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