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 of
Urinary 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:
Finesteride
Prazocin
Terazocin
Doxazocin
 
Uro-selective:
Alfuzocin
Tamsulosin
 : Surgery :
Minimally invasive procedures:
Balloon dilatation of the prostate
Prostate stents
Transurethral 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 PSA
IN 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.I
9. Avoid treating stricture urethra with metal dilatation.
THANK U