Sabiston Textbook of Surgery, 19th Ed: VGHTC

VGHTC
Sabiston Textbook of Surgery, 19th ed
Chief Round
報告 : R3 楊哲瑞
Contents
1 urologic anatomy for the general surgeon
2 endoscopic urologic surgery
3 urologic infectious disease
4 voiding dysfunction, BOO,BPH, and incontinence
5 male reproductive and sexual dysfunction
Department of Surgery
VGHTC
Contents
6 urolithiasis
7 urologic trauma
8 nontraumatic urologic emergencies
9 urologic oncology
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VGHTC
Urologic Anatomy
for the general
surgeon
Department of Surgery VGHTC

UROLOGIC ANATOMY
Upper Abdomen and Retroperitoneum
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UROLOGIC ANATOMY
the surrounding organs:
Right Left
Posterior 12th rib 11th~12th rib

psoas muscle psoas muscle,
Anterior Liver pancreas tail and splenic
hepatorenal ligament vessels,
(coronary ligament) lesser sac and stomach,
duodenum, jejunum,
hepatic flexure of the splenorenal ligament
colon
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UROLOGIC ANATOMY
VGHTC
UROLOGIC ANATOMY
URETER
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UROLOGIC ANATOMY
Ureter
• lie on the psoas muscle
• pass medially to the sacroiliac joints
• cross the iliac vessels anteriorly
• swing laterally near the ischial spines
• pass medially to penetrate the base of the bladder
• vasa deferentia pass anterior to the ureters
• uterine arteries are closely related to the lower ureters
blood supply
• The calyces, pelvis, and upper ureter: renal arteries
• The lower ureter: common and internal iliac, internal
spermatic, and vesical arteries
UROLOGIC ANATOMY
Pelvic Anatomy: Bladder, Prostate,
and Seminal Vesicles
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UROLOGIC ANATOMY
BLADDER
Capacity: ~500 mL
Cephalad: urachus, a fibrous remnant of the cloaca
Superior: covered by peritoneal reflection
Inferior: attached to the pubic bone by puboprostatic ligaments /
pubovesical ligaments
Artery:
• hypogastric a.(internal iliac a.)Æsuperior, middle, and inferior vesical arteries
• vaginal and uterine a.
Vein:
• vesicle plexus Æ internal iliac v.
Lymphatics:
• The bulk of the lymphatic drainage Æ external iliac LN
• Anterior, lateral drainage Æ obturator, internal iliac node
• Base, trigone Æ internal, common iliac groups
transitional epithelial cell = urothelium = bladder mucosa
Æ lamina propria
Æ muscularis propria = detrusor muscle
UROLOGIC ANATOMY
Pelvic Anatomy: Bladder, Prostate,
and Seminal Vesicles
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UROLOGIC ANATOMY
PROSTATE
Weight:~20 g
Anterior: puboprostatic ligament
Inferiorly: urogenital diaphragm
Posterior: Denonvilliers' fascia x2 layersÆ rectum
Zonal anatomy
• peripheral zone
• central zone
• transitional zone
• anterior segment(anterior fibromuscular stroma)
• preprostatic sphincteric zone
• *BPH develops from the median or lateral lobes, posterior lobe is
prone to cancerous formation.
ejaculatory ductsÆ verumontanum
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UROLOGIC ANATOMY
PROSTATE
Artery:
• inferior vesical a.
• internal pudendal a.
• middle rectal (hemorrhoidal) a.
Vein:
• periprostatic plexus, which has connections with the deep
dorsal vein of the penis and the internal iliac
(hypogastric) veins
neurovascular bundles (NVB): near the posterolateral
surface of the urethra and prostate gland
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UROLOGIC ANATOMY
Groin, Genitalia, and Perineum
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UROLOGIC ANATOMY
Male urethra
20 cm
four anatomic sections
• Prostatic urethra
• Membranous urethra
• Bulbous urethra
• penile urethra.
female urethra
4 cm
lies below the pubic symphysis
anterior to the vagina
voluntary external urinary sphincter:
lies within the urogenital diaphragm
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UROLOGIC ANATOMY
Spermatic cord, contains:

vas deferens
internal and external spermatic arteries,
artery of the vas
spermatic vein
Lymphatics
Nerves
epididymis
1~3 seminiferous tubules Ærete testis in the mediastinum Æ12~
20 efferent ductules Æhead of the epididymis Æsingle coiled
duct of the epididymis
testis
4 × 3 × 2.5 cm in diameter
Tunica albuginea, connects with the lobules within the testis
Ævisceral tunica vaginalis Æ serous tunica vaginalis
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VGHTC
endoscopic urologic
surgery

Endoscopic
urologic surgery
Cystoscopy/cystourethroscopy(CUS)
rigid or flexible
adult
• 17Fr diagnostic rigid scopes
• 24 to 26 Fr operating resectoscopes
Cold cup biopsy forcep
Cone-tipped / straight ureteral catheter
Retrograde pyelography (RP): May be safely
performed to patients with a history of contrast allergy
To aid in identifying the ureters during surgery
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Endoscopic
urologic surgery
Optical urethrotome: urethral stricture
incision
Electroresectoscope
cutting loop
Green Light laser
Holmium laser
bipolar resection system
Ellik evacuator
Continuous bladder irrigation (CBI)
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Endoscopic
urologic surgery
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Urologic Infectious
Disease

Urologic infectious
disease
Emphysematous Infection
DM
Emphysematous pyelonephritis
• fulminant infection involving the renal parenchyma progress
to involve the perinephric space
• most common causative agent: E.coli
• percutaneous drainage
• urgent nephrectomy: delay if improving with medical
treatment
Emphysematous pyelitis
• gas within the renal collecting system but not within the
parenchyma
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Urologic infectious
disease
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Urologic infectious
disease
Emphysematous cystitis
• gas-forming infection involving the bladder wall
• urinary catheter drainage
Acute papillary necrosis
• ischemic state involving the renal papillae
• sloughed papilla into the collecting system and
ureter, causing obstruction
• urgent drainage of the obstructed upper tract
Gas present in the urinary tract
• anaerobic urinary infection, instrumentation or
catheterization, colovesical fistula
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Urologic infectious
disease
Xanthogranulomatous Pyelonephritis
foamy, lipid-laden, macrophage infiltrate in the renal
parenchyma
chronic bacterial infection, usually in the presence of
stones and chronic obstruction
poorly functioning kidney
fistulization to the flank or adjacent organs
drainage often are unproductive, Nephrectomy is
usually indicated
• “cooling off period” for active infection
• risk of iatrogenic adjacent organ injury is high
• the renal vessels cannot be individually dissected
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Urologic infectious
disease
Epididymitis, Epididymo-Orchitis, Without
and With abscess
infected through ascending infection from the urinary
tract down the vas deferens into the scrotum
DDx:
• testicular torsion
• incarcerated inguinal hernia
• testicular tumor with necrosis and inflammation
Scrotal ultrasound
• abscess: surgical drainage +/- orchiectomy
• testicular ischemia: exploration +/- orchiectomy
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Urologic infectious
disease
Fournier’s Gangrene
Necrotizing soft tissue infections of the genitalia
scrotal and genital pain, swelling, discoloration or
frank necrosis, crepitus, foul-smelling discharge
broad-spectrum antibiotic, supportive care, urgent
surgical debridement
separate the parietal tunica vaginalis of the testes
from the overlying necrotic dartos and skin and
preserve the tunical compartment intact
If the penile skin is necrotic, it can be débrided down
to but not through the Buck’s fascial layer
urinary tract source: urethral stricture with perforation
　Foley
meshed STSG for the scrotum and nonmeshed thick
STSG for the penile shaft
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Urologic infectious
disease
VGHTC
Urologic infectious
disease
Genitourinary Fungal Infections
diabetics, immunocompromised patients
extensive nosocomial and antibiotic exposure
invasive fungal infections of the bladder or
kidneys may be life-threatening
antifungal bladder irrigation
fungus balls in the renal colleting
system:direct irrigation or endoscopic removal
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Urologic infectious
disease
Genitourinary Tuberculous Infections
Urine cultures from the first morning void
Upper urinary tract tuberculosis infection
• may cause ureteral strictures, result in silent
obstruction and renal loss
Tuberculous epididymitis
chronic epididymitis results in cutaneous
fistula formation
test for an immunocompromised state,
including HIV
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Voiding Dysfunction,
BOO, BPH, and
Incontinence

Voiding dysfunction
Postoperative Acute Urinary Retention
Cause:
• Immobility
• Narcosis
• anticholinergic side effects of anesthetic agents
• underlying subclinical bladder outlet obstruction,
• local pain and spasm (typical after hemorrhoid or groin hernia
surgery)
• transient prostatic swelling following coronary bypass surgery
or other procedures requiring cardiopulmonary bypass
Treatment:
• Catheterization 　 voiding trial 　 second catheterization +
indwelling Foley catheter for 1 or more days
• alpha blocker
• adequate analgesics
• urodynamic studies
• cystoscopy
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Voiding dysfunction
Urinary Incontinence
Urgency incontinence
• loss of urine associated with an urge to void
• overactive bladder / detrusor instability
• anticholinergic / antimuscarinic
– SE: dry mouth, constipation, confusion
– Contraindication: narrow-angle glaucoma
Stress incontinence
• loss of urine with movement, straining, or increase in
abdominal pressure
• multiple vaginal deliveries, psot radical prostatectomy
• pelvic floor exercises, sling, artificial urinary sphincter
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Voiding dysfunction
Overflow incontinence
• loss of urine when the bladder becomes full and
there is an inability to empty volitionally
• palpate the full bladder, measurement of postvoid
residual by ultrasound or catheter drainage
• the cause of the bladder distention: obstructive
versus detrusor dysfunction
Mixed incontinence
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Voiding dysfunction
Neurourology and Voiding

Dysfunction of the Neurologically
Impaired
cerebral dysfunction: uninhibited detrusor
function
cervical cord lesions: detrusor-sphincter
dyssynergia (DESD)
lower lumbar / sacral lesions: bladder
flaccidity and impaired emptying
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Voiding dysfunction
Benign Prostatic Hyperplasia and

Bladder Outlet and Urethral
Obstruction
LUTS (lower urinary tract symptoms)
little correlation between the measured
volume of the prostate and degree of
symptomatology that results
watchful waiting
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Voiding dysfunction
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Voiding dysfunction
medical therapy
• α-adrenergic blocking agents
– orthostatic side effects
• 5-alpha-reductase inhibitors
– block the conversion of testosterone to dihydrotestosterone
– reduce the actual volume of the prostate
– alters the serum PSA level (reduces it ≈50%)
– maximal effects seen by 6 months
minimally invasive
standard surgical intervention
• laser procedures
• TURP
• open simple prostatectomy
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male reproductive &

sexual dysfunction

Male Infertility
Infertility affects 15% ~ 20% of couples

Male factor: 50% of these cases.
Hx:
• potential gonadotoxic exposure
• urologic and sexually transmitted infections
• trauma and prior surgery involving the pelvis, groin, and
genitalia
• family history of infertility
PE:
• Masculinization
• meatal location
• testicular size
• presence and normalcy of the
epididymis and vas deferens
• Varicocele
• DRE
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Male Infertility
Semen analysis
• semen volume
• consistency
• sperm concentration
• sperm total count
• percentage motility
• quality of sperm movement
• sperm morphology
• presence of RBC/WBC/bacteria
serum hormone studies
• FSH
• LH
• testosterone
• free testosterone
• prolactin
VGHTC
Male Infertility
azoospermia: complete absence of sperm from

the semen
• lack of sperm production
– normal semen volume
– elevated serum follicle-stimulating hormone (FSH) level
• defects in sperm transport or ejaculation
– ductal obstruction
» iatrogenic injury (e.g., inguinal hernia repair)
– ejaculatory dysfunction.
abnormal bulk semen parameters: reduced sperm

numbers, motility, or morphology
• varicocele
• antisperm antibodies
• genital duct infection with pyospermia causing sperm dysfunction
• gonadotoxic exposure
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Male Sexual
Dysfunction
40% of men at 40y/o and 70% of
men at 70y/o
erectile dysfunction can be an early
indication of significant
atherosclerotic vascular disease
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Urolithiasis

Urolithiasis
Risk factors
20~50y/o, males, Caucasians and Asians
family history of stone disease
Low fluid intake (<1200ml/day)
High animal protein intake
Low activity levels
Chronic UTI
primary hyperparathyroidism
Sarcoidosis
Familial renal tubular acidosis
hyperoxaluria
cystinuria
inflammatory bowel disease
short gut syndrome
medullary sponge kidney
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Urolithiasis
Symptoms
acute onset pain, hematuria, and possibly
nausea, vomiting, and ileus.
Image:
KUB: 90% of stones are radio-opacity
Ultrasound: hydronephrosis
non-contrast CT: the stone and the dilated
collecting system proximal to it
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Urolithiasis
Acute episodes: obstruction /

infection
Hydration
Analgesics
Decompressed urgently if with infection
• retrograde ureteral stent insertion
• percutaneous nephrostomy insertion
• Ureteroscopic lithotripsy is contraindicated.
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Urolithiasis
Treatment
Watchful waiting pilots
Extracorporeal lithotripsy (ESWL)
Intracorporeal techniques
• Ureteroscopic stone manipulation
• Flexible ureteroscopy and laser treatment
• Percutaneous nephrolithotomy (PCNL)
Open/Laparoscopic stone surgery
• Pyelolithotomy
• Anatrophic (avascular) nephrolithotomy
• Nephrectomy
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Urologic Trauma

Urologic trauma
Urologic injury
10% of penetrating abdominal trauma cases
variable percentage of blunt abdominal
trauma cases
Renal injuries
1.4% to 3.25% of all trauma patients
4% to 8% of penetrating trauma patients
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Urologic trauma
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Urologic trauma
Renal Injuries
Imaging :CT scan
• renal vasculature and of parenchymal lacerations
• displaced or nonperfused parenchymal fragments
• urinary extravasation
• assessing function of the contralateral uninjured kidney
• one-shot IVP may be obtained 10 minutes after the
injection of iodinated contrast
Treatment
• Grade 1 ~ 3:routinely managed nonoperatively
• Grade 4:controversial
– hemodynamic
– Interventional radiology options
• grade 5:operative intervention
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Urologic trauma
Ureteral Injuries
5% to 10% of penetrating abdominal trauma
uncommon in blunt trauma
gross hematuria may be absent
Imaging
• Contrast-enhanced CT + delayed excretory phase
• retrograde pyelography
• IVP
Treatment
• penetrating injuries / blunt avulsion: best managed by
surgical repair
• Ureteral contusions:
– prophylactic stenting to reduce progressive edema, occlusion, and
ischemia and postinjury extravasation
• avoid devascularization to prevent ischemic injury
• spatulated, tension-free anastomosis
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Urologic trauma
Bladder Injuries
Gross hematuria
Penetrating injuries with laparotomy planned:
• direct inspection of the injury site intraoperatively
Blunt trauma
• stress cystogram to distinguish intraperitoneal from extraperitoneal
injury
Extraperitoneal rupture
• pelvic fracture Æ tearing and shear forces related to injury to the pelvic
ring
• catheter drainage alone
• repair may be necessary when failure of catheter management
Intraperitoneal rupture
• sudden compression of the bladder by impact to the lower anterior
abdominal wall --> laceration of the bladder dome
• exploration and repair
Complex bladder injuries
• extensive lacerations of the bladder neck in women, or concomitant
injury to the lower bladder segment and rectum or vagina
• require operative repair
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Urologic trauma
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Urologic trauma
exploration of the bladder:
• midline anterior cystotomy
• examine interior of the bladder
• evacuate blood clot
• assess critical structures
– intramural ureters
– ureteral orifices
– passing feeding tubes up the ureters
– intraoperative retrograde pyelography
– bladder neck
• close defects in the bladder wall in two layers
– care should be taken when suturing the bladder near
the ureteral orifices or intramural ureter
– intraoperative stenting
• Injuries in continuity with rectal or vaginal injuries
– omental flap interposition to prevent fistula
• diversion with a large-bore Foley catheter (22~24Fr)
• suprapubic cystostomy tubes
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Urologic trauma
Urethral Injuries
suspicion of urethral injury
• blood per the urethra or blood at the urethral meatus
following blunt trauma
– pelvic fracture
– straddle injury with perineal impact
• penetrating trauma
– severe pubic diastasis
– marked vertical shear pelvic fracture
retrograde urethrography prior to Foley

catheter insertion
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Urologic trauma
Treatment
• primary immediate goal: provide urinary bladder
drainage – suprapubic catheter
• early catheter realignment for posterior urethral
disruption
• delay repair
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Urologic trauma
Genital Injuries
Early exploration and repair
Penile injuries
• remove foreign material
• cleanse the wound
• hemostasis
• repair defects in the tunica albuginea or urethra
– Penile fracture: sudden flexion of the erect penis during sexual
activity
Scrotal and testicular injuries
• scrotal ultrasound: whether the testis is ruptured
• débridement of devitalized parenchyma
• closure of the capsule (tunica albuginea of the testis)
• repair of the scrotum
• Orchiectomy
– thoroughly destroy the blood supply to the testis
– no viable parenchyma available to salvage.
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VGHTC
Nontraumatic
Urologic Emergencies

Testicular Torsion
congenital deformity: “bell clapper deformity”

→able to rotate freely on its spermatic cord pedicle
→progressive edema and venous and arterial occlusion
→testicular infarction
occurring usually in the pediatric, adolescent,
and young adult groups
DDx:
• trauma,
• epididymitis,
• incarcerated hernia
Doppler ultrasound: absence of arterial flow
to the testis.
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Testicular Torsion
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Testicular Torsion
Best results: detorsion within 4 hours of the onset
of pain
8 ~ 12 hours: testicular viability and function
decreases significantly
Ultrasound: within 1 hour after presentation
surgical exploration if high suspicion and
ultrasound is not available in a reasonable
time frame
scrotal incision Æ detorsion Æ orchiopexy Æ
orchiopexy on the contralateral side at the
same setting
Even a late torsion is suspected (e.g., several
days of fixed swelling, firmness), urgent
exploration is still indicated
VGHTC
Gross Hematuria With Clot Retention
Surgical Emergency:
• with a hazardous degree of blood loss
• with urinary clot retention
Etiology:
• post-OP bleeding after TURP /TURBt
• radiation cystitis
• pelvic trauma
• arteriocalyceal fistula
VGHTC
Gross Hematuria With Clot
Retention
Treatment
• large-bore (20 to 26 Fr), three-way Foley
catheter for removal of clots from the bladder
by catheter irrigation
• evacuation of clots under rigid cystoscopy and
resectoscope sheath
• fulguration
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Priapism
Definition:
Prolonged and often painful erection in the absence
of a sexual stimulus, lasting > 4~6h
may resolve spontaneously but, if it persists longer
than 2 to 3 hours, measures should be taken
Etiology:
sickle cell disease
drugs
pelvic or genital trauma
hematologic malignancy
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Priapism
Low-flow priapism
Due to veno-occlusion, typical of sickle cell
patients
More common than high-flow priapism
sludging of blood in the corpora cavernosa results
in the accumulation of dark thick material
Ischaemic priapism > 4h: emergency intervention
Aspiration of blood from corpora:50ml portions
using a 18~20 gauge butterfly needle
Intracavernosal injection of α1 -adrenergic
agonist
medical treatment of the sickle crisis :
rehydration, oxygenation, analgesia, and
haematological input (consider exchange
transfusion). Department of Surgery
VGHTC
Priapism
High-flow priapism
after penile or perineal trauma
fistula develops between a central corporal
artery and the vascular space within the
corpus cavernosum
Aspiration: arterial appearance and arterial
blood gas parameters
cool bath / icepack
embolization of the internal pudendal artery
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VGHTC
Urologic Oncology

urologic oncology
Renal Tumor
Diagnosis
• solid renal tumors > 3 cm: 65% ~ 75% represent renal cell carcinomas
• Bx prior to surgical extirpation is reserved
• DDx:
– lymphoma
– minimally fat-containing angiomyolipoma,
– Sarcoma
– pseudotumor
Paraneoplastic syndromes: found in 20% of patients with
RCC
• hypercalcemia
• anemia
• Stauffer's syndrome(Nonmetastatic hepatic dysfunction)
• ESR elevation
• *cytokine
• *Hepatic function normalizes after nephrectomy: 60% to 70%
Cystic renal masses: Bosniak classification

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urologic oncology
VGHTC
urologic oncology
Histologic Classification
Conventional
• Clear cell
• Granular
• Mixed
Chromophilic/papillary
• Type1
• Type2
Chromophobic
Collecting duct
• Medullary cell
Unclassified
*Sarcomatoid variants of almost all the histologic subtypes
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urologic oncology
Partial nephrectomy
• small, well-encapsulated, superficial, exophytic, polar lesion
• positive margin and local recurrence rate: acceptable range < 5%
Radical nephrectomy
• multiple tumors, large central tumor, postoperative hemorrhage,
necrosis, or loss of collecting system integrity
Open, laparoscopic or robotic technique
+/- regional lymph node dissection
+/- splenectomy, distal pancreatectomy, wedge
resection of the liver, duodenum, partial resection
of the colon, resection of flank musculature
+/- renal vein or vena caval tumor thrombus
resection
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urologic oncology
Urothelial Cancer: Upper and Lower
Tract
Risk factors:
• age
• Tobacco smoking
• chemical exposures:
– aniline dyes
– aromatic amine compounds
– rubber, leather, dye and petroleum workers
– Cyclophosphamide
• chronic inflammation: SCC
• Schistosomiasis:Schistosoma hematobium:
SCC
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urologic oncology
Bladder cancer
TCC: 90%
• consider upper tract imaging
• long-term recurrence rate: 50%
SCC: 5% ~ 10%
• schistosomal infection
• chronic inflammatory
• smoking
Adenocarcinoma: 1% ~ 2%
• urachal in origin, typically seen at the upper bladder
dome
• history of bladder exstrophy
• evaluation of the GI system to ensure that the tumor has
not arisen from another organ system
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urologic oncology
Symptoms:
• gross painless hematuria: 75%
• chronic irritative voiding symptoms
• pelvic mass
• flank pain: upper tract obstruction
• flank mass
Dx:
• Urine cytology / bladder wash cytology
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urologic oncology
Treatment:
• TURBt
• BCG intravesical immunotherapy: initial + maintenance
• Intravesical Chemotherapy: Mitomycin C
– immediately following standard TUR
• Radical cystectomy: muscle-invasive bladder cancer
– +/- neoadjuvant chemotherapy
– male: cystoprostatectomy
– female: cystohysterectomy
– +/- urethrectomy
– urinary diversion
» ileal conduit
» cutaneous catheterizable reservoirs
» orthotopic bladder substitution / neobladder:
Studer pouch
• Chemotherapy: MVAC or GC
VGHTC
urologic oncology
Upper tract TCC

Treatment:
• Surgical resection
– +/- neoadjuvant chemotherapy
– Nephroureterectomy, including ureteral orifice
• distal ureterectomy + ureteral reimplantation
• endoscopic ablation
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urologic oncology
Prostate Cancer
Adenocarcinomas(95%)
Dx:
• Asymptomatic
• DRE, PSA, discovered incidentally during radical
cystectomy or TURP
Risk factors:
• family history : Y chromosome
• advancing age
• African American heritage
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urologic oncology
Prostate Cancer
Screening for prostate cancer: PSA and DRE
• recommended by the American Cancer Society
and American Urologic Association
• in all men older than 50 years
• with elevated risk factors: 40 / 45 years
• PSA
– normal-range
» 50 y/o: 2.5ng/mL
» 60 y/o 3.5ng/mL
– percentage of free PSA
» >25%: <10% risk
» <10%: >50% risk
– PSA velocity: <0.75 U/year
• improve survival, but controversy
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urologic oncology
Prostate Cancer
Dx:
• TRUS Bx
• Gleason score: two highest and most prominent
grades observed
• CT scan: lymph nodes metastasis
• Bone scan: bone metastasis
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urologic oncology
Prostate Cancer
Tx:
• localized disease
– watchful waiting: low PSA level, low-grade, low-volume tumor
– brachytherapy
– cryotherapy
– radical prostatectomy
– External beam therapy
• advanced disease
– androgen ablation therapy
» luteinizing hormone-releasing hormone (LHRH) agonists
» bilateral simple orchiectomy
• Castration-Resistant Prostate Cancer
– chemotherapy
VGHTC
urologic oncology
Penile, Urethral, and Other Genital

Malignancies
Penile cancer
•Uncommon
•SCC
•chronic phimosis and local infection: HPV
•circumcision, distal penectomy, or radical
penectomy +/- inguinal lymphadenectomy
Urethral cancer
• women > men
• TCC
• partial or total urethrectomy
Squamous cell cancers of the scrotum
• chimney sweeps: carcinogenic effects of inspissated soot
• Local excision
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VGHTC

Sabiston Textbook of Surgery, 19th Ed: VGHTC

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VGHTC

Sabiston Textbook of Surgery, 19th ed

1 urologic anatomy for the general surgeon

2 endoscopic urologic surgery

3 urologic infectious disease

4 voiding dysfunction, BOO,BPH, and incontinence

5 male reproductive and sexual dysfunction

8 nontraumatic urologic emergencies

Department of Surgery VGHTC

Upper Abdomen and Retroperitoneum

 the surrounding organs:

Posterior 12th rib 11th~12th rib

 Spermatic cord, contains:

Department of Surgery VGHTC

Department of Surgery VGHTC

Department of Surgery VGHTC

Neurourology and Voiding

Benign Prostatic Hyperplasia and

male reproductive &

Department of Surgery VGHTC

 Infertility affects 15% ~ 20% of couples

 azoospermia: complete absence of sperm from

 abnormal bulk semen parameters: reduced sperm

Department of Surgery VGHTC

Acute episodes: obstruction /

Department of Surgery VGHTC

 retrograde urethrography prior to Foley

Department of Surgery VGHTC

 congenital deformity: “bell clapper deformity”

Department of Surgery VGHTC

 Cystic renal masses: Bosniak classification

Upper tract TCC

Penile, Urethral, and Other Genital

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Upper Abdomen and Retroperitoneum

the surrounding organs:

Spermatic cord, contains:

Neurourology and Voiding

Benign Prostatic Hyperplasia and

Infertility affects 15% ~ 20% of couples

azoospermia: complete absence of sperm from

abnormal bulk semen parameters: reduced sperm

Acute episodes: obstruction /

retrograde urethrography prior to Foley

congenital deformity: “bell clapper deformity”

Cystic renal masses: Bosniak classification

Upper tract TCC

Penile, Urethral, and Other Genital