Genitourinary Notes
PROCESS OF EXCRETION INVOLVES FINDING AND REMOVING WASTE
MATERIALS PRODUCED BY THE BODY.
PRIMARY ORGANS: SKIN, LUNGS AND KIDNEYS.
LUNGS – WASTE GASES CARRIED BY BLOOD TRAVELING THROUGH VEINS
TO THE LUNGS WHERE RESPIRATION TAKES PLACE.
SKIN – DEAD CELLS AND SWEAT ARE REMOVED FROM THE BODY
THROUGH THE SKIN.
KIDNEYS – LIQUID WASTE IS REMOVED FROM THE BODY THROUGH THE
KIDNEYS.
BLOOD PASSES THROUGH THE KIDNEYS IN ORDER TO DEPOSIT USED AND
UNWANTED WATER, MINERALS AND A NITROGEN-RICH MOLECULE
CALLED UREA.
KIDNEYS FILTER METABOLIC WASTE FROM BLOOD FORMING A
LIQUID CALLED URINE. URINE IS FORMED FOR THE ACTIVITIES OF
THE KIDNEYS. THE KIDNEYS ARE ORGANS THAT REGULATE THE
COMPOSITION AND VOLUME OF BLOOD BY BALANCING FLUID AND
ELECTROLYTES. THEY BALANCE ACID BASE. KIDNEYS INFLUENCE
BLOOD PRESSURE BY SECRETING THE ENZYME RENIN.
KIDNEYS FUNNEL URINE INTO BLADDER ALONG TWO SEPARATE TUBES
CALLED URETERS.
BLADDER STORES URINE UNTIL MUSCULAR CONTRACTIONS FORCE URINE
OUT OF BODY THROUGH THE URETHRA.
DAILY 1.5 L OF URINE PRODUCED – URINATION REMOVES IT.
DISEASED KIDNEYS BUILD UP WASTE. CAN CAUSE DEATH.
DIALYSIS PT AVERAGE 60 HOURS/WEEK FOR FILTRATION.
ANATOMY – 2 KIDNEYS, 2 URETERS, 1 BLADDER, 1 URETHRA
1. KIDNEYS
STRUCTURE:
a. CORTEX – OUTER LAYER
i. NEPHRONS – FILTER AND REMOVE TOXIC WASTE FROM
BLOOD, BALANCE BLOOD pH, REABSORB AND SECRETE
TO CONTROL BLOOD VOLUME AND CONCENTRATION
BY REMOVING SELECTED AMOUNTS OF WATER AND
SOLUTES. 1.25 MILLION NEPHRONS/KIDNEY
b. MEDULLA – MIDDLE LAYER
i. RENAL COLUMNS & PYRAMIDS
c. CALYX – CUP LIKE STRUCTURE AT PT OF PYRAMID, FORM
INTERIOR CAVITY (RESERVOIR) LEADS TO URETER OPENING.
THE RENAL PELVIS IS THE PART OF THE KIDNEY THAT IS THE
COLLECTING POINT FOR URINE FORMED IN THE KIDNEYS.
PERISTALSIS CARRIES URINE FROM THE RENAL PELVIS TO
THE URETER.
i. RENAL CORPUSCLE – GLOMERULUS AND BOWMAN’S
CAPSULE ASSIST IN URINE FORMATION
TISSUE LAYERS:
a. RENAL FASCIA – OUTER LAYER COVERS KIDNEYS AND
ANCHORS THEM TO PERITONEUM AND ABDOMINAL WALL
b. PERIRENAL ADIPOSE – MID LAYER THAT SURROUNDS AND
BUFFERS KIDNEYS
c. GEROTA’S CAPSULE – INNER LAYER THAT FORMS A
SMOOTH, FIBROUS SURFACE
SURROUNDING TISSUE AND STRUCTURES:
ADRENAL GLANDS – PAIR LIE IN FASCIA SUPERIOR TO KIDNEYS.
LEFT > CRESCENT SHAPE, RT > TRIANGLE
RENAL HILUM – NOTCH WHERE OTHER STRUCTURES ENTER OR
LEAVE KIDNEY
RENAL PELVIS – ENLARGED PORTION OF URETER THAT JOINS IT TO
KIDNEYS
HIGHLY VASCULAR ORGAN WITH UNUSUAL BLOOD FLOW PATTERN.
BLOOD SUPPLY CRUCIAL DURING SURGERY
BLOOD SUPPLY – RENAL ARTERY OFF AORTA
RENAL VEIN OFF INFERIOR VENA CAVA
RENAL ARTERY DIVIDES, SMALLER BRANCHES INTO NEPHRONS, EXIT
THRU SMALL VESSELS THAT BECOME RENAL VEINS AND FLOW INTO
INFERIOR VENA CAVA FOR RETURN TO HEART.
ADRENAL VENULES ALSO IMPORTANT.
NERVE SUPPLY – SPLANCHNIC NERVES – COME FROM THORACIC
SYMPATHETIC GANGLIA WHICH INNERVATE VISCERAL ORGANS.
2. URETERS – SLENDER, MUSCULAR TUBES LOCATED IN
RETROPERITONEAL CAVITY – EXTEND FROM KIDNEY TO BLADDER –
PASS URINE VIA GRAVITY AND PERISTALTIC ACTION
STRUCTURE – UPPER, MIDDLE – L5 TO SI JOINT, BOTH ABD AND
PELVIC AREAS INCLUDED, LOWER- CLOSEST TO BLADDER
THREE TISSUE LAYERS – FIBROUS, MUSCLE, MUCOUS OF
EPITHELIALS
BLOOD SUPPLY – ADRENAL/RENAL ARTERIES, HYPOGASTRIC
ARTERY, SPERMATIC/OVARIAN ARTERIES, UMBILICAL ARTERY
VENOUS DRAINAGE – ILIAC VESSELS, EPIGASTRIC VESSELS,
PREAORTIC NODES
NERVE SUPPLY – PART OF AUTONOMIC NERVOUS SYSTEM,
RESULTING IN PERISTALTIC ACTION
3. BLADDER – BAG RESERVOIR EXPANDS OR COLLAPSES BASED ON
URINE FLOW FROM KIDNEY
250 ML USUALLY BRINGS SENSATION TO VOID – voiding reflex
STRUCTURE – TRIGONE FLOOR – ATTACHED AT POSTERIOR
CORNERS OF TRIGONE FLOOR ON EITHER SIDE ARE OPENINGS FROM
EACH URETER AND A SINGLE LARGER HOLE AT BLADDER NECK
BLADDER NECK ATTACHED TO URETHRA AND TO SPECIALIZED
LIGAMENTS
TISSUE LAYERS – INCOMPLETE PERITONEUM LAYER COVERS ONLY
UPPER PORTION BLADDER
URETHRAL SPHINCTERS – TWO MUSCULAR STRUCTURES THAT
PREVENT URINE FROM LEAVING THE URINARY BLADDER. EACH
URETHRAL SPHINCTER IS A CIRCULAR MASS OF MUSCLE TISSUE.
RELAXATION OF THE SPHINCTERS ALLOWS URINE TO BE FORCED
THROUGH THEM.
INVOLUNTARY DETRUSOR MUSCLE MID LAYER FOR STRETCHING
MUCOSAL/SUBMUCOSAL LINING FOLDS INTO RUGAE WHEN
COLLAPSED
GENDER DIFFERENCES – MALE - BLADDER NECK CLOSE TO
PROSTATE – ANCHORED TO POSTERIOR PUBIS BY PUBOPROSTATIC
LIGAMENTS ON SIDES OF PENIS DORSAL VEIN
FEMALE – DIRECT CONTACT WITH LEVATOR ANI ANCHORED TO
POSTERIOR PUBIS BY TWO PUBOVESICAL LIGAMENTS ON EITHER
SIDE OF CLITORIS DORSAL VEINS
ARTERIES – SUPERIOR/INFERIOR VESICAL ARTERIES
NERVES – SACRAL AND PARASYMPATHETIC
4. URETHRA – SMALL, SHORT TUBE DRAINS BLADDER
LEADS FROM BLADDER FLOOR TO URINARY MEATUS
EXCRETIVE AND REPRODUCTIVE COMBINE IN MALE, NOT IN FEMALE.
STRUCTURE – UPPER – CLOSEST TO BLADDER
MIDDLE – BLADDER TO MEATUS
LOWER – CLOSEST TO MEATUS
FEMALE – BLADDER FRLOOR 3-4 CM TO OUTSIDE
MALE – 20 CM IN LENGTH – PASSES URINE
PROSTATE GLAND – LIES BELOW URINARY BLADDER AND
SURROUNDS MALE URETHRA
COWPER’S GLANDS – SECRETE MUCUS
TESTIS – CONTAINED IN SCROTUM
PENIS – SPONGY TISSUE EMPTY BLOOD SPACES
THREE CORPUS SEGMENTS – SPONGIOSUM CONTAINS URETHRA,
CAVERNOSUM – SURROUNDS EACH SIDE SPONGIOSUM, GLANS PENIS –
DISTAL TIP COVERED BY PREPUCE
5. URINARY MEATUS – External opening
PROSTATE CANCER IS THE 3RD LEADING CAUSE OF CANCER RELATED
DEATHS IN MALES
1. LUNG 2.COLORECTAL
METASTASIS – LYMPHATIC / VASCULAR CHANNELS
OBTURATOR LYMPH NODES REMOVED FOR FROZEN SECTION TO
ASSESS METS BEFORE PROCEEDING WITH RADICAL PROSTATE
MALE REPRODUCTIVE ORGANS –
BLOOD SUPPLY – DORSAL, HYPOGASTRIC, PUDENDAL, RECTAL,
SPERMATIC, VESICAL ARTERIES
NERVES – DORSAL NERVES – VESICAL,PERINEAL,PROSTATIC NERVES
CONDITION OR DISEASE GU SURGERY
CONGENITAL DISEASE –
HYPOSPADIAS – ANTERIOR URETHRA TERMINATES ON
UNDERSURFACE OF PENIS OR ABOVE FEMALE CLITORIS
PHIMOSIS – CONSTRICTION OF FORESKIN
WILMS TUMOR – CHILDHOOD MALIGNANT NEOPLASM OF KIDNEY
PRESENTS AS A FIRM, PAINLESS MASS WHOSE ENLARGEMENT MAY
LITERALLY DISTEND THE ABDOMEN
ACQUIRED DISEASE–
BALANTITIS – INFLAMMATION OF GLANS PENIS
CANCER – PRESENCE OF FLANK MASS
HYPERNEPHROMA – TUMOR WHOSE CELLS RESEMBLE ADRENAL
CORTEX
NEUROBLASTOMA – MALIGNANT TUMOR AFFECTING ADRENAL
GLANDS
CUSHINGS DISEASE – ADRENAL OR HYPOTHALAMUS DYSFUNCTION
OR METABOLIC DISORDER RESULTING IN WEIGHT GAIN, EDEMA,
HYPERPLASIA/GLYCEMIA
HYDROCELE – MALE – SEROUS FLUID TESTES/CORD
FEMALE – FLUID IN VAGINA/LABIUM
BPH – Benign Prostatic hypertrophy or ENLARGEMENT OF PROSTATE
RENAL CALCULI – BASED ON UREA THAT HAS AN ACID PH OR URINE IS
SUPERSATURATED FOR EXTENDED PERIODS SO THAT CALCIFIED
CHUNKS OR CRYSTALLIZED MINERALS FORM IN CHUNKS
40% PT GET 2ND STONE IN 2 YRS
80% PT GET 2ND STONE AT SOME TIME
RENAL FAILUE AND UREMIA – KIDNEYS FAIL TO PROCESS PLASMA
AND PRODUCE URINE
UREMIA -= FINAL STAGE OF RENAL FAILURE. WASTE PRODUCTS
ACCUMULATE IN BLOOD
TORTION TESTICLE – TWISTED ON SPERMATIC CORD. PAINFUL.
EMERGENT. TISSUE DEATH CAN OCCUR
UTI – CYSTITIS, NEPHRITIS, URETHRITIS
TRAUMA
ELECTIVE SURGERY –
CIRCUMCISION – Excision of foreskin of glans penis. A few adult medical
conditions such as Phimosis, penile malignancies or balantitis require this surgery.
VASECTOMY – Excision of a section of the vas deferens as a permanent method of
male sterilization or prior to a prostatectomy to prevent spread of infection from the
urethra to the epididymis.
Genitourinary Procedure Notes
PURPOSES OF GENITOURINARY SURGERY:
1. Investigate and restore function to principal organs of the urinary system.
2. Investigate and restore function to related organs of the urinary system such as
the adrenal glands and the prostate, testicle and penis.
3. Detect and inhibit urinary system disease, including the partial or total
removal of diseased urinary system tissues and supporting structures when
other measures have failed.
The urinary system is composed of two kidneys, two ureters, the urinary bladder,
urethra and urinary meatus. Its processes include regulation, filtration,
reabsorption and secretion. This functions to balance blood plasma by regulating
water content and maintaining water balance, produce urine as waste product
during regulation, adjust blood pH and blood contents, such as sodium and
potassium, excrete the resulting toxins, electrolytes and water after adjustments are
made, and regulate red blood cell production and blood pressure (Renin – natural
kidney hormone).
STRUCTURE SPECIFIC PATHOLOGY:
1. Anuria – lack or absence of urine
2. Dysuria – pain during urination
3. Hematuris – presence of blood in the urine
4. Hydronephrosis – distention of the pelvis and calyces of the kidney from
urinary retention
5. Nocturia – need to urinate at night, often disturbing sleep many times
6. Obstructive uropathy – weak urine stream, hesitancy starting urine stream
7. Oliguria – very little urination
8. Pyruia – the presence of pus in the urine
9. Urinary retention – inability to completely empty the bladder
COMMON LAB/DIAGNOSTIC TESTS:
1. Biopsy
2. BUN – Blood Urine Nitrogen – measures waste products of protein
metabolism to assess renal function
3. PSA – prostate specific antigen – measures the level of Prostatic antigens
4. UA – urinalysis – chemical screening of urine. Urine is 95% water. Color,
odor, specific gravity, appearance, pH, protein, ketones, occult blood,
leukocyte esterase, nitrite and glucose content are determined by urinalysis.
Microscopic exam of urine. High protein diet increases acidity of urine while
mostly vetetables increases the alkalinity of urine. High altitude, fasting and
exercise are other factors that affect urinary pH.
5. Urine culture – diagnoses UTI (urinary tract infection) a colony count is done
and along with symptoms may reveal cystitis.
6. CT scan – detects subtle differences in tissue density, differentiating between
benign and malignant renal cysts. It can also detect suprarenal masses,
hydronephrosis, and kidney tumors.
7. KUB – flat plate x-ray of Kidneys,Ureters,Bladder to determine size, shape
and kidney location. Renal calculi, tumors and abnormalities may also be
seen.
8. Intravenous pyelogram – IVP – study of structures of urinary system by
injecting contrast medium into the circulatory system. Contrast makes its way
to the kidneys for excretion. Multiple x-rays taken can reveal ureteral
obstructions, trauma or retroperitoneal tumors Post void film can check
bladder emptying. Poor excretion may result in the last film 24hrs post first.
9. Retrograde pyelogram – x-ray of renal pelvis and any calyces in the kidneys
and ureters as well as shape and position of kidneys and ureters following
injection of contrast medium via catheters placed in each ureter.
10. Renal angiography – x-ray of renal blood vessels to help diagnosis renal artery
stenosis, abnormality, mass or renovascular hypertension. Catheter inserted
into femoral artery and threaded up the aorta to the level of the renal arteries.
Dye is injected and rapid filming is done.
11. Renal Biopsy – A biopsy needle is inserted through the skin into the lower
lobe of the kidney. Harvested tissue is examined to diagnose renal disease or
to track progression of renal disease. Post procedure patient needs to lie still
for 4 – 12 hours and is monitored by nursing staff. Possible complications
include infection and hemorrhage.
12. Renal scans – A radioactive isotope is injected intravenously. Using a gamma
camera or probe, radioactivity in each kidney is measured as the tracer leaves
the kidney. This results in a curve. Various curves are associated with specific
conditions. Renal scans are often used to detect abscesses, cysts, tumors,
trauma or track rejection of a transplanted kidney.
13. Renal ultrasound – Helps differentiate a solid tumor from a renal cyst or
identify obstructions.
14. Urethrogram or cystogram – x-ray visualization of the urethra or bladder
following injection of a contrast medium.
15. Urodynamic studies – Performed when patient reports micturition difficulties
a. Uroflowmetry – records flow rate of urinary stream
b. Cystometry – graphic representation of the bladder’s response to
pressure and its capacity for fluid as the bladder is filled with saline,
sterile water or carbon dioxide.
c. Electromyography – records electrical activity in striated muscles to
evaluate neuromuscular coordination of bladder activity.
SPECIAL FEATURES OF GENITOURINARY SURGERY
1. Preoperative prerequisites – Most GU procedures are minimally invasive
procedures, but an invasive surgery setup may be required to avoid delay
should a more invasive procedure be necessary.
2. Positioning – Some GU procedures require exacting positioning requiring the
surgeon’s assistance. Lateral positioning is standard for kidney cases, but table
flexion can be critical and varies greatly from procedure to procedure.
Lithotomy is standard for closed cases.
3. Intraoperative issues – Generally, highly vascular areas require greater
preparation and thought.
BASIC SUPPLIES, EQUIPMENT AND INSTRUMENTATION FOR GU
SURGERY
1. Equipment – Cysto table with x-ray unit, ESU, Maxwell table (shortened
table)
2. Instrumentation – as listed on handouts
3. Instrument sets – hospital urology set, major laparoscopic set, cystoscopy,
ureteroscopy, TUR equipment, minor basic set
4. Cystectomy – major lap set and bowel resection set
5. Prostatectomy – basic lap plus prostatectomy instruments
6. Vasectomy and meatotomy – minor basic plus vas instruments
7. Stopcocks – valves to control flow of a substance
8. Urethral sounds – used for dilation (Van Buren – common)
9. Supplies – contrast medium, syringes and needles
Cystotomy or laparotomy pack
Ellick evacuator – for removing substances from surgical site
Urethral and ureteral catheters – non-retaining, self-retaining
Urostomy pouch – for diversion of urine to bag
Water soluble surgical jelly – non-conductive lubricant
CHARACTERISTICS AND SIZING OF CATHETERS
1.General Information
Made of latex or silicone
Most are radiopaque
Diameter of lumen – divide French size/3. An 18 French has a 6mm lumen.
Size depends on age and sex of patient – children – 8 or 10 urethral cath
Adults – 14 – 18 urethral catheter
2. Ureteral catheter characteristics
Smaller in diameter and longer than urethral caths
Range in size from 3 – 14 French
Many styles, sizes – plain whistle tip, olive tip, cone tip
Usually inserted into ureter by urologist through cystoscope
Place a ureteral stent, obtain renal pelvis specimen, splint ureter, inject dye
Must be labeled left or right, taped securely in place and connected to bag
4. Urethral catheter characteristics
Shorter and larger in diameter than ureteral caths
Range in size from 8 to 30 French
5. Suprapubic catheter characteristics
Contain a third lumen for irrigation
Used as closed drainage system when placed by suprapubic incision or trocar
puncture
RELEVANT GU POSITIONS AND INCISIONS
1. Closed surgeries – lithotomy position
2. Kidney – generally lateral position
a. Lumbar or simple flank incision – thorax forward and downward to iliac
b. Nagamatsu or dorsolumbar flap incision – made over 11th and 12th ribs
c. Thoracoabdominal incision – 10th, 11th ribs resected, chest opened
d. Supracostal extrapleural – along superior margin of 12th rib
e. Subcostal and transverse abdominal – medial line from 12th rib in a curve
along the lower costal margin
f. Vertical abdominal incision – midline or paramedium incision 2cm from
midline, extending upward to at or above xyphoid
g. Transperitoneal midline incision – semirecumbent position extending
below ribs to abdomen for effective rib retraction
3. Ureter – generally lateral for anterior or posterior approaches and lithotomy for
vaginal approach
a. Upper – flank or kidney incision – runs parallel to 12th rib
Foley muscle splitting incision – oblique cut below 12th rib
b. Middle – same as upper, but extended into RLQ of abdomen
c. Lower-Foley muscle splitting incision
Gibson – (hockeystick) modified flank incision from clost to ilium
and just below umbilicus to the spine to just above symphysis
pubis
Lumbodorsal – cuts through lumbodorsal fascia
Midline or paramedian (a finger width from midline) –
Longitudinal cut straight up from symphysis pubis to just under
umbilicus
Transverse – transverse suprapubic incision
Pericervical or vaginal – incision through vaginal wall for calculi
in the lowest portion of ureter (lithotomy position)
4. Bladder and urethra – usually supine position
a. Transverse suprapubic – two fingers above symphysis pubis
b. Vertical suprapubic – made in midline from just below umbilicus to
symphysis pubis
5. Male Reproductive system – usually supine or exaggerated lithotomy position
a. Inverted U incision – curved incision just above anal rim
b. Vertical or transverse suprapubic
COMMON ADRENAL, KIDNEY AND URETERAL PROCEDURES
1. OPEN
a. Adrenalectomy – removal of one or both adrenal glands
b. Curaneous ureterostomy – Permanent diversion of flow of urine from
kidney, via ureter, away from bladder and onto skin of abdomen
c. Foley-Y pyeloureteroplasty – combined connection of a redundant renal
pelvis with resection of a stenotic area of ureter
d. Kidney transplant – transplant of a living or cadaveric donor kidney into
recipient’s iliac fossa. Performed to restore renal function for life.
e. Nephrectomy – removal of kidney to treat congenital abnormalities,
tumors, diseases or injuries to kidney
Heminephrectomy – partial excision of kidney
Radical nephrectomy – excision kidney, perirenal fat, adrenal
gland, Gerota’s capsule and periaortic lymph nodes
f. Nephrolithotomy – removal or large intact stone or exploration of calyx
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Nephrostomy – incision into kidney for temporary or permanent drainage
Nephrotomy – incision into kidney
Nephroureterectomy – removal of kidney and entire ureter that drains it
Pyelolithotomy – removal of stone or stones through opening made in
renal pelvis
Pyeloplasty – reconstruction of renal pelvis
Pyelostomy – incision into renal pelvis for temporary or permanent
diversion of urine
Pyelotomy – incision into renal pelvis
Ureterectomy – complete removal or ureter
Ureteroileostomy (ileal conduit) – diversion of ureter into ileal segment
Ureterolithotomy – incision into ureter for surgical removal of stone or
calculi from kidney, renal pelvis or ureters
Ureteroneocystotomy- division of ureter from bladder and reimplantation
of ureter into bladder at another site to treat urinary reflux or performed
with partial cystectomy
Ureteroplasty – reconstruction of the ureter (ureteropelvic junction)
Ureterosigmoidostomy – diversion of ureter into a segment of the sigmoid
colon
Ureterostomy – opening the ureter for continued drainage from it into
another part
Ureteroureterostomy – division of ureter and reconstruction in continuity
with another ureteral segment
2. Closed
a. ESWL – Extracorporal shock wave lithotripsy – fragments stones
b. Nephroscopy – direct visualization of interior of kidney
c. Ureteroscopy – direct visualization of interior of ureter
3. COMMON BLADDER PROCEDURES
OPEN:
a. Cystotomy – incision into bladder
b. Cystolithotomy – incision into bladder to remove stones
c. Cystostomy – incision into bladder for continuous drainage
d. Cysstectomy – partial or complete removal of bladder
e. Bladder neck operation (Y-V plasty) – plastic repair of bladder neck to
overcome contracture of the bladder neck caused by primary or secondary
stricture
CLOSED:
a. Cystoscopy – direction visualization of interior of bladder and urinary
tract through the urethra
4. COMMON URETHRAL PROCEDURES
OPEN:
a. Urethral meatotomy – surgically enlarges meatus to provide adequate
drainage
b. Urethral dilation and internal urethrotomy – gradual dilation and removal
of urethral stricture to provide adequate urinary drainage
c. Urethroplasty – repair of urethral stricture that fails to respond to
intermittent dilation
CLOSED:
a. Litholapaxy – bladder calculi crushed and removed through urethra
b. Urethroscopy – direct visualization of interior of urethra
5. COMMON MALE PROCEDURES
OPEN:
a. Circumcision – removal of glans penis foreskin
b. Epi/Hypospadias repair – repair of chordee (defect in epispadius is on
dorsal surface – defect in Hypospadias is on ventral surface
c. Orchiectomy – castration or removal of testes
d. Orchipexy – surgical intervention to place undescended testes into scrotal
sac
e. Penile implant – costal cartilage or silastic is used to construct an artifical
penis. Performed for post penile amputation or impotency.
f. Prostatectomy – excision of prostate
Retropubic – abdominal incision in upper surface of prostate for direct
open procedure to enucleate Prostatic hypertrophied masses
Suprapubic – prostate gland enucleated in open surgery. Wide area of
exploration permits treatment of bladder problems as well
Radical – enucleation of prostate gland, including bilateral resection of
retroperitoneal lymphatic nodes and resection of spermatic vessels on the
affected side
Perineal – rarely performed. It involves enucleation of neoplasms of the
entire prostate gland through a curved incision just above anal margin.
This approach offers direct and accurate approach to prostate gland, but
there is higher risk of postoperative impotence and urinary incontinence.
Testicular torsion repair – twisting that occurs around spermatic cord
obstructs blood supply and can lead to necrosis if surgery is not
immediate. A small window of time, 4 -6 hours, exists within which the
testes can be saved. Orchiectomy will follow if circulation does not
improve.
Vasectomy – surgery on vas deferens for male sterilization or as
preoperative condition to TURP to avoid epididymitis.
CLOSED:
Transurethral resection – TURP – most common approach – piecemeal
resection of prostate gland by means of a resectoscope passed through the
urethra and used for moderately enlarged, benign, hypertrophied glands.