Category Archives: Urology

Print Release, Urology

PUBLISHED: Ureteroscopy and Laser Lithotripsy for Ureteral and Renal Stones in a Patient with a Nephrostomy Tube

Ureteroscopy and Laser Lithotripsy for Ureteral and Renal Stones in a Patient with a Nephrostomy Tube
Zachary Tully, MD; Joseph Y. Clark, MD
Penn State Health Milton S. Hershey Medical Center

Ureteroscopy is a minimally invasive surgical procedure used for the diagnosis and treatment of ureteral and renal pathology, most often urolithiasis. The presence of a percutaneous nephrostomy tube, commonly placed for urgent decompression of an obstructed kidney, often in obstructing stone disease, introduces unique perioperative considerations. Indications for ureteroscopy in this setting involve persistent obstruction with failure of spontaneous stone passage when percutaneous nephrolithotomy is not indicated. Surgical treatment aims to remove obstructing calculi, restore antegrade urinary drainage, and prevent long-term complications such as decline of renal function. Ureteroscopy involves cystoscopic access, ureteroscopic stone fragmentation, and extraction. When coupled with antegrade access as provided by a nephrostomy tract, it enables combined antegrade and retrograde (“rendezvous”) approaches. This video presents a case of a patient with a left-sided distal ureteral stone, nonobstructing renal stones, and an indwelling nephrostomy tube who underwent definitive management with ureteroscopy and laser lithotripsy.

Print Release, Urology

PUBLISHED: Percutaneous Nephrostolithotomy for Treatment of Impacted Ureteropelvic Junction Calculus

Percutaneous Nephrostolithotomy for Treatment of Impacted Ureteropelvic Junction Calculus
Max S. Yudovich, MD; Joseph Y. Clark, MD
Penn State Health Milton S. Hershey Medical Center

Percutaneous nephrostolithotomy (PCNL) is a minimally invasive urologic procedure used to treat large kidney stones or stones which are not accessible from a retrograde approach. When untreated, these stones can cause chronic pain, infections, and over time, decreased renal function. The indications for PCNL include total renal stone burden greater than 20 mm, lower pole stone burden greater than 10 mm, or any stone burden which cannot be treated with ureteroscopy or extracorporeal shockwave lithotripsy, such as in the setting of a ureteral stricture or ureteropelvic junction obstruction.

During the procedure, the patient is typically positioned prone, and a needle is used to puncture the kidney through the flank. As in the case of our procedure, a pre-existing nephrostomy tube can also be used. After wire access to the kidney is obtained, the tract is dilated and an access sheath is placed to facilitate irrigation and insertion of instruments. Large stones can be removed through ultrasonic lithotripsy, pneumatic (ballistic) lithotripsy, laser lithotripsy (typically holmium:YAG or thulium lasers), and combination devices that integrate ultrasonic and pneumatic mechanisms. Smaller stones, such as in our case, can be extracted using graspers. In this video, we present a left-sided PCNL in which we remove a total of 2.1 cm of renal stone burden. Following stone removal, a ureteral stent and nephrostomy tube were placed to enable maximal drainage of the kidney. Postoperative CT showed complete clearance of stone burden.

Basic Skills for the OR, Print Release, Urology

PUBLISHED: Female Foley Catheter Placement Preoperatively

Female Foley Catheter Placement Preoperatively
Linda J. Guan, MD; Joseph Y. Clark, MD
Penn State Health Milton S. Hershey Medical Center

Urinary catheterization is a standard procedure performed in the perioperative setting. In this video, the procedure is initiated after the patient has been placed under anesthesia, and the lower extremities are positioned in a frog-leg configuration to provide optimal access to the perineum. A standard Foley catheter tray is utilized, which contains all necessary components for the procedure under sterile conditions. The placement of a Foley catheter in female patients preoperatively represents a fundamental yet critical procedure in perioperative care. Though technically straightforward, its proper execution demands meticulous attention to anatomical detail, strict sterile technique, and awareness of potential challenges. Furthermore, technical proficiency in catheter placement contributes to improved patient outcomes by reducing the risk of urethral trauma and catheter-associated infections.

Print Release, Urology

PUBLISHED: Cystoscopy, Right Ureteroscopy, and Ureteral Stent Insertion with Aborted Biopsy and Potential Laser Ablation of a Right Renal Mass

Cystoscopy, Right Ureteroscopy, and Ureteral Stent Insertion with Aborted Biopsy and Potential Laser Ablation of a Right Renal Mass
Ryan A. Hankins, MD
MedStar Georgetown University Hospital

This article describes a case of a 58-year-old male patient with a renal mass, which was incidentally discovered on an imaging of chest CT scan, without any signs and symptoms indicative for renal masses. The patient has no history of ureteroscopy before, and no prior history of urolithiasis. The multiphasic, contrast-enhanced abdominal CT scan shows 2.5-cm hyperattenuating enhancing mass in the upper pole of the right kidney. Transverse unenhanced CT image shows hyperattenuating mass with no evidence of fat. Transverse CT image shows enhancement of the mass from 60 HU to 116 HU. The chest CT scan showed no abnormalities. This video describes a complex urological procedure that initially aimed to perform diagnostic and potentially therapeutic intervention but was modified due to anatomical constraints. The procedure demonstrates the importance of surgical adaptability and the role of staged approaches in urological surgery.

Print Release, Urology

PUBLISHED: Open Hydrocelectomy for Scrotal Hydrocele

Open Hydrocelectomy for Scrotal Hydrocele
Jennifer A. Kane, MD; Joseph Y. Clark, MD
Penn State Health Milton S. Hershey Medical Center

Hydrocelectomy is a common and effective surgical procedure used to treat hydrocele, a condition in males defined as an accumulation of benign peritoneal fluid between the layers of the scrotum. The indications for hydrocelectomy include pain, poor cosmetic appearance, or negative impact on patient quality of life. Surgical treatment of hydroceles aims to treat symptoms as well as prevent complications of hydroceles left untreated, including chronic pain or testicular ischemia. A scrotal incision is the most common approach for surgical management of non-communicating hydroceles. The hydrocele sac is isolated, the fluid is drained, and the sac is excised and closed to prevent recurrence. This video presents a case of a patient with a left sided non-communicating hydrocele that was treated with hydrocelectomy. As part of the procedure, a surgical drain was left in place.

General Surgery, Pediatrics, Print Release, Urology

PUBLISHED: Cloacal Exstrophy Repair

Cloacal Exstrophy Repair
William Remley1; Howard Jen, MD2; Carl-Christian A. Jackson, MD2; Jeremy Wiygul, MD2
1Lake Erie College of Osteopathic Medicine
2Tufts Medical Center

Cloacal exstrophy is congenital malformation marked by an abdominal wall defect with open and exposed hindgut and bladder. It is the most severe birth defect within the exstrophy-epispadias complex, and when spinal defects are also present, it is called the OEIS (omphalocele, exstrophy, imperforate anus, and spinal defect) complex. Cloacal exstrophy is rare, occurring in 1/200,000–400,000 births, but it can be diagnosed on prenatal ultrasound. The defect results in two exstrophied hemibladders separated by an exposed cecal plate, with the distal hindgut being foreshortened and blind-ending, resulting in an imperforate anus. There is diastasis of the pubic symphysis, and the genitalia are separated. In males, the phallus is usually split in half, flattened and shortened, with the inner surface of the urethra exposed. In females, the clitoris is split, the labia are widely separated, and there may be two vaginal openings. Cloacal exstrophy is also highly associated with other birth defects, especially spina bifida, which coexist in up to 75% of cases. Multidisciplinary care followed by surgical management should begin immediately following the baby’s delivery.

Surgical goals in the neonatal period include closure of the meningocele and repair of the exstrophy and omphalocele, resulting in approximation of the bladder halves and repair of the hindgut defect with colostomy creation. Closure of the bladder, with positioning within the pelvis, can either occur at the initial operation or be staged to occur after a period of monitored growth, and is best performed with pelvic osteotomies to protect the closure from tension. Subsequent surgeries over several years will address genital reconstruction and colonic pull-through for fecal continence, if the patient is a candidate. Here, we present a patient diagnosed with OEIS complex by prenatal ultrasound, with a postnatal exam confirming the diagnosis and demonstrating a closed (covered) myelomeningocele. The cloacal exstrophy and omphalocele were repaired in one stage, with primary closure of the involved bowel and the bladder, facilitated by pelvic osteotomies.

Global Surgery, Print Release, Urology

PUBLISHED: Scrotal Hydrocelectomy Made Simple During a Surgical Mission

Scrotal Hydrocelectomy Made Simple During a Surgical Mission
Jaymie Ang Henry, MD, MPH1; Lissa Henson, MD2; Domingo Alvear, MD3
1Florida Atlantic University, G4 Alliance
2Philippine Society of Pediatric Surgeons
3World Surgical Foundation

A hydrocele is a condition characterized by the abnormal accumulation of serous fluid between the layers of the tunica vaginalis in the scrotum. While most hydroceles are typically asymptomatic or subclinical, larger ones can cause discomfort, heaviness, and cosmetic concerns. The surgical management of hydroceles aims to alleviate symptoms, improve cosmetic appearance, and prevent potential complications associated with untreated hydroceles, such as testicular ischemia or chronic pain.

This video highlights the surgeon’s expertise and attention to detail, ensuring a thorough and meticulous surgical technique. The step-by-step approach and clear communication with the surgical team facilitate a smooth and efficient procedure. The importance of this surgical technique extends beyond the individual patient. Providing a simplified and effective treatment option for hydroceles has the potential to improve patient outcomes and reduce the burden on healthcare systems, particularly in resource-limited settings or during surgical missions. Overall, the video serves as a valuable educational resource for surgical trainees and practitioners, demonstrating a simplified and effective approach to the treatment of scrotal hydroceles.

Print Release, Urology

PUBLISHED: Cystoscopy and Transurethral Resection of Bladder Tumors with Stent and Foley Catheter Placement

Cystoscopy and Transurethral Resection of Bladder Tumors with Stent and Foley Catheter Placement
Austin Bramwell, MD; Tullika Garg, MD, MPH, FACS
Penn State Health Milton S. Hershey Medical Center

Bladder cancer is the sixth most common cancer in the United States. Transurethral resection of bladder tumor (TURBT) is a common urologic surgical procedure used to diagnose, stage, and treat bladder cancer. This article presents a patient who had multiple episodes of gross hematuria and was found to have multifocal bladder tumors. In this case, TURBT was performed to confirm the diagnosis of bladder cancer, remove all visible bladder tumors, and prevent further episodes of gross hematuria.

Print Release, Urology

PUBLISHED: Ureteroscopy, Laser Lithotripsy, and Stent Replacement for an Obstructing Left Proximal Ureteral Stone with Forniceal Rupture

Ureteroscopy, Laser Lithotripsy, and Stent Replacement for an Obstructing Left Proximal Ureteral Stone with Forniceal Rupture
Ryan A. Hankins, MD1; John A. Wahl, MS2
1MedStar Georgetown University Hospital
2Georgetown University School of Medicine

The case demonstrates the use of ureteroscopy with laser lithotripsy in the treatment of an obstructed left proximal ureteral stone with forniceal rupture. The patient presented to the emergency department with the signs and symptoms of a ureteral stone and was taken for imaging and a diagnostic ureteroscopy. Following confirmation of the diagnosis, the patient was scheduled for ureteroscopy with laser lithotripsy.

A guidewire was placed, followed by visualization with a retrograde pyelogram and a subsequent flexible ureteroscopy. Laser lithotripsy was performed to fragment the stone. Following fragmentation, the renal pelvis and calyces were visualized to examine for retrograde movement of stone fragments. A confirmatory retrograde pyelogram was then performed, followed by placement of a temporary stent for fluid drainage. The patient was then discharged with opioids for pain medication and prophylactic antibiotics to prevent urinary tract infections and the subsequent risk of urosepsis.

General Surgery, Global Surgery, Pediatrics, Print Release, Urology

PUBLISHED: Right Orchiopexy to Correct Undescended Testicle and Circumcision to Correct Phimosis

Right Orchiopexy to Correct Undescended Testicle and Circumcision to Correct Phimosis
Lissa Henson, MD1; Domingo Alvear, MD2
1Capitol Medical Center, Philippine Society of Pediatric Surgeons
2World Surgical Foundation

Cryptorchidism, or undescended testis, is a condition in which one or both testes fail to descend from the abdomen into the scrotum during fetal development. Phimosis, on the other hand, is a condition characterized by the inability to retract the foreskin over the glans penis.

This video serves as a step-by-step guide on orchiopexy to correct an undescended testicle and circumcision to correct phimosis. The importance of this surgical intervention lies in the preservation of testicular function, fertility potential, and the prevention of long-term complications associated with cryptorchidism. Early treatment is crucial, as it significantly reduces the risk of testicular damage and associated complications.