Surgery F

Md Najmus Sakir
K-75
A) Ruptured urethra

B) Investigation
➢ Retrograde/ascending urethrogram (dye injected in urethra, and
visualized by X ray whether rupture has occurred)
➢ X ray of the Pelvis and KUB (for fracture management)

A) DD: -Renal stone -Ureteric stone

B) Investigations:
➢ X ray KUB

➢ USG of KUB

➢ IVU

➢ Cystoscopy

➢ Retrograde uretero/pyelography
▪ CBC
▪ ESR
▪ Serum electrolytes
▪ Serum creatinine
▪ Urine RME & C/S

A) Intravenous Urogram (IVU) is an imaging test where intravenous dye is

injected and thereafter image of the urinary tract is taken to see any
pathology.

B) -Plain Xray KUB -USG of KUB -Serum creatinine -Urine RME

C) "Pre-contrast X-ray: A baseline X-ray of the abdomen or pelvis is taken

before the administration of the contrast dye. This image serves as a
reference to compare with the subsequent images.

Nephrographic Phase: This phase involves a series of X-ray images taken

at specific time intervals after the injection of the contrast dye. Typically, X-
rays are taken at 5, 10, and 15 minutes after the injection. These early-
phase X-rays capture the visualization of the contrast dye as it passes
through the kidneys, renal pelvis, and ureters.

Pyelographic Phase: After the nephrographic phase, additional X-ray

images are taken at specific intervals to visualize the contrast dye as it fills
the bladder. These X-rays are usually taken at 15, 30, and 45 minutes after
the injection.
Delayed Images: In some cases, delayed X-ray images may be acquired
after several hours, typically around 2 to 4 hours, to assess the excretion of
the contrast dye and identify any abnormalities or obstructions."

A) Post operative acute urinary retention

B) Possible causes:
-Anesthetics effect
-Pain medications
-Surgical trauma
-Bladder distension (atony)
-Urethral obstruction (blood clot, Catheter blockage)

C)
Post-operative retention Acute retention
After operative procedure Sudden onset
Hx of catheterization Not such
Due to anesthetics, pain medication, BEP, urethral rupture
atony
A) Bilateral renal injury

B) -Polycystic Kidney Disease

-Posterior Urethral valve leading to hydronephrosis

A) ➢ It refers to Aseptic dilatation of urinary tract (mainly pelvis and renal

calyces) due to urinary tract obstruction

B) Causes:
➢ unilateral
o intraluminal: stone in renal pelvis, papilla; sloughed papilla in case
of papillary necrosis
o intramural: congenital PUJO, Ureter cancer, stricture ureter
o extramural: ca cervix, ca rectum, retroperitoneal fibrosis
➢ bilateral (causes of chronic retention of urine)
o congenital
▪ meatal stenosis (pin hole meatus)
▪ posterior urethral valve (failure of canalization)
 o acquired
▪ BPH
▪ Ca prostate
▪ Ca cervix
▪ Ca rectum
▪ Post operative fibrosis/stricture of bladder neck
▪ Phimosis
Congenital PUJO: most common cause

C) Complications: -Stone -Obstructive uropathy -Infection: Pyonephrosis

-Perinephric abscess -Renal failure

A) According to composition:
➢ Oxalate stone (in oxaluria; sharp pointed stone with irregular shape)
(Calcium oxalate stone = most common kidney stone) (hyperoxaluria –
primary)
➢ Phosphate stone: includes,
o Struvite stone (Mg NH4 PO4): in proteus UTI → causes staghorn calculi
(infection)
➢ Uric acid stone & Urate stone: Radiolucent stone (seen in CT, rather
than X ray) (hyperuricemia)
➢ Cysteine stone (cystinuria)
➢ Xanthine stone (rare)
B) Phosphate stone

C) Treatment:

➢ General rx: NSAID for pain relief + monitor patient + antibiotic + plenty of
fluid

➢ Expectant (stone <5 mm will pass away spontaneously -follow up by

Xray 6-8 weekly)

➢ Surgical (to relieve symptoms by removing/destroying stone)

o Minimal access methods

▪ Extra corporeal shockwave lithotripsy (ECSWL)

▪ Percutaneous Nephrolithotomy (PCNL)

▪ Ureteroscopy

• Followed by dormie basket stone retrieval

• Or followed by lithotripsy (litholaplaxy)

o Open surgical methods (pyelolithotomy, nephrolithotomy,

partial/total nephrectomy)

➢ Medical (to prevent future stone)

o Hypercalcemia: increase fluid intake, calcium binding agent

o Renal tubular acidosis and cystinuria: NaHCO3/KHCO3 (make

urine alkaline)

o Uric acid stone: allopurinol

o UTI: antimicrobials
A) Dx: Benign enlargement of prostate

B) DRE:
o Prostate enlarged
o Smooth, convex
o Firm consistency
o Median sulcus is predominant
o Non tender
o Rectal mucosa free from prostate
o Residual urine felt above prostate level
o After taking out, finger is not blood stained

C) Investigations:
-USG of KUB region & prostate e PVR & MCC
-Xray of KUB
-IVU
-Urine R/M/E
-Blood urea
-Serum creatinine
-Flow rate measurement
-Prostate specific antigen
A) Dx: UTI

B) Cause: Escherichia coli (85%), Staphylococcus saprophyticus,

Enterococcus faecalis, Proteus and Klebsiella.

C) Investigations:
-Urine RME
-Urine C/S ( clean catch mid-stream urine)
-USG of KUB
-Xray KUB

A) Dx: Acute retention of urine most probably due to BEP

B) Catheterization, if fails then suprapubic cystostomy
C) Complications: -Rupture of urethra -Bleeding -Infection
A) Dx: Bladder rupture

B) Types: -Intraperitoneal -Extraperitoneal -Mixed

C) Measures:
Extraperitoneal injury-
-urethral catheterisation with free bladder drainage for 10–14 days
-followed by a cystogram to ensure that the injury has healed prior to
removal of the catheter
Intraperitoneal injury-
-open surgical repair to reduce the risks of urinary contamination of the
peritoneal space
A) DD: -Undescended testis -Retractile testis

B) Testicular manipulation: Gently manipulate the testis on the left side to

evaluate if it can be pulled down into scrotum (Retractile testis) or if it
remains fixed in position (Undescended testis)

C) Inv:
-USG od W/A
-CT scan
-Diagnostic Laparoscopy