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Open Urological Surgeries

Open Urological surgery is a traditional surgery where an incision is made to access the area of the body that requires treatment. A Urologic condition is any disease or disorder that affects the male reproductive organs or the male and female urinary tract (kidneys, bladder, ureters and urethra).

Types Of Open Urological Surgeries

Bilateral Orchiectomy

An orchiectomy is surgery done to remove one or both of your testicles. It’s commonly performed to treat or prevent prostate cancer from spreading. An orchiectomy can treat or prevent testicular cancer and breast cancer in men, too. It’s also often done before sexual reassignment surgery (SRS) if you’re a transgender woman making the transition from male to female.

Types of orchiectomy

Simple orchiectomy- One or both testicles is removed through a small cut in your scrotum. This may be done to treat breast cancer or prostate cancer if your doctor wants to limit the amount of testosterone that your body makes.

Radical inguinal orchiectomy- One or both testicles is removed through a small cut in the lower part of your abdominal area instead of your scrotum. This may be done if you’ve found a lump in your testicle and your doctor wants to test your testicular tissue for cancer. Doctors may prefer to test for cancer using this surgery because a regular tissue sample, or biopsy, can make cancer cells more likely to spread.

This type of surgery may also be a good option for a transition from male to female.

Subcapsular orchiectomy- The tissues around the testicles are removed from the scrotum. This allows you to keep your scrotum intact so that there’s no outward sign that anything has been removed.

Bilateral orchiectomy- Both testicles are removed. This may be done if you have prostate cancer, breast cancer, or are transitioning from male to female

Open Urological Surgeries

Outlook

An orchiectomy is an outpatient surgery that doesn’t take long to fully recover from. It’s much less risky than hormone therapy for the treatment of prostate or testicular cancer.

Be open with your doctor if you’re getting this surgery as part of your transition from male to female. Your doctor may be able to work with you to reduce scar tissue in the area so that future SRS may be more successful.

AV fistula for Dialysis access : Used in kidney failure patient

A hemodialysis access, or vascular access, is a way to reach the blood for hemodialysis. The access allows blood to travel through soft tubes to the dialysis machine where it is cleaned as it passes through a special filter, called a dialyzer. An access is placed by a minor surgery. As a hemodialysis patient, your access is one of the following:

  • A fistula, an access made by joining an artery and vein in your arm.
  • A graft, an access made by using a piece of soft tube to join an artery and vein in your arm.
  • A catheter, a soft tube that is placed in a large vein, usually in your neck.

Caring For Your Access

Whether your access is a fistula, graft or catheter, you should make sure to take good care of it. Your dialysis care team will teach you the steps of good access care. The chart below gives you some general tips about everyday access care and how to prevent problems.

Fistula or Graft

  • Wash with an antibacterial soap each day, and always before dialysis. Do not scratch your skin or pick scabs.
  • Check for redness, a feeling of excess warmth or the beginning of a pimple on any area of your access.
  • Ask your dialysis care team to rotate the needles when you have your dialysis treatment.

Catheter

  • Keep catheter dressing clean and dry.
  • Make sure the area of the access is cleaned and the dressing is changed by your care team at each dialysis session.
  • Keep an emergency dressing kit at home in case you need to change your dressing between treatments.
  • Never open your catheter to the air.
Urethroplasty For Urethral Stricture-

The urethra’s main job in males and females is to pass urine outside the body. This thin tube also has an important role in ejaculation for men. When a scar from swelling, injury or infection blocks or slows the flow of urine in this tube, it is called a urethral stricture. Some people feel pain with a urethral stricture.

Anastomotic Urethroplasty: Used for short urethral strictures. In this case, a cut is made between the scrotum and rectum. The urethra can then be reconnected after removing the stricture. Hospital stay is between 2 to 4 days in such cases. A catheter is left for 10 to 21 days.

Substitution Urethroplasty: When the stricture is long, the tissue can be transferred to replace the section that had the stricture. In difficult cases, substitution repairs may need to be done in stages. There are 3 types of substitution procedures namely, Free graft (Penile or Buccal Mucosal), Penile skin flap, Staged.

Symptoms

Simply put, the urethra is like a garden hose. When there is a kink or narrowing along the hose, no matter how short or long, the flow is reduced. When a stricture is narrow enough to decrease urine flow, you will have symptoms. Problems with urinating, UTIs, and swelling or infections of the prostate may occur. Severe blockage that lasts a long time can damage the kidneys.

Some signs are:

  • bloody or dark urine
  • blood in semen
  • slow or decreased urine stream
  • urine stream spraying
  • pain with urinating
  • abdominal pain
  • urethral leaking
  • UTIs in men
  • swelling of the penis
  • loss of bladder control

There are many options depending on the size of the blockage and how much scar tissue is involved.

Treatments Include:
  • dilation – enlarging the stricture with gradual stretching
  • urethrotomy – cutting the stricture with a laser or knife through a scope
  • open surgery – surgical removal of the stricture with reconnection and reconstruction, possibly with grafts (urethroplasty)

There are no available drugs to help treat strictures.

Without treatment, you will continue to have problems with voiding. Urinary and/or testicular infections and stones could develop. Also, there is a risk of urinary retention (when you can’t pass urine), which could lead to an enlarged bladder and kidney problems.

Dr Rahul Yadav has a successful record for open urological surgeries in Lucknow (UP) India. Since this involves an open cut or open surgical procedures, it must be handled with expertised urologists who are experienced with these surgeries. The success rate for these open urological surgeries is quite high, which makes them a viable option.

A Urologic condition is any disease or disorder that affects the male reproductive organs(Testis, Penis, Epididymis, Vas deferens, Seminal Vesicles, Prostate and Ejaculatory Ducts) or the male and female urinary tract (kidneys, ureter, bladder and urethra) and Adrenal Glands.

With the advent of Laparoscopy/Robotics/Endourology and Lasers, open surgery is rarely practiced and have limited role only in management of few diseases in Urology.

To name a few, open surgeries in Urology includes Circumcision, Bilateral Orchidectomy, Urethroplasty, AV Fistula creation and few more.

Treatments

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