undergraduate, Access to urinary system v2

1. Urology Department
Under-graduate courses
Access to Genito-Urinary system
By M.A.Wadood , MD, MRCS

2. For our Lectures and Scientific resources
visit our web sites,
Uroainshams.blogspot.com
Uronotes2012.blogspot.com
©

3. Approaches to Kidney
By M.A.Wadood , MD, MRCS

4. Flank approach
• Standard approach for renal
& upper ureteric stones
open surgery or simple
nephrectomy or partial
nephrectomy.
• Can be used in renal or
adrenal tumors if: small
tumors, obese or unfit
patients.
 Subcostal.
 Transcostal.
 Supracostal (Intercostal).
The patient is in the flank position. Gerota´s fascia is opened
posteriorly, so that the peritoneal cavity is not entered.
By M.A.Wadood , MD, MRCS

5. Anterior Transperitoneal approach
• Standard approach for renal
or adrenal tumors excision.
• Involves:
 bilateral subcostal (Chevron)
 hemi-chevron
 midline incision.
• allows access to the peritoneal
cavity and inspection to rule
out metastasis and/or
extraadrenal disease.
Chevron incision
By M.A.Wadood , MD, MRCS

6. Anterior Transperitoneal approach
Hemi-Chevron incision Midline incision
By M.A.Wadood , MD, MRCS

7. Thoraco-abdominal approach
• for exposure of large tumors and upper-pole tumors.
By M.A.Wadood , MD, MRCS

8. Dorsal lumbotomy
• for UPJ obstruction and stone surgery in children or
thin patients
By M.A.Wadood , MD, MRCS

9. Approaches to ureter
By M.A.Wadood , MD, MRCS

10. Subcostal and anterior 12th
rib supracostal incision
Subcostal incision Anterior 12th rib supracostal incision
• for upper ureteric stones or pathology
By M.A.Wadood , MD, MRCS

11. Gibson and Abernathy incision
• for mid-ureteric stones
By M.A.Wadood , MD, MRCS

12. Lower Midline incision
• for lower ureteric stones or pathology.
By M.A.Wadood , MD, MRCS

13. Approaches to bladder and
prostate
©
By M.A.Wadood , MD, MRCS

14. Lower midline incision
• Standard approach for Bladder and prostate pathology
surgery.
©
By M.A.Wadood , MD, MRCS

15. Pfannenstiel incision
• Alternative minimally invasive approach but with less
exposure.
©
By M.A.Wadood , MD, MRCS

16. Perineal incision for prostate
• For radical perineal prostatectomy.
©
By M.A.Wadood , MD, MRCS

17. Percutaneous Cystostomy
The bladder must be filled with 400 - 600 ml of saline
until it can be palpable
When the trocar is pushed into the bladder, the obturator is
removed and fluid will escape. Immediatelly must be insert
special catether through the sheat.
By M.A.Wadood , MD, MRCS

18. Approaches to penis and
urethra
©
By M.A.Wadood , MD, MRCS

19. Perineal incisions
Mercedes perineal incision Midline perineal incision
• To access bulbar and posterior urethra
©
By M.A.Wadood , MD, MRCS

20. Penile incisions
Subcoronal incision Penoscrotal incision Midline penile incision
• For penile and urethral surgery.
©
By M.A.Wadood , MD, MRCS

21. Approaches to
inguinoscrotal structures
©
By M.A.Wadood , MD, MRCS

22. Inguinal incision
Adult Pediatric
(along skin crease)
• For hernia, hydrocele & undescended testis in children
and radical orchiectomy in adults.
By M.A.Wadood , MD, MRCS

23. Varicocele incisions
Sub-inguinal incisions
inguinal incisions
Balomo approach
By M.A.Wadood , MD, MRCS

24. Scrotal incision
Transverse scrotal incision Incision over spermatocele
By M.A.Wadood , MD, MRCS

25. Endoscopic urology
©
By M.A.Wadood , MD, MRCS

26. Flexible urethro-cystoscopy
1. telescope;
2. adapter for cold light,
3. working adapter for
introducing additional
instruments,
4. Alberran…
5. adapter for irrigation
inflow,
6. adapter for irrigation
outflow,
7. sheath,
By M.A.Wadood , MD, MRCS

27. Flexible urethro-cystoscopy
By M.A.Wadood , MD, MRCS

28. Resection set
• For TURP and TURBT
• Contain: Lens, Working element, Loop and sheath.
By M.A.Wadood , MD, MRCS

29. Rigid and flexible ureteroscopy
By M.A.Wadood , MD, MRCS

30. Percutaneous nephrolithotomy
(PCNL)- Nephroscope
By M.A.Wadood , MD, MRCS

31. Nephroscope with lithotriptor
By M.A.Wadood , MD, MRCS

32. Nephroscope with grasper
By M.A.Wadood , MD, MRCS

33. Flexible Nephroscopy
By M.A.Wadood , MD, MRCS

34. Laparoscopy in urology
©
By M.A.Wadood , MD, MRCS

35. Basic Laparoscopy set
By M.A.Wadood , MD, MRCS

36. Techniques of peritoneal entry
Verrese needle (classical technique) Open (Hasson technique)
through infraumbilical incision
By M.A.Wadood , MD, MRCS

37. Ballon for retroperitonoscopy
By M.A.Wadood , MD, MRCS

38. Trocar
By M.A.Wadood , MD, MRCS

39. Graspers and Scissors
By M.A.Wadood , MD, MRCS

40. Thank You
By M.A.Wadood , MD, MRCS