COMMON UROLOGICAL PROBLEMS

GUJSURGCON – 2005NADIAD

DR. SUSHIL KARIA MS, FRCS (ENGLAND),

FRCS (EDINBURGH),FRCS (GLASGOW)

COUNSULTANT UROLOGICAL SURGEONANISH INSTITUTE OF KIDNEY DISEASES

B.T.SAVANI KIDNEY HOSPITALH.J.DOSHI HOSPITAL & RESEARCH CENTRE

RAJKOT

MODERATOR

: SPECIAL INTEREST :URO-ONCOLOGY & RENAL TRANSPLANT SURGERY

DR. KANDARP PARIKH MS, M.Ch. (Urology)

D.N.B. (Urology)COUNSULTANT UROLOGICAL SURGEON

SHYAM UROLOGICAL HOSPITAL

STERLING HOSPITAL

JIVRAJ MEHTA HOSPITAL

M.P.SHAH CANCER HOSPITAL

AHEMEDABAD

MODERATOR

SPECIAL INTEREST : LAPAROSCOPIC UROLOGICAL SURGERY

PENELISTS :• DR. JANAK DESAI-AHEMEDABAD

SPECIAL INTEREST: URO-ONCOLOGY, PCNL

• DR. ULHAS SATHYE-JAMNAGAR

SPECIAL INTEREST: RECONSTRUCTIVE UROLOGY

• DR. DIPAK RAJYAGURU-MEHSANA

SPECIAL INTEREST: GENERAL UROLOGY & PCNL

• DR. KUMAR NAIK-SURAT

SPECIAL INTEREST: PAEDIATRIC UROLOGY

• DR. PRAJESH SRIVASTAV-NADIAD

SPECIAL INTEREST: ENDO-UROLOGY & LAPAROSCOPIC SURGERY

• DR. HEMANG BAXI – AHMEDABAD

SPECIAL INTEREST: GENERAL UROLOGY

FRIENDS UROLOGISTS R 1

OF THE STRONGEST

PLAYERS IN TEAM SURGERY

& UROLOGY IS 1 OF THE

OLDEST, WELL ESTABLISTED

& MOST ADVANCED SPECILITY

THAT IS WHY V

THE UROLOGISTS

R CHOSEN BY THE

ORGENISORS, ESPECIALLY

BY DR. PANKAJ CHAPEL AS

THE OPENING TEAM

MY SELF DR. SACHIN KARIA

& DR. KANDARP SAHEWAG

R THANKFUL 2 THE

ORGANISORS IN PUTTING

TRUST IN US AS

OPENING BATSMEN

V HAVE A VERY STRONG

BATING LINEUP OF

UROLOGIST 4 THIS

EXCELLENT SCIENTIFIC

BONANSA

HOPE THIS WILL BE

ENTERTAINING, EXITING

& USEFUL SESSION OF

1ST MATCH OF 90 MIN.

PROBLEMS

• 40% OF PRACTISE OF GENERAL SURGERY

• UROLOGISTS ARE MORE IN URBAN AREA

• MOBILE UROLOGIST NOW ACCESSIBLE TO MANY GENERAL SURGEONS

TODAY’S DISCUSSION

• COMMON UROLOGICAL PROBLEMS TACKLED BY GENERAL SURGEONS

• IDENTIFY THE SITUATIONS WHERE TRADITIONAL CONCEPTS HAVE CHANGED

• MODERN MODALITIES IN MANAGEMENT OF UROLOGICAL PROBLEMS.

Management ofUrinary Stone

Disease

BLADDER / URETHRAL STONE

RGU

TAKE HOME MESSAGE

- IDENTIFY ETIOLOGY OF BLADDER STONE

-CYSTOSCOPY SHOULD BE DONE IN ALL CASES

X-RAY

PROBLEMS

• DIFFICULTIES SHOULD BE ANTICIPATED.

TAKE HOME MESSAGE

TO PREVENT URS COMPLICATIONS :

• IVU MUST BE DONE IN ALL CASES• PROPER SELECTION OF CASE IS A MUST• YOU SHOULD BE FAMILIAR WITH AND

SHOULD HAVE ALL ENDOSCOPES AND ANCILLIARY INSTRUMENTS LIKE C-ARM

• DO NOT PULL TOO MUCH OR TOO HARD • INCASE OF DIFFICULT ACCESS – PLACE

DJ - STENT

CASE - 3

• A PATIENT WITH SOLITORY KIDNEY HAVING A 2 CMS SIZE PELVIC STONE

QUESTIONS

• WHAT ARE THE MANAGEMENT OPTIONS IN THIS PATIENT..?

• CAN WE PERFORM ESWL WITHOUT DJ STENTING..?

TAKE HOME MESSAGE

• ESWL IS NOT AN ANSWER TO EACH AND EVERY STONE. IT SHOULD BE JUDGED ACCORDING TO THE SIZE, LOCATION OF STONE AND RENAL FUNCTION.

• DJ STENT IS A MUST IN PATIENTS WITH SOLITARY UNIT , LARGE STONE BURDEN OR IMPACTED STONE.

CASE 4

QUESTIONS

• MANAGEMENT OPTIONS IN THIS PATIENT ?

• INCIDENCES OF RESIDUAL STONE ?

• HOW DO YOU MANAGE RESIDUAL CALCULI ?

• WOULD YOU LIKE TO GIVE PACKAGE DEAL FOR COMPLETE CLEARANCE ?

MESSAGE

• THE ULTIMATE AIM IS TO MAKE PATIENT STONE FREE. HOWEVER IT IS NOT ADVISABLE TO GIVE PACKAGE DEAL.

• OPEN SURGERY:

• ANATROPIC NEPHROLITHOTOMY.

• EXTENDED PYELO-LITHOTOMY OR PYELO-NEPHRO-LITHOTOMY SHOULD BE CONSIDERED.

Renal stones

CASE - 4

• A MALE PATIENT OF 35 YEARS. PRESENTED WITH RUPTURE URETHRA & RETENTION OF URINE WITH URETHRAL BLEEDING

QUESTIONS

• SHOULD WE ATTEMPT PRIMARY RAIL ROADING ?

• HOW TO PROCEED FOR THAT ?

TAKE HOME MESSAGE

• GENTLE RETROGRADE STUDY OF URETHRA

• SUPRAPUBIC DIVERSION & RECONSTRUCTIVE SURGERY AFTER 12 WEEKS IS THE BEST ALTERNATE

• REALIGNMENT CAN BE ATTEMPTED BY EXPERINCED UROLOGIST WITH A FLEXIBLE CYSTO-URETHRO SCOPE

Benign Prostatic Hyperplasia

CASE-5

• 60 YEARS OLD MAN WITH FREQUENCY OF MICTURIGION WHO WAS FOUND TO HAVE ENLARGEMENT OF PROSTATE 60 GMS ON ULTRASONOGRAPHY WITH NO RESIDUAL URINE

A prostate examination.. “Medical students learning how to perform a prostate examination”

QUESTIONS

• DOES HE NEED FURTHER INVESTIGATIONS AND SURGERY?

• WHEN TURP IS INDICATED ?

• WHICH ARE THE INDICATION OF OPEN SURGERY ?

• WHAT ARE THE INDICATION FOR MEDICAL MANAGEMENT ?

B.P.H.Medical management:

FinesteridePrazocinTerazocinDoxazocin

 Uro-selective:

AlfuzocinTamsulosin

: Surgery :Minimally invasive procedures: Balloon dilatation of the prostate

Prostate stentsTransurethral microwave thermotherapy

Transurethral needle ablation (TUNA) uses shielded needles, deployed from a special

catheter into the prostate, to emit radiowaves that locally heat the prostate and cause coagulative

necrosis.Laser prostatectomy

TAKE HOME MESSAGE

• TURP IS STILL A GOLD STANDARD.

• OPEN SURGERY-MILLIIN’S RETROPUBIC PROSTATECTOMY IN SELECTED CASES.

• MEDICAL MANAGEMENT SHOULD BE TRIED FIRST IN CASES OF MINIMAL RESIDUAL URINE, PATIENT WHO ARE NOT FIT FOR SURGERY, OR NOT WILLING FOR SURGERY.

ROLE OF PSAIN CASES OF

ENLARGED PROSTATE

CASE - 6

• 55 YEAR OLD MAN PRESENTED WITH THREE EPISODES OF HAEMATURIA IN 2 MONTHS TIME.

• SONOGRAPHY REVEALED 3 CMS SIZE BLADDER MASS ON LT. LATERAL WALL

X-RAY

• BIOPSY BY A GENERAL SURGEON. HP REPORT - TCC OF BLADDER WITHOUT MUSCLE INVASION

QUESTIONS

• DO WE NEED MUSCLE BIOPSY ALONG WITH THE TUMOUR ?

• IS ONLY TISSUE DIAGNOSIS SUFFICIENT ?

• WHAT IS YOUR SUGGESTIONS FOR THIS PATIENT’S MANAGEMENT ?

TAKE HOME MESSAGE

• COMPLETE RESECTION WITH MUSCLE TISSUE IS A MUST IN CASE OF RESECTABLE BLADDER TUMOR

• TRANS URETHRAL BIOPSY CAN BE TAKEN IN CASES OF ADVANCED MALIGNANCY FOR DIAGNOSIS

• ONLY CUP BIOPSY IN BLADDER TUMOUR IS NOT SUFFICIENT FOR COMPLETE DIAGNOSIS

P. U. VALVE

MANAGEMENT ?

• ENDOSCOPY & RESECTION OF VALVES ?

• CUTANEOUS VESICOSTOMY ?

TAKE HOME MESSAGE

• CUTANEOUS VESICOSTOMY IN NEW BORN

• ENDOSCOPY & RESCTION FOR OLDER CHILDREN

• ASSESSMENT OF UPPER TRACK MUST BE DONE

• LOOK FOR V.U. REFLUX

CONCLUSION:

Dos in Urology:1. Tackle any Urological emergency within your means.

2. Treat simple Urological problems as office urologist.

3. Investigate young children thoroughly having U.T.I.

4. Do not hasitate to put supra pubic catheter in emergency.

5. Give pain killers like Diclofanac Sodium for ureteric colic.

6. Bladder stones:

Treat them but with atleast basic Urological investigations.

It is kinder to give Pfannenstiel’s Incision to children.

And use subcuticular stitches for skin closure.

Dos in Urology (Cont..):

7. Investigate Male partner first in case of Infertility.

8. Don’t Hasitate to use Double J Stents in case of open renal surgery.

Your urologis colleague will be able to remove at your clinic later on.

9. Always encourage ROAMING UROLOGISTS to come to your clinic for consultation and further guidance and even for surgery like TUR(P), OR in emergency situation.

10 Refer the patients to Specialist Urologist for major Urological problems like

• Uro-Oncology.

• Infertility

• Complicated Stone Diseases

• Laparoscopic urolocial surgery.

• Transplant Surgery.

Don’ts in Urology

1. Don’t do prostatic surgery without help of ROAMING UROLOGIST.2. But don’t encourage Roaming Urologist to perform Mega surgery at

your clinic.3. Don’t attempt laparoscopic Urological surgery.4. Don’t keep treating Infertile woman without investigating male

partner.5. No point in giving hydro therapy and lasix in case of already

obstructed kidney.6. Please do not attempt congenital hernias with hydrocole in young

children.7. Avoid reconstructive Urological surgery.8. Don’t give antibiotics to patients having haemeturia without any U.T.I9. Avoid treating stricture urethra with metal dilatation.

THANK U