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Chapter 144 - Vasectomy
- from Section 26 - Urologic Surgery
- Edited by Michael F. Lubin, Emory University, Atlanta, Thomas F. Dodson, Emory University, Atlanta, Neil H. Winawer, Emory University, Atlanta
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- Book:
- Medical Management of the Surgical Patient
- Published online:
- 05 September 2013
- Print publication:
- 15 August 2013, pp 809-810
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Summary
Vasectomy is an extremely common, cost-effective, and permanent form of contraception dating back to the late 1800s. Presently, in the USA, approximately 500,000 vasectomies are performed annually. An approximated 11% of the USA population uses vasectomy as their means of contraception, making it the most commonly performed urologic procedure in the USA.
In comparison with other methods, vasectomy has been estimated to produce a 5-year saving of nearly $14,000. Contraception saves the USA $19 billion a year in medical costs. The three most cost-effective forms of contraception when comparing all types are the copper-T IUD, vasectomy, and the LNG-20 IUS.
Couples often come to a personal decision on contraception, and therefore must choose from various options. Urologists can educate patients regarding vasectomy as a safe, costeffective, permanent form of contraception.
The initial office visit of a patient seeking a vasectomy should begin with a complete history/physical and specific questions regarding the patient’s reasons for seeking a vasectomy. Questions to the patient should include: if discussion about vasectomy has occurred with the partner; how many children they have, and if they know anyone else who has had a vasectomy. Other pertinent questions should include family history of bleeding disorders, patient use of antiplatelet or anticoagulant medications, and any past history of surgery/ trauma to the testis or inguinal canal (i.e., hernia). The exam, while complete, should focus on palpation of both vasa deferentia. The feasibility of performing the vasectomy procedure is based on the patient’s anatomy. Complications to be discussed include epididymitis, recanalization, chronic orchialgia, and anti-sperm antibodies.
Chapter 138 - Management of upper urinary tract calculi
- from Section 26 - Urologic Surgery
- Edited by Michael F. Lubin, Emory University, Atlanta, Thomas F. Dodson, Emory University, Atlanta, Neil H. Winawer, Emory University, Atlanta
-
- Book:
- Medical Management of the Surgical Patient
- Published online:
- 05 September 2013
- Print publication:
- 15 August 2013, pp 787-789
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Summary
The term “Endourology” has been adopted for the minimally invasive endoscopic surgery of upper urinary calculus disease. Since the introduction of shock wave lithotripsy, this modality has become the most common form of stone therapy, allowing an almost completely hands-off treatment for radio-opaque calculi. Due to the technological advances of endourologic procedures such as ureteroscopy and percutaneous nephrolithotomy (PCNL), the incidence of open kidney stone surgery is almost non-existent. Due to the popularity of the daVinci robot (Intuitive, CA), traditional open calculus surgeries are being performed robotically for stones that would otherwise require several endoscopic procedures. It is important to note that as advanced as surgical intervention has evolved for nephrolithiasis, medical management and prevention of complicated urolithiasis still fall short of the ideal.
Nephrolithiasis affects as much as 12% of the population in industrialized nations. Urolithiasis patients will agree that the sensation of stone passage is perhaps the most painful and intense experience of their lives, surpassing even childbirth. Urolithiasis may present as hematuria (ranging from asymptomatic microscopic hematuria to painful gross hematuria), abdominal/flank/back pain, urinary tract infection, renal failure, or as an incidental radiologic finding.
Chapter 141 - Nephrectomy
- from Section 26 - Urologic Surgery
- Edited by Michael F. Lubin, Emory University, Atlanta, Thomas F. Dodson, Emory University, Atlanta, Neil H. Winawer, Emory University, Atlanta
-
- Book:
- Medical Management of the Surgical Patient
- Published online:
- 05 September 2013
- Print publication:
- 15 August 2013, pp 797-800
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Summary
Nephrectomy is a common urologic procedure indicated for malignancy, certain benign conditions of the kidney and renal transplantation. Simple, radical, partial and donor nephrectomies and nephroureterectomy all have common surgical steps but have unique complications. Renal tumor ablative interventions are the more commonplace attempts to limit patient morbidity.
Simple nephrectomy is indicated for benign but not trivial conditions. Indications include non-functioning kidneys causing pain (usually from congenital obstruction or urolithiasis), reno-vascular disease causing uncontrollable hypertension, benign symptomatic tumors (angiomyolipomas), trauma, or treatment of infectious diseases (xanthogranulomatous pyelonephritis, chronic or emphysematous pyelonephritis, and tuberculosis). During simple nephrectomy, the kidney is removed within Gerota's fascia along with a small amount of ureter. Nephrectomy for inflammatory conditions can be the most exacting of procedures; medical comorbidities add to the challenge of patient management.
Donor nephrectomy is a simple nephrectomy in which a healthy kidney (usually the left because of increased vein length) is removed and transplanted as an allograft in a controlled scheduled situation. These donor patients are all healthy and have had extensive preoperative evaluations. Transplant nephrectomy is a simple nephrectomy in which the renal allograft is removed, usually because of rejection complications.
Radical nephrectomy involves the removal of all structures within Gerota’s fascia, which includes the adrenal, kidney, and peri-renal tissue. Adrenal-sparing radical nephrectomy, especially for lower pole tumors, has become commonplace because of the low incidence of ipsilateral adrenal invasion or metastases. Most renal tumors are found incidentally by CT or MRI, or during the process of hematuria screening. Upwards of 95% of enhancing renal masses are malignant; therefore, needle biopsy or pathologic proof before surgery is not routinely obtained.
129 - Nephrectomy
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- By John G. Pattaras, Emory University, School of Medicine, Atlanta, GA
- Edited by Michael F. Lubin, Emory University, Atlanta, Robert B. Smith, Emory University, Atlanta, Thomas F. Dodson, Emory University, Atlanta, Nathan O. Spell, Emory University, Atlanta, H. Kenneth Walker, Emory University, Atlanta
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- Book:
- Medical Management of the Surgical Patient
- Published online:
- 12 January 2010
- Print publication:
- 10 August 2006, pp 775-779
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Summary
Nephrectomy is a common urologic procedure indicated for malignancy, certain benign conditions of the kidney, and renal transplantation. While simple, radical, partial, donor nephrectomy, and nephroureterectomy all have common surgical steps, they each have unique complications.
Simple nephrectomy is indicated for benign but not trivial conditions. Indications include non-functioning kidneys (causing pain from congenital obstruction or urolithiasis), renovascular disease causing uncontrollable hypertension, benign symptomatic tumors (angiomyolipomas), trauma, or infectious diseases (xanthogranulomatous pyelonephritis, chronic or emphysematous pyelonephritis, and tuberculosis). The kidney is removed within Gerota's fascia along with a small amount of ureter. Patients who undergo nephrectomy for inflammatory conditions can be some of the most difficult to manage due to their medical comorbidities.
Donor nephrectomy is a simple procedure in which a healthy kidney (typically the left kidney because of increased vein length) is removed and transplanted as an allograft in a controlled, scheduled situation. The donor patients are healthy and have had extensive preoperative evaluations. Transplant nephrectomy is a simple nephrectomy in which the renal allograft is removed, usually for rejection complications.
Radical nephrectomy involves the removal of all structures within Gerota's fascia, which includes the ipsilateral, adrenal, kidney, and perirenal tissue. Adrenal sparing radical nephrectomy, especially for lower pole tumors, has become commonplace because of the low incidence of ipsilateral adrenal invasion or metastases. Most renal tumors are found incidentally by advanced radiologic imaging or during hematuria screening. Approximately 95% of enhancing renal masses are malignant; therefore, needle biopsy or pathologic proof before surgery is not routinely performed.
134 - Management of upper urinary tract calculi
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- By John G. Pattaras, Emory University, School of Medicine, Atlanta, GA
- Edited by Michael F. Lubin, Emory University, Atlanta, Robert B. Smith, Emory University, Atlanta, Thomas F. Dodson, Emory University, Atlanta, Nathan O. Spell, Emory University, Atlanta, H. Kenneth Walker, Emory University, Atlanta
-
- Book:
- Medical Management of the Surgical Patient
- Published online:
- 12 January 2010
- Print publication:
- 10 August 2006, pp 793-795
-
- Chapter
- Export citation
-
Summary
The term “endourology” was adopted for the minimally invasive endoscopic surgery of upper urinary calculus disease. Since the introduction of shock wave lithotripsy, this modality has become the most common form of stone therapy as it allows virtual hands-off treatment for radio opaque calculi. Owing to the technological advances of endourologic procedures such as ureteroscopy and percutaneous nephrolithotomy, the incidence of open kidney stone surgery is almost non-existent. Despite the evolution of surgical intervention for nephrolithiasis, it is important to note that the medical management and prevention of complicated urolithiasis remains difficult.
Nephrolithiasis affects as much as 12% of the population in industrialized nations. Urolithiasis patients will agree that the sensation of stone passage is perhaps the most painful and intense experience of their lives. Urolithiasis may present as hematuria (ranging from asymptomatic microscopic hematuria to painful gross hematuria), abdominal/flank/back pain, urinary tract infection, renal failure, or an incidental radiologic finding. Decompression of the acutely obstructed system with either cystoscopic stenting or percutaneous nephrostomy drainage is emergently mandatory for patients with a solitary kidney, infected obstruction, immunocompromised state (diabetes, AIDS, transplant), history of renal insufficiency, and worsening renal function.
The absolute minimum work-up of the potential nephrolithiasis patient should include: general history, determination of any prior history or family history of nephrolithiasis, physical examination, urine analysis (and culture for any hematuria, pyuria, fevers, or elevated WBC count), and radiologic examination if clinically warranted.