Top Tips in Urology E-Book

John McLoughlin

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 200

Veröffentlichungsjahr: 2012

Beschreibung

The second edition of Top Tips in Urology provides highly clinical tips and rapid-reference "tricks of the trade" to the most common questions and problems that arise for both the practicing urologist and the urologic surgeon. Covering each of the major areas of urology and with contributions for experience practicing urologists and surgeons, this book is a unique book containing valuable information for all urologists dealing with patients on a day to day basis.

Leseprobe

Contents

List of contributors

Foreword

Preface

List of abbreviations

PART 1 Open Urology

1 A technique to minimise the risk of ureteric injury in patients with an enlarged median lobe undergoing radical prostatectomy

2 Novel methods to aid vesicourethral anastomosis in radical retropubic prostatectomy

3 Surgical technique to reduce intraoperative bleeding during open prostatectomy

4 Millin’s prostatectomy

5 Cystectomy

6 Salvage cystectomy and prostatectomy

7 Creating an ileal conduit spout

8 Prefashioning a urostomy

9 A novel technique for parastomal hernia repair

10 Parastomal hernia repair

11 Nephrectomy: vascular control during caval thrombectomy

12 Secure ligation of foreshortened large veins

13 How to avoid dislodging the vascular clamp

14 Ligating the renal artery

15 Renal hypothermia using an innovative ice sludge technique

16 Making the best of a short suture length in a deep dark hole

17 Anterior approach for a pyeloplasty

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

19 Radical orchidectomy for germ cell tumours

20 Don’t lose the lumen at urethroplasty

21 Emergency call to the gynae/obstetric theatre

22 Is it urine in the drain?

23 Cutaneous fistula

24 Postoperative abdominal drain

PART 2 Laparoscopic and Robotic Urology

25 Modified Hassan technique in super-obese patients

26 A modification to the Hassan technique for securing pneumoperitoneum

27 Finger access is the safest

28 Keep it simple

Patient position for renal laparoscopy

Port position for renal laparoscopy

The correct plane

29 The Ten Commandments

30 Controlling a small hole in the inferior vena cava

31 Remember Endoloops?

32 Tips in laparoscopic urology

Preparation

Conversion

Bleeding

Instruments

Pyeloplasty

33 Laparoscopic suturing using the Storz dolphin-nosed forceps

34 Laparoscopic suturing

35 Improving your laparoscopic suturing

36 Cholangiogram catheters can help antegrade wire placement at the time of pyeloplasty

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

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

39 Laparoscopic nephrectomy: port sites for left nephrectomy

40 Laparoscopic nephrectomy

41 Employing an extra port for laparoscopic nephrectomy

42 Improved control of the renal vein during laparoscopic nephrectomy

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

44 Robotic-assisted laparoscopic pyeloplasty

45 Laparoscopic prostatectomy

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

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

48 Robotic radical prostatectomy

49 A technique to relocate the robotic prostatectomy retrieval bag to the midline camera port

50 The rectal injury test

51 Identifying potential breaches in the rectum during minimally invasive surgery

52 The wrong plane

53 Spreading tough tissue with robotic forceps

54 Robotic-assisted radical prostatectomy

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

56 Use of Ethicon Vicryl foil and robotic camera lights to warm the robotic scope lens to prevent lens fogging

57 Management of anastomotic leak following radical prostatectomy

58 Identification of ureters during minimally invasive radical cystectomy

59 Maintaining pneumoperitoneum during minimally invasive female cystectomy

60 Robotic-assisted radical cystectomy

PART 3 Upper Tract Endourology

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

62 Prevention of migration of the Amplatz sheath during percutaneous nephrolithotomy

63 Using safety wires during percutaneous nephrolithotomy

64 Tips to make percutaneous nephrolithotomy easier

Securing the percutaneous nephrolithotomy tract

8F self-retaining nephrostomy tube for post-PCNL drainage

Technique to remove the Amplatz sheath after placement of nephrostomy tube

Securing the Amplatz sheath in morbidly obese patients undergoing PCNL

Balloon tamponade of nephrostomy tract

Percutaneous cystolithotomy (PCCL), an underutilised technique for large bladder stones

65 Using multiple guidewires during percutaneous nephrolithotomy

66 Encrusted nephrostomy tubes

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

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

69 Flexible renoscopy and stone fragmentation

70 A novel technique to treat large mid or upper ureteric stones

71 Rigid ureteroscopy

72 The Boston shouldered stent

73 Ureteroscopy

74 The pinhole scope: part 1

75 Use of the dual-lumen catheter

76 Flexible ureteroscopy

77 Lasering stones

78 Renal pelvic stones

79 Difficult urethral stricture encountered at ureteroscopy

80 General tips for a simpler and safer ureteroscopy

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

82 Optimising the view for difficult stent insertion

83 A novel technique for stent exchange over an ileal-ureteric anastomosis

84 Stents

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

86 Paired JJ stents for retroperitoneal fibrosis

87 Four tips relating to ureteric stenting

88 Insertion of JJ stent

89 Basketing of stones

90 Backloading guidewires

91 Insertion of a guidewire into the ureter

92 A solution for stent-related bladder symptoms

PART 4 Lower Urinary Tract

93 Holmium laser enucleation of the prostate: laser technique

94 Holmium laser enucleation of the prostate: safe morcellation

95 Holmium cystolitholapaxy

96 Transurethral resection of prostate 1

97 Transurethral resection of prostate 2

98 Transurethral vaporisation of the prostate

99 Use of catheter introducer

Tips

100 An alternative way to pass a urethral catheter post transurethral resection of prostate

101 The 17F integral cystoscope

Advantages

Disadvantages

102 Non-irrigating resectoscope

103 Urethral strictures

104 Assessment of paediatric urethral strictures

105 The pinhole scope: part 2

106 How to remove air bubbles in the dome of the bladder

107 Resecting multiple bladder tumours

108 Primary transurethral resection of bladder tumour

109 Trawling for flat superficial bladder tumour

110 Resecting bladder tumours

111 Never use an Ellick in a clot retention

112 Displaced suprapubic catheter

PART 5 Andrology

113 Glans ‘droop’ following the insertion of a penile prosthesis

114 The key to a successful epididymectomy:the bungee manoeuvre

115 Haemostasis for Nesbit’s procedure

116 Nesbit’s procedure

117 Tension-free vasectomy reversal

118 Intracorporeal perforation during penile implantation

PART 6 Female Urology

119 Recurrent cystocoele and rectocoele repair using modified mesh: new technique

120 Eroded transvaginal tape

121 Midurethral tension-free tapes

122 Treatment of TVT mesh eroding the bladder

PART 7 General

123 Circumcision

124 Dressing a circumcision

125 Postcircumcision dressing: the gauze sporran

126 Difficult reduction of paraphimosis

127 Round-bodied needles

128 Bladder clots

Sucking small clots via a flexible cystoscope

Larger clots in the bladder

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

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

131 Inserting a catheter over a guidewire

132 Cryoanalgesia for prostate biopsy

133 Pain relief in epididymo-orchitis

134 Hydrocoele

135 Epididymal cyst

136 Shape of the male urethra

137 Local anaesthetic injection through skin

138 Transrectal ultrasound

Correct positioning

Digital rectal examination

The needle

Local anaesthetic

Getting the best cores

Bleeding

139 Modified transrectal biopsy of prostate

140 Transperineal biopsy probe set-up

141 Changing a difficult or encrusted suprapubic catheter

142 How to predict the difficult catheter? Use the force!

143 Urodynamics

PART 8 Clinical Management

144 Neurourology

145 Managing urinary tract damage due to ketamine abuse

146 Top tips for foreskin assessment

147 Lower urinary tract symptom progression

148 Management of chronic prostatitis/chronic pelvic pain syndrome: top 10 tips

1. Chronic prostate infection (category II chronic bacterial prostatitis) can be ruled out by performing a pre and post massage test

2. There is no clinical rationale to perform microscopic evaluation of prostate-specific specimens in clinical practice

3. The NIH Chronic Prostatitis Symptom Index (NIH-CPSI) saves time and frustration in clinical practice

4. Learn the phenotypic approach to CPPS classification employing UPOINT

5. Develop individual treatment plans for each patient by focusing therapies on specific UPOINT domains

6. Consider a combination of the 5 as for initial therapy for category III CPPS: Avoidance, Antibiotics, Alpha-blockers, Anti-inflammatories, 5-Alpha reductase inhibitors

7. Multimodal therapy works better than monotherapy

8. Don’t disregard the phytotherapies

9. Get your non-urological colleagues involved

10. Set realistic expectations

149 Uro-gynae tips

150 Psychological problems and surgery

151 Use of analogies to assist with explanation of urological problems

Chronic pain syndromes

Surgical intervention for symptomatic conditions

Pelviureteric junction obstruction

Hormone therapy for prostate cancer

Quotes submitted on the back of other tips

Index

This edition first published 2013, © 2013 by John Wiley & Sons, Ltd

Wiley-Blackwell is an imprint of John Wiley & Sons, formed by the merger of Wiley’s global Scientific, Technical and Medical business with Blackwell Publishing.

Registered OfficeJohn Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK

Editorial Offices9600 Garsington Road, Oxford, OX4 2DQ, UKThe Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK111 River Street, Hoboken, NJ 07030-5774, USA

For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell.

The right of the author to be identified as the author of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher.

Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought.

The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by physicians for any particular patient. The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. Readers should consult with a specialist where appropriate. The fact that an organisation or website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organisation or website may provide or recommendations it may make. Further, readers should be aware that internet websites listed in this work may have changed or disappeared between when this work was written and when it is read. No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom.

Library of Congress Cataloging-in-Publication Data

Top tips in urology / edited by John McLoughlin ... [et al.]. – 2nd ed.p. ; cm.Includes bibliographical references and index.

ISBN 978-0-470-67293-8 (pbk. : alk. paper)I. McLoughlin, J.[DNLM: 1. Urogenital System–surgery–Handbooks. 2. Surgical Procedures, Operative–methods–Handbooks. WJ 39]616.6–dc23

2012032719

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Cover design by Opta

List of contributors

Tev Aho, Consultant Urological Surgeon, Addenbrooke’s Hospital, Cambridge, UKBen Ayres, SpR Urology, Croydon University Hospital, Croydon, UKRuzi Begum, SpR Urology, Heatherwood and Wexham Park Hospital, Slough, UKRichard Bell, Consultant Urological Surgeon, Northampton General Hospital, Northampton, UKJeetesh Bhardwa, SpR Urology, Heatherwood and Wexham Park Hospital, Slough, UKAnthony Blacker, Consultant Urological Surgeon, University Hospital, Coventry, UKSimon Bott, Consultant Urological Surgeon, Frimley Park Hospital, Frimley, UKDavid Bouchier-Hayes, Consultant Urological Surgeon and Robotic Surgeon, Galway Clinic, Co. Galway, IrelandMatthew Bultitude, Consultant Urological Surgeon, Guy’s and St Thomas’ Hospitals, London, UKNeil Burgess, Consultant Urological Surgeon Norfolk and Norwich University Hospital Norwich, Norfolk, UKJohn G. Calleary, Consultant Urological Surgeon, North Manchester General Hospital, Manchester, UKJon Cartledge, Consultant Urological Surgeon, St James’s University Hospital, Leeds, UKDavid Chadwick, Consultant Urological Surgeon, James Cook University Hospital, Middlesbrough, UKBen Challacombe, Consultant Urological Surgeon and Honorary Senior Lecturer, Guy’s Hospital and King’s College London, London, UKAasem Chaudry, Consultant Urological Surgeon, Bedford Hospital, Bedford, UKJustin Collins, Consultant Urological Surgeon, St Peters Hospital, Chertsey, UKGlyn Constantine, Consultant Gynaecologist, Good Hope Hospital, Sutton Coldfield, UKPeter W. Cooke, Consultant Urological Surgeon, Royal Wolverhampton Hospitals, Wolverhampton, UKDavid Cranston, Consultant Urological Surgeon and Senior Lecturer in Surgery, Churchill Hospital, Oxford, UKGary Das, Consultant Urological Surgeon, Croydon University Hospital, Croydon, UKProkar Dasgupta, Professor of Robotic Surgery and Urological Innovation, Kings College London, King’s Health Partners, London, UKAndrew Doble, Consultant Urological Surgeon, Addenbrooke’s Hospital, Cambridge, UKChris Eden, Consultant Urological Surgeon, The Prostate Clinic, The Hampshire Clinic, Basingstoke, UKDerek Fawcett, Consultant Urological Surgeon, Harold Hopkins Department of Urology, Royal Berkshire NHS Foundation Trust, Reading, UKSimon Fulford, Consultant Urological Surgeon, James Cook University Hospital, Middlesbrough, UKStephen Gordon, Consultant Urological Surgeon, Epsom and St Helier University Hospitals NHS Trust, Surrey, UKRob Gray, SpR Urology, Heatherwood and Wexham Park Hospital, Slough, UKJames Hall, Consultant Urological Surgeon, Royal Hallamshire Hospital, Sheffield, UKPaul Halliday, Consultant Urological Surgeon, Ninewells Hospital, Dundee, UKRizwan Hamid, Consultant Urological Surgeon, Royal National Orthopaedic Hospital, Stanmore and University College London Hospitals, London, UKDamian Hanbury, Consultant Urological Surgeon, Lister Hospital, Stevenage, UKNeil Harris, Consultant Urological Surgeon, St James’ University Hospital, Leeds, UKMatt Hayes, Consultant Urological Surgeon, Southampton General Hospital, Southhampton, UKDavid Hendry, Consultant Urological Surgeon, Gartnavel General Hospital, Glasgow, UKDominic Hodgson, Consultant Urological Surgeon, Queen Alexandra Hospital, Portsmouth, UKAdam Jones, Consultant Urological Surgeon, Harold Hopkins Department of Urology, Royal Berkshire NHS Foundation Trust, Reading, UKRob Jones, Consultant Urological Surgeon, Musgrove Park Hospital, Taunton, UKOmer Karim, Consultant Urological Surgeon, Heatherwood and Wexham Park Hospital, Slough, UKPatrick F. Keane, Consultant Urological Surgeon, Belfast City Hospital, Belfast, UKJohn Kelleher, Consultant Urological Surgeon, Wycombe Hospital, High Wycombe, UKJohn D. Kelly, Professor of Urology Honorary Consultant Urological Surgeon University College Hospital, London, UKMuhammad Jamal Khan, SpR Urology, Heatherwood and Wexham Park Hospital, Slough, UKAlex Kirkham, Consultant Uroradiologist, University College London Hospitals, London, UKPardeep Kumar, Specialist Registrar Urology and Fellow in Uro-Oncology, Royal Marsden Hospital, London, UKSunil Kumar, Consultant Urological Surgeon, Harold Hopkins Department of Urology, Royal Berkshire NHS Foundation Trust, Reading and Heatherwood and Wexham Park Hospital, Slough, UKMarc Laniado, Consultant Urological Surgeon, Heatherwood and Wexham Park Hospital, Slough, UKLing Lee, Consultant Urological Surgeon, Royal Bolton Hospital, Bolton, UKRu MacDonagh, Consultant Urological Surgeon, Musgrove Park Hospital, Taunton, UKPeter Malone, Consultant Urological Surgeon, Harold Hopkins Department of Urology, Royal Berkshire NHS Foundation Trust, Reading, UKPaul McInerney, Consultant Urological Surgeon, Derriford Hospital, Plymouth, UKJohn McLoughlin, Consultant Urological Surgeon, West Suffolk Hospital, Bury St Edmunds, UKAlan McNeill, Consultant Urological Surgeon, Western General Hospital, Edinburgh, UKSuks Minhas, Consultant Uro-Andrologist, University College London Hospitals, London, UKHanif Motiwala, Consultant Urological Surgeon, Heatherwood and Wexham Park Hospital, Slough, UKKMozolowski, CT1 Urology Trainee, NW Deanery, North Manchester General Hospital, Manchester, UKAsif Muneer, Consultant Urological Surgeon and Andrologist, University College London Hospitals, London, UKRichard Napier-Hemy, Consultant Urological Surgeon, Manchester Royal Infirmary, Manchester, UKSenthil Nathan, Consultant Urological Surgeon, Whittington Hospital, London and Institute of Urology, University College London Hospitals, London, UKJ. Curtis Nickel, Consultant Urological Surgeon, Queen’s University, Kingston, ON, CanadaDavid Nicol, Consultant Urological Surgeon, Royal Free Hospital, London, UKEdgar Paez, SpR Urology, Freeman Hospital, Newcastle upon Tyne, UKToby Page, Consultant Urological Surgeon, Freeman Hospital, Newcastle upon Tyne, UKBo Parys, Consultant Urological Surgeon, Rotherham District General Hospital, Rotherham, UKJhumur Pati, Consultant Urological Surgeon, Barts and the London Hospital, London, UKAmjad Mumtaz Peracha, Consultant Urological Surgeon, Royal Derby Hospitals, Derby, UKAsif Raza, Consultant Urological Surgeon, Ealing Hospital, Middlesex and Charing Cross Hospitals, London, UKTony Riddick, Consultant Urological Surgeon, Western General Hospital, Edinburgh, UKPeter Rimmington, Consultant Urological Surgeon, Eastbourne District General Hospital, Eastbourne, UKGerald Rix, Consultant Urological Surgeon, Colchester Hospital, Colchester, UKSimon Robinson, SpR Urology, Heatherwood and Wexham Park Hospital, Slough, UKHenry Sells, Consultant Urological Surgeon, Derriford Hospital, Plymouth, UKNimish Shah, Consultant Urological Surgeon, Addenbrooke’s Hospital, Cambridge, UKRajindra Singh, SpR Urology, Barts and the London Hospital, London, UKGraham Sole, Consultant Urological Surgeon, Hereford County Hospital, Hereford, UKMark J. Speakman, Consultant Urological Surgeon, Musgrove Park Hospital, Taunton, UKStephanie J. Symons, Consultant Urological Surgeon, Pinderfields Hospital, Mid Yorkshire NHS Trust, Wakefield, UKNikesh Thiruchelvam, Consultant Urological Surgeon, Addenbrooke’s Hospital, Cambridge, UKAndrew C. Thorpe, Consultant Urological Surgeon, Freeman Hospital, Newcastle upon Tyne, UKPhilip van Kerrebroeck, Professor of Urology, University of Maastricht, Maastricht, The NetherlandsNikhil Vasdev, Consultant Urological Surgeon, James Cook University Hospital, Middlesbrough, UKDan Wilby, SpR Urology, Southampton General Hospital, Southampton, UKGeorgina Wilson, Consultant Urological Surgeon, West Suffolk Hospital, Bury St Edmunds, UKOliver Wiseman, Consultant Urological Surgeon, Addenbrooke’s Hospital, Cambridge, UKDan Wood, Consultant Adolescent and Reconstructive Urological Surgeon, University College London Hospitals, London, UKSarah Wood, Consultant Urological Surgeon, Norfolk and Norwich University Hospital, Norwich, UKChristopher Woodhouse, Emeritus Professor of Adolescent Urology, University College London and Consultant Urologist, Royal Marsden Hospital, London, UKLehana Yeo, ST4 Urology, Barts and the London Hospital, London, UK

Foreword

‘You can’t teach an old dog new tricks’ and I am about as old a dog as you can get! Actually, I have learnt a few new tricks and, what is more, my cynical expectation that they would all, actually, be old tricks that have been rediscovered, has proved to be unfounded.

When John McLoughlin produced the first edition of this book I thought it was an interesting idea, and a second edition is entirely justified by the huge expansion in laparoscopic and robotic urology since that first edition. There are tips and tricks here that are no more than one sentence long and so this is an easy book to pick up and browse as well as to search for an answer to a particular point.

It is interesting to see the number of tips that include the comment ‘I learnt this tip from …’. I suspect that in the book as a whole we therefore have the collective memory of British Urology.

I thought this was not just an interesting book but an intellectually amusing one as well, and for that reason I heartily recommend it to urologists anywhere and everywhere.

Anthony R. MundyPhD(Hon) MS FRCP FRCSProfessor of UrologyInstitute of Urology, London, UK

Preface

This is not a textbook. It is intended to pass on useful tips, operative ­manoeuvres or pearls of wisdom from experienced urologists that may not otherwise find their way into standard urological texts. At its heart are those questions which trainees ask their senior colleagues, such as ‘What would you do when…?’ or ‘How do you like to do it?’. By their nature the replies are quirky, and often personal.

Wherever possible, the text has not been altered from the original, other than removal of references and diagrams professionally redrawn.

Sadly, we felt unable to accept the anonymous contribution that read ‘My top tip is to always place the wheel barrow in the direction of travel before filling it with soil’. At the end are included a few quotes that were sent in. They don’t really fit into any particular category but are worth reading.

John McLoughlinNeil BurgessHanif MotiwalaMark J. SpeakmanAndrew DobleJohn Kelly

List of abbreviations

AP

anteroposterior; abdomino-perineal resection

ASIS

anterior superior iliac spine

BMI

Body Mass Index

BNI

bladder neck incision

BXO

balanitis xerotica obliterans

CP

chronic prostatitis

CPPS

chronic pelvic pain syndrome

CT

computed tomography

DRE

digital rectal examination

DVC

dorsal vein complex

EAUE

uropean Association of Urology

FC

flexible cystoscope

GA

general anaesthetic

IPSSI

nternational Prostate Symptom Score

IVC

inferior vena cava

LUTS

lower urinary tract symptoms

MRI

magnetic resonance imaging

MSU

midstream urine

NIH-CPSI

NIH Chronic Prostatitis Symptom Index

OP

open prostatectomy

PCCL

percutaneous cystolithotomy

PCNL

percutaneous nephrolithotomy

PS

pubic symphysis

PSA

prostate-specific antigen

PUJ

pelvi-ureteric junction

RALP

robotic-assisted laparoscopic pyeloplasty

RARC

robotic-assisted radical cystectomy

RARP

robotic-assisted radical prostatectomy

RP

radical prostatectomy

SUI

stress urinary incontinence

TCC

transitional cell carcinoma

TURBT

transurethral resection of bladder tumour

TURP

transurethral resection of prostate

TWOC

trial without catheter

UO

ureteric orifices

US

urethral stump

VUJ

vesico-ureteric junction

PART 1

Open Urology

1

A technique to minimise the risk of ureteric injury in patients with an enlarged median lobe undergoing radical prostatectomy

Nikhil Vasdev and David Chadwick

With an increasing number of patients undergoing radical prostatic surgery (laparoscopic, robotic and open) for prostate cancer worldwide, there continues to be an increasing risk of ureteric injury. The risk is minimised with adequate identification of the ureteric orifices.

We present a ‘top tip’ of performing a cystoscopy and cannulating both ureteric orifices (UO) prior to performing prostatic surgery in patients with an enlarged median lobe in order to minimise the risk of inadvertent injury to the UO while opening the bladder during a radical prostatectomy (RP). The technique involves a cystoscopy and cannulation of both UO with ureteric catheters (Figure 1.1). The patient is then operated on using the planned technique of radical prostatectomy (laparoscopic, robotic and open) and the ureteric catheters are identified on opening of the bladder neck. Upon ­completion of this step the bladder neck and UOs are clearly identified at the time of excision of the prostate specimen and bladder reconstruction. We advocate this step to prevent inadvertent ureteric injury. Using this technique, the incidence of ureteric injury at our centre in patients undergoing open RP is 0.06% (1/1500). A demonstration of the median lobe is presented in Figure 1.2.

Figure 1.1 Open radical prostatectomy with large median lobe and laterally situated ureteric orifices.

Figure 1.2 Radical prostatectomy specimen with enlarged median lobe.

2

Novel methods to aid vesicourethral anastomosis in radical retropubic prostatectomy

Lehana Yeo, Rajindra Singh and Jhumur Pati

Vesicourethral anastomosis is a technically challenging aspect of retropubic radical prostatectomy. Here are two novel and inexpensive methods that may be used to facilitate anastomosis of the urethral stump to the bladder neck where direct visualisation of the stump is difficult (e.g. prominent bony spur or retracted urethral stump).