Disclaimer
These are model operation notes provided to support efficient and structured documentation. They are intended as examples only.
Surgical technique, operative findings, peri-operative planning (including antibiotics), post-operative instructions (including follow-up), and all clinical decisions must be based on individual patient factors and the responsible clinician’s judgement. These templates should be adapted accordingly and not copied verbatim into patient records.
Emergency Surgery
Catheter insertion over Guidewire
DVT Proph: [ ] Antibiotics: [ ] Blood Loss: Minimal Blood Transfusion: NA
Indication: [ ] Bladder scan: [ ]
PMH: [ ]
Findings: [ ]
Procedure:
- Sterile Prep and Drape
- Cystoscopy attempted, unable to pass scope past penile urethra, findings as above
- Sensor guidewire inserted
- S-Shape dilators used sequentially from the smallest to dilate till ??Fr
- Clear urine obtained, ??Fr Silicone Catheter placed over guidewire, 10ml in balloon
- Urine volume of about ???ml drained in the bag, clear urine, no signs of infection
- Foreskin replaced
Post-op instructions:
- Routine Obs
- Eat, drink and mobilize as able
- Aim home later today if well
- VTE Prophylaxis: TEDS tonight and prophylactic LMWH from tomorrow if remains inpatient
- Antibiotics Plan: Continue antibiotics for 3 days
- Anticoagulation/ Anti-platelets Plan:
Follow-up plan:
- TWOC and ISD teaching in 2 weeks
- Outpatient clinic appointment with flows on arrival in 3 months (routine)
Emergency Suprapubic Catheter SPC Insertion
Date: [ ] Time: [ ]
Surgeon: [ ] Consultant: [ ] Anesthesia: LA, xx ml of 1% Lignocaine without Adrenaline Antibiotics: IV Gentamicin OR Oral Ciprofloxacin/ Co-Amoxiclav/ Co-Trimoxazole Indication: Urine Retention secondary to
SPC Checks:
- Palpable bladder:
- Bladder scan:
- Anticoagulation:
- Previous Abdominal Surgeries:
- Scans reviewed:
- Bladder cancer:
Procedure:
- USS scan used to confirm bladder distention volume and position
- Bladder distended till the abdominal wall, no intersecting bowel loop, amenable to safe SPC insertion
- Edge of bladder, pubic symphysis and SPC insertion site 2-4cm above the pubic symphysis marked
- Sterile Prep and Drape with Povidone, LA injected
- 16Fr SPC inserted using Seldinger technique, 10ml in balloon
- Easy insertion, inserted on first attempt
- Volume drained:
- Tegaderm dressing applied
Post-op instructions:
- Size 16Fr Silicone SPC catheter in situ with 10ml in balloon, change in community in 12 weeks’ time
- Home later today if well and draining urine fine
- VTE Prophylaxis: TEDS tonight and prophylactic LMWH from tomorrow if remains inpatient
- Antibiotics Plan:
- Anticoagulation/ Anti-platelets Plan:
Follow-up plan:
- Community catheter changes every 12 weeks
Scrotal Exploration for Suspected Testicular Torsion
DVT Proph: TEDS Antibiotics: Not required Blood Loss: Nil Blood Transfusion: NA
Indication: Suspected Testicular Torsion
Duration of pain: [ ]
Pre-op examination findings: [ ]
EUA: [ ]
Intra-op findings:
Right Side: Left Side:
Procedure:
- WHO checklist/ Supine position/ TEDS/ GA/ No prophylactic antibiotics
- Sterile Prep and drape
- Median Raphe midline incision away from the base of the penis
- Incision directed to right testes and right hemiscrotum opened up layer by layer using Monopolar diathermy
- Findings as noted above
- Haemostasis secured using Bipolar diathermy
- Tunica vaginalis everted using Vicryl 3/0
- 3 point fixation done in correct anatomical position using Prolene 3/0
- Dartos layer closed with 2/0 Vicryl continuous sutures
- 0.5% Levobupivacaine LA applied at wound edges 10mls in total
- Skin closed with 3/0 Vicryl Rapide simple interrupted and vertical mattress sutures
- Skin glue applied
- Gauze and Scrotal support applied
Post-op instructions:
- Eat, drink and mobilize as able
- Aim home tomorrow once well
- Chase UTI/ STI screen
- VTE Prophylaxis: TEDS tonight and prophylactic LMWH from tomorrow if remains inpatient
- Antibiotics Plan:
- Anticoagulation/ Anti-platelets Plan:
Follow-up plan:
- If any signs of infection (such as discharge or wound breakdown), please get in touch with your doctor for antibiotics
- No routine follow-up required unless requested by GP due to any post-op issues
Emergency Ureteric Stent Insertion
DVT Proph: TEDS Antibiotics: IV Gentamicin Blood Loss: Minimal Blood Transfusion: N/A
Indication: Infected obstructed kidney secondary to a
PMH:
Findings: ?Stone visible on Image Intensifier ?Pus drained
Procedure:
- WHO checklist/ Supine position/ TEDS/ GA/ IV antibiotics
- Sterile Prep and drape
- Cystoscopy performed after copious lubrication, no concerning cystoscopy findings
- Both UO’s visualised, and left/right ureter identified
- Reference images taken with Image Intensifier
- Sensor wire inserted, easily passed upto the kidney
- Ureteral Catheter inserted and Renal Pelvis urine sample taken for MCS
- Retrograde Pyelogram done to delineate pelvicalyceal system
- Sensor wire inserted, and position confirmed with II
- Ureteral Catheter taken out and x/y Percuflex JJ ureteric stent inserted over the guidewire
- Position of stent confirmed in Kidney using II and in bladder visually with the cystoscope
- Minimal bleeding during the procedure
- Bladder emptied, instillagel to urethra, foreskin replaced
Post-op instructions:
- Eat, drink and mobilize as able
- Repeat bloods (FBC, U&E, CRP, Serum Ca & Urate) tomorrow am
- Aim home tomorrow if well after X-Ray KUB
- Encourage oral fluid intake, can expect some hematuria, should settle by itself
- VTE Prophylaxis: TEDS tonight and prophylactic LMWH from tomorrow if remains inpatient
- Antibiotics Plan: Chase intra-operative Urine MCS, continue antibiotics for xx days
- Anticoagulation/ Anti-platelets Plan:
Follow-up plan:
- Refer to Stone MDT regarding management of stone and stent (stent registry completed)
Peno-Scrotal Procedures
Standard Circumcision
DVT Proph: TEDS Antibiotics: Not required Blood Loss: Minimal Blood Transfusion: NA
Indication: Phimosis ? BXO
PMH:
Procedure:
- WHO checklist/ TEDS/ Supine position/ LA Penile block 1% plain Lidocaine + 0.25% Levobupivacaine (1:2) total ??ml/ No prophylactic antibiotics
- Sterile Prep and Drape
- Foreskin incision made at the Coronal Prominence
- Dorsal Slit performed
- Foreskin retracted and incision made below the corona
- Excess sleeve of Foreskin removed with scissors
- Haemostasis secured with Bipolar diathermy
- Frenulum reconstructed
- Skin edges approximated with 4/0 Vicryl Rapide simple interrupted sutures
- Gelonet dressing applied
Post-op instructions:
- Eat and drink as able, home today once well
- Dressing can come off in 24 hours
- Can shower from tomorrow, keep wound clean and dry (post-op care as per the BAUS patient information leaflet)
- Avoid sexual activity for 4-6 weeks until wound is completely healed
- Can apply Vaseline to wound to prevent friction with garments
- VTE Prophylaxis:
- Antibiotics Plan: NA
- Anticoagulation/ Anti-platelets Plan:
Follow-up plan:
- If any signs of infection (such as discharge or wound breakdown), please get in touch with your doctor for antibiotics
- No routine follow-up required unless requested by GP due to any post-op issues
Dorsal Slit Procedure
DVT Proph: Not required Antibiotics: Not required Blood Loss: Minimal Blood Transfusion: No
Indication: Phimosis
PMH:
Findings:
Procedure:
- WHO Checklist/ TEDS/ Supine Position/ LA Penile Block with 1% plain Lidocaine + 0.25% Levobupivacaine (1:2) total ??ml/ No prophylactic antibiotics
- Sterile Prep and drape
- Foreskin stretch to secure glans and meatus
- Glans adhesions with foreskin peeled away
- Foreskin clamped at 12’o clock position
- Foreskin cut using scissors at 12’ o clock position away from the meatus and glans
- Vicryl Rapide 3/0 simple interrupted sutures applied to the cut lips of the foreskin
- Satisfactory haemostasis, no diathermy required
- Gelonet dressing applied
Post-op instructions:
- Routine Obs
- Eat, drink and mobilize as able
- Aim home today once well, no routine follow-up required
- Can shower from tomorrow, keep wound clean and dry (post-op care as per the BAUS Circumcision patient information leaflet provided)
- Dressing can come off anytime
- Can apply Vaseline to wound to prevent friction with garments
- If any signs of infection (such as discharge or wound breakdown), please get in touch with your doctor for antibiotics
- VTE Prophylaxis:
- Antibiotics Plan:
- Anticoagulation/ Anti-platelets Plan:
Follow-up plan:
- No routine follow-up required unless requested by GP due to any post-op issues
Hydrocoele Repair
DVT Proph: TEDS Antibiotics: [ ] Blood Loss: Minimal Blood Transfusion: N/A
Indication: Symptomatic Hydrocele
PMH: [ ]
Procedure:
- WHO checklist/ TEDS/ Supine position/ GA/ No prophylactic antibiotics
- Sterile Prep and drape
- Median Raphee/ Horizontal hemi-scrotum incision
- Diathermy to get to the Tunica
- Blunt dissection with wet gauze to peel of fascial layers off the Tunica vaginalis
- Tunica vaginalis opened and hydrocoele drained (??ml)
- Hemostasis secured using diathermy (monopolar and bipolar)
- Jaboulay’s Repair done using 3/0 Vicryl
- Dartos closed using Vicryl 2/0
- 1% plain Lidocaine given at the wound edges (??ml)
- Skin closed with 4/0 Vicryl Rapide
- Skin glue applied, dressing gauze and scrotal support applied
Post Op Plan:
- Routine Obs
- Eat, drink and mobilize as able
- Aim home later today once well
- Can shower from tomorrow, keep wound clean and dry (post-op care as per the BAUS Hydrocele repair patient information leaflet)
- Scrotal support for 7-10 days
- Avoid strenuous activity for 4-6 weeks until wound fully healed
- If any signs of hematoma or infection (such as excessive scrotal swelling, discharge from the wound or wound breakdown) or any other concerns, please get in touch with your doctor for review and antibiotics
- VTE Prophylaxis:
- Antibiotics Plan:
- Anticoagulation/ Anti-platelets Plan:
Follow-up plan:
- No routine follow-up required unless requested by GP due to any post-op issues
Epididymal Cyst Excision
DVT Proph: TEDS Antibiotics: Blood Loss: Minimal Blood Transfusion: NA
Indication: Symptomatic Epididymal Cyst
PMH:
Procedure:
- WHO checklist/ TEDS/ Supine position/ GA/ No prophylactic antibiotics
- Sterile Prep and drape
- Median Raphee/ Horizontal hemi-scrotum incision
- Diathermy to get to the Tunica
- Blunt dissection with wet gauze to peel of fascial layers off the Tunica vaginalis
- Tunica opened and mild hydrocele drained
- Epididymal cyst identified, dissected and excised in total
- Hemostasis secured using diathermy (monopolar and bipolar)
- Jaboulay’s eversion done with Vicryl 3/0
- Dartos closed using Vicryl 2/0
- 1% plain Lidocaine given at the wound edges (??ml)
- Skin closed with 3/0 Vicryl Rapide
- Skin glue, dressing gauze and scrotal support applied
Post-op Plan:
- Routine Obs
- Eat, drink and mobilize as able
- Aim home later today once well
- Can shower from tomorrow, keep wound clean and dry (post-op care as per the BAUS patient information leaflet)
- Scrotal support for 7-10 days
- Avoid strenuous activity for 4-6 weeks until wound fully healed
- If any signs of hematoma or infection (such as excessive scrotal swelling, discharge from the wound or wound breakdown) or any other concerns, please get in touch with your doctor for review and antibiotics
- VTE Prophylaxis:
- Antibiotics Plan:
- Anticoagulation/ Anti-platelets Plan:
Follow-up plan:
- No routine follow-up required unless requested by GP due to any post-op issues
Radical Orchidectomy
DVT Prop: TEDS and Flowtrons Antibiotics: Not required Blood Loss: Minimal Blood Transfusion: NA
Indication:
PMH:
Findings:
Procedure:
- WHO checklist/ TEDS/ Supine position/ GA/ No prophylactic antibiotics
- Sterile Prep and drape
- Groin crease incision made
- Dissection done down till the External Oblique Aponeurosis using blunt dissection and monopolar diathermy
- Superficial Inferior Epigastric vein ligated
- External Oblique Aponeurosis incised and opened using scissors till the superficial ring
- Ilio-inguinal Nerve identified and safeguarded
- Spermatic cord dissected off the inguinal canal floor using finger dissection method
- Cord clamped at the level of the Deep inguinal ring
- Testicle delivered from the wound site and dissected off the fascial attachments and gubernaculum
- Cord divided and then transfixed and also ligated using Vicryl 0
- Specimen to pathology
- Haemostasis secured
- External Oblique Aponeurosis closed using continuous 2/0 vicryl suture while keeping Ilioinguinal nerve away
- Subcutaneous tissues approximated with 2/0 vicryl interrupted sutures
- LA 0.5% Levobupivacaine 20mls in total injected at wound site
- Skin closed with vicryl rapide 3/0 subcuticular sutures
- Skin glue and opsite dressing applied.
- Scrotal support applied and padded with dressing gauze.
Post-op instrustions:
- Routine Obs
- Eat, drink and mobilize as able
- Aim home later today once well
- Shower from tomorrow and keep wound clean and dry (post-op care as per the BAUS patient information leaflet)
- Scrotal support for 7-10 days
- Avoid strenuous activity for 4-6 weeks
- If any signs of hematoma or infection (such as excessive scrotal swelling, discharge from the wound or wound breakdown) or any other concerns, please get in touch with your doctor for review and antibiotics
- VTE Prophylaxis:
- Antibiotics Plan:
- Anticoagulation/ Anti-platelets Plan:
Follow-up plan:
- Histology to consultant, follow-up pending histopathology results and MDT
Vasectomy
Endoscopic Lower Urinary Tract Procedures
Rigid Cystoscopy
DVT Proph: TEDS Antibiotics: IV Gent Blood Loss: Minimal Blood Transfusion: NA
Indication: [ ]
Background: [ ]
PMH: [ ]
Flexible Cystoscopy: [ ]
Imaging: CTU mm/yy did not report any urological concerns or UTUC or mets
Intent: Diagnostic
Findings:
Urethra: Prostatic Urethra: Bladder: Tumour Number: Appearance: Papillary / Solid/ Mixed Size:
Procedure:
- WHO Checklist/ TEDS/ GA/ Lloyd-Davies position/ Prophylactic antibiotics
- Sterile prep and drape
- 22ch Rigid Cystoscope passed easily after lubrication
- Cystoscopy performed, findings above
- No biopsies or intervention required
- Bladder emptied
- Instillagel to Urethra, Foreskin replaced
Post-op instructions:
- Routine Obs
- Eat, drink and mobilize as able
- Aim Home today once well
- VTE Prophylaxis:
- Antibiotics Plan:
- Anticoagulation/ Anti-platelets Plan:
Follow-up plan:
- Check Flexible Cystoscopy in 3 months
Cystoscopy + Cystodiathermy
DVT Proph: TEDS Antibiotics: IV Gent Blood Loss: <50ml Blood Transfusion: NA
Indication:
PMH:
Flexi:
Imaging: CTU mm/yy did not report any urological concerns or UTUC or mets
Intent: Curative
Findings:
Urethra: Prostatic Urethra: Bladder: Tumor Number: Appearance: Papillary / Solid/ Mixed Size:
Procedure:
- WHO Checklist/ TEDS/ GA/ Lloyd-Davies position/ Prophylactic antibiotics
- Sterile prep and drape
- 22ch Resectoscope passed easily after lubrication
- Cystoscopy performed, findings above
- Bugbee electrode/ Roller ball monopolar diathermy of the lesion done
- Haemostasis checked, no significant bleeding
- All landmarks left intact
- Bladder emptied, instillagel to urethra, foreskin replaced
Post-op instructions:
- Routine Obs
- Eat, drink and mobilize as able
- Aim Home today once well
- VTE Prophylaxis:
- Antibiotics Plan:
- Anticoagulation/ Anti-platelets Plan:
Follow-up plan:
- Check Flexible Cystoscopy in 3 months
Cystoscopy + Biopsy + Cystodiathermy
DVT Proph: TEDS Antibiotics: IV Gent Blood Loss: <50ml Blood Transfusion: N/A
Indication:
Background:
PMH:
Flexi:
Imaging: CTU mm/yy did not report any urological concerns or UTUC or mets
Intent: Curative
Findings: Urethra: Prostatic Urethra: Bladder: Tumour Number: Appearance: Papillary / Solid/ Mixed Size:
Procedure:
- WHO Checklist/ TEDS/ GA/ Lloyd-Davies position/ Prophylactic antibiotics
- Sterile prep and drape
- 22Fr Rigid Cystoscope passed easily after lubrication
- Cystoscopy performed, findings above
- Cold cup biopsy of areas as noted above
- Bugbie electrode used and haemostasis done
- Haemostasis checked, no significant bleeding
- All landmarks left intact
- Bladder emptied, instillagel to urethra, foreskin replaced
Post-op instructions:
- Routine Obs
- Eat, drink and mobilize as able
- Aim home today once well
- VTE Prophylaxis:
- Antibiotics Plan:
- Anticoagulation/ Anti-platelets Plan:
Follow-up plan:
- Histology to consultant and follow-up based on histology
Cystolitholapaxy / Endoscopic Bladder Stone Removal
DVT Proph: TEDS Antibiotics: IV Gent Blood Loss: <50ml Blood Transfusion: NA
Indication:
PMH:
Findings:
Equipment:
Procedure:
- WHO Checklist/ TEDS/ GA/ Lloyd-Davies position/ Prophylactic antibiotics
- Sterile prep and drape
- Cystoscopy done, findings as above
- Stone identified and fragmented + removed with the Shockpulse
- Other fragments crushed with Stone punch
- Ellick’s done to remove the stone fragments
- Instillagel to urethra and xxFr y-way silicone catheter inserted, 10ml in balloon
Post-op instructions:
- Routine Obs
- Eat, drink and mobilize as able
- Irrigation until urine is clear
- TWOC tomorrow am if urine clear
- Aim home after TWOC once well (post-op care as per the BAUS patient information leaflet)
- VTE Prophylaxis:
- Antibiotics Plan:
- Anticoagulation/ Anti-platelets Plan:
Follow-up plan:
- Outpatient clinic appointment with flows on arrival in 3 months (routine)
- Consider for Bladder Outlet Surgery to prevent bladder stone recurrence
Optical Urethrotomy
DVT Proph: TEDS Antibiotics: IV Gent Blood Loss: <50ml Blood Transfusion: NA
Indication:
PMH:
Findings:
Procedure:
- WHO Checklist/ TEDS/ GA/ Lloyd-Davies position/ Prophylactic antibiotics
- Sterile prep and drape
- Urethroscopy done, pin-hole stricture noted in
- Sensor Guidewire passed, gentle, conservative optical urethrotomy done to visualise lumen
- Gentle dilation done by passing the scope over the guidewire (21Fr Optical Urethrotome)
- Instillagel to Urethra,18Fr short term catheter left in situ with 10mls in balloon
- Foreskin replaced
Post-op instructions:
- Routine Obs
- Eat, drink and mobilize as able
- Irrigation until urine is clear
- TWOC in 5 days in community
- Home later today once well (post-op care as per the BAUS patient information leaflet)
- VTE Prophylaxis:
- Antibiotics Plan:
- Anticoagulation/ Anti-platelets Plan:
Follow-up plan:
- Outpatient clinic appointment with flows on arrival in 3 months (routine)
Transurethral Resection of Prostate TURP
DVT Proph: TEDS Antibiotics: IV Gent Blood Loss: <500ml Blood Transfusion: NA
Indication:
PMH:
Findings:
Energy Type: Monopolar/ Bipolar Resection Time:
Procedure:
- WHO Checklist/ TEDS/ GA/ Lloyd-Davies position/ Prophylactic antibiotics
- Sterile prep and drape
- Resectoscope inserted
- Both UOs seen and marked, Verumontanum noted and marked
- Resection done till the veru
- Good channel post resection, all landmarks left intact
- Haemostasis secured and confirmed
- Wardill Test:
- Instillagel to urethra and 22Fr 3 way silicone catheter inserted, 30mls in balloon
- Foreskin replaced
Post-op instructions:
- Eat, drink and mobilize as able
- Irrigation until urine is clear
- TWOC tomorrow 6am if urine clear
- Home after TWOC if well, with patient information leaflet on Male Pelvic Floor Exercises (post-op care as per the BAUS patient information leaflet)
- VTE Prophylaxis:
- Antibiotics Plan:
- Anticoagulation/ Anti-platelets Plan:
Follow-up plan:
- Outpatient clinic appointment with flows on arrival in 3 months (routine)
HoLEP- Holmium Laser Enucleation of Prostate
DVT Proph: TEDS Antibiotics: IV Gent Blood Loss: <500ml Blood Transfusion: NA
Indication:
PMH:
Findings: Large Trilobar Occlusive prostate
Energy Type: Holmium Laser, Enucleation Time: , Morcelation Time:
Procedure:
- WHO Checklist/ TEDS/ GA/ Lloyd-Davies position/ Prophylactic antibiotics
- Sterile prep and drape
- Cystoscopy after copious lubrication
- Both UOs seen, Verumontanum noted
- Early Apical Release done
- En-bloc enucleation of the prostate
- Haemostasis secured and confirmed
- Morcelation done
- Instillagel to urethra and 22Fr 3 way silicone catheter inserted, 30mls in balloon
- Foreskin replaced
Post-op instructions:
- Routine Obs
- Eat, drink and mobilize as able
- Irrigation until urine is clear
- TWOC tomorrow 6am if urine clear
- Home after TWOC if well, with patient information leaflet on Male Pelvic Floor Exercises (post-op plan as per the BAUS patient information leaflet)
- VTE Prophylaxis:
- Antibiotics Plan:
- Anticoagulation/ Anti-platelets Plan:
Follow-up plan:
- Outpatient clinic appointment with flows on arrival in 3 months (routine)
Bladder Neck Resection/ Incision
DVT Proph: TEDS Antibiotics: IV Gent Blood Loss: <100ml Blood Transfusion: NA
Indication:
PMH:
Flexible Cystoscopy:
Findings:
Energy Type:
Procedure:
- WHO Checklist/ TEDS/ GA/ Lloyd-Davies position/ Prophylactic antibiotics
- Sterile prep and drape
- Resectoscope inserted, findings as above
- Both UOs seen and marked, verumontanum noted and marked
- Resection of the bladder neck done till the veru from 4’o clock to 8’o clock position
- Good channel post resection, all landmarks left intact
- Haemostasis secured and confirmed
- Instillagel to urethra and 22Fr 3 way silicone catheter inserted with 40ml in balloon
- Foreskin replaced.
Post-op instructions:
- Routine Obs
- Eat, drink and mobilize as able
- Irrigation until urine is clear
- TWOC tomorrow 6am if urine clear
- Home after TWOC if well, with patient information leaflet on Male Pelvic Floor Exercises (post-op plan as per the BAUS patient information leaflet)
- VTE Prophylaxis:
- Antibiotics Plan:
- Anticoagulation/ Anti-platelets Plan:
Follow-up plan:
- Outpatient clinic appointment with flows on arrival in 3 months (routine)
Elective Suprapubic Catheter SPC Insertion under Cystoscopic Guidance
DVT Proph: TEDS Antibiotics: IV Gent Blood Loss: <50ml Blood Transfusion: NA
Indication:
PMH:
Flexible Cystoscopy:
Findings:
Procedure:
- WHO Checklist/ TEDS/ GA/ Lloyd-Davies position/ Prophylactic antibiotics
- Sterile prep and drape
- Bladder distended cystoscopically and visualized using USS, no intersecting bowel loop, amenable to safe SPC insertion
- Markings made at the edge of bladder, pubic symphysis and SPC insertion site 2-4cm above pubic symphysis and LA injected
- 16Fr SPC inserted using Seldinger technique under cystoscopic guidance, 10ml in balloon
- Easy insertion, inserted on first attempt
- Tegaderm dressing applied
Post-op instructions:
- Routine Obs
- Eat, drink and mobilize as able
- Home later today if well and draining urine fine
- Size 16Fr Silicone SPC catheter in situ with 10ml in balloon, change in community in 12 weeks’ time
- Home after TWOC if well, with patient information leaflet on Male Pelvic Floor Exercises (post-op plan as per the BAUS patient information leaflet)
- VTE Prophylaxis:
- Antibiotics Plan:
- Anticoagulation/ Anti-platelets Plan:
Follow-up plan:
- Outpatient clinic appointment in 3 months (routine)
Hydrodistension
DVT Proph: TEDS Antibiotics: IV Gent Blood Loss: <50ml Blood Transfusion: NA
Indication:
PMH:
Flexible Cystoscopy:
Findings:
- Cystoscopy:
- Cystometric capacity at 10cm of water:
- Hydrodistension at 80cm of water:
- Cystoscopy post hydrodistension:
- Bladder Biopsies:
Procedure:
- WHO Checklist/ TEDS/ GA/ Lloyd-Davies position/ Prophylactic antibiotics
- Sterile prep and drape
- 22ch Rigid Cystoscope passed easily after lubrication
- Cystoscopy performed, findings above
- No biopsies or intervention required
- Bladder emptied
- Instillagel to Urethra, foreskin replaced
Post-op instructions:
- Routine Obs
- Eat, drink and mobilize as able
- Aim Home today once well
- VTE Prophylaxis:
- Antibiotics Plan:
- Anticoagulation/ Anti-platelets Plan:
Follow-up plan:
- Outpatient clinic appointment (routine)
Endoscopic Upper Tract Procedures
Elective Ureteric Stent Insertion
DVT Proph: TEDS Antibiotics: IV Gent Blood Loss: Minimal Blood Transfusion: NA
Indication: Background:
PMH:
Findings:
Procedure:
- WHO Checklist/ TEDS/ GA/ Lloyd-Davies position/ Prophylactic antibiotics
- Sterile prep and drape
- Cystoscopy performed after copious lubrication, no concerning cystoscopy findings
- Both UO’s visualised, and left/right ureter identified
- Reference images taken with Image Intensifier
- Sensor wire inserted, easily passed upto the kidney
- Ureteral Catheter inserted and Retrograde Pyelogram done to delineate PCS
- Sensor wire inserted, and position confirmed with II
- Ureteral Catheter taken out and x/y Percuflex JJ ureteric stent inserted over the guidewire
- Position of stent confirmed in Kidney using II and in bladder visually with the cystoscope
- Minimal bleeding during the procedure
- Bladder emptied, instillagel to urethra, foreskin replaced
Post-op instrustions:
- Stent registry completed
- Routine Obs
- Eat, drink and mobilize as able
- Aim Home today once well (post-op care as per the BAUS patient information leaflet)
- Encourage oral fluid intake, can expect some hematuria, should settle by itself
- VTE Prophylaxis:
- Antibiotics Plan:
- Anticoagulation/ Anti-platelets Plan:
Follow-up plan:
Right/ Left Ureteric Stent Exchange
DVT Proph: TEDS Antibiotics: IV Gent Blood Loss: Minimal Blood Transfusion: N/A
Indication: Background:
PMH:
Findings:
Procedure:
- WHO Checklist/ TEDS/ GA/ Lloyd-Davies position/ Prophylactic antibiotics
- Sterile prep and drape
- Cystoscopy performed after copious lubrication, no concerning cystoscopy findings
- Stent identified, findings above.
- Reference image take on Image Intensifier
- Stent grasped and pulled out to meatus
- Sensor wire through stent, up to kidney
- Ureteric Catheter to perform retrograde pyelogram to delineate pelvicalyceal system
- x/yFr stent exchanged over wire
- Good stent position confirmed with II in the kidney and cystoscopically in the bladder – images saved to PAC
- Bladder emptied, instillagel to urethra, foreskin replaced
Post-op instructions:
- Stent registry completed
- Routine Obs
- Eat, drink and mobilize as able
- Aim Home today once well (post-op care as per the BAUS patient information leaflet)
- Encourage oral fluid intake, can expect some hematuria, should settle by itself
- VTE Prophylaxis:
- Antibiotics Plan:
- Anticoagulation/ Anti-platelets Plan:
Follow-up plan:
- Change of Ureteric stent in 6-8 months
Uretero-Reno-Scopy and Laser Stone Fragmentation (Ureter)
Surgeon:
DVT Proph: TEDS Antibiotics: IV Gent Blood Loss: Minimal Blood Transfusion: NA
Indication: Background:
PMH:
Findings:
Procedure:
- WHO Checklist/ TEDS/ GA/ Lloyd-Davies position/ Prophylactic antibiotics
- Sterile prep and drape
- Cytoscopy done after copious lubrication
- Ureteric orifice identified and sensor wire advanced to the kidney
- Semi-Rigid Ureteroscope inserted using a second PTFE guidewire
- Ureteic stone identified and dusted using TFL laser (6W, irrigation at room temperature)
- Flexible URS to the Kidney
- Ureter inspected on the way out, no significant trauma
- 5/24Fr Precuflex stent inserted. Bladder emptied. Instillagel to urethra.
Post-op instructions:
- Stent registry completed
- Routine Obs
- Eat, drink and mobilize as able
- Aim Home today once well (post-op care as per the BAUS patient information leaflet)
- Encourage oral fluid intake, can expect some hematuria, should settle by itself
- VTE Prophylaxis:
- Antibiotics Plan:
- Anticoagulation/ Anti-platelets Plan:
Follow-up plan:
- Stent out in
- XR KUB in
- Letter with results of stone analysis
Uretero-Reno-Scopy and Laser Stone Fragmentation (Ureter + Renal)
Surgeon:
DVT Proph: TEDS Antibiotics: IV Gent Blood Loss: Minimal Blood Transfusion: NA
Indication: Background:
PMH:
Findings:
Procedure:
- WHO Checklist/ TEDS/ GA/ Lloyd-Davies position/ Prophylactic antibiotics
- Sterile prep and drape
- Cytoscopy done after copious lubrication
- Ureteric orifice identified and Sensor wire advanced to the kidney
- Semi-Rigid Ureteroscope inserted using a second PTFE guidewire
- Ureteric stone identified and dusted using TFL laser (6W, irrigation at room temperature)
- Flexible URS to the Kidney
- Stone identified and treated with laser (12W, irrigation at room temperature)
- Ureter inspected on the way out, no significant trauma
- 5/24Fr Precuflex stent inserted. Bladder emptied. Instillagel to urethra.
Post-op instructions:
- Stent registry completed
- Routine Obs
- Eat, drink and mobilize as able
- Aim Home today once well (post-op care as per the BAUS patient information leaflet)
- Encourage oral fluid intake, can expect some hematuria, should settle by itself
- VTE Prophylaxis:
- Antibiotics Plan:
- Anticoagulation/ Anti-platelets Plan:
Follow-up plan:
- Stent out in
- XR KUB in
- Letter with results of stone analysis
Diagnostic URS
Surgeon:
DVT Proph: TEDS Antibiotics: IV Gent Blood Loss: Minimal Blood Transfusion: NA
Indication: Background:
PMH:
Findings: Urethra: Normal Bladder : Normal URS:
Procedure:
- WHO Checklist/ TEDS/ GA/ Lloyd-Davies position/ Prophylactic antibiotics
- Sterile prep and drape
- Cytoscopy done after copious lubrication
- Ureteric orifice identified and Sensor wire advanced to the kidney
- 2 wire technique used to do semi-rigid ureteroscopy
- Switched to flexible URS over PTFE wire
- Findings as above
- Kidney emptied, ureter inspected on the way out, no significant trauma
- Bladder emptied, instillagel to the urethra, foreskin replaced
Post-op instructions:
- Stent registry completed
- Routine Obs
- Eat, drink and mobilize as able
- Aim Home today once well (post-op care as per the BAUS patient information leaflet)
- Encourage oral fluid intake, can expect some hematuria, should settle by itself
- VTE Prophylaxis:
- Antibiotics Plan:
- Anticoagulation/ Anti-platelets Plan:
Follow-up plan:
Prosate Biopsies
Trans-Perineal (TP) Prostate Biopsies
PSA: MRI Scan: vol-/PSAD- /Grade-/T DRE:
IPSS: /35, QoL: /6 LUTS Medication: Uroflowmetry: Qmax/ TVV/ PVR
LA: 6ml of Lidocaine with Adrenaline to the skin + 15ml in total (7.5ml on either side), 1:1 mixture of 0.25% Levobupivacaine and 1% Lidocaine as Peri-Prostatic Block.
Systematic sampling from both prostatic lobes and separate target biopsies. Biopsies went as planned with no immediate post-procedure complication.
Plan:
- Histology to Consultant
- MDT pending histology
- Telephone patient with results and MDT
- Anticoagulation/ Anti-platelets Plan:
Trans-Rectal UltraSound guided (TRUS) Prostate Biopsies
PSA: MRI Scan: vol-/PSAD- /Grade-/T DRE:
IPSS: /35, QoL: /6 LUTS Medication: Uroflowmetry: Qmax/ TVV/ PVR Risks such as bleeding, urine infection and sepsis explained. Systematic biopsies done from the Right and Left prostate lobes under local anesthesia and antibiotic cover (ciprofloxacin), with written consent. Uneventful procedure.
Plan:
- Histology to Consultant
- MDT pending histology
- Telephone patient with results and MDT
- Anticoagulation/ Anti-platelets Plan:
Op List Prep Template
Op List Prep Template pdf