prostatectomy retractors; lateral, anterior, bifurcated (e.g. Young) (Fig. 11.15).

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archives for access and review

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

To create consumer/provider engagement visit www.surginstruatlas.blogspot.com

www.surgseminar.blogspot.com     www.drmmkapur.blogspot.com

UROLOGIC OPERATION 9 millins retropubic prostatectomy

Millin’s Retropubic Prostatectomy

Objective

In case BPH removal of prostate through the capsule of prostate without opening the bladder.

Position

Supine, Trendelenburg.

Anesthesia

Epidural or General.

Procedure

1.  Same as in transvesical upto opening transversalis fascia.

2.  Expose prostatic capsule retropubic.

3.  Incise prostatic capsule.

4.  Enucleate prostate.

5.  Close prostatic fascia after hemostasis.

6.  Leave self-retaining urethral catheter.

Instruments

•   General set

•   Prostatectomy set

•   Young boomerang needle (Fig. 11.12)

•   Millin suture holding forceps (Fig. 11.13)

•   Millin retractor (Fig. 11.14).

Any questions be sent to drmmkapur@gmail.com

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

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

To create consumer/provider engagement visit www.surginstruatlas.blogspot.com.

www.surgseminar.blogspot.com         www.drmmkapur.blogspot.com

UROLOGIG OPERATION 8 Transvesical Prostectomy

Transvesical Prostatectomy

Objective

In case of benign enlargement of the prostate:

•   Opening of the bladder

•   Removal of prostate.

Position

Supine.

Anesthesia

Epidural or General.

Procedure

   1.  Fill the bladder with sterile saline.

   2.  Four inch midline subumbilical incision.

   3.  Rectus sheath opened.

   4.  Exposed trasnversalis fascia opened.

   5.  Peritoneum pushed upwards.

   6.  Stay sutures (two) in bladder wall.

   7.  Bladder opened.

   8.  Vein sutured the procedure upto this step is a suprapubic cystostomy.

   9.  Anterior commissure of prostate split with index finger.

10.  Plane found and prostate lobe shelled out.

11.  Hemostasis obtained.

12.  Self-retaining suprapubic and urethral catheter left in place.

13.  Bladder closed in two layers around suprapubic catheter.

Instruments

•   General set

•   Prostatectomy set.

Any questions be sent to drmmkapur@gmail.com

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

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

To create comnsumer/provider engagement visit www.surginstruatlas.blogspot.com  

www.surgseminar.blogspot.com              www.drmmkapur.blogspot.vom