Handbook of Office Urological Procedures (eBook)

Title Page 2
Copyright Page 4
Foreword 5
Preface 6
Acknowledgments 7
Table of Content 8
Contributors 11
1. Sutures and Scalpels 12
Sutures 12
Degradation 12
Structure 12
Material Type 13
Color 13
Size 13
Coating 13
Mounting 14
Other Physical Characteristics of Sutures 14
Needles 16
Scalpels and Holders 20
References 21
2. Electrosurgical Diathermy 22
Principles of Diathermy 22
Types of Diathermy 22
Generators 23
Mode Settings 24
General Safety Principles 26
Reference 26
3. Urinary Catheters 27
Indications 27
Methods of Bladder Catheterization 27
Classification of Urinary Catheters 28
Complications of Urinary Catheters 32
Reference 33
4. Urological Endoscopic Equipment 34
5. Local Anesthesia and Nerve Blocks 43
Indications 43
Types of Local Anesthetics 43
Inguinal Block 43
Spermatic Cord Block 44
Penile Block 45
References 45
6. Reduction of Torsion of Testis and Fixation 46
Indications 46
Procedure: Simple Orchidectomy 46
Complications 49
References 50
7. Simple and Subcapsular Orchidectomies (Orchiectomies) 51
Indications 51
Procedure: Simple Orchidectomy 51
Procedure: Subcapsular (Intracapsular) Orchidectomy 53
Complications 54
References 54
8. Radical Orchidectomy (Orchiectomy) 55
Indications 55
Procedure 55
Complications 58
References 58
9. Insertion of Testicular Prosthesis (Implant) 59
Indications 59
Procedure 59
Complications 62
References 63
10. Testicular Biopsy 64
Indications 64
Procedure 64
Complications 65
References 66
11. Hydrocele Repair in Adults 67
Indications 67
Procedure 67
Complications 70
References 70
12. Excision of Epididymal Cystor Spermatocele 72
Indications 72
Procedure 72
Complications 73
Complications 73
References 74
13. Vasectomy 75
Indications 75
Procedure: Scalpel Technique 75
Procedure: No-Scalpel Technique 78
Complications 80
References 80
14. Epididymectomy 82
Indications 82
Procedure 82
Complications 84
References 85
15. Inguinal Orchidopexy (Orchiopexy) 86
Indications 86
Procedure 86
Complications 92
References 92
16. Varicocelectomy 93
Indications 93
Procedure: Inguinal Varicocelectomy 93
Procedure: Abdominal Varicocelectomy 96
Complications 97
References 98
17. Circumcision 99
Indications 99
Procedure 99
Adults 99
Complications 102
References 102
18. Optical Urethrotomy 103
Indications 103
Procedure 103
Complications 105
References 105
19. Urethral Dilation 106
Indications 106
Procedure 106
Complications 109
Reference 109
20. Injectables 110
Indications 110
Procedure 110
In Females (1) 110
In Males (2) 112
Zuidex Procedure in Females 112
Complications 115
References 116
21. Transrectal Ultrasound Scan and Biopsy of the Prostate 117
Indications 117
Procedure 117
Complications 122
References 123
22. Urodynamics 124
Indications 124
Procedure 124
Complications 131
References 131
23. Flexible Cystoscopy 132
Indications 132
Procedure 132
Complications 134
References 134
24. Rigid Cystoscopy 135
Indications 135
Procedure 135
Complications 138
References 138
25. Suprapubic Catheterization 139
Indications 139
Procedure 139
In the Setting Where Urethral Access Is Inadvisable or Not Available (1) 139
In the Setting Where Urethral Access Is Available 140
Using a Percutaneous Kit 141
Complications 141
Reference 142
26. Cystodiathermy 143
Indications 143
Procedure 143
Complications 144
Reference 144
27. Cystodistension (Hydrodistension) 145
Indications 145
Procedure 145
Complications 146
References 146
28. Extracorporeal Shockwave Lithotripsy (ESWL) 147
Indications 147
Procedure 147
Complications 149
References 150
29. Insertion of Double-J Stent 151
Indications 151
Procedure 151
Complications 153
Reference 153
30. Retrograde Pyelography 154
Indications 154
Procedure 154
Complications 157
Reference 157
31. Ureteroscopy (Semi-Rigid) 158
Indications 158
Procedure 158
Complications 160
Reference 161
Index 162

"28. Extracorporeal Shockwave Lithotripsy (ESWL) (p. 136-137)

Christopher Wolter and Roger Dmochowski

Indications

ESWL has proven over time to be a major breakthrough in urology. It is the procedure by which shockwaves are generated at a point external to the body (F1 point) and are focused on a kidney stone in the body (F2 point) (Figure 28.1). The shockwaves themselves are relatively weak at their source and can thus traverse the body without any untoward effects. However, at the point at which they are focused, they are suf? ciently powerful to fragment a kidney stone.

This is guided by ? uoroscopy in most instances, though ultrasound- guided techniques have been described. Fragmenting almost any stone can be attempted with this technique, but the success varies greatly depending on the size and location of the stone. Generally speaking, for stones in the upper and interpolar calyces, and the renal pelvis, the size limit is 2 cm, and for stones in the lower pole, the size limit is 1 cm. Most stones in the upper ureter can be fragmented as well.

The larger the stone, the higher the likelihood there will be a need for a second procedure. Contraindications to this procedure include active urinary tract infection, uncontrolled bleeding diathesis, poorly controlled hypertension, and pregnancy. Relative considerations that may prohibit use of ESWL are obesity, deformity of body habitus, suspected anatomic obstruction, stones in a calyceal diverticulum, and renal failure.

Procedure

1. Obtain consent for the procedure, ensuring that the listed complications below are discussed and the side to be treated is marked.
2. Prior to the procedure, obtain a urine culture. Even if the culture is negative, some doctors contemplate using pre-operative antibiotics. Choose an antibiotic that achieves good levels in urine, (i.e., a ? uoroquinolone).
3. Depending on the type of machine being used, the anesthesia/ analegesia chosen can vary. For the older-generation machines (e.g., Dornier HM3), general anesthesia is necessary. For newer, lowerpowered machines, simple analgesia, sedation, or monitored anesthetic care can be used.
4. If necessary, a ureteral stent can be placed pre-operatively, either at the same setting or at an earlier date. 5. Place the patient on the ESWL table in the supine position. If using a HM3 lithotriptor, the patient will need to be placed in the harness. Position the patient correctly over the shockwave generator. This may vary depending on the model being used."