Urology for General Surgeons

8/7/2019 Urology for General Surgeons

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HOPE THIS WILL BE

ENTERTAINING, EXITING& USEFUL SESSION OF

1

ST

MATCH OF 90 MIN.



PROBLEMS

40% OF PRACTISE OF

GENERAL SURGERY

UROLOGISTS ARE

MORE IN URBAN

AREA

MOBILE UROLOGIST

NOW ACCESSIBLE TO

MANY GENERAL

SURGEONS





Management of

Urinary StoneDisease



BLADDER / URETHRAL STONE



RGU



TAKE HOME MESSAGE

- IDENTIFY ETIOLOGY OF BLADDER STONE

-CYSTOSCOPY SHOULD BE DONE IN

ALL CASES



X-RAY



PROBLEMS

DIFFICULTIES SHOULD BE ANTICIPATED.



TAKE HOME MESSAGE

TO PREVENT URS COMPLICATIONS :

IVU MUST BE DONE IN ALL CASES PROPER SELECTION OF CASE IS A MUST

YOU SHOULD BE FAMILIAR WITH ANDSHOULD HAVE ALL ENDOSCOPES ANDANCILLIARY INSTRUMENTS LIKE C-ARM

DO NOT PULL TOO MUCH OR TOO HARD

INCASE OF DIFFICULT ACCESS ± PLACE

DJ - STENT



CASE - 3

A PATIENT WITH SOLITORY KIDNEY

HAVING A 2 CMS SIZE PELVIC STONE



QUESTIONS

WHAT ARE THE MANAGEMENT OPTIONS

IN THIS PATIENT..?

CAN WE PERFORM ESWL WITHOUT DJSTENTING..?



TAKE HOME MESSAGE

ESWL IS NOT AN ANSWER TO EACH AND

EVERY STONE. IT SHOULD BE JUDGED

ACCORDING TO THE SIZE, LOCATION OFSTONE AND RENAL FUNCTION.

DJ STENT IS A MUST IN PATIENTS WITH

SOLITARY UNIT , LARGE STONE BURDEN

OR IMPACTED STONE.



CASE 4



QUESTIONS

MANAGEMENT OPTIONS IN THIS PATIENT ?

INCIDENCES OF RESIDUAL STONE ?

HOW DO YOU MANAGE RESIDUALCALCULI ?

WOULD YOU LIKE TO GIVE PACKAGE

DEAL FOR COMPLETE CLEARANCE ?



MESSAGE

THE ULTIMATE AIM IS TO MAKE PATIENT

STONE FREE. HOWEVER IT IS NOT

ADVISABLE TO GIVE PACKAGE DEAL. OPEN SURGERY:

ANATROPIC NEPHROLITHOTOMY.

EXTENDED PYELO-LITHOTOMY OR PYELO-

NEPHRO-LITHOTOMY SHOULD BE

CONSIDERED.



R enal stones







CASE - 4

A MALE PATIENT OF 35 YEARS.

PRESENTED WITH RUPTURE URETHRA &

RETENTION OF URINE WITH URETHRAL

BLEEDING



QUESTIONS

SHOULD WE ATTEMPT PRIMARY RAIL

ROADING ?

HOW TO PROCEED FOR THAT ?



TAKE HOME MESSAGE

GENTLE RETROGRADE STUDY OF

URETHRA

SUPRAPUBIC DIVERSION &

RECONSTRUCTIVE SURGERY AFTER 12

WEEKS IS THE BEST ALTERNATE

REALIGNMENT CAN BE ATTEMPTED BYEXPERINCED UROLOGIST WITH A

FLEXIBLE CYSTO-URETHRO SCOPE



Benign Prostatic

Hyperplasia



CASE-5

60 YEARS OLD MAN WITH FREQUENCY

OF MICTURIGION WHO WAS FOUND TO

HAVE ENLARGEMENT OF PROSTATE 60GMS ON ULTRASONOGRAPHY WITH NO

RESIDUAL URINE





A prostate examination.. ³Medical students learning how to perform

a prostate examination´



QUESTIONS

DOES HE NEED FURTHER INVESTIGATIONS

AND SURGERY?

WHEN TURP IS INDICATED ? WHICH ARE THE INDICATION OF OPEN

SURGERY ?

WHAT ARE THE INDICATION FOR MEDICAL

MANAGEMENT ?



B.P.H.

Medical management:

Finesteride

Prazocin

TerazocinDoxazocin

Uro-selective:

Alfuzocin

Tamsulosin



: Surgery :

Minimally invasive procedures:

Balloon dilatation of the prostate

Prostate stents

Transurethral microwave thermotherapyTransurethral needle ablation (TUNA) uses

shielded needles, deployed from a special

catheter into the prostate, to emit radiowaves

that locally heat the prostate and cause

coagulative necrosis.

Laser prostatectomy



TAKE HOME MESSAGE

TURP IS STILL A GOLD STANDARD.

OPEN SURGERY-MILLIIN¶S RETROPUBIC

PROSTATECTOMY IN SELECTED CASES. MEDICAL MANAGEMENT SHOULD BE

TRIED FIRST IN CASES OF MINIMAL

RESIDUAL URINE, PATIENT WHO ARE

NOT FIT FOR SURGERY, OR NOT

WILLING FOR SURGERY.



ROLE OF PSA

IN CASES OFENLARGED PROSTATE



CASE - 6

55 YEAR OLD MAN PRESENTED WITH

THREE EPISODES OF HAEMATURIA IN 2

MONTHS TIME. SONOGRAPHY REVEALED 3 CMS SIZE

BLADDER MASS ON LT. LATERAL WALL



X-RAY

BIOPSY BY AGENERALSURGEON. HPREPORT - TCCOF BLADDERWITHOUTMUSCLE

INVASION



QUESTIONS

DO WE NEED MUSCLE BIOPSY ALONG

WITH THE TUMOUR ?

IS ONLY TISSUE DIAGNOSIS

SUFFICIENT ?

WHAT IS YOUR SUGGESTIONS FOR

THIS PATIENT¶S MANAGEMENT ?



TAKE HOME MESSAGE

COMPLETE RESECTION WITH MUSCLE

TISSUE IS A MUST IN CASE OF

RESECTABLE BLADDER TUMOR TRANS URETHRAL BIOPSY CAN BE TAKEN

IN CASES OF ADVANCED MALIGNANCY

FOR DIAGNOSIS

ONLY CUP BIOPSY IN BLADDER TUMOURIS NOT SUFFICIENT FOR COMPLETE

DIAGNOSIS



P. U. VALVE

MANAGEMENT ?

ENDOSCOPY & RESECTION OF VALVES ?

CUTANEOUS VESICOSTOMY ?



TAKE HOME MESSAGE

CUTANEOUS VESICOSTOMY IN NEW

BORN

ENDOSCOPY & RESCTION FOR OLDERCHILDREN

ASSESSMENT OF UPPER TRACK MUST

BE DONE

LOOK FOR V.U. REFLUX





CONCLUSION:



Dos in Urology:

1. Tackle any Urological emergency within your means.

2. Treat simple Urological problems as office urologist.

3. Investigate young children thoroughly having U.T.I.

4. Do not hasitate to put supra pubic catheter in emergency.5. Give pain killers like Diclofanac Sodium for ureteric colic.

6. Bladder stones:

Treat them but with atleast basic Urological investigations.

It is kinder to give Pfannenstiel¶s Incision to children.

And use subcuticular stitches for skin closure.



Dos in Urology (Cont..):

7. Investigate Male partner first in case of Infertility.

8. Don¶t Hasitate to use Double J Stents in case of open renal surgery.

Your urologis colleague will be able to remove at your clinic later on.

9. Always encourage R O

AMI N

G UR OLO

GISTS to come to your clinic for consultation and further guidance and even for surgery like TUR(P), OR in

emergency situation.

10 Refer the patients to Specialist Urologist for major Urological problems like

Uro-Oncology.

Infertility Complicated Stone Diseases

Laparoscopic urolocial surgery.

Transplant Surgery.



Don¶ts in Urology

1. Don¶t do prostatic surgery without help of R OAMI NG UR OLOGIST.

2. But don¶t encourage Roaming Urologist to perform Mega surgery atyour clinic.

3. Don¶t attempt laparoscopic Urological surgery.

4. Don¶t keep treating Infertile woman without investigating male

partner.

5. No point in giving hydro therapy and lasix in case of alreadyobstructed kidney.

6. Please do not attempt congenital hernias with hydrocole in youngchildren.

7. Avoid reconstructive Urological surgery.8. Don¶t give antibiotics to patients having haemeturia without any U.T.I

9. Avoid treating stricture urethra with metal dilatation.



THA NK U

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Urology for General Surgeons