Surgery and procedures Flashcards
(37 cards)
Indications for circumcision (9)
pathological Phimosis
paraphimosis
Recurrent balanoposthitis (infec glans and prepuce)
Carcinoma of penis
Condylomata acuminata (multiple penile warts under foreskin)
Foreskin trauma eg zipper
Religion (Jewish, Islam), (culture)
Recurrent UTIs (esp in infants and in association with other urinary abnormalities)
Balanitis xerotica obliterans and other chronic inflammatory conditions
Inadequate previous circumcision eg iatrogenic phimosis
Hygiene eg mentally impaired
(Prevent HIV)
Urisheath/condom catheter application
(Psychological)
Where is resistance felt on catheter insertion in males
External urethral sphincter
Instrument used to view bladder and urethra
Cystoscope
NB in bladder cancer
Name 5 contraindications to circumcision
- neonatal prematurity
- neonatal illness, unstable
- neonatal blood dyscrasia
- family history bleeding disorder
- congenital penniless abnormalities (may be needed later for reconstruction): hypospadias, chordee, buried penis, webbed penis, epispadias
- Poor hygiene = relative
- fashion and requests = relative
Name 5 early complications of circumcision
- bleeding most common, most minor + self-limiting
- infection
- glans injury: esp associated with clamp procedures, iatrogenic hypospadias/epispadias
- amputation
- slippage of circumcision device
- rarely death
Name 10 late complications of circumcision
- redundant foreskin
- cosmetic issues eg scar
- inclusion cysts in suture line (implantation smegma/ surgical “rolling in” of epidermis)
- adhesions/skin bridges between shaft + glans
- suture sinus tracts
- ventral curvature/chordee
- secondary buried penis
- phimosis
- urethrocutaneous fistula
- meatal stenosis after meatal ulcer due to exposure to ammonia in urine soaked nappies
- rarely necrosis (due to diathermy + clamping, adrenaline use, tourniquet, tight dressing)
- urinary retention / bladder rupture very rare
Name 6 indications suprapubic catheter
- Urinary retention: failed urethral catheterisation ey due to stricture, bladder neck contracture
- suspected traumatic urethral. injury
- necrotising fasciitis of perineum (Fournier’s gangrene)
- temporary urinary diversion after urological surgery
- selected patients with neuropathic bladder, unsuitable for CISC
- patients with transurethral catheter and acute epididymitis
Name 5 contraindications suprapubic catheter
• Bladder not distended, not easily palpable, empty or small capacity, can’t be localised with US
• previous lower abdominal surgery: possibility adhesions between bowel and bladder risk bowel injury
. History bladder cancer, macroscopic haematuria
• skin disease in suprapubic area
• gross obesity
Relative: coagulopathy, pelvic cancer, orthopedic hardware for pelvic fracture repair
How insert suprapubic catheter? (11)
1 local anaesthetic ( 10 ml of 1 % lignocaine) 1-2 cm above symphysis pubis in midline after cleaning and ensuring sterility
2. When needle give way in bladder, aspirate until urine obtained.
3. Pull back syringe and needle as unit and measure how deep needle was in abdo to guide depth of trocar.
4 make 1cm incision with disposable scalpel deep enough to incise rectus sheath
5. Insert trocar and sheath ( introducer): will feel “giving way “ when passing through rectus. sheath first, then again through bladder wall - will see stream of urine
6. Push in 5mm more to make space for balloon inflation in case of bladder wall thickness
7. Remove trocar and place thumb over sheath to prevent mess.
8. Insert Foley catheter already attached to urine bag
9. inflate balloon with 5 -7 ml
10. Remove sheath then peel and pull tab to remove sheath away from catheter
11. Secure with nylon skin suture and plaster
Never cover penis with sheets! If pt void, stop procedure.
Name 10 complication suprapubic cystostomy
- haematuria: common but usually transient
- migration (dislodgement) of catheter extravesically
- bowel injury eg perforation : rare
- rectal injury and injury to iliac vessels: rare
- catheter occlusion eg by blood, mucus, kinking
- UTI
- uro sepsis
- bladder stones
- bladder cancer
- fistula
Name the equipment needed for a suprapubic cystostomy (13)
- Sterile gloves
- sterile drapes
- marking pen
- 10 ml 1% lignocaine
- needle
- disposable scalpel
- 5-10ml sterile water or saline in syringe to inflate balloon
- skin tape
- 3-0 nylon suture on curved needle
- tissue forceps
- needle holder
- urine bag
- suprapubic catheter kit including peel-away sheath introducer with trochar and Foley catheter
Catheter size in men?
16-18 F
Catheter size in women?
14-16 F
Catheter size if macroscopic haematuria?
22-24 F foley catheter or 3 way irrigation catheter 20-30 F
Which catheter is preferred in patients needing long term catheter eg spinal patient?
Silicone catheter- less urethral damage, can remain indwelling up to 3 months
Which catheter is used post-op short term?
Foley latex catheter. Don’t leave in > 1 week- forms encrustations, unethical irritability, risk allergy
Which catheter is used post-op short term?
Foley latex catheter. Don’t leave in > 1 week- forms encrustations, unethical irritability, risk allergy
What type of catheter is used for prostate obstruction?
Coudé tip catheter 18 F
What type of catheter is used for neonates?
Younger than 6 months: feeding tube 5f with tape
How determine foley catheter size for children?
Age ÷2 + 8
Name 7 indications continuous urethral catheterisation
- Accurate monitoring urine output
- relief urinary retention due to medication, neurogenic bladder or intravesical obstruction
- temporary therapy urinary incontinence
- perineal wounds
- clot prevention (22-24f) for CBI (continuous bladder irrigation)
- intra and post op
- comfort for end of life
Name 4 contraindications urethral catheter
- Blood at urinary meatus
- scrotal haematoma
- pelvic #
- high riding prostate
What is a radical prostatectomy?
Prostate , prostatic capsule and seminal vesicles and their vessels removed
Can be done retro pubic, perineal or laparoscopic
Internal iliac and obturator lymph nodes may be dissected and sent for pathology
Name 3 intraoperative complications radical prostatectomy
- blood loss haemorrhage
- rectal injury very rare
- ureteral injury very rare
