Urology

Urology

Circumcision

Circumcision is performed for a number of reasons in adults The most common reasons for performing circumcision are scarring or narrowing of the foreskin. Occasionally foreskins can split with certain conditions and also cause pain on intercourse. In some cases a circumcision may be required in men who have torn their frenulum. Usually this is performed as a day case under general anaesthesia and the scarred area is removed by the ‘sleeve’ technique and then sutured with very fine Vicryl sutures which dissolve.

Cystoscopy

Cystoscopy allows the doctor to look inside your bladder during an operation. A chemical called hexyl amino levulinate (HAL) will be inserted into your bladder. This is done by passing a fine tube (catheter) along your urethra and into the bladder. With a special camera and a blue light, your doctor can then check your bladder. During the operation, cancer cells absorb the chemical and then glow red in the blue light, so they are easier to see.

Lithothrispy

Lithotripsy comes from the Greek words ‘lithos’ and ‘tripsis’ and literally means ‘stone breaking’. The procedure uses shock waves to break your kidney stones into small, sand-like particles that can then pass out of your body through your urine.

When a doctor find the stone or group of stones in the kidney or ureter (narrow, muscular tube that connects your kidney to your bladder). Kidney stones can be painful and can cause infection or blood in urine then treatment- Lithotripsy is recommended. If nothing is done to remove them, they may continue to grow and could damage kidney or block ureter.

Lithotripsy is performed on the basis of Day care, meaning that you can come into hospital, have the procedure, and return home the same day. It avoids the need for surgery and anaesthetic, reducing your hospital stay and the amount of time you will need to recover from the procedure.

Male Infertility / Fertility

Infertility is defined as the failure to conceive after one year of unprotected intercourse. Approximately 15% of couples attempting their first pregnancy meet with failure. In about 50% of couples seeking treatment, the infertility will be caused by a problem in the male. It is therefore important that both partners are seen and investigated together. Often the male partner is not assessed and patients are sent directly for IVF treatment without having the male partner assessed.

There have been great technological advances in the development and success of assisted conception in the last two decades, such that many couples with infertility can now be offered treatment.

Penile Reconstruction

There are a number of medical problems, which can affect the penis, which can also be related to a previous surgery. In some cases, especially at the time of circumcision, there may be too much skin removed, which can result in pain and difficulty penetrating during intercourse. The area may also be unsightly due to scarring, particularly with circumcisions performed as a child. In these cases the skin can either be removed or joined up again or alternatively if more skin is required, plastic surgical techniques including skin grafting, Z-plasty and other grafting procedures may be used to try and stretch the skin. In some cases where there has been a condition called Balanitis Xerotica Obliterans or Lichen Sclerosis, the skin on the head of the penis, or glans, is very scarred and ulcerated. In cases which fail to respond to steroid treatment, the skin of the head of the glans can in part, or completely be removed and resurfaced using skin grafts (see published outcome data). In other instances there may be swelling of the penis and scarring of the penis due to previous surgery or radiotherapy treatments. Again reconstructive techniques can be used in these cases to achieve a good functional and cosmetic result.

Percutaneous Nephrolithotomy(PCNL)

With this technique, a large bore tract (30Fr) is dilated over a guide wire passed from the loin, traversing the renal parenchyma and entering into the pelvicalyceal system via a renal papilla. A nephroscope is then passed down the tract and calculi are fragmented and removed. This is then followed by a period of post-operative nephrostomy drainage (1-2 days) and typically the patient is in hospital for 3-4 days. The wound is approximately 1cm in diameter and normal activities are rapidly resumed, although full contact sport should be avoided for 4-6 weeks.
The indications for PCNL are large renal stone burdens (i.e. ›2cm, ›1.5cm for lower pole), ESWL or flexible ureterorenoscopic failures and in the treatment of concurrent intrarenal pathology (i.e. pelviureteric junction obstruction, calyceal diverticulum). Over the past few years, there has been a resurgence of interest in this technique as the indications for ESWL become more tightly defined. The technique continues to evolve with present research concentrating on the role of smaller tracts (the so-called Miniperc) and “tubeless” post-operative management.

Radial Prostatectomy

A radical prostatectomy is an operation to remove the prostate gland and some of the tissue around it. It is done to remove prostate cancer. This operation may be done by open surgery or it may be done by laparoscopic surgery through small incisions. Laparoscopic surgery may be done by hand. But some doctors now do it by guiding robotic arms that hold the surgery tools. This is called robot-assisted prostatectomy.

Transutheral Resection of Prostate (TURP)

A TURP is an operation in which an instrument (resect scope) is inserted up the urethra (water pipe) and used to remove a part of the prostate that is blocking the flow of urine. You will be given either a general or a spinal anaesthetic for the procedure.

The operation takes about 45 minutes and you will be in hospital for about three to four days.

Vasectomy

A vasectomy is a simple surgery done by a doctor on OPD basis. The small tubes in your scrotum that carry sperm are cut or blocked off, so sperm can’t leave body and cause pregnancy. The procedure is very quick, and patient can go home the same day. And it’s extremely effective at preventing pregnancy — almost 100%.

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