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.

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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

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UROLOGIC OPERATION 3 Hypospadius repairr

Hypospadias Repair

Objective

In case of:

•   Arrested development of urethra opening at some point on the ventral surface of the penis.

•   Transfer of the opening to the tip of the penis.

Position

Supine (legs apart).

Anesthesia

General.

Procedure

1.  The chordee (bend in penis) by excising the fibrous tissue on the under aspect of the penis.

2.  On the under surface of the penis in place of the absent urethra, urethra is reconstructed.

3.  Incision is made on the under aspect of the penis.

4.  The reconstructed urethra tube splinted by a catheter, is placed in the tunnel over which the remaining foreskin is grafted.

Instruments

•   Basic/Minor procedure tray

•   Urethral sounds (Fig. 11.3).

•   Electrosurgical unit.

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UROLOGIC OPERATION2 2 Hydrocelectomy

Hydrocelectomy (Joubley’s)

Objective

In case of:

•   Hydrocele

•   Excision of a portion of the tunica vaginalis testis with evacuation of fluid contained.

Position

Supine (legs apart).

Anesthesia

Spinal or general.

Procedure

1.  A scrotal approach is employed.

2.  The hydrocele fluid is aspirated through a small incision or with a needle and syringe.

3.  Excessive sac wall is excised or may be wrapped around and sutured behind the epididymis.

4.  If a hernia is present it is repaired.

5.  The incision is closed.

Instruments

•   General set (adult)

•   Electrosurgical unit.

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