Top Tips in Urology

Mr John McLoughlin, Consultant Urological Surgeon, West Suffolk Hospitals NHS Trust and Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.

List of Contributors xvii

Foreword xxiii

Preface xxv

List of abbreviations xxvi

Part 1: Open Urology

1 A technique to minimise the risk of ureteric injury in patients with an enlarged median lobe undergoing radical prostatectomy 3
Nikhil Vasdev and David Chadwick

2 Novel methods to aid vesicourethral anastomosis in radical retropubic prostatectomy 5
Lehana Yeo, Rajindra Singh and Jhumur Pati

3 Surgical technique to reduce intraoperative bleeding during open prostatectomy 7
Nikhil Vasdev, Edgar Paez and Andrew C. Thorpe

4 Millin’s prostatectomy 9
Rob Jones and Ru MacDonagh

5 Cystectomy 10
Patrick F. Keane

6 Salvage cystectomy and prostatectomy 12
Senthil Nathan

7 Creating an ileal conduit spout, 13
Simon Fulford

8 Prefashioning a urostomy 14
Richard Bell

9 A novel technique for parastomal hernia repair 16
Jeetesh Bhardwa, Rob Gray and Hanif Motiwala

10 Parastomal hernia repair 18
Derek Fawcett

11 Nephrectomy: vascular control during caval thrombectomy 21
Dan Wilby and Matt Hayes

12 Secure ligation of foreshortened large veins, 22
Dan Wilby and Matt Hayes

13 How to avoid dislodging the vascular clamp, 23
Asif Muneer

14 Ligating the renal artery, 24
David Cranston

15 Renal hypothermia using an innovative ice sludge technique, 25
Ruzi Begum and Hanif Motiwala

16 Making the best of a short suture length in a deep dark hole, 27
John McLoughlin

17 Anterior approach for a pyeloplasty 29
John McLoughlin

18 Ureteric injuries – lower third: adaptations of the Boari flap 31
John Kelleher

19 Radical orchidectomy for germ cell tumours 35
David Hendry

20 Don’t lose the lumen at urethroplasty 36
Andrew Doble

21 Emergency call to the gynae/obstetric theatre 37
John McLoughlin

22 Is it urine in the drain? 39
Christopher Woodhouse

23 Cutaneous fistula 40
Senthil Nathan

24 Postoperative abdominal drain 41
Senthil Nathan

Part 2: Laparoscopic and Robotic Urology

25 Modified Hassan technique in super-obese patients 45
Tev Aho

26 A modification to the Hassan technique for securing pneumoperitoneum 47
Ben Challacombe and Pardeep Kumar

27 Finger access is the safest 51
Richard Napier-Hemy

28 Keep it simple 52
Jon Cartledge

29 The Ten Commandments 56
Peter Rimmington

30 Controlling a small hole in the inferior vena cava 58
Richard Napier-Hemy

31 Remember Endoloops? 60
Richard Napier-Hemy

32 Tips in laparoscopic urology 61
Dominic Hodgson

33 Laparoscopic suturing using the Storz dolphin-nosed forceps 63
Alan McNeill

34 Laparoscopic suturing 64
Henry Sells

35 Improving your laparoscopic suturing 65
Chris Eden

36 Cholangiogram catheters can help antegrade wire placement at the time of pyeloplasty 66
Richard Napier-Hemy

37 Laparoscopic nephrectomy: introduction of a balloon-tipped trocar in an obese patient 67
Damian Hanbury

38 Laparoscopic nephrectomy: closing the exit site in an obese patient 68
Damian Hanbury

39 Laparoscopic nephrectomy: port sites for left nephrectomy 69
Damian Hanbury

40 Laparoscopic nephrectomy 70
Peter W. Cooke

41 Employing an extra port for laparoscopic nephrectomy 71
Toby Page

42 Improved control of the renal vein during laparoscopic nephrectomy 72
Tony Riddick

43 Aiding dissection of the renal artery during a laparoscopic radical nephrectomy 73
Adam Jones

44 Robotic-assisted laparoscopic pyeloplasty 74
Prokar Dasgupta

45 Laparoscopic prostatectomy 75
Peter W. Cooke

46 Use of the Endo Close device for prostatic elevation during robotic-assisted radical prostatectomy 76
David Bouchier-Hayes

47 Additional points of note when performing prostate suspension during minimally invasive radical prostatectomy 79
Ben Challacombe

48 Robotic radical prostatectomy 80
Senthil Nathan

49 A technique to relocate the robotic prostatectomy retrieval bag to the midline camera port 81
Muhammad Jamal Khan and Omer Karim

50 The rectal injury test 83
Ben Challacombe

51 Identifying potential breaches in the rectum during minimally invasive surgery 84
Justin Collins

52 The wrong plane 85
Anonymous

53 Spreading tough tissue with robotic forceps 86
Marc Laniado

54 Robotic-assisted radical prostatectomy 87
Prokar Dasgupta

55 Steps to free up robotic arm and assistant availability during robotic radical prostatectomy 88
Adam Jones

56 Use of Ethicon Vicryl foil and robotic camera lights to warm the robotic scope lens to prevent lens fogging 89
Muhammad Jamal Khan and Omer Karim

57 Management of anastomotic leak following radical prostatectomy 90
Ruzi Begum and Omer Karim

58 Identification of ureters during minimally invasive radical cystectomy 91
Ben Challacombe

59 Maintaining pneumoperitoneum during minimally invasive female cystectomy 92
Ben Challacombe

60 Robotic-assisted radical cystectomy 93
Prokar Dasgupta

Part 3: Upper Tract Endourology

61 Puncturing the calyx in order to obtain access for percutaneous nephrolithotomy: the three-finger rule 97
Gerald Rix

62 Prevention of migration of the Amplatz sheath during percutaneous nephrolithotomy 98
Oliver Wiseman

63 Using safety wires during percutaneous nephrolithotomy 100
Sunil Kumar

64 Tips to make percutaneous nephrolithotomy easier 101
Aasem Chaudry

65 Using multiple guidewires during percutaneous nephrolithotomy 104
Stephanie J. Symons

66 Encrusted nephrostomy tubes 106
James Hall

67 Reaching stones in the kidney during flexible ureterorenoscopy with a large renal pelvis 107
Gerald Rix

68 The advantages of using the Peditrol during flexible and rigid ureterorenoscopy 108
Sunil Kumar

69 Flexible renoscopy and stone fragmentation 111
Bo Parys

70 A novel technique to treat large mid or upper ureteric stones 114
Asif Raza and Muhammad Jamal Khan

71 Rigid ureteroscopy 115
Matthew Bultitude

72 The Boston shouldered stent 119
Bo Parys

73 Ureteroscopy 121
Nimish Shah

74 The pinhole scope: part 1 123
Sunil Kumar and Peter Malone

75 Use of the dual-lumen catheter 124
Oliver Wiseman

76 Flexible ureteroscopy 126
Stephen Gordon

77 Lasering stones 127
Senthil Nathan

78 Renal pelvic stones 128
Anthony Blacker

79 Difficult urethral stricture encountered at ureteroscopy 129
James Hall

80 General tips for a simpler and safer ureteroscopy 130
Sunil Kumar

81 Flexible ureteroscopy/retrograde study of the right collecting system post cystectomy 132
Senthil Nathan

82 Optimising the view for difficult stent insertion 133
John McLoughlin

83 A novel technique for stent exchange over an ileal-ureteric anastomosis 135
Rob Gray and Hanif Motiwala

84 Stents 137
Peter W. Cooke

85 Placing a stent in a female patient without having to reload the cystoscope or performing a stent change in a female patient with a flexible cystoscope only 138
Gerald Rix

86 Paired JJ stents for retroperitoneal fibrosis 139
John McLoughlin

87 Four tips relating to ureteric stenting 141
Sunil Kumar

88 Insertion of JJ stent 143
Senthil Nathan

89 Basketing of stones 144
Senthil Nathan

90 Backloading guidewires 145
David Hendry

91 Insertion of a guidewire into the ureter 146
Senthil Nathan

92 A solution for stent-related bladder symptoms 147
Paul Halliday

Part 4: Lower Urinary Tract

93 Holmium laser enucleation of the prostate: laser technique 151
Tev Aho

94 Holmium laser enucleation of the prostate: safe morcellation 155
Tev Aho

95 Holmium cystolitholapaxy 156
Sunil Kumar

96 Transurethral resection of prostate 1 157
Nikesh Thiruchelvam

97 Transurethral resection of prostate 2 158
Peter W. Cooke

98 Transurethral vaporisation of the prostate 159
Senthil Nathan

99 Use of catheter introducer 160
Derek Fawcett

100 An alternative way to pass a urethral catheter post transurethral resection of prostate 161
Ben Ayres and Gary Das

101 The 17F integral cystoscope 163
Graham Sole

102 Non-irrigating resectoscope 165
Graham Sole

103 Urethral strictures 166
Anthony Blacker

104 Assessment of paediatric urethral strictures 167
Amjad Mumtaz Peracha

105 The pinhole scope: part 2 168
Sunil Kumar and Peter Malone

106 How to remove air bubbles in the dome of the bladder 170
David Hendry

107 Resecting multiple bladder tumours 171
Senthil Nathan

108 Primary transurethral resection of bladder tumour 172
Aasem Chaudry

109 Trawling for flat superficial bladder tumour 173
John McLoughlin

110 Resecting bladder tumours 175
Richard Bell

111 Never use an Ellick in a clot retention 176
Simon Bott

112 Displaced suprapubic catheter 177
Dan Wilby and Matt Hayes

Part 5: Andrology

113 Glans ‘droop’ following the insertion of a penile prosthesis 181
Asif Muneer Suks Minhas and Alex Kirkham

114 The key to a successful epididymectomy: the bungee manoeuvre 183
John McLoughlin

115 Haemostasis for Nesbit’s procedure 185
Suks Minhas

116 Nesbit’s procedure 187
John McLoughlin

117 Tension-free vasectomy reversal 190
Asif Muneer

118 Intracorporeal perforation during penile implantation 191
Suks Minhas

Part 6: Female Urology

119 Recurrent cystocoele and rectocoele repair using modified mesh: new technique 195
Rob Gray and Hanif Motiwala

120 Eroded transvaginal tape 199
Rizwan Hamid

121 Midurethral tension-free tapes 201
Neil Harris

122 Treatment of TVT mesh eroding the bladder 202
Georgina Wilson

Part 7: General

123 Circumcision 205
Andrew Doble

124 Dressing a circumcision 207
Simon Bott

125 Postcircumcision dressing: the gauze sporran 208
Andrew Doble

126 Difficult reduction of paraphimosis 210
Andrew Doble

127 Round-bodied needles 211
Richard Bell

128 Bladder clots 212
Ling Lee

129 Performing a flexible cystoscopy for a bladder which is full of debris 214
Asif Muneer

130 Passing a urethra catheter across a stricture after a guidewire is passed via the flexible cystoscope 215
Ling Lee

131 Inserting a catheter over a guidewire 216
Simon Bott

132 Cryoanalgesia for prostate biopsy 217
Simon Robinson and Hanif Motiwala

133 Pain relief in epididymo-orchitis 219
Andrew Doble

134 Hydrocoele 220
Senthil Nathan

135 Epididymal cyst 221
Senthil Nathan

136 Shape of the male urethra 222
Simon Bott

137 Local anaesthetic injection through skin 223
Paul McInerney

138 Transrectal ultrasound 224
John McLoughlin

139 Modified transrectal biopsy of prostate 227
Ruzi Begum Rob Gray and Hanif Motiwala

140 Transperineal biopsy probe set-up 229
John McLoughlin

141 Changing a difficult or encrusted suprapubic catheter 230
John McLoughlin

142 How to predict the difficult catheter? Use the Force! 232
K. Mozolowski and John G. Calleary

143 Urodynamics 233
Sarah Wood

Part 8: Clinical Management

144 Neurourology 237
Philip van Kerrebroeck

145 Managing urinary tract damage due to ketamine abuse 238
Dan Wood

146 Top tips for foreskin assessment 239
Dan Wood

147 Lower urinary tract symptom progression 240
Mark J. Speakman

148 Management of chronic prostatitis/chronic pelvic pain syndrome: top 10 tips 241
J. Curtis Nickel

149 Uro-gynae tips 244
Glyn Constantine

150 Psychological problems and surgery 245
Paul McInerney

151 Use of analogies to assist with explanation of urological problems 246
David Nicol

Quotes submitted on the back of other tips 249

Index 251