Hashim / Abrams / Dmochowski Handbook of Office Urological Procedures

1. Auflage 2010
ISBN: 978-1-84628-706-0
Verlag: Springer
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 156 Seiten, eBook

Provides an invaluable source of information and advice on how perform common diagnostic tests and surgical procedures apparent with the increased emphasis on office-based practice and out-patient/short-stay surgeryCombines both operative day case urology and diagnostic urology into a practical and comprehensive summary of the most common ‘day case’ urological procedures, in a form that is concise, and relevant to urological residents, consultants or nurses

Zielgruppe

Professional/practitioner

Autoren/Hrsg.

Hashim, Hashim

Abrams, Paul

Dmochowski, Roger R

Inhaltsverzeichnis

Sutures and Scalpels.- Electrosurgical Diathermy.- Urinary Catheters.- Urological Endoscopic Equipment.- Local Anesthesia and Nerve Blocks.- Reduction of Torsion of Testis and Fixation.- Simple and Subcapsular Orchidectomies (Orchiectomies).- Radical Orchidectomy (Orchiectomy).- Insertion of Testicular Prosthesis (Implant).- Testicular Biopsy.- Hydrocele Repair in Adults.- Excision of Epididymal Cyst or Spermatocele.- Vasectomy.- Epididymectomy.- Inguinal Orchidopexy (Orchiopexy).- Varicocelectomy.- Circumcision.- Optical Urethrotomy.- Urethral Dilation.- Injectables.- Transrectal Ultrasound Scan and Biopsy of the Prostate.- Urodynamics.- Flexible Cystoscopy.- Rigid Cystoscopy.- Suprapubic Catheterization.- Cystodiathermy.- Cystodistension (Hydrodistension).- Extracorporeal Shockwave Lithotripsy (ESWL).- Insertion of Double-J Stent.- Retrograde Pyelography.- Ureteroscopy (Semi-Rigid).

Leseproben

"28. Extracorporeal Shockwave Lithotripsy (ESWL) (p. 136-137)

Christopher Wolter and Roger Dmochowski

Indications

ESWL has proven over time to be a major breakthrough in urology. It is the procedure by which shockwaves are generated at a point external to the body (F1 point) and are focused on a kidney stone in the body (F2 point) (Figure 28.1). The shockwaves themselves are relatively weak at their source and can thus traverse the body without any untoward effects. However, at the point at which they are focused, they are suf? ciently powerful to fragment a kidney stone.

This is guided by ? uoroscopy in most instances, though ultrasound- guided techniques have been described. Fragmenting almost any stone can be attempted with this technique, but the success varies greatly depending on the size and location of the stone. Generally speaking, for stones in the upper and interpolar calyces, and the renal pelvis, the size limit is 2 cm, and for stones in the lower pole, the size limit is 1 cm. Most stones in the upper ureter can be fragmented as well.

The larger the stone, the higher the likelihood there will be a need for a second procedure. Contraindications to this procedure include active urinary tract infection, uncontrolled bleeding diathesis, poorly controlled hypertension, and pregnancy. Relative considerations that may prohibit use of ESWL are obesity, deformity of body habitus, suspected anatomic obstruction, stones in a calyceal diverticulum, and renal failure.

Procedure

1. Obtain consent for the procedure, ensuring that the listed complications below are discussed and the side to be treated is marked.
2. Prior to the procedure, obtain a urine culture. Even if the culture is negative, some doctors contemplate using pre-operative antibiotics. Choose an antibiotic that achieves good levels in urine, (i.e., a ? uoroquinolone).
3. Depending on the type of machine being used, the anesthesia/ analegesia chosen can vary. For the older-generation machines (e.g., Dornier HM3), general anesthesia is necessary. For newer, lowerpowered machines, simple analgesia, sedation, or monitored anesthetic care can be used.
4. If necessary, a ureteral stent can be placed pre-operatively, either at the same setting or at an earlier date. 5. Place the patient on the ESWL table in the supine position. If using a HM3 lithotriptor, the patient will need to be placed in the harness. Position the patient correctly over the shockwave generator. This may vary depending on the model being used."