Urology

Transurethral Resection of Prostate Endoscopic

Transurethral resection of the prostate (TURP) is a surgical procedure used to deal with urinary issues due to an enlarged prostate.

Procedure

The resectoscope is placed into the top of your penis and extended via your urethra and into the prostate region. Your doctor may not need to make any incisions on the outside of your body.

Resectoscope is used by your doctor to trim the tissue from the interior of your prostate gland, one tiny piece at a time. Irrigating fluid carries them into your bladder as small pieces of tissue are cut from inside your prostate. They are taken out at the end of the operation.

Optical Urethrotomy

The endoscopic procedure known as Optical Urethrotomy is used to treat urethral stricture (narrowing). It is done to deal with urethral stricture. It is a therapeutic choice for urethral strictures of less than 1.5cm.

This surgical procedure needs general or spinal anesthesia. During the procedure, the patient is placed in the gynecological examination position, the area has to be cleansed and the urethra lubricated. A tiny camera is placed via the urethra to open up the stenosed region. The stenosed region is opened with the help of an instrument connected to the camera. A catheter is inserted at the end of the procedure.

Hospital stay is based on the extension of the injury. However, on average it is predicted to be about 2 days.

Urethroplasty

Urethroplasty is a surgical operation wherein the urethra is reconstructed to treat issues like urethral strictures. The types of surgical procedures are numerous and based on the location, length and cause of the stricture. Most surgical procedures can take among 3 to 6 hours to complete.

An incision is created over the region of the stricture within the penis, scrotum, or perineum (the region between the scrotum and the anus). After the procedure a urethral catheter is left in for 2-4 weeks based upon the form of surgical operation that was completed. When patients return to health center the bladder is full of X-ray evaluation and the catheter is gently taken out.

The patient voids and the place of the surgical operation is evaluated as the X-rays are being taken. If the region of surgery is healed, then the catheter is overlooked and patients begin to void normally.

Ureteroscopy for Ureteric stones

A ureteroscopy is known to be outpatient procedure that is performed to treat ureteric stones (the tubes that attaches the bladder to the kidneys) or kidney. It can also be used to assess and treat other causes of kidney blockage or blood within the urine.

A ureteroscopy is carried out with a ureteroscope, a long, skinny tube that has an eyepiece on one end and a tiny lens and a light on the opposite end. Generally, there are two ways to perform ureteroscopy for stones:

  1. Your doctor will place a scope into the ureter to eliminate the stone if the stone is small. The scope which is used in this procedure will have a small basket at the end of a wire which runs via an extra channel in the ureteroscope. The purpose of basket is to collect the stone.
  2. Your doctor will place a flexible fiber through the scope up to the stone when the stone is larger. The doctor fragments stones to be passed out of the body with urine with a laser beam shining through the scope.

Stenting

Ureteral stents are small tubes placed into the ureter to deal with or prevent a blockage to avoid the flow of urine from the kidney to the bladder. The most common cause for ureteral stents is the treatment of kidney stones.

A ureter is the tube-like shape that transfers the urine from the kidney to the urinary bladder. Ureters run vertically (up and down) inside the middle part of the abdomen. There is one ureter for each kidney. Some humans are born with two ureters to one kidney or ureters to both kidneys. This is known as duplication.

What is a stent?

A stent is a tiny hollow tube which is inserted into the ureter. It is flexible and about 10 inches long.

When inserted within the ureter, the top part of the stent has a small curl that sits within the kidney and the other part ends curls within the bladder.

Stents can also have a string at the end which is seen outside the body. All stents doesn’t have a visible string.

Why are ureteral stents placed?

When the normal flow is blocked, ureteral stent is inserted to enable urine to flow from the kidney to the bladder. It may also be placed to prevent blockage.

Percutaneous NephroLithotomy (PCNL) for Key hole surgery

Percutaneous NephroLithotomy (PCNL) is one of the most preferred method to treat large kidney stones (over 2cm in diameter) which are located in the kidney. It entails keyhole surgical operation that is done through a 1cm incision within the skin. A mini-PERC is same in technique, but represents a refinement in the method because of having tiny cameras, higher stone lasers and specialized tools. The cut that is created within the skin is much smaller and enables for faster recovery and results in a safer procedure.

What are the advantages?

  1. Enables for large or complex stones to be dealt with in a minimally invasive procedure, which in the past this would have required a large incision, and longer hospital stay.
  2. Hospital stay is two to four days, and the out of hospital recovery time is drastically shorter than the conventional open surgical strategies.
  3. Quicker return to work. This procedure is done under a general anaesthetic and takes up to approximately 2 to 3 hours. Lying on the front “stomach”, you will be placed on the operating room table for the surgery.

With the help of x-ray imaging or ultrasound to lead the entry of a hollow tube into the kidney, the procedure is performed. This gives an access into the kidney drainage system enabling telescopes, laser fibres, and stone grasping instruments to envision, fragment and eliminate kidney stones. At the end of the procedure, a drainage catheter or nephrostomy tube which exits through the skin maybe left in the kidney.

Extracorporeal Shock Wave Lithotripsy (ESWL) for Kidney Stones

ESWL is considered as outpatient process where a patient doesn’t have to stay a night in the hospital. After ESWL, stone fragments typically to pass in the urine for some days and leads to moderate ache. You may be in need of more ESWL or other treatments, if you are having large stones.

ESWL can be used on an individual having a kidney stone that causes pain or blockage in the urine flow. Stones which might be between 4 mm and 2mm in diameter are mostly treated with ESWL. The stone is pushed back into the kidney by your surgeon with a small instrument (ureteroscope) and then ESWL is used.

Laser lithotripsy may be an option if other non-surgical treatments have failed or if kidney stones are:

  1. Irregular in shape.
  2. Too large to pass.
  3. Leading in bleeding or damage to surrounding tissue.

Nephrectomy

Nephrectomy is a surgical operation to eliminate issues of all or part of a kidney:

  1. Radical (complete) nephrectomy. During a radical nephrectomy, the urology doctor eliminates the complete kidney and some additional structures consisting of a part of the tube that attaches the kidney to the bladder (ureter), or different adjacent structures along with the adrenal gland or lymph nodes.
  2. Partial nephrectomy. In a partial nephrectomy, the surgeon eliminates diseased tissue from a kidney and leaves only those tissue in place that are healthy.

A nephrectomy is most often done to treat kidney cancer or to eliminate a noncancerous (benign) tumor. It is performed to deal with a diseased or seriously damaged kidney.

In donor nephrectomy, the urology doctor removes an entire kidney from a donor for transplant into someone who needs a functioning kidney.

A nephrectomy may be also performed by urology surgeon through a single incision in the abdomen or side (open nephrectomy) or through a series of tiny cuts in the abdomen by using a camera and small instruments (laparoscopic nephrectomy).

Transurethral Resection of Bladder Tumor

A TURBT is a procedure wherein bladder tumors may be removed from the bladder wall. In this procedure, a scope is placed through the urethra into the bladder. As it is an outpatient procedure, it is generally done inside the hospital setup with the affected person anesthetized.

A scope with a unique cutting device is inserted through the herbal channel into the bladder and then the tumor is eliminated during the procedure. The resulting region of resection can then also be cauterized by way of specialized instruments.

Cystolithotripsy for Bladder Stones

Cystolithotripsy is used in treating urinary bladder stones. It is a therapeutic choice which is indicated for almost all bladder stones, with the exception of the very large ones.

Cystolithotripsy is performed under general or spinal anesthesia. Initially, the patient is placed in the gynaecological examination position, the genital region gets cleansed and the urethra lubricated.

To localize the stones, a camera is placed through the urethra. An instrument connected to the camera, the lithotripter, is used to suppress stones into small pieces and eliminate them. A catheter is inserted at the end of the procedure. There is requirement for continuous bladder irrigation in case of hematuria (blood in the urine), Average length of hospital stay is about 2 days.

As soon as urine clears up from blood, catheter is removed. On average, this happens on the first postoperative day.

Pyelolithotomy

The term pyelo means renal pelvis, and the term lithotomy means removal of stone. However, before these newer technologies, pyelolithotomy was the procedure of choice for stones within the renal pelvis, that includes stones that demonstrated minimal invasion into calyces and infundibulum.

Pyelolithotomy differs from an anatrophic nephrolithotomy, as the anatrophic nephrolithotomy enables for greater access to calyces and is allowed for repair of infundibulum and calyces. Anatrophic nephrolithotomy is indicated for large multiple-branched staghorn calculi with infundibular stenosis.

Nephrolithotomy

If the kidney stones are too large then surgery may be an option where nephrolithotomy is used. A small scope is used along with instruments to pluck or vaccum the stones via small incision in your back with this surgery. It is sometimes called as percutaneous nephrolithotomy or stone extraction.

Surgery

Prior to the procedure, your surgeon may test your urine and blood for infection. You’ll also have to go through an ultrasound, CT scan, or X-ray so your doctor can see exactly where the stones are.

The surgery may take up to an hour or two. You will be allowed to lie face-down on a surgical table. General anesthesia will be given so you won’t be awake or feel any pain. The dye or carbon dioxide will be injected into your bladder so the branches of your kidney can be mapped through a scope.

A small incision will be made down the back on the side with the stones. A fiber-optic camera is used to place to peer in. Stones are removed by the doctor wherein laser, ultrasonic, or mechanical device is used to break the stones first. When your stones are suppressed before removal, it is called as nephrolithotripsy.

Reimplantation of Ureter

Ureteral reimplant surgical operation changes the way an abnormally placed ureter connects with the bladder. Ureters are the tubes where urine is carried from the kidneys to the bladder. Normally, the ureter makes an entry into the bladder, that is created from muscle, in any such manner that urine is allowed to enter the bladder however no longer allowed to back up to the kidney. When the ureter makes an entry into the bladder abnormally, the muscle backing of the bladder does not completely cover the ureter and urine flows back toward the kidney. This condition is known as vesicoureteral reflux.

A tiny cut is made in the lower abdomen, below the bikini line. All stitches are dissolvable. There might be one stitch in the skin to secure a catheter that is removed.

A tiny cut is made in the lower abdomen, below the bikini line. All stitches are dissolvable. There might be one stitch in the skin to secure a catheter that is removed.

A clear plastic dressing which will be removed two days after surgery may cover the incision. Little pieces of tape, called "steri-strips," along the cuts eventually will curl up and fall off.

Hypospadias Repair in children

Hypospadias repair is surgical procedure used to correct a defect in the opening of the penis which is present at birth. As urethra ends on the underside of the penis but doesn’t end at the tip of the penis. In more severe cases, the urethra will open at the mid or bottom of the penis, or in or behind the scrotum.

Most often When boys are between 6 months and 2 years old, Hypospadias repair is performed. After the procedure, the child rarely has to spend a night in the hospital. Boys with hypospadias must not be circumcised at birth. During surgery, the extra tissue of the foreskin may be required to repair the hypospadias.

General anesthesia is given to the patient before surgery. This will make the patient to sleep and numb towards the pain during surgery. Mild defects might be repaired in one procedure. Severe defects may require two or more procedures.

The surgeon uses a small piece of foreskin or tissue from other site to create a tube that maximizes the length of the urethra. Extending the urethra length will enable it to open at the tip of the penis.

During surgical procedure, the surgeon inserts a catheter (tube) in the urethra to make it hold its new shape. To keep it in place, the catheter may be sewn or fastened to the head of the penis. Catheter is removed 1 to 2 weeks after surgery.

Fulguration of Posterior Urethral Valves

Posterior urethral valves (PUV), arise in men and are extra flaps of tissue within the posterior urethra, that is the tube that drains urine from the bladder to the external of the body for removal. These extra flaps in the urethra block the regular float of urine out from the body. This can purpose damage to the bladder, ureters and kidneys.

The amount of damage that could occur relies upon on the amount of obstruction in the urethra and the way early and quick the patient receives medical intervention. Early diagnosis and intervention, combined with lengthy-time period care, offers the best results for patients.

Based upon the severity of the PUV, it can be treated with various surgical interventions. The most common surgical procedure is Endoscopic incision of valves. With medical management, maximum boys with PUV will lead healthy lives and feature ordinary kidney function, bladder function and continence (the capacity to control urination).