Urological Procedures

Original article by Tom Leach | Last updated on 8/5/2014
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Circumcision

Phimosis

This is a tight foreskin that cannot be retracted behind the glans. This is normal in new-borns, and as the child grows, then the foreskin should normally become retractable (by the age of 2-3 years)
Often in this condition, there is overgrowth of bacteria behind the foreskin (smegma bacillus)
The two main causes are tumour of the glans, and recurrent infections (balanaitis) of which diabetes is a contributing factor.
 

Balanitis xerotica obliterans (BXO)

This is a cause of phimosis
This is a skin condition affecting the male genitalia. This appears on the foreskin and the glans penis. White patches appear on the affected area, and there may be fibrosis of some of the tissue that prevents retraction. This condition is treated by circumcision.
 

Paraphimosis

This is where the retracted foreskin cannot be replaced over the glans, and it is stuck behind the coronal sulcus. It can be very painful. The glans of the penis can swell, and necrosis may occur if the condition is not treated.
A tight band may be palpable in the subcoronal area.
This can be treated by compression and manual reduction, but if this is not successful, or more urgent treatment is needed, then a slit may be made in the dorsal side, and then later a circumcision is performed.
 
Often found in young men – perhaps sex for the first time, or maybe an old man who has not / cannot replaced the foreskin.
 
The get it back, you can do a ‘ring block’ where you put local anaesthetic in the base of the penis. Then squeeze it for 20 minutes as hard as you can (‘white knuckle pressure’).
A ring block is used for anaesthetic in distal regions – because in these regions you can’t use adrenalin because it is a vasoconstrictor.
If this doesn’t retract it, then you have to do an emergency circumcision.
 

Priaprism

80% of these have no underlying cause.
This is prolonged erection of the penis. In the modern situation it is often related to treatments for penile dysfunction.
Trauma may also cause this condition, usually through the formation of an AV fistula. This is high flow priaprism.
In recreational drug use there may be a low flow priprism whereby there is lots of deoxygenated blood in the penis which can cause necrosis and tissue damage.
They are painful! The tissue of the penis can become ischemic.
 

Peyronie’s disease

This is an abnormal shaped penis. It is often due to fibrosis of tissue in the covering of the corpus spongiosum.
 

Vasectomy

This is a procedure where the vas deferens is cut as a permanent form of contraception.
 
There are several type of procedure. In the traditional procedure, both ‘cut’ ends are closed off (e.g. with metal clips). In a variation, the bottom end is left open, allowing sperm to spill out into the scrotum, thus reducing pressure in the epididymis. This is called an ‘open-ended’ vasectomy.
The sperm will be broken down by the body’s immune system. After a year, 60-70% of patients will have anti-sperm antibodies.
 
Early failure of the procedure is about 1%
Late failure of the procedure is very close to 0%.
 
There is about a 10% risk of reduced sexual function.
Sperm only account for 10% of the volume of the semen, and thus there is no noticeable difference in the sight, smell or texture of the semen after this procedure.
 
The hospital will keep a part of the vas deferens to prove that they have carried out the procedure correctly (the sample is analysed in histology to prove this), in case that in the future they are sued.
 
 

Cystoscopy

This is endoscopy of the bladder via the urethra.
It is carried out to investigate for lots of things, including:
 

Ureteroscopy

This is looking into the ureter with an endoscope.
It is a useful procedure in the diagnosis and treatment of kidney stones.
 

Urethrotomy

An incision of the urethra, especially for the relief of a stricture.
 

Lithopaxy

This is a procedure where stones in the bladder are crushed, and then the fragments are extracted (e.g. by suction).
 

Sebacious cysts

This is a closed sac (cyst) that resembles the upper part of a hair follicle. Sebaceous glands are located near the top of a hair follicle, and they secrete sebum that lubricates the hair. Sebaceous glands are found all over the body except the palms of the hands and the soles of the feet.
In relation to urology, sebaceous cysts are likely to occur on the scrotum. In males they are commonly found on the scrotum and on the chest.
When the gland or hair follicle becomes blocked, or in the presence of excess testosterone then a sebaceous cyst may form. The glands secrete lots of sebum, which forms an enclosed semi-solid sac. Around this sac, there may be keratin, and dead cells.
They are usually not tethered to surrounding tissue (will be tethered to the skin though), and will be smooth to touch.
The keratin surrounding the cyst often resembles cottage cheese!
To remove them surgically, you should use a local anaesthietic, then open the skin, and squeeze out the keratin and dead cells (the sebum). You will then be left with the solid cyst, and this can usually be poked out by a finger. If the cyst is removed totally intact like this, then the cure rate is 100%.
 
You should never try to pop a cyst because this is likely to lead to infection.
They can often become infect on their own anyway.
 

Stuck catheter

If the catheter is stuck, you can’t deflate the balloon.
Cut the water tube of the catheter (Not the whole catheter, leave the output port intact. DO NOT CUT THE CATHETER IN HALF) at the very end. This is often where the blockage occurs, and thus the water will drain and then you can remove the catheter.