Cystoscopy and Suprapubic Tube Placement Sample Report
DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Eroded artificial urinary sphincter.
POSTOPERATIVE DIAGNOSIS: Eroded artificial urinary sphincter.
OPERATION PERFORMED:
1. Cystoscopy.
2. Placement of suprapubic tube.
3. Explantation of artificial urinary sphincter.
SURGEON: John Doe, MD
ANESTHESIA: General.
ANESTHESIOLOGIST: Jane Doe, MD
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old gentleman with history of prostate cancer treated by radiation therapy and subsequent cryoablation therapy. He had rather significant stress urinary incontinence following his cryoablation procedure. He had male urinary sling and collagen injections by his primary urologist. He was ultimately referred for management. We placed an artificial urinary sphincter two years ago. This had kept him reasonably dry for a period of time. He has had increasing difficulty with elevated postvoid residuals. His PSA is detectable recently. A cystoscopy two months ago showed intact artificial urinary sphincter with radiation changes in the area of the prostatic urethra but no significant obstructive component. He was admitted to an outside hospital last week with acute urinary retention and elevated creatinine. He presented to our office five days ago with a Foley catheter in place, stating that he wanted his artificial sphincter removed. A cystoscopy was performed this morning, which showed erosion of the proximal cuff of the artificial sphincter as well as likely a small erosion of the distal cuff. We therefore brought him to the operating room today urgently for explantation of artificial urinary sphincter. He has had no fevers or signs of infection.
INTRAOPERATIVE FINDINGS:
1. No evidence of extravasation upon removal of the distal cuff.
2. Small amount of extravasation after removal of the proximal cuff.
3. Most obstructive component during cystoscopy is the area at the bladder neck where there appears to be some obstruction from the remaining prostatic tissue.
FINDINGS AND PROCEDURE: After obtaining consent, the patient was taken to the operating room and placed in supine position, whereupon general anesthesia was administered. He was then placed in the lithotomy position, prepped and draped in the normal sterile fashion. He received perioperative antibiotics.
A Jordan-Bookwalter retractor and a Wilson scrotal pack was utilized. A transverse scrotal incision was made. The pump was identified. We dissected around this and found the tubing. The tubing to the reservoir was identified in the right inguinal space. The reservoir was emptied and reservoir balloon delivered intact. Both cuffs wrapped around the urethra were excised. The distal cuff was removed initially and the urethra irrigated. There was no extravasation upon irrigation. Proximal cuff was also removed, and with irrigation, there was a small amount of extravasation at the right dorsolateral aspect of the urethra. The area was copiously irrigated with one liter of antibiotic solution.
A cystoscopy was performed with a 21-French cystoscope. The area of the erosions was still healthy and viable. The scope passed through this area. There was some mild resistance at the bladder neck. The scope was passed in here and bladder was distended. The patient was placed in Trendelenburg position. A small suprapubic incision was made with a 15 blade. The area was infiltrated with 0.25% Marcaine with epinephrine. A Bard suprapubic set was used to place the suprapubic tube. The 12-French suprapubic tube was draining well as visualized endoscopically. This was sutured in place with a 2-0 Prolene suture. A guidewire was placed through the cystoscope and coiled in the bladder. A 20-French Councill catheter was placed over the guidewire. Mildly pink urine was obtained from both catheters.
The operative site was infiltrated with approximately 20 mL of 0.25% Marcaine with epinephrine. The periurethral tissue was closed in two layers. A TLS drain was placed prior to closing the incision, and the skin incision was closed with 3-0 Monocryl suture. The sponge and needle counts were correct x2. There were no apparent intraoperative complications. The patient tolerated the procedure well and was taken from the operating room to the recovery room in stable condition.
PLAN: Intraoperative events were discussed with the patient’s wife. He will be admitted to the hospital postoperatively. He will likely be hospitalized for a minimum of 24 to 48 hours.
