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Musgrove Park
E s s e n t i a l
urology
by Mr Surayne Segaran MRCS and
Mr Nick Burns-Cox MD FRCS (Urol)
Contribution from Mr Joe Jelski
FOREWORD
Welcome to urology at Musgrove
Park hospital. We hope you will
enjoy your time in the department.
Ensuring the best care for patients
is hard work and access to relevant
information and a supportive team
is key.
The aim of this booklet is to provide
instant clinically relevant urological
information. It should be used as
you work and referred to as you
come across urological challenges.
Mr Surayne Segaran
Mr Nick Burns-Cox
So keep this booklet in your pocket (or use the
QR code to download it onto your smart phone)
and it will give you a essential guidance.
‘What you do may seem insignificant to
you, but it is important that you do it.’
(Mahatma Ghandi)
June 2012
3
4
INDEX
Introduction and useful information
6
Acute testicular pain
10
- Torsion
11
­- Epididymo-orchitis
12
Haematuria and clot retention
16
Paraphymosis20
Acute urinary retention
24
Practical tips for urethral catheterisation
25
Suprapubic catheterisation
28
Loin pain and ureteric/renal colic
32
Sepsis and infection
36
Fournier’s gangrene
38
Discharging patients
40
Further reading and Glossary of terms
40
5
Basic Urological Emergencies
Introduction
Up to 20% of admissions to an acute surgical take
are urological. With progressively less exposure to
urology in basic medical training, junior doctors can
find these patients particularly daunting. We hope that
this booklet helps you to approach the emergency
urological patient with a little more confidence.
The basics
The approach to any unwell patient from any specialty
follows a common pathway. You don’t have to know
the diagnosis or underlying cause to do the following:
• Airway – ensure the patient is able to breathe
• Breathing - check O2 saturation and provide oxygen
via a non-rebreathable facemask if appropriate
• Circulation – check the blood pressure, heart rate
and capillary refill time. Gain IV access early (this
may also help for pain relief and antibiotics, apart
from fluid resuscitation)
• Pain relief – give this early and generously. There
is never a case for withholding analgesia “to make
the diagnosis easier”.
Chain of command – who do I call?
Most urological emergencies will be admitted on
the acute surgical take. It is the responsibility of the
junior team (F1, F2 or Core Trainee) to clerk in the
patient, order the initial investigations and make a
provisional diagnosis. Do make an attempt at making
a diagnosis, but if one is not clear have a differential &
management plan.
6
If you are out of your depth and feel that your
patient needs more senior input - or if the patient is
deteriorating rapidly – you should call for help. F1s
should first go to the surgical F2 or CT; this should
then be escalated to the on-call General Surgical
Registrar. In most cases emergency referral to the oncall Urology Consultant should come after review by
the Registrar. Of course, if a patient is very unwell and
senior members of the Surgical team are not available
(in theatre or dealing with another emergency), call a
Urologist.
Seen & checked by F1 / F2
Review by
Core Surgical Trainee
Discuss with Surgical Registrar
Refer to Urology
The Urology consultants are on call on a weekly basis
starting each Monday. New referrals and emergency
admissions are seen by this consultant or a designated
team member. There is only one Urology Registrar
and therefore he/she may not always be available to
answer a bleep. Try the SHO or Consultant if urgent.
If you need to make a routine referral, please use
electronic referral system by searching for the “redtop Urology” on the hospital intranet. For TWOC
appointments please complete the appropriate form
and contact the Surgical Investigation Unit on 2111.
7
When calling for urgent help (Surgical or Urological)
there are several points of good practice:
• make sure the initial blood tests and investigations
have been ordered. Try to have background information and results of previous investigations to hand
• start basic emergency care – oxygen, IV fluids,
pain relief, etc.
• if you are calling for help with a procedure, get the
appropriate equipment ready
• if at all possible, stay to give a verbal handover to
your senior
• ensure that you document everything clearly
• keep the nursing staff well informed and involved
Prescribing
The antibiotic and medication regime were correct
at the time of publication but please check for upto-date local guidance and if in doubt speak to the
micro-biologist.
Useful contact numbers in Urology
Registrar – bleep 2038
CT – bleep 2202
F2 – bleep 2168
F1s – bleep 2165 / 2173
Clinical Nurse Practitioner (Val) – bleep 2383
Nurse Specialist (Gus) – Ext 4924
Research Registrar – Ext 3112
Uro-oncology Nurse specialists
(Wendy & Julia) – Ext 4628
Surgical Investigation Unit (SIU) – Ext 2111
Fax number for referrals – 3571
The on-call Urology Consultant can be reached via
switchboard.
Consultants – Mark Speakman, Ru Macdonagh,
Andrea Cannon, Nick Burns-Cox and Robert Jones.
8
Acute
testicular pain
9
Acute testicular pain
The most important causes of acute scrotal pain are
testicular torsion and epididymo-orchitis. Determining
the exact cause of the pain acutely can be very
difficult; therefore approach every case of testicular
pain as potential testicular torsion. You have only
4 hours from the onset of the pain before testicular
viability drops sharply. DO NOT DELAY!
What to do if you see a patient with suspected
testicular torsion:
• Keep the patient fasted. They are likely to need
surgery.
• Provide adequate analgesia
• Inform your senior that you are seeing a possible
torsion. If no senior is available, examine the
patient then call the on-call urologist immediately.
You will frequently find that the patient is in too much
discomfort to be examined. Findings to support the
diagnosis of torsion include:
• sudden onset of pain
• a tender testicle
• a high testicle
• nausea and vomiting
• inflamed scrotal skin
10
Ultrasonography in
acute testicular pain
There is sometimes a role
for imaging in testicular
pain, but it should never
delay an operation. The
decision to image should
be made by a urologist.
Operations for torsion
– what happens and
points for consent
When a scrotum is
explored, an incision is made in the scrotum and the
testicle inspected. If it is torted, it is untwisted and
time is given for it to reperfuse. As torsion is due to
a congenital “bell-clapper” deformity, the other testicle
is at risk of torsion too, and is therefore fixed in place
with 3 stitches.
If the affected testicle recovers, it is fixed in place
as well. If it is not viable, then an orchidectomy is
performed.
If another pathology is found, it is dealt with as
necessary and the operation note will describe this.
The most common alternate conditions are epididymoorchitis and a torted testicular appendix or hydatid of
Morgagni.
When consenting the patient (and frequently
parents):
• Remember to stress that this is a diagnostic as
well as a therapeutic procedure. It may not be
torsion, but an operation is still needed.
11
• Explain that if it is a torsion, that the other side will
be fixed as well
• Mention the possibility of orchidectomy, but
reassure patients and parents that this will not
affect sexual development and function or fertility,
and that a prosthesis can be fitted later.
Epididymo-orchitis
Testicular pain in patients over 30 is more frequently
due to infection rather than torsion. Points to support
the diagnosis are:
• Age
• Gradual onset of symptoms (although this is not always the case)
• Systemic symptoms (fever, malaise)
12
• Urinary symptoms (dysuria, frequency, urgency)
• Positive urine dip test for infection (i.e. nitrites +/- leukocytes).
Take urine samples for culture, then treat the patient
with a 10-day course of oral ciprofloxacin, 500mg BD.
Penetration of antibiotics to the testicle is poor, and
a further course may be appropriate if symptoms
persist. In sexually active patients cover for Chlamydia
is essential – doxycycline 100mg BD for 10 days is
usually the antibiotic of choice. Older patients more
commonly have infection due to coliforms.
Other causes of testicular pain
Local
Always ask about testicular trauma – even if the
injury was some time ago, a haematoma can become
infected and present acutely. More acute injuries can
of course cause testicular rupture.
Rarely, haemorrhage into a testicular tumour can
present with pain. Be wary if there is a history of a
lump, or if you can feel one. Refer to urology urgently.
Referred
Ureteric colic from stones can be referred to the
testicle – if a patient doesn’t seem to have a very
tender or inflamed testicle, and if a urine dip tests
positive for blood consider a CTKUB.
Spinal nerve root compression can sometimes
cause testicular discomfort. And always palpate the
abdomen to exclude an aortic or iliac aneurysm.
13
Systemic
Viral infections (such as mumps) commonly cause
testicular pain, but this tends to be bilateral. The
history will also be consistent with an infection with
fever, malaise and a gradual onset. Remember to ask
about immunisation.
14
Haematuria
& Clot Retention
15
Haematuria & clot retention
Haematuria can arise from anywhere in the urinary
tract. In the emergency situation, the priority is to
control the bleeding and prevent clot from accumulating
in the bladder – diagnostics can wait. First, ensure the
patient is haemodynamically stable. Give oxygen, gain
IV access, take baseline bloods (including a clotting
profile) and provide analgesia if the patient is in pain.
Microscopic (dipstick) haematuria is not an emergency
and can be investigated as an outpatient.
3-way catheterisation and bladder irrigation
Haematuria is controlled with bladder irrigation and
washouts, usually via a large-bore (20-24F) 3-way
catheter. While the sight of the catheter may be
intimidating, they are usually quite easy to insert due
to the stiffness of the catheter. A few helpful tips on
3-way catheters and irrigation:
• Use plenty of lubrication – at least 2 tubes of
Instillagel
• 3-way catheters don’t come with a pre-filled syringe
to fill the balloon – you will need a 20 or 30ml
syringe and some sterile water for this
• 20ml is usually enough to fill the balloon but always
document how much you put in
• You will need a plastic bung to stop the third
channel – make sure you have this ready or you
will make a mess!
• After you insert a 3-way catheter, perform a
bladder washout as described below; once clot is
removed commence irrigation
16
• Start bladder irrigation at full flow, then slow down
the flow gradually. It should go from burgundy to
rosé in colour – if you get vodka, it’s flowing too fast.
Irrigation will prevent further clot from forming in the
bladder; it will not remove existing clots. To do this, a
bladder washout is needed.
How to do an effective bladder washout
A 3-way catheter should be in place to perform an
adequate bladder washout. While it is possible to
perform one with a 2-way catheter, it is generally
ineffective and not advisable.
Equipment needed:
• a 50ml catheter-tipped syringe
• a sterile jug
• 1-litre bottle of sterile saline at room temperature
• 2 or 3 disposable kidney dishes
• inco-pads – lots of them, or risk the wrath of
the nurses!
• Sterile gloves
Procedure:
• Expose the patient and line the area with
inco-pads
• Open the bottle of saline and pour into the jug
• Disconnect irrigation and place a stopper into
outermost channel of the catheter
• Place a kidney dish to catch outflow
• Don sterile gloves and draw up 50mls of saline in
the syringe
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• Inject the saline using the central channel. You need to use a fair amount of force to agitate the clot and break it up
• Withdraw 30-40ml of saline and clot, and
expel it into the kidney dish
• Repeat until clear
• Do not attempt to withdraw all 50mls – you will cause discomfort
• Sometimes deflating the catheter balloon can help; make sure you hold on to the catheter though (or get an assistant to help)
18
Paraphimosis
19
Paraphimosis
This usually follows urethral catheterisation when the
foreskin has not been replaced after the procedure.
Some patients may also present acutely. There is
oedema of the glans and a tight band of the foreskin
can be felt underneath it. The patient tends to be
very uncomfortable and the sight of the condition has
traumatised many juniors!
The key steps to managing paraphimosis are:
• Keep the patient nil by mouth (in case you fail and
the patient needs to go to theatre)
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• Analgesia. Give strong oral agents, and a
penile block is useful if you know how. Inhaled
nitrous oxide can be helpful while reducing the
paraphimosis.
• Reduce the oedema. This requires firm, constant
pressure and patience. Wrap the glans in gauze
and grasp it in your hand, squeezing gently.
Increase the pressure gradually (as tolerated by
the patient) and maintain the grip for at least 5
full minutes. You will feel the oedema gradually
decrease under your hand.
• Push the glans back into the foreskin with your
thumbs as illustrated above
• Ensure that the paraphimosis is completely
reduced all around the circumference of the glans
If this fails, call a senior or a urologist – a dorsal slit
or emergency circumcision may be needed.
21
How to perform a penile block
There are 2 ways of doing this: a penile nerve block,
or a subcutaneous ring block.
A ring block is easier and provides more complete
and reliable anaesthesia to the entire penis. Mixing
lignocaine and bupivacaine (Marcain) provides quick
analgesia that lasts for up to 4-6 hours.
Never use local anaesthetics containing adrenaline
on the penis! They can cause vasoconstriction,
ischaemia and necrosis of the penis.
Equipment needed:
• a 20ml syringe
• 10ml 1% lignocaine
• 10ml 0.5% bupivacaine
• A large-bore needle to draw up
(21G, green or larger)
• A smaller needle for injection
(23G blue or smaller)
• Alcohol / chlorhexidine wipes for prep
Check and draw up the anaesthetics in the same
syringe and mix well. Starting with the dorsum of
the penis, inject the anaesthetic subcutaneously at
the base. You should put in enough to raise a bleb.
Work your way around the base of the penis; you may
have to remove the needle and re-insert it – be sure to
insert it where a bleb has already been raised to avoid
unnecessary discomfort.
Give the anaesthetic 5 minutes to work before you
start the procedure.
22
ACUTE URINARY
RETENTION
23
Acute urinary retention
You will inevitably see some cases of acute urinary
retention, although not many patients will be as
obvious as this! First confirm that the patient is
actually in retention – make sure that failure to void
is not due to anuria, or the suprapubic mass is not a
solid tumour. You should be able to do this clinically;
a bladder scanner can be helpful but is not always
reliable, particularly in the obese.
The immediate priority is of course catheterisation.
Once this is done, address potential precipitating
factors such as infection, constipation, opioids and
sympathomimetic drugs. Perform a rectal examination
– both to assess prostate size and to exclude obvious
prostate cancer. Check the patient’s renal function
and perform a urine dip test. Start an alpha-blocker
24
such as tamsulosin 400mcg once daily. There is no
point in starting a 5-alpha-reductase inhibitor such as
finasteride acutely – they take 6 months to work!
Generally speaking you should wait for the patient to
receive 2 doses of an alpha-blocker before attempting
trial without catheter (TWOC).
Practical tips for male
catheterisation
Equipment needed:
• 14F or 16F 2-way catheter. A standard short-term
catheter is fine for acute retention. Never use a
female catheter – check carefully
• Instillagel – have a spare tube handy as well
• A catheter kit (with gloves, a drape, gauze and a
kidney dish)
• A drainage bag – there’s nothing worse than
inserting a catheter then realising you have
nowhere to connect the free-flowing end!
• Sterile saline or water for prep. You don’t need to
use chlorhexidine
How to insert a urethral catheter:
• Get everything ready and open all packaging. Your
trolley will be a sterile field so there is no need to
flounder about with one instillagel-covered hand,
trying in vain to open a catheter pack!
25
• Expose the patient, don your gloves and prep the
patient.
• Grasp the penis behind the glans and pull it
upwards firmly to straighten the urethra
• Inject the Instillagel slowly – rapid injection into the
urethra is painful
• Keeping tension on the penis, insert the catheter
and advance it all the way
• Only start filling the balloon when the bifurcation of
the catheter is at the meatus
• Pull the catheter back and ensure it is draining
urine
• Connect up the drainage system and make sure
the bag is below the level of the bladder
• Tidy up after yourself!
Points to remember
• If there is pain when inflating the balloon, stop
immediately. You are probably not in the bladder
and will rupture the urethra if you continue
• Always record the residual volume. This is
critical in planning further care of the patient
• Never, ever use an introducer. You are far more
likely to cause severe injury than to succeed.
• There may be a diuresis following catheterisation;
accurate fluid balance charts are essential.
Prescribe IV fluids if the patient is in negative
balance and can’t drink.
26
• There may be some bleeding post-catheterisation.
This is from rupture of capillaries following
decompression of the bladder. It is usually selflimiting, but if problematic treat it as any other
haematuria – with washouts and irrigation.
Difficult catheterisation
• As you will probably find out, not every catheter
goes in easily. Here are some tips for difficult
situations:
• Put the catheter in with confidence
• Use more lubricant and make sure the penis is
pulled upwards firmly
• If you find the catheter is getting “stuck” try a larger
catheter instead of a smaller one – it is less likely
to get stuck in a false passage, or to cause one
• Get an assistant to slowly inject 50ml of saline into
the catheter while you are inserting it – this can
sometimes make passing it easier
• Coudé-tip catheters have a curve on the end that
makes them easier to insert past large prostates
and false passages. The curve should point to the
ceiling while inserting it
• If you have had 3 tries and still fail, it is time to call
someone more experienced
• Don’t call your senior because you think that it
might be difficult. Try once and see how it goes.
27
Suprapubic catheterisation
If urethral catheterisation fails, insertion of a
suprapubic catheter (SPC) is an alternative. However,
as the risks of SPC insertion are substantial, you
should not attempt one unless you have been trained
adequately. This is not something to have a go at for
the first time while unsupervised.
If you would like to learn how to insert a SPC please
contact the Surgical Investigation Unit on 2111 –
there are dedicated SPC insertion clinics that are run
by our very experienced Nurse practitioner Angus
MacCormick.
There are several contraindications to blind SPC
insertion:
• Inability to aspirate urine from the bladder
• A known bladder tumour
• Haematuria of unknown cause – this is assumed
to be bladder cancer until proven otherwise
• Uncorrected coagulopathy – for instance if the
patient is on warfarin. Low-dose aspirin is not a
contraindication
• Previous lower abdominal surgery – there is a high
chance of bowel injury
Suprapubic aspiration
If you are unable to catheterise a patient in painful
retention and no senior is available, you can aspirate
the bladder. Aspiration is a safe and easy procedure
28
Equipment needed:
• a 50ml syringe and 21G (green) needle or venflon
• a 3-way tap and tubing – this allows you to drain
off the urine in stages without re-inserting the
needle
• skin prep
• a jug or other suitable container for urine collection
Insert the needle 90 degrees to the skin surface 2cm
above the pubic symphysis, aspirating as you go down
until you obtain urine. Once you have aspirated as
much as you can, withdraw the needle and cover the
site with a simple dressing.
Problems with catheters
Blocked catheters – try a washout. Most blocked
catheters, however, will need replacement rather than
unblocking.
Discomfort and urine bypassing the catheter – these
are usually caused by bladder spasm from irritation
of the trigone. Reducing the volume of water in the
catheter balloon can help, as can a washout (to
remove any debris that may be causing irritation). If
the problem persists, try an anticholinergic such as
solifenacin (5-10mg OD) or tolteridine (4mg OD).
Unable to remove catheter – Do not pull hard! This
is usually due to failure of the balloon to completely
deflate and pulling out the catheter will cause trauma.
Cut the end off the balloon inlet valve and leave for
10 minutes (the channel is narrow and it takes time
to empty). Then squirt a tube of Instillagel down
29
the catheter and try removing it again. Firm, gentle,
constant pressure is needed rather than hard tugs. If
this fails, call a senior.
Catheter fallen out or pulled out – There may be
bleeding and urethral injury if the catheter was pulled
out with the balloon intact; try recatheterisation with
a larger-bore catheter and lots of lubricant. Call for
help early if you fail. In patients with dementia who
keep pulling out catheters, taping a decoy catheter in
the path of a wandering hand can sometimes prevent
further incidents.
Suprapubic catheters that fall out need to be replaced
promptly as the tract closes quickly . If you fail,
place a urethral catheter and fill up the bladder using
a bladder syringe and 250-300ml of saline, then try
replacing the SPC again.
30
LOIN PAIN &
URETERIC / RENAL
COLIC
31
Loin pain & ureteric / renal colic
The following flowchart summarises the approach to the pati
On-call surgical team review
HISTORY, examination and investigation
URINE: Dipstick +/- MSU
SERUM: Creatinine, Calcium, Phosphate,
(+ others to exclude differential diagnosis
RADIOLOGY: KUB +/- erect CXR
Review / Discuss
with SpR on-call
High clinical suspicion
for ureteric colic
Yes
Patient well / apyrexial
No
Resuscitate: NBM, IVI, Oxygen
Group and save, Clotting screen
Treat renal failure as per protocol
Urgent imaging USS / CT KUB
If evidence of obstruction and infection +/renal failure discuss with Consultant
Radiologist/Consultant Urologist for
urgent decompression of renal tract
32
Yes
ient presenting with loin pain:
Urate
e.g. amylase, ß-HCG
No
Oral fluids, analgesia
CT KUB/IVU (next day if
out of hrs)
Investigate for other
causes
• Abdominal Aortic
aneurysm
Diagnosis confirmed
No
Yes
• Appendicitis
• Biliary colic
• Ischaemic bowel
• Sigmoid volvulus
• Perforated viscus
• Acute peritonitis
• Ectopic pregnancy
• Diverticulitis
• Renal vein thrombosis
Review by Urology
(Admit for analgesia
or discharge)
33
Key points to remember:
• Until there is radiological evidence of a stone,
always consider other causes of pain.
• Many stones are managed conservatively – there
is no need to routinely starve patients
• All patients with lower ureteric stones should
receive an alpha-blocker such as tamsulosin
400mcg OD. This increases the chances of
spontaneously passing the stone.
• If a patient has had all relevant investigations,
has a proven lower ureteric stone, and has wellcontrolled pain they can be discharged with a
urology outpatient appointment in 4 weeks, with a
KUB X-ray on arrival.
• An obstructed, infected kidney is a life-threatening
emergency. If there is a proven stone and the
patient is pyrexial, start antibiotics and fluid
resuscitation and call a senior urgently
34
SEPSIS &
INFECTION
35
Sepsis & infection
UTIs
Always obtain cultures before starting antibiotic
treatment. First-line therapy is usually trimethoprim
200mg BD; a 3-day course is adequate for
uncomplicated UTIs in women. Men and those
with recurrent infections should have a 7-day
course. Subsequent treatment should be guided by
sensitivities.
Patients who have recurrent, symptomatic UTIs may
benefit from prophylactic antibiotics; before starting
this you should have a positive urine culture. Treat the
patient with a 2-week course of appropriate antibiotics,
then start them on a prophylactic low dose (e.g. 100mg
trimethoprim OD). If you start prophylactic treatment
without eradicating the existing infection you will only
breed resistance. Patients should be reviewed in a
urology outpatient clinic 3-4 months after this.
Catheters are colonised by bacteria within days;
therefore any urine dip or MSU from a patient with an
indwelling catheter is likely to be positive. Only treat
the patient if they have unexplained pyrexia or other
symptoms and signs of a UTI (suprapubic or loin pain,
purulent urine, etc).
Pyelonephritis
Patients are unwell with pyrexia, loin pain and renal
angle tenderness. There may be symptoms of a lower
UTI as well (dysuria, frequency and urgency). Urine
dip tests usually show the presence of leukocytes,
nitrites and sometimes blood.
36
Ensure the patient is safe with the usual ABC
approach. The next priority is to rule out obstruction –
arrange an urgent ultrasound scan of the renal tracts.
If there is no obstruction, treatment with Amoxicillin
500mg TDS (IV or oral) plus gentamicin 5mg/kg/24hrs
is appropriate – these should be administered within
an hour of presentation, as per the Surviving Sepsis
guidelines. IV Teicoplanin should be substituted for the
amoxicillin in patients with a penicillin allergy – give 3
doses of 400mg 12 hours apart to load, then 400mg
/24hrs.
Urosepsis
If a patient has urinary tract obstruction and is
septic, this is a medical emergency. Urgent
decompression of the obstruction is needed, along
with antibiotic treatment and fluid resuscitation.
Decompression can be radiological (nephrostomy) or
surgical (stenting); in the unwell patient a nephrostomy
is preferred as it avoids a general anaesthetic.
Urosepsis can kill even young and fit patients within
hours – if you suspect it, involve your seniors and
the critical care outreach team early. Imaging and
decompression will not wait until morning if the
patient is admitted overnight. Antibiotic treatment is as
for pyelonephritis, but increase the dose of amoxicillin
to 1g/8hrs.
37
Fournier’s gangrene
This is necrotising fasciitis of the scrotum and genitalia.
It is caused by synergistic infection with multiple
organisms. The typical patient is an elderly, obese,
diabetic man, but it can present in anyone with a single
risk factor. Another cause is urinary extravasation from
traumatic catheterisation. The diagnosis is not always
obvious unless you look for it, so always examine the
perineum in an unwell patient.
This is an emergency and there is a mortality
rate of around 50%. Start broad-spectrum IV
antibiotics (meropenem 1g/8hrs and clindamycin
1.2g/6hrs) and fluid resuscitation, call critical care
outreach and inform your seniors immediately.
Patients need urgent surgical debridement of the
affected area, which can be extremely extensive.
38
Discharging
Patients & Further
Reading
39
Discharging patients
Acute surgical beds are usually in short supply, and
medical staff may feel under pressure to discharge
patients. In some situations this is acceptable, but
if you are unsure never discharge a patient – get a
senior opinion. It is all too easy to forget about patients
who have been discharged – make sure that you hand
them over to the Urology team.
Patients with a large residual volume are at risk of
post-catheterisation diuresis and should NOT be
discharged.
Further reading
Oxford Handbook of Urology,
2nd Edition - John Reynard
John Reynard, Simon Brewster, Suzanne Biers, Oxford
University Press 2009 ISBN 978-0198530954
Urological Emergencies in Hospital Medicine
- Iqbal S Shergill, Manit Arya
Hiten R Patel and Inderbir S Gill, Quay Books 2007
ISBN 978-1-85642-337-3
Urology: A Handbook for Medical Students
– S. Brewster, D. Cranston, J. Noble, J. Reynard, BIOS
Scientific Publishers 2001 ISBN 1-85996-300-5
Copies of some of these are available in the Urology
Department.
40
Glossary of Urological inpatient
procedures and terms
Transurethral resection of the prostate (TURP)
- Endoscopic procedure to remove prostatic tissue
blocking the urethra causing either urinary symptoms or
acute urinary retention.
Transurethral resection of bladder tumour (TURBT)
- Endoscopic procedure to remove a bladder tumour.
Ureteroscopy- endoscopic examination of the ureter
usually to fragment ureteric stones or diagnose a tumour.
Extracorporeal shockwave lithotripsy( ESWL)
- The use of focussed sound waves to fragment kidney
calculi. Patients are awake but require analgesia.
Percutaneous nephrolithotomy (PCNL)
- An endoscope is passed through the loin in to the
kidney, the kidney stone is located fragmented and
extracted. A nephrostomy tube draining the kidney is
usually placed.
Radical prostatectomy - This is the removal of the
prostate for localised prostate cancer. It involves an
anastomosis between the urethra and the bladder. It
can be performed through an incision (radical retropubic
prostatectomy) or laparoscopically. An abdominal drain is
always placed post operatively and the urinary catheter
remains for a minimum of 2 weeks. If the catheter falls
out then the oncall consultant urologist needs to be
contacted before any attempt to replace.
41
Radical nephrectomy - Removal of the kidney for renal
cancer. Larger cancers with complex anatomy will be
removed through an incision, smaller cancers can be
removed laparoscopically.
Musgrove Park Hospital
Taunton, Somerset TA1 5DA
42
This book is supported by
Musgrove Park Urology Research Fund
and an Educational Grant from GlaxoSmithKline