Urology for General Surgeons
-
Upload
anis-hospital -
Category
Documents
-
view
220 -
download
0
Transcript of Urology for General Surgeons
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 1/43
HOPE THIS WILL BE
ENTERTAINING, EXITING& USEFUL SESSION OF
1
ST
MATCH OF 90 MIN.
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 2/43
PROBLEMS
40% OF PRACTISE OF
GENERAL SURGERY
UROLOGISTS ARE
MORE IN URBAN
AREA
MOBILE UROLOGIST
NOW ACCESSIBLE TO
MANY GENERAL
SURGEONS
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 3/43
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 4/43
Management of
Urinary StoneDisease
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 5/43
BLADDER / URETHRAL STONE
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 6/43
RGU
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 7/43
TAKE HOME MESSAGE
- IDENTIFY ETIOLOGY OF BLADDER STONE
-CYSTOSCOPY SHOULD BE DONE IN
ALL CASES
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 8/43
X-RAY
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 9/43
PROBLEMS
DIFFICULTIES SHOULD BE ANTICIPATED.
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 10/43
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
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 11/43
CASE - 3
A PATIENT WITH SOLITORY KIDNEY
HAVING A 2 CMS SIZE PELVIC STONE
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 12/43
QUESTIONS
WHAT ARE THE MANAGEMENT OPTIONS
IN THIS PATIENT..?
CAN WE PERFORM ESWL WITHOUT DJSTENTING..?
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 13/43
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.
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 14/43
CASE 4
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 15/43
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 ?
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 16/43
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.
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 17/43
R enal stones
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 18/43
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 19/43
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 20/43
CASE - 4
A MALE PATIENT OF 35 YEARS.
PRESENTED WITH RUPTURE URETHRA &
RETENTION OF URINE WITH URETHRAL
BLEEDING
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 21/43
QUESTIONS
SHOULD WE ATTEMPT PRIMARY RAIL
ROADING ?
HOW TO PROCEED FOR THAT ?
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 22/43
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
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 23/43
Benign Prostatic
Hyperplasia
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 24/43
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
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 25/43
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 26/43
A prostate examination.. ³Medical students learning how to perform
a prostate examination´
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 27/43
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 ?
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 28/43
B.P.H.
Medical management:
Finesteride
Prazocin
TerazocinDoxazocin
Uro-selective:
Alfuzocin
Tamsulosin
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 29/43
: 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
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 30/43
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.
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 31/43
ROLE OF PSA
IN CASES OFENLARGED PROSTATE
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 32/43
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
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 33/43
X-RAY
BIOPSY BY AGENERALSURGEON. HPREPORT - TCCOF BLADDERWITHOUTMUSCLE
INVASION
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 34/43
QUESTIONS
DO WE NEED MUSCLE BIOPSY ALONG
WITH THE TUMOUR ?
IS ONLY TISSUE DIAGNOSIS
SUFFICIENT ?
WHAT IS YOUR SUGGESTIONS FOR
THIS PATIENT¶S MANAGEMENT ?
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 35/43
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
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 36/43
P. U. VALVE
MANAGEMENT ?
ENDOSCOPY & RESECTION OF VALVES ?
CUTANEOUS VESICOSTOMY ?
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 37/43
TAKE HOME MESSAGE
CUTANEOUS VESICOSTOMY IN NEW
BORN
ENDOSCOPY & RESCTION FOR OLDERCHILDREN
ASSESSMENT OF UPPER TRACK MUST
BE DONE
LOOK FOR V.U. REFLUX
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 38/43
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 39/43
CONCLUSION:
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 40/43
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.
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 41/43
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.
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 42/43
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.
8/7/2019 Urology for General Surgeons
http://slidepdf.com/reader/full/urology-for-general-surgeons 43/43
THA NK U