Endourology: a specific specialty area in urology

Endourology refers to a specific specialty area in urology in which small internal endoscopes and instruments are used to se the urinary tract and perform surgery

1. ENDOUROLOGY INTRODUCTION Endourology refers to a specific specialty area in urology in which small internal endoscopes and instruents are used to se the urinary tract and perform surgery

2. ENDOUROLOGY en·do·u·rol·o·gy Genitourinary operative procedures (diagnostic and therapeutic) performed through instruments; may be cystoscopic,pelviscopic, celioscopic, laparoscopic, percutaneous, or ureteroscopic. Farlex Partner Medical Dictionary © Farlex 2012  the branch of urologic surgery concerned with closed procedures for visualizing or manipulating the urinary tract. Dorland's Medical Dictionary for Health Consumers. © 2007 by Saunders, an imprint of Elsevier, Inc. All rights reserved.  Closed diagnostic and manipulative procedures carried out within the urogenital tract. Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005

3. URINARY SYSTEM MEATAL STRICTURE URETHRAL STRICTURE URETHRAL STONE BPH/BLADDER NECK HIGH BLADDER STONE BLADDER GROWTH VUJ STRICTURE VUJ STONE URETERIC STRICTURE URETERIC STONE TCC PROXIMAL STONE PUJ STONE PUJ STRICTURE RENAL STONE M Razif AZ

4. ENDOUROLOGY INDICATIONS Urethroscopy : used to treat strictures or blockages of the urethra. Cystoscopy : used to treat bladder stones and tumors. Obstructing prostate tissue can be removed with this approach as well (a procedure called “TURP”). Flexible plastic tubes called stents can be passed up the ureter using cystoscopy and x-rays to relieve blockage of the ureter . Ureteroscopy : used to treat stones and tumors of the ureter . Nephroscopy : used to treat stones and tumors of the kidney lining.

5. PREPARATION & ROLES OF ASSISTANT Peri -Op visit will be done by OT Scrub Nurse 1/7 before.

6. PREPARATION & ROLES OF ASSISTANT On OT Day Work as a team Checked the SSSL Form properly. Corrected the Patient’s Name,Diagnosis,Type of Surgery with OT list Display the latest imaging films. Preparing Instrument & Pre-Op Test OT Set Up Patient’s position Light Source Energy Source Monitor System Laser Machine/ Lithoclast Scopes Fluid Irrigation Additional Devices

7. REPARATION & ROLES OF ASSISTANT ANAESTHESIA LA /GA/RA POSITION Supine/ Lithotomy /Prone ADMIT WARD @ DAYCARE

8. Optimizing Patient Positioning in the OR Optimal positioning not only ensures the best possible access to the surgical site, but also prevents long-term consequences such as nerve damage or pressure ulcers. These secondary complications can delay rehabilitation and recovery. Patients have better outcomes when hospitals can avoid these secondary consequences.

9. OT SET UP GA MACHINE I-I MONITOR C-ARM SYSTEM MONITOR SCRUB TABLE OT TABLE LASER MACHINE LITHOCLAST FLUID IRRIGATION M Razif AZ

10. PREPARATION & ROLES OF ASSISTANT

11. PREPARATION & ROLES OF ASSISTANT

12. PREPARATION & ROLES OF ASSISTANT

13. PREPARATION & ROLES OF ASSISTANT PRE-OP TEST

14. CYTOSCOPY Rigid/Flexible

15. CE+ RPG +Inserted wire CE+ RPG +Inserted wire M Razif AZ

16. CE+ RPG +Inserted wire M Razif AZ

17. TUR SET

18. 4.5FR 6.5FR 6FR 7.5FR 6.5FR 8.5FR SCOPE SIZE URETERENOSCOPY (URS & RIRS) Rigid & Flexible

19. R.I.R.S RETROGRADE INTRA RENAL SURGERY

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21. SET UP FOR LITHOTRIPSY FOR BLAST STONE CHOOSE & CONNECT LASER FIBRE SIZE (365/600 MICRON) LITHO PROGRAME STONE DUSTING MODE (0.8J 10HZ) STANDBY MODE DURING FIBRE INSERTED ACTIVATED LASER BEAM WAIT UNTIL THE TIP OF LASER +BLUE LAYER SEEN IN MONITOR ACTIVATED READY BUTTON ON MACHINE WHEN UROLOGIST READY INFORM THE ENERGY ,THE FREQUENCY LEVEL TO UROLOGIST INFORM UROLOGIST WHEN LASER READY FOR BLASTING. - M Razif AZ

22. M Razif AZ Stone Cone is a safe, effective and easy to use device. It effectively prevents migration of the stone fragments or the whole stone during ureteroscopic lithotripsy for proximal ureteral calculi, and makes it’s safe retrieval possible

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24. NEPHROSCOPY

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27. Stent form POST PROCEDURE

28. ENDOUROLOGY BLADDER PROSTATE URETHRAL STRICTURE/INJURY/STONE BPH URETHRA CE INTERNAL URETHROTOMY DILATATION BLADDER STONE BLADDER NECK HI BLADDER TUMOUR BNI VESICOLITHOTRIPSY/LAPEXY TURBT BIOPSY TURP URETER STRICTURE STONE TUMOUR URS DIAGNOSTIC BIOPSY ENDOURETEROTOMY LASER LITHORIPSY OBS.UROPATHY RPG KIDNEY STONE PCNL RIRS STENTING PCVL

29. BIL PROCEDURES PREPARATION CE RIGID /FLEXIBLE CBD set/Linen depend on position RIGID ROS Biopsy Forcep Wire/S Curve Dilatation/Clayton Dilator 0/12/30 Degree Telescope Bridge Outersheath 17-22Fr Flexible scope VESICO LITHOITRIPSY/LAPEXY CE Cytonephroscope Outer sheath 24+trocar Maermayuer Stone crusher CBD SET Minor Linen Dressing Towel Hole Tower Mayor Tray Cover x2 Lithotripter: Laser Fibre 600-800 micron Lithocalst Probe 3.3mm Lithoclast Handpiece Lithoclast machine Holmium YAG laser machine TURP/BT/EVACUATION BLOOD CLOT CE Resector scope set (Bipolar/ monopolar Irrigation; Diathermy Saline- Bipo Outlet tubing Glycine / Bactron / Distile -mono Setting mono TURP 120/80 Ellik bottle TURBT 100/80 Otis knife Clayton Dilator Electrode Loops(Cutting/ RollerBall /Mushroom) Telescope 12/30 degree Diathermy.ERBE / Valleylab 3way catheter/wire/blunt needle/Tommy

30. URS/RIRS CE: Telescope rigid 0/30 degree Bridge Cytoscope outer sheath size 20Fr URS: Semi rigid 6Fr/7.5Fr Richard Wolf URS scope Semi rigid 6.5Fr/8.5Fr Richard Wolf URS scope RIRS: Flexible URS Richard Wolf Flexor Ureteral Access Sheath 12 FrID /14FrOD/35cm@45cm Guide Wire: Roadrunner Bentson Ureteral catheter ( Angiocath ) 5Fr/70 cm Bulb Irrigator (Pathfinder) Others: URS Semi Rigid Forcep Nitinol Stone Basket/ Dormia Basket Stone Cone ( Tipless /Non Tipless ) Balloon dilator Ureteral dilatorDressing Towel Hole Tower Mayor Tray Cover x2 Lithotripter: Laser Fibre 200-270 micron Laser Fibre 365-600 micron Lithocalst Probe 08mm-1.0mm Lithoclast Handpiece

31. PCNL/PCVL CE: Telescope rigid 0/30 degree Bridge Cytoscope outer sheath size 20Fr Small set PCNL Drape Nephroscope (Mini/Standard) Outrsheath 15/16/22/24/26Fr Amplantz Dilator Guide Wire: Roadrunner++ Bentson Ureteral catheter ( Angiocath ) 5Fr/70 cm++ Bulb Irrigator (Pathfinder) Contrasrt /Syringe 20ccx4 Stopper Plasterx3 Ultrasonic+Lithoclast probe/ handpiece Spanar Stone cathcher Others: PCNL Forcep ( Tuffron / Grassjaw /Crocodile) Malecot Suture 2/0 Pressure Monotoring Line/Tommy Lithoripter System Ultrasonic system Laser system