Professional Documents
Culture Documents
Renal Surgery
Renal Surgery
• Dietel Crisis
– Feature of Unilateral, Intermittent Hydronephrosis
– After an attack of acute renal pain, a swelling in the
loin is found. Some hour later, following the passage
of urine pain is relieved and swelling dissapears
Hydronephrosis Association
• Prune Belly Syndrome (Eagle Barret Syndrome)
• Dietls Crisis
• Dietel Crisis
– Feature of Unilateral, Intermittent Hydronephrosis
– After an attack of acute renal pain, a swelling in the
loin is found. Some hour later, following the passage
of urine pain is relieved and swelling dissapears
Prune Belly Syndrome
• Fascia of Denonvilliers
– The posterior surface of the prostate gland is
separated from the rectum by fascia of
Denonvilliers
Different zones of prostate gland
• Peripheral zone (PZ) which lies mainly posteriorly
and most carcinomas arise from this zone. This is
the reason; we have to palpate the prostate from
the rectum to find the hard prostate to rule out
carcinoma.
• Central zone
• Periurethral transitional zone from which most
benign prostatic hyperplasia (BPH) arises
• NOTE: BPH results in obstruction of urinary tract.
The specific condition is associated with
enlargement of the Median lobe
Drugs used for BPH
• Alpha 1 adrenergic blocking agent: Prazosin,
Terazosin, Tamsulosin
• 5-alpha reductase inhibitor inhibits conversion
of testosterone to dihydrotestosterone, e.g.
Finasteride
• Antiandrogen may help men with significantly
enlarged prostates. e.g. Flutamide
TURP
• The verumontanum is the single most important
anatomical landmark in TURP.
• The verumontanum lies immediately proximal to the
external sphincter muscle and serves as the distal landmark
for prostate resection to prevent injury to the external
sphincter.
• Hyponatremia is avoided by using 1.5% isotonic glycerin for
irrigation. (Distilled Water is never used for irrigation)
• Absorption of water into circulation at the time of TURP
(water intoxication) can give rise to CHF, hyponatremia, and
hemolysis which may manifest as confusion and other
cerebral events mimicking a stroke.
• Post TURP first complication Vomiting
• Most common complication: Retrograde Ejaculation
Indications of prostatectomy in BPH
• Acute retention- BPH is the most common cause
of urinary retention in elderly males.
• Chronic retention and renal impairment:
Residual urine of 200 ml or more, a raised blood
urea, hydroureter or hydronephrosis demons-
trated on urography and uremic manifestations.
• Complications of bladder outflow obstruction:
stone, infection and diverticulum formation.
• Hemorrhage
• Most common site of obstruction after TURP is
– Bladder Neck
• Teratozoospermia
– Presence of high number of malformed spermatozoa in
the semen
Common tumor of Testis
• Seminoma (MC overall, Yolk sac tumor is MC in children,
Lymphoma is elderly)
• Teratoma
• Combined Seminoma and teratoma
• Lymphoma
• Interstitial tumor