Republic of the Philippines

Department of Health
HEALTH FACILITIES AND SERVICES REGULATORY BUREAU

Checklist of Requirements in Equipment/Instruments for

Urologic Ambulatory Surgery
The following equipment/instruments shall be required for the specified procedure. Place a check (/) if the ASC
is compliant and x mark (X) if not compliant.
PROCEDURE AVAILABILITY ADDITIONAL EQUIPMENT/INSTRUMENTS COMPLIANCE REMARKS
(/ if available)
1. Circumcision (none)
2. Testicular Biopsy
3. Vasectomy
4. Varicocelectomy Major surgical set :
• Adson forceps (2)
• Blade Handle (1)
5. Hydrocelectomy • Kelly curve (4)
6. Orchiectomy • Kelly straight (4)
• Needle holder (1)
• Mosquito curve (4)
• Mosquito straight (4)
• Retractors
o Army –Navy (2)
o Richardson (2)
• Scissors
o Mayo (1)
o Metzenbaum (1)
• Thumb forceps (2)
• Tissue forceps (2)
7. Urethral Calibration Urethral sounds set:
and Dilatation French 16, 18, 20, 22, 24, 26, 28
8. Cystoscopy Cystoscope set (sheath,obturator,
lens 0-30 deg):
Light source/light cable
Water canister and tubing
Optional:
Bladder biopsy grasper
Electrocautery machine with
underwater capability
Ureteral stent, guide wire
Resectoscope set
9. Ureteroscopy Light source/light cable
Water canister & tubing
Ureteroscope
Optional:
Lithotriptor machine
Stone basket extractor
Ureteral biopsy grasper
10. Extracorporeal Ear muffs
Shock Wave Lead gown, shields for thorax and neck
Lithotripsy (ESWL) Lithotriptor machine with fluoroscope
and/or ultrasound imaging capability
11. Percutaneous Biopsy needle
Nephrostomy, Percutaneous set
Renal Cyst High resolution ultrasound machine
Aspiration, with rectal probe
Prostate Biopsy
DOH-ASC-LTO-AT Checklist Urologic
Revision:01
01/26/2015
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