OPERATIVE CASE LOG
PLEASE NOTE: The case log is now required to be in this format. Please do not upload
another format or file type to your application.
Name__________________________________________________________________
Total number of cases (Adult & Pediatric)______________________________________
Time Period (from) _______/_______ (to)_______/_______
Number of Pediatric Cases__________________________________________________
SUMMARY OF PEDIATRIC CASES
Cystoscopy (includes retrogrades, urethral dilation, etc)______
Ureteroscopy
__________________
Endoscopic calculus extraction
__________________
ESWL
__________________
Transurethral incision of ureterocele
__________________
Transurethral ablation of posterior urethral valves___________
Circumcision, minor penile procedures __________________
Meatotomy, meatoplasty
__________________
Orchiopexy
__________________
Hydrocele/hernia repair
__________________
Minor scrotal procedures
(torsion, scrotal orchiopexy, orchiectomy)
___________
Varicocelectomy
__________________
Pyeloplasty
__________________
Nephrectomy
__________________
Partial nephrectomy
__________________
Pyelolithotomy/Nephrolithotomy
__________________
Renal biopsy
__________________
Renal transplant
__________________
Ureteral reimplantation
__________________
Ureteroureterostomy, ureteropyelostomy, TUU _____________
Ureteral tapering
__________________
Cutaneous ureterostomy, cutaneous pyelostomy
_______
Closure of bladder exstrophy
__________________
Partial/Simple cystectomy
__________________
Radical cystectomy
__________________
Augmentation cystoplasty
__________________
Cutaneous vesicostomy (bowel or ureter) __________________
Open cystostomy, cystolithotomy, repair bladder trauma _______
Bladder neck reconstruction (Young Dees, Kropp, etc) _________
Bladder neck suspension (MMK, Raz, sling)
_______________
Conduit (ileal, colon)
__________________
Continent urinary diversion
__________________
Correction of chordee without hypospadias
______________
Correction of hidden penis, webbed penis, penile torsion______
Distal hypospadias repair (MAGPI)
__________________
Proximal hypospadias repair
(subcoronal, midpenile, penoscrotal)
Staged hypospadias repair
__________________
__________________
Free graft (buccal/bladder mucosal) hypospadias repair______
Repair of urethrocutaneous fistula
__________________
Repair of urethral stricture
__________________
Epispadias repair
__________________
Laparoscopy, diagnostic
__________________
Laparoscopy, therapeutic (list)
__________________