Oxford Handbook of Urology
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Oxford Handbook of Urology

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Chapter 17 Urological surgery and equipment

John Reynard, Simon Brewster and Suzanne Biers

  • Preparation of the patient for urological surgery [link]
  • Antibiotic prophylaxis in urological surgery [link]
  • Complications of surgery in general: DVT and PE [link]
  • Fluid balance and the management of shock in the surgical patient [link]
  • Patient safety in the urology theatre [link]
  • Transurethral resection (TUR) syndrome [link]
  • Catheters and drains in urological surgery [link]
  • Guidewires [link]
  • Irrigating fluids and techniques of bladder washout [link]
  • JJ stents [link]
  • Lasers in urological surgery [link]
  • Diathermy [link]
  • Sterilization of urological equipment [link]
  • Telescopes and light sources in urological endoscopy [link]
  • Consent: general principles [link]
  • Cystoscopy [link]
  • Transurethral resection of the prostate (TURP) [link]
  • Transurethral resection of bladder tumour (TURBT) [link]
  • Optical urethrotomy [link]
  • Circumcision [link]
  • Hydrocele and epididymal cyst removal [link]
  • Nesbit’s procedure [link]
  • Vasectomy and vasovasostomy [link]
  • Orchidectomy [link]
  • Urological incisions [link]
  • JJ stent insertion [link]
  • Nephrectomy and nephro-ureterectomy [link]
  • Radical prostatectomy [link]
  • Radical cystectomy [link]
  • Ileal conduit [link]
  • Percutaneous nephrolithotomy (PCNL) [link]
  • Ureteroscopes and ureteroscopy [link]
  • Pyeloplasty [link]
  • Laparoscopic surgery [link]
  • Endoscopic cystolitholapaxy and (open) cystolithotomy [link]
  • Scrotal exploration for torsion and orchidopexy [link]
  • Electromotive drug administration (EMDA) [link]

1 Masood J, Hafeez, Calleary J, Barua JM. (2007) Aspirin use and transrectal ultrasonography-guided prostate biopsy: a national survey. Br J Urol Int 99:965–6.

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2 Enver MK, Hoh I, Chinegwundoh FI (2006) The management of aspirin in transurethral prostatectomy: current practice in the UK. Ann R Coll Surg Engl 88:280–3.[CrossRef] [Web of Science] [Medline] 

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3 Nielsen JD, Holm-Nielsen A, Jespersen J, et al. (2000) The effect of low-dose acetylsalicylic acid on bleeding after transurethral prostatectomy—a prospective, randomized, double-blind, placebo-controlled study. Scan J Urol Nephrol 34:194–8. [Web of Science] [Medline] 

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4 Stephen Jones J. (2007) Urologists: be aware of significant risks of stopping anticoagulants in patients with drug eluting coronary stents. Br J Urol Int 99:1330–1.

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* Cl difficile. Gram positive, anaerobic, spore-forming bacillus. Most common cause of nosocomial diarrhoea and antibiotic associated colitis. Disease arises as a consequence of faeco-oral transmission of Cl difficile spores (Ribotype 027 seems to be particularly pathogenic). Once colonization has occurred, progression to diarrhoea or colitis depends on coexisting conditions and host immune response. Cl difficile toxins A and B are responsible for pathogenicity. They bind to intestinal epithelial receptors. Inflammatory cytokines cause fluid secretion, mucosal destruction and tissue necrosis. Other risk factors for Cl difficile associated disease: age >65 years. Use of proton-pump inhibitors, laxatives, nasogastric tubes, prolonged hospital stay. Treatment for diarrhoea and colitis: stop causative antibiotics, isolate and barrier nurse (wash hands with soap and water as alcohol hand rubs are ineffective against spores), oral metronidazole (oral vancomycin reserved for serious or recurrent infection).

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1 Donat R, Mancey–Jones B (2002) Incidence of thromboembolism after transurethral resection of the prostate (TURP). Scan J Urol Nephrol 36:119–23.[CrossRef] [Web of Science] [Medline] 

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2 Geerts WH, Heit JA, Clagett PG, et al. (2001) Prevention of venous thromboembolism. (American College of Chest Physicians (ACCP) Guidelines on prevention of venous thrombo-embolism) Chest 119:132S–175S.[CrossRef] [Web of Science] [Medline] 

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3 Quinlan DJ, McQuillan A, Eikelboom JW (2004) Low molecular weight heparin compared with intravenous unfractionated heparin for treatment of pulmonary embolism. Ann Intern Med 140:175–83.[Abstract/Full Text]

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4 Lowe GDO, Greer IA, Cooke TG, et al. (1992) Risk of and prophylaxis for venous thromboembolism in hospital patients. Thromboembolic Risk Factors (THRIFT) Consensus Group. BMJ 305:567–74.

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5 Howard A, et al. (2004) Randomized clinical trial of low molecular weight heparin with thigh-length or knee-length antiembolism stockings for patients undergoing surgery. BJS 91:842–7.[CrossRef]

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6 Soderdahl DW, Henderson SR, Hansberry KL (1997) A comparison of intermittent pneumatic compression of the calf and whole leg in preventing deep venous thrombosis in urological surgery. J Urol 157:1774–6.[CrossRef] [Web of Science] [Medline] 

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7 Golash A, Collins PW, Kynaston HG, Jenkins BJ (2002) Venous thromboembolic prophylaxis for transurethral prostatectomy: practice among British urologists. J Roy Soc Med 95:130–1.[Abstract/Full Text]

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1 Dunn AS, Turpie AG (2003) Perioperative management of patients receiving oral anticoagulants: a systematic review. Arch Intern Med 163:901–8.[Abstract/Full Text]

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2 Kearon, C. (2003) Managment of anticoagulation before and after elective surgery. Am Soc Hematol Educat Program Book, pp. 528–34.

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1 Madsen PO, Naber KG (1973) The importance of the pressure in the prostatic fossa and absorption of irrigating fluid during transurethral resection of the prostate. J Urol 109:446–52. [Web of Science] [Medline] 

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2 Coppinger SW, Lewis CA, Milroy EJG (1995) A method of measuring fluid balance during transurethral resection of the prostate. Br J Urol 76:66–72. [Web of Science] [Medline] 

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3 Hahn RG (1993) Ethanol monitoring of extravascular absorption of irrigating fluid. Br J Urol 72:766–69.[CrossRef] [Web of Science] [Medline] 

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* The definition of ’uncomplicated’ ureteroscopy is not precise. ‘Complicated’ ureteroscopy has been variously defined as (a) ureteral perforation (i.e. mucosal injury); (b) severe ureteric oedema at the site of the stone; (c) impaction (which means difficulty getting a guidewire past the stone (‘cork in a bottle’ stone); (d) prolonged operation (no precise definition of what ‘long’ is); (e) one where ureteral dilatation was carried (to define such ureteroscopies as ‘complicated’ is conetentious because some urologists routinely ‘dilate’ with a dual lumen catheter to allow double guidewire placement. Does this automatically make all their ureteroscopies ‘complicated’?).

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1 Al-Awadi KA et al. (1999) Steinstrasse: a comparison of incidence with and without J stenting and the effect of J stenting on subsequent management. BJU Int 84:618–21.[CrossRef] [Web of Science] [Medline] 

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2 Preminger GM et al. (2007) 2007 Guideline for the management of ureteral calculi, joint EAU/AUA Nephrolithiasis Guideline Panel. J Urol 178:2418–34.[CrossRef] [Web of Science] [Medline] 

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3 Djaladat H et al. (2007) Ureteral catheterization in uncomplicated ureterolithotripsy: a randomized, controlled trial. Eur Urol 52:836–41.[CrossRef] [Web of Science] [Medline] 

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1 Joshi HB, Stainthorpe A, MacDonagh RP et al. Indwelling ureteral stents: evaluation of symptoms, quality of life and utility. J Urol 2003; 169:1065-9.

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1 Srivastava A, et al. (2003) Routine stenting after ureteroscopy for distal ureteral calculi is unnecessary: results of a randomized controlled trial. J Endourol 17:871–4.[CrossRef] [Web of Science] [Medline] 

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2 Netto Jr NR et al. (2001) Routine ureteral stenting after ureteroscopy for ureteral lithiasis: is it really necessary? J Urol 166:1252–4.[CrossRef] [Web of Science] [Medline] 

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3 Ramsay JW, et al. (1985) The effects of double J stenting on obstructed ureters. An experimental and clinical study. Br J Urol 57:630–4. [Web of Science] [Medline] 

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1 Docimo SG. (1989) High failure rate of indwelling ureteral stents in patients with extrinsic obstruction: experience at two institutions. J Urol 142:277–9. [Web of Science] [Medline] 

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2 Pearle MS et al (1998) Optimal method of urgent decompression of the collecting system for obstruction and infection due to ureteral calculi. J Urol 160:1260–4.[CrossRef] [Web of Science] [Medline] 

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3 Preminger GM et al. (2007) 2007 Guideline for the management of ureteral calculi Joint EAU/AUA Nephrolithiasis Guideline Panel. J Urol 178:2418–34.[CrossRef] [Web of Science] [Medline] 

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1 Collinge J (1999) Variant Creutzfeldt-Jakob disease. Lancet 354:317–23.[CrossRef] [Web of Science] [Medline] 

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2 Collins SJ, Lawson VA, Masters CL (2004) Transmissible spongiform encephalopathies. Lancet 363:51–61.[CrossRef] [Web of Science] [Medline] 

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3 Nix P (2003) Prions and disposable surgical instruments. Int J Clin Pract 57:678–80. [Web of Science] [Medline] 

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4 The Advisory Committee on Dangerous Pathogens and Spongiform Encephalopathy (1998) Transmissible spongiform encephalopathy agents: safe working and the prevention of infection. London: HM Stationery Office.

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1 In days gone by, when a tiny lamp at the end of the telescope was used for illumination, it was necessary to have a slightly angled line of vision otherwise the light bulb got in the way of the view. The 30° scope is a throw back to this historical requirement.

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2 Blandy J, Fowler C (1995) Urology. Oxford: Blackwell Science, pp. 3–5.

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1 Pearce and another v. United Bristol Healthcare NHS Trust, 48 BMLR 118. 1996.

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1 Patel AR, Jones JS, Babineau D (2008). Lidocaine 2% gel versus plain lubricating gel for pain reduction during flexible cystoscopy: a meta-analysis of prospective, randomized controlled trials. J Urol 179:986–90.[CrossRef] [Web of Science] [Medline] 

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1 Emberton M, et al. (1995) The National Prostatectomy Audit: the clinical management of patients during hospital admission. Br J Urol 75:301–16. [Web of Science] [Medline] 

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1 Bailey RC, Moses S, Parker CB, et al. (2007) Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomized controlled trial. Lancet 369:643–56.[CrossRef] [Web of Science] [Medline] 

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2 Gray RH, Kigozi G, Serwadda D, et al. (2007) Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet 369:657–66.[CrossRef] [Web of Science] [Medline] 

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1 Hopper KD, Sherman JL, Williams MD, et al. (1987) The variable anteroposterior position of the retroperitoneal colon to the kidneys. Invest Radiol 22:298–302.[CrossRef] [Web of Science] [Medline] 

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2 Inglis JA, Tolly DA (1988) Antibiotic prophylaxis at the time of percutaneous stone surgery. J Endourol 2:59–62.[CrossRef]

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3 Martin X (2000) Severe bleeding after nephrolithotomy: results of hyperselective embolisation. Eur Urol 37:136–9.[CrossRef] [Web of Science] [Medline] 

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4 Clayman J (1987) Percutaneous nephrostomy: Assessment of renal damage associated with semi-rigid (24F) and balloon (36F) dilation. J Urol 138:203–6. [Web of Science] [Medline] 

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1 Garvin TJ, Clayman RV (1991) Balloon dilation of the ureter for ureteroscopy. J Urol 146:742–5. [Web of Science] [Medline] 

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1 Srivastava A, et al. (2003) Routine stenting after ureteroscopy for distal ureteral calculi is unnecessary: results of a randomized controlled trial. J Endourol 17:871.[CrossRef] [Web of Science] [Medline] 

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1 Kuntze JR (1985) Testicular torsion after orchidopexy. J Urol 134:1209–10. [Web of Science] [Medline] 

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2 Frank JD (2002) Fixation of the testis. Br J Urol Int 89:331–3.

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* Physion Srl, Medolla, Italy.

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DOI: 10.1093/med/9780199534944.003.0017

2nd edition

The Oxford Handbook of Urology covers a wide spectrum of diseases and their treatment in the field of urology and surgical aspects of kidney, bladder, prostate and scrotal disorders. It aims to give a brief overview of many different urological subjects including urology emergencies, cancers, infections, children's disorders and kidney stone disease.

Disclaimer

Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work.

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