1. Cystoscopy 2. Internal Urethrotomy 3. Laparoscopic Pyeloplasty 4. Nephrostomy 5. Orchiectomy 6. Percutaneous Nephrolithotomy 7. Radical Nephroctomy 8. Radical Prostatectomy 9.

Total Cystectomy 10. Urethroplasty

CYSTOSCOPY Cystoscopy is a procedure in which a Cystoscope is used to see inside your urinary bladder and urethra. When a Cystoscope is used to examine the ureter, the procedure is called Ureteroscopy. The urethra is the tube that carries urine from the bladder to the outside of the body. The cystoscope has lenses like a telescope or microscope. These lenses let the doctor focus on the inner surfaces of the urinary tract. Some cystoscopes use optical fibres (flexible glass fibres) that carry an image from the tip of the instrument to a viewing piece at the other end. Cystoscopes range from between the thickness of a pencil, up to approximately 9mm and have a light at the tip. Many cystoscopes have extra tubes to guide other instruments for surgical procedures to treat urinary problems. There are two main types of cystoscopy - flexible and rigid - differing in the flexibility of the cystoscope. Flexible cystoscopy is carried out without the use of local anaesthesia on both sexes. Typically, xylocaine gel (such as the brand name Instillagel) is used as an anaesthetic, instilled in the urethra. Rigid cystoscopy can be performed under the same conditions, but is generally carried out under general anaesthesia, particularly in male subjects, due to the pain caused by the probe. Cystoscopy may be recommended for any of the following conditions:[1]

Frequent urinary tract infections Blood in the urine (hematuria)

Loss of bladder control (incontinence) or overactive bladder Unusual cells found in urine sample Need for a bladder catheter Painful urination, chronic pelvic pain, or interstitial cystitis Urinary blockage such as from prostate enlargement, stricture, or narrowing of the urinary tract Stone in the urinary tract Unusual growth, polyp, tumor, or cancer

The doctor will gently insert the tip of the Cystoscope / Ureteroscope into the urethra and slowly glide it up into the bladder. Relaxing the pelvic muscles will help make this part of the test easier. A sterile liquid (water or saline) will flow through the Cystoscope / Ureteroscope to slowly fill the bladder and stretch it so that the doctor has a better view of the bladder wall. As the bladder reaches capacity, the patient will feel some discomfort and the urge to urinate. He will be able to empty his bladder as soon as the examination is over. The time from insertion of the Cystoscope / Ureteroscope to removal may be only a few minutes, or it may be longer if the doctor finds a stone and decides to remove it. Taking a biopsy (a small tissue sample for examination under a microscope) will also make the Cystoscopy / Ureteroscopy procedure last longer. In most cases, the entire examination, including preparation, will take about 15 - 20 minutes. Diagnostic cystoscopy is usually carried out with local anaesthesia. General anaesthesia is sometimes used for operative cystoscopic procedures. In most cases, patients lie on their backs with their knees slightly parted. Occasionally, a patient may also need to have their knees raised. This is particularly when undergoing a Rigid Cystoscopy examination. INTERNAL URETHROTOMY

Internal Urethrotomy, also known as Direct Vision Internal Urethrotomy (DVIU) is a surgical procedure used to treat urethral strictures (narrowing) due to scarring. Internal Urethrotomy can be categorized as Reconstructive Urology procedure where the normal anatomy and function of the urethra is restored by dilatation of the urethra. Internal Urethrotomy is a minimally invasive endoscopic procedure where a small cut is made in the narrowed part to fix the abnormal narrowing of the urethra.

It may be done to patients with a narrowing of the urethra due to any of the causes i.e. repeated episodes of urethritis, benign prostatic hyperplasia, scarring from a previous surgery, injury or trauma to the pelvic region or if there is narrowing of the urethra due to a tumour pressing on it.

The urinary bladder will be emptied using a suprapubic catheter before the Internal Urethrotomy to prevent urinary tract infection. You will lie on your back on the operating table with your legs wide apart. Internal Urethrotomy is performed in a hospital setting under general anesthesia. An endoscope with a sharp cutting edge (knife) is inserted into the urethra and an incision is made to open the narrowed portion of the urethra. A catheter is inserted to hold the urethra open until the internal cut heals.

LAPAROSCOPIC PYELOPLASTY Laparoscopic Pyeloplasty is a Minimally Invasive Laparoscopic procedure which relieves the obstruction between the ureter and the kidney at the ureteropelvic junction (UPJ). Laparoscopic Pyeloplasty relieves the obstruction in the upper part (renal pelvis) of the ureter. Laparoscopic Pyeloplasty is performed under general anesthesia. Three small incisions (about 1 - 1.5 cm) are made near the umbilicus, a Laparoscope is inserted through the incision, the ureteropelvic junction (UPJ) is relieved of it's cause of obstruction and a stent is inserted inside the ureter at the ureteropelvic junction (UPJ) to keep it patent, bridge the pyeloplasty repair and help drain the kidney. The entire procedure of Laparoscopic Pyeloplasty takes about 3 - 4 hours. A catheter will be placed in your bladder to drain the urine for the next few days. The patient is moved to the flank position with the ipsilateral side rotated up approximately 20-degrees. An axillary role is placed, pressure points are padded and the table is flexed slightly at the hips. The patient is secured to the table using wide cloth tape at the lower extremities, hips and shoulders. This allows for the patient to be rotated from a relatively horizontal position to the flank position by simply rotating the table. NEPHROSTOMY

Nephrostomy or Percutaneous Nephrostomy is a procedure that involves inserting a tube (Nephrostomy tube) or a catheter through the skin inside the kidney to drain urine. Nephrostomy tube or catheter can be kept patent by inserting a stent inside it. Nephrostomy can be temporary or permanent. Nephrostomy is a kind of 'Interventional Radiology' procedure.

Nephrostomy is usually performed when one of the ureters is blocked and the urine that is produced by the kidney cannot flow forward. As a result the back pressure of accumulated urine can cause damage to the kidney tissue and result in kidney failure. Nephrostomy can also be performed to access the kidney stone in the upper part of renal pelvis, that way it can either be dissolved chemically or by Intracorporeal Shortwave Lithotripsy (ICSWL).

The entire procedure may take about an hour. Nephrostomy is performed in the operating theatre under stringent sterile conditions. Nephrostomy will be performed under local anesthesia and sedation to relieve anxiety, pain and discomfort during the procedure. The patient lies flat on the stomach on the operating table. A small tube will be inserted through the back into the kidney below the twelfth rib. Contrast material will be injected through this needle to visualize the urinary tract so that the Nephrostomy tube or catheter will be placed. This catheter will remain in place to drain urine in a drainage bag. The catheter will be secured by a tape and a dressing will be applied to the catheter entry site.

ORCHIECTOMY

Orchiectomy, also known as Orchidectomy or Castration is a surgical procedure to remove one or both testicles in men. Testicles are sex organs in the males that produce sperms and testosterone (a hormone). Orchiectomy will make you sterile (infertile) and may reduce your sex drive due to loss of testosterone. Orchiectomy can be:

Unilateral Orchiectomy - Only one testicle is removed, either the right or the left. Bilateral Orchiectomy or Radical Orchiectomy - Both the testicles are removed Inguinal Orchiectomy - The operation is performed through an incision in the groin Scrotal Orchiectomy - The operation is performed by making an incision through the scrotum.

Orchiectomy is performed under general anesthesia, prior hospitalization may or may not be necessary. The lower abdomen and scrotum will be shaved and thoroughly cleaned before the operation. Either general anesthesia or local anesthesia with spinal block will be given to ensure that you do not experience any pain during the Orchiectomy procedure. Testicles will be removed through an incision in the scrotum or the groin. At the end of the Orchiectomy operation, the incision will be sutured. The surgery generally takes between 30 minutes and 1 hour. Your surgeon might suggest to insert a prosthesis (scrotal implant) or artificial replacement for the testes in your scrotum to give your scrotum a normal look. Some of the lymph nodes that are located deep in the abdomen or inguinal area may also be removed. In this surgical procedure, the patient is placed in supine position.

PERCUTANEOUS NEPHROLITHOTOMY Percutaneous Nephrolithotomy is a minimally invasive procedure which is performed to remove stone from the kidney by inserting a tube through the skin into the kidney (using a Minimally Invasive or 'key hole' approach).

Percutaneous Nephrolithotomy is performed to remove stones from the kidney and upper part of the ureter. Only those stones that cannot be treated by Lithotripsy or Cystoscopy / Ureteroscopy due to it's shape (stag-horn shape stone(s) in the renal calyces), very large size, number (multiple stones) or location (deeply impacted in the kidney tissue or upper part of urinary bladder) are treated and removed using Percutaneous Nephrolithotomy.

Percutaneous Nephrolithotomy is performed under general anesthesia and may take about 3 - 4 hours. An incision in the skin, about 1/2 inch in length is made in the flank area, overlying the kidney. A thin tube (nephrostomy tube) is passed through the incision under x-ray guidance to visualize the stone. A Lithotripter is used to break the stone and the stone fragments are then removed through the tube. The nephrostomy tube is left in the kidney to allow easy drainage of urine, blood and residual fragments of stone. A stent may be placed to ensure patency of the ureter and facilitate drainage from the kidney to the urinary bladder. A catheter will be placed to drain urine from your urinary bladder.

Percutaneous nephrolithotomy is usually performed with the patient in prone position through a posterior calyx.

RADICAL NEPHRECTOMY

Radical Nephrectomy is a surgical procedure in which the entire kidney with it's collecting system is removed along with the adrenal gland and lymph glands of the same side. Radical Nephrectomy is performed under general anesthesia. Radical Nephrectomy can be performed either by Open Abdominal approach or Laparoscopic approach. Abdominal approach can be anterior subcostal (incision runs on the front of the abdomen across the rib cage), thoracoabdominal, or flank (on the side) approach. The kidney is dissected free of it's

attachments. The renal artery and vein are dissected and cut, ureter is cut and the adrenal gland is freed and removed along with the kidney. A drain will be left in and the wound will be closed. Laparoscopic Radical Nephrectomy is a minimally invasive procedure in which the kidney is removed by making four small incisions (each about 3 inches wide). Surgical instruments are used to free the kidney from it's surrounding structures and the kidney is removed through an incision in the front of the abdominal wall below the navel. The renal artery, renal vein and the ureter are then tied off and the incision is sutured. Radical Nephrectomy when using abdominal approach can take up to three hours. Laparoscopic Radical Nephrectomy can take a little longer. It may be done by any of five basic surgical approaches including extraperitoneal flank, dorsal lumbotomy, abdominal, thoracoabdominal, and laparoscopy. The extraperitoneal flank approach involves placing the individual on his or her side with the middle of the table elevated. This position is particularly useful for the obese individual but cannot be used for individuals with scoliosis or cardiorespiratory problems. The dorsal lumbotomy approach is done with the individual lying face down (prone) with the incision done on the back. The abdominal approach is done with the individual on his or her back (supine position). The thoracoabdominal approach involves a long incision on the chest and abdomen with the individual on his side.

RADICAL PROSTATECTOMY

This is a surgical procedure in which the entire prostate gland and seminal vesicles are removed. The lymph nodes from the surrounding area may either be removed or only biopsy material may be obtained. A patient with prostate cancer that is localized and has not advanced (metastasized) and are strong enough to undergo a major surgery is an ideal candidate for Radical Prostatectomy.
Open Radical Prostatectomy - An incision is made in the abdomen (either retropubic or perineal approach). The entire prostate gland and seminal vesicles are removed, the urethra is sewn back to the urinary bladder and a catheter is inserted which stays in for about 3 weeks. The entire procedure takes about 3 hours and is performed under general anesthesia. The surgeons world wide have mastered what is called the 'nerve saving technique' of prostatectomy. In this technique the prostate gland and the surrounding tissues are carefully dissected out to avoid damaging the nerve bundles responsible for erection. The only downside to this technique

is that in doing so, the surgeon may unknowingly leave behind some cells and the cancer may recur. This method is of choice only if the prostate cancer is localized in it's early stages. Laparoscopic Radical Prostatectomy - The entire procedure takes about 3 - 4 hours and is performed either under general anesthesia or spinal block with sedation. In Laparoscopic Radical Prostatectomy, 3 - 4 small incisions are made to ensure a 3 dimensional view of the inside of the abdomen and completely remove the prostate gland. As mentioned earlier, this surgery is quite difficult and is certainly a challenge for your surgical team. Radical perineal prostatectomy is performed with the patient in the high lithotomy position. TOTAL CYSTECTOMY Cystectomy is surgical removal of all or part of the urinary bladder. Total Cystectomy, also known as Radical Cystectomy is surgical is the removal of the entire bladder, nearby lymph nodes (lymphadenectomy), part of the urethra, and nearby organs that may have been invaded by the cancer cells. In men, the nearby organs that are removed are the prostate, the seminal vesicles, and part of the vas deferens. In women, the cervix, the uterus, the ovaries, the fallopian tubes, and part of the vagina are also removed. The ureters are disconnected from the bladder and urinary diversion is created. A patient that has a bladder cancer that has invaded the muscle layer and is locally invasive or if the cancer has come back after the initial treatment is an ideal candidate for Total Cystectomy. Total Cystectomy is performed under general anesthesia and may take about 2 - 3 hours. An incision is made across the lower abdomen, the ureters are cut from the bladder, freeing it for removal. The bladder and associated organs i.e. prostate gland, seminal vesicles, vas deferens in men and the uterus, fallopian tubes, ovaries, and part of the vagina in women. A method of urinary diversion is created to remove the urine (as discussed above) after Total Cystectomy. The tissues and nerves around the prostate and bladder are dissected very carefully to ensure not to damage them (nerve sparing technique) during Total Cystectomy procedure. However, the nerves controlling erection of penis may be damaged during the surgery. In women, your surgeon will reconstruct the vagina after Total Cystectomy. A modified lithotomy position is used with either Allen or LloydDavies stirrups. Careful padding to prevent pressure points, which may cause a perineal nerve compression or anterior compartment syndrome, is important. The vagina and perineum must be well prepped.

URETHROPLASTY Urethroplasty is a open surgical procedure for urethral reconstruction to treat urethral stricture. Urethroplasty can be performed by 2 methods; primary repair which involves complete excision of the narrowed part of the urethra. The proximal and distal patent parts are then

rejoined. The second method of Urethroplasty utilizes tissue transfer or free graft technique. In this method, tissue is grafted from bladder epithelium, or buccal mucosa and is used to enlarge the strictured (narrowed) segment of the urethra. Urethroplasty is performed under general anesthesia. Two Urethroplasty techniques are popularly used:
Anastomotic Technique - In this method of Urethroplasty, the narrowed part of the urethra is cut and the proximal and distal parts of the urethra are re-joined, a foley's catheter will be left in for the next 2 weeks to ensure complete healing and repair. This method of Urethroplasty is used for small urethral strictures i.e. less than 2 cm wide. Tissue Transfer - In this method of Urethroplasty, Skin and Tissue is Grafted from a non-hair bearing part of the body like the buccal mucosa or bladder mucosa. Free grafts like Full Thickness Skin Grafts or Split Thickness Skin Grafts can be used for this purpose. Tissue Transfer Urethroplasty can be also be carried out in 2 stages if sufficient local tissue is not available for a Skin Flap Procedure and local tissue factors are not suitable for a free graft.

Position for Urethroplasty is exaggerated lithotomy.

Report In N.C.M. 103

Submitted By: Rizzi Jones Devera Rosalie Delfin Joash Roy Doromal Elma Dayanan Rosalyn Del Rio April Melody Diamante