| Urology
is a surgical subspecialty that deals with problems of the urinary
system of both men and women and the male genital system. See the list at right for more information about some of
the conditions we treat.
For procedures not routinely performed in our ambulatory
surgery center, we also see patients and perform procedures
in our partner
hospitals, including procedures that may require a short
inpatient hospital stay. For more information regarding other services
we provide, see below.
ARTIFICIAL URINARY SPHINCTER (AUS)
INSERTION About the Procedure: In mn who have significant incontinence, the placement of an inflatable artificial urinary sphincter may be required. This procedure is usually performed under general anesthesia and takes between 2 and 3 hours. It can be placed through an incision at the base of the penis, or in the skin behind the scrotum (the perineum). Patients usually go home on the day of their surgery. Once the sphincter is in place and functioning, the patient releases the sphincter and empties the bladder by depressing a button hidden in the scrotum. Once urination is complete, the sphincter automatically closes, keeping the urine in the bladder and keeping the patient dry. While the sphincter is designed to provide continence, it will not be ready for use until 6 weeks after its insertion. It should only be activated by your doctor. You should not expect to be dry immediately following your procedure. If you are dry immediately after the procedure, notify your doctor, as this may be a sign that the sphincter has been activated before it is ready for use. For more information regarding AUS insertion, click here.
Preparing for the Procedure: Do not eat or drink anything after midnight the night before the procedure. You should take your usual medications as you normally would the morning of your procedure with a small sip of water only (avoid juice, milk, coffee, etc.). starting 5 to 10 days prior to your procedure (ask your doctor for a specific time), it is important to stop taking medications that might increase your risk of bleeding. For a list of blood-thinning medications that should be avoided, click here or ask you doctor. Make arrangements for someone to drive you home on the day of your procedure.
After the Procedure: Some patients will require a catheter for a few days after their procedure. The catheter should only be removed by your Urologist. Drink 6 to 8 glasses (1500cc) of fluid daily until the catheter is removed. If blood appears in your urine (red fluid in the tubing of the catheter), increase your fluid intake and decrease your activity level until it clears. While at home, keep the catheter connected to the large drainage bag. It is OK to use the smaller drainage bag if you plan on going out of the house. It is normal for your catheter to have pink to reddish urine, especially with increased activity or bowel movements. Decreasing your activity and increasing fluids will usually make the urine clear. Men with a catheter may notice pink discharge at the tip of the penis—this is normal. Applying over-the-counter antibacterial ointment (e.g. Neosporin or Bacitracin) 2 to 4 times daily to the tip of the penis will help decrease irritation. On the second day after your surgery, it is OK to shower, but baths and soaking in a tub should be avoided for 2 weeks after the procedure. The incision should be kept clean and dry to allow it to heal, so it is important to shower once a day. The incision generally heals in five to seven days, and the stitches will dissolve and their own and do not need to be removed. Avoid any strenuous activity, exercise, or heavy lifting for 4 to 6 weeks after the procedure. You should abstain from sexual intercourse for 6 weeks following the procedure. It is usually OK to resume your blood-thinning
medications the day after your procedure, but check with your
doctor to be sure. Take all the medications prescribed by your doctor
(including any antibiotics and pain medications), and schedule an
appointment to follow up with him within the first 2 weeks after the
procedure (ask your doctor if you are unsure when to follow up).
BRACHYTHERAPY
(RADIOACTIVE SEED IMPLANTATION) OF THE PROSTATE
Take only clear liquids on the day prior to the procedure. Acceptable liquids include tea or coffee (no milk or cream), water, apple juice, Gatorade or other sports drinks, popsicles, italian ice, or chicken broth. Drink five ounces of citrate of magnesium at 4:00 pm the day before the procedure. If this does not produce a bowel movement by 7:00 pm take an additional 2 ounces of citrate of magnesium. This is available over the counter in the laxative section of your pharmacy. Remember to drink plenty of clear liquids to stay hydrated while preparing for your procedure. Do not eat or drink anything after midnight the night before the procedure. You should take your usual medications as you normally would the morning of your procedure with a small sip of water only (avoid juice, milk, coffee, etc.). Starting 5 to 10 days prior to your procedure (ask your doctor for a specific time), it is important to stop taking medications that might increase your risk of bleeding. For a list of blood-thinning medications that should be avoided, click here or ask you doctor. Additionally, your doctor may have prescribed for you an enema, which should be taken rectally 2 hours before coming in to the hospital on the day of your surgery. Check the packaging of the enema for specific instructions.
In addition to being sent home with a catheter in you bladder, there will be a dressing over the procedure site in your groin (perineum). This can usually be removed the day after you arrive home (the second day after surgery). After that, it is OK to shower, but baths and soaking in tubs should be avoided for 2 weeks following the procedure. Avoid heavy lifting, exercise, and strenuous activity for 4 to 6 weeks following your procedure. You will be discharged with a catheter in your bladder. This is typically left in place for 1 to 2 weeks. The catheter should only be removed by your Urologist. Drink 6 to 8 glasses (1500cc) of fluid daily until the catheter is removed. If blood appears in your urine (red fluid in the tubing of the catheter), increase your fluid intake and decrease your activity level until it clears. While at home, keep the catheter connected to the large
drainage bag. It is OK to use the smaller drainage bag if you plan on
going out of the house. It is normal for your catheter to have pink to
reddish urine, especially with increased activity or bowel movements.
Decreasing your activity and increasing fluids will usually make the
urine clear. You may notice pink discharge at the tip of the
penis—this is normal. Applying over-the-counter antibacterial
ointment (e.g. Neosporin or Bacitracin) 2 to 4 times daily to the tip
of the penis will help decrease irritation.
PENILE PROSTHESIS INSERTION About the Procedure: For some men with erectile dysfunction, the
insertion of an rigid or inflatable penile prosthesis may be an option.
A mechanical device is inserted into the penis through a small incision
at the base of the penis, and when an erection is desired, it is
achieved by depressing a pump hidden within the scrotum. Once the
erection is no longer desired, the device can be
“deflated” by depressing the same button. The
procedure is performed under general anesthesia and usually takes
between 2 and 3 hours. Most patients go home the day of the procedure. While the penile prosthesis is designed to create an
erection, it will not be ready for use until 6 weeks after your
procedure and should only be activated by your doctor. This will allow
the incision and tissues time to heal, allowing the device to be used
safely and without discomfort. To learn more about penile prosthesis insertion, click here.
Do not eat or drink anything after midnight the night before the procedure. You should take your usual medications as you normally would the morning of your procedure with a small sip of water only (avoid juice, milk, coffee, etc.). starting 5 to 10 days prior to your procedure (ask your doctor for a specific time), it is important to stop taking medications that might increase your risk of bleeding. For a list of blood-thinning medications that should be avoided, click here or ask you doctor. Make arrangements for someone to drive you home on the day of your procedure.
On the second day after your surgery, it is OK to
shower, but baths and soaking in a tub should be avoided for 2 weeks
after the procedure. The incision should be kept clean and dry to allow
it to heal, so it is important to shower once a day. The incision
generally heals in five to seven days, and the stitches will dissolve
and their own and do not need to be removed. Avoid any strenuous
activity, exercise, or heavy lifting for 4 to 6 weeks after the
procedure. You should abstain from sexual intercourse for 6 weeks
following the procedure. It is usually OK to resume your blood-thinning
medications the day after your procedure, but check with your
doctor to be sure. Take all the medications prescribed by your doctor
(including any antibiotics and pain medications), and schedule an
appointment to follow up with him within the first 2 weeks after the
procedure (ask your doctor if you are unsure when to follow up).
RADICAL CYSTECTOMY About the Procedure: In some pateints with bladder cancer, removal of the bladder and the creation of an alternate drainage system for the body's urine, may be required. This urinary diversion is necessary because the kidneys will continue to produce urine even after the bladder has been removed. The bladder is removed through a vertical 10 to 15 centimeter incision in the middle of the lower abdomen (from below the belly button to the pubic bone), in a procedure that takes between 4 and 6 hours under general anesthesia. Patients are usually in the hospital for 5 to 7 days after their prcedure. Depending on the type of cancer, and the needs of each patient, the urine may be diverted to a urostomy, which is a permanent drainage opening on the skin of the lower abdomen that empties urine into a bag. Alternatively, your doctor may elect to create a new bladder (a neobladder) out of part of your bowel. This may empty through the normal urinary channel (the urethra), or it may be formed into a pouch inside of the body that needs to emptied using a catheter passed through a small openning on the skin periodically throughout each day. There are many options to consider, and you should ask your doctor as to which form of urinary diversion would work best for you.
Take only clear liquids on the day prior to the procedure. Acceptable liquids include tea or coffee (no milk or cream), water, apple juice, Gatorade or other sports drinks, popsicles, italian ice, or chicken broth. Drink five ounces of citrate of magnesium at 4:00 pm the day before the procedure. If this does not produce a bowel movement by 7:00 pm take an additional 2 ounces of citrate of magnesium. This is available over the counter in the laxative section of your pharmacy. Remember to drink plenty of clear liquids to stay hydrated while preparing for your procedure. Do not eat or drink anything after midnight the night before the procedure. You should take your usual medications as you normally would the morning of your procedure with a small sip of water only (avoid juice, milk, coffee, etc.). starting 5 to 10 days prior to your procedure (ask your doctor for a specific time), it is important to stop taking medications that might increase your risk of bleeding. For a list of blood-thinning medications that should be avoided, click here or ask you doctor. Additionally, your doctor may have prescribed for you an enema which should be taken rectally 2 hours before coming in to the hospital on the day of your surgery. Check the packaging of the enema for specific instructions.
After the Procedure: The care of your urinary diversion will differ depending on the type of procedure you have. Ask your doctor regarding specific instructions. In general, there will be a dressing on the incision that can be removed on the second day after the procedure. After that, it is OK to shower (let soap and water run over the incision, then pat dry), but baths and soaking in a tub should be avoided for 2 weeks after the procedure. The incision should be kept clean and dry to allow it to heal, so it is important to shower once a day. The incision generally heals in five to seven days, but avoid any strenuous activity and exercise or heavy lifting for 4 to 6 weeks after the procedure. Your doctor will remove the surgical staples in your incision at your first office visit following your discharge from the hospital. This is not painful and only takes a few minutes. It is usually OK to resume your blood-thinning
medications the day after your procedure, but check with your
doctor to be sure. Take all the medications prescribed by your doctor
(including any antibiotics and pain medications), and schedule an
appointment to follow up with him within the first 2 weeks after the
procedure (ask your doctor if you are unsure when to follow up).
PROSTATE CRYOTHERAPY About the Procedure: Take only clear liquids on the day prior to the procedure. Acceptable liquids include tea or coffee (no milk or cream), water, apple juice, Gatorade or other sports drinks, popsicles, italian ice, or chicken broth. Drink five ounces of citrate of magnesium at 4:00 pm the day before the procedure. If this does not produce a bowel movement by 7:00 pm take an additional 2 ounces of citrate of magnesium. This is available over the counter in the laxative section of your pharmacy. Remember to drink plenty of clear liquids to stay hydrated while preparing for your procedure. Do not eat or drink anything after midnight the night before the procedure. You should take your usual medications as you normally would the morning of your procedure with a small sip of water only (avoid juice, milk, coffee, etc.). starting 5 to 10 days prior to your procedure (ask your doctor for a specific time), it is important to stop taking medications that might increase your risk of bleeding. For a list of blood-thinning medications that should be avoided, click here or ask you doctor. Additionally, your doctor may have prescribed for you an enema, which should be taken rectally 2 hours before coming in to the hospital on the day of your surgery. Check the packaging of the enema for specific instructions.
In addition to being sent home with a catheter in you bladder, there will be a dressing over the procedure site in your groin (perineum). This can usually be removed the day after you arrive home (the second day after surgery). After that, it is OK to shower, but baths and saoking in tubs should be avoided for 2 weeks following the procedure. Avod heavy lifting, exercise, and strenuous activity for 4 to 6 weeks following your procedure. You will be discharged with a catheter in your bladder. This is typically left in place for 1 to 2 weeks. The catheter should only be removed by your Urologist. Drink 6 to 8 glasses (1500cc) of fluid daily until the catheter is removed. If blood appears in your urine (red fluid in the tubing of the catheter), increase your fluid intake and decrease your activity level until it clears. While at home, keep the catheter connected to the large
drainage bag. It is OK to use the smaller drainage bag if you plan on
going out of the house. It is normal for your catheter to have pink to
reddish urine, especially with increased activity or bowel movements.
Decreasing your activity and increasing fluids will usually make the
urine clear. You may notice pink discharge at the tip of the
penis—this is normal. Applying over-the-counter antibacterial
ointment (e.g. Neosporin or Bacitracin) 2 to 4 times daily to the tip
of the penis will help decrease irritation.
RADICAL RETROPUBIC PROSTATECTOMY About the Procedure: This procedure is performed primarily in the treatment
of prostate cancer, and it involves
the removal of the entire prostate and the seminal vesicals, and,
occassionally, the lymph nodes in the pelvis. This procedure is
performed through a 10 to 15 centimeter vertical incision, just below
the belly button. The procedure usually takes 3 to 4 hours, under
general anesthesia, and you should expect to spend at least one to two
nights in the hospital. Take only clear liquids on the day prior to the procedure. Acceptable liquids include tea or coffee (no milk or cream), water, apple juice, Gatorade or other sports drinks, popsicles, italian ice, or chicken broth. Drink five ounces of citrate of magnesium at 4:00 pm the day before the procedure. If this does not produce a bowel movement by 7:00 pm take an additional 2 ounces of citrate of magnesium. This is available over the counter in the laxative section of your pharmacy. Remember to drink plenty of clear liquids to stay hydrated while preparing for your procedure. Do not eat or drink anything after midnight the night before the procedure. You should take your usual medications as you normally would the morning of your procedure with a small sip of water only (avoid juice, milk, coffee, etc.). starting 5 to 10 days prior to your procedure (ask your doctor for a specific time), it is important to stop taking medications that might increase your risk of bleeding. For a list of blood-thinning medications that should be avoided, click here or ask you doctor. Additionally, your doctor may have prescribed for you an
enema which should be taken rectally 2 hours before coming in to the
hospital on the day of your surgery. Check the packaging of the enema
for specific instructions.
After the Procedure: General: Activities: Diet: Catheter care: Common Problems: Scrotal/Penile swelling: Incision opening: Bruising around the incision: Constipation/bloating:
"SLING PROCEDURE" FOR INCONTINENCE About the Procedure: In both men and women with certain types of incontinence, the insertion of a
sling—a mesh tape that provides support to the
urethra—may provide an improvement in symptoms. This
procedure is performed under sedation or general anesthesia on an
outpatient basis—most patients are able to go home the day of
the procedure—and takes 1 to 2 hours to perform. While some
patients may require a catheter for a few days after the procedure,
most will urinate normally immediately after the procedure, beginning
in the recovery room. To learn more about the procedure click here (for men) or click here (for women)
Do not eat or drink anything after midnight the night
before the procedure. You should take your usual medications as you
normally would the morning of your procedure with a small sip of water
only (avoid juice, milk, coffee, etc.). Starting 5 to 10 days prior to your procedure (ask your
doctor for a specific time), it is important to stop taking medications
that might increase your risk of bleeding. For a list of blood-thinning
medications that should be avoided, click
here or ask you doctor. Make arrangements for someone to drive you home on the
day of your procedure. After the Procedure:
TRANSURETHRAL RESECTION OF BLADDER TUMOR
(TURBT) About the Procedure: In some cases, especially during the work up of
hematuria (blood in the urine), your doctor may discover a mass in your
bladder that will need to be removed, or resected.
While the mass may be suspicious for bladder cancer, your doctor will
not know for certain until he can remove all or part of the tissue in
the bladder. This procedure is also sometimes performed after a bladder
biopsy, where your doctor is aware of the presence of bladder cancer and he wants to
remove it from your bladder. The procedure is usually done under
general anesthesia, but no incisions are made in the skin. Instead a
telescope is passed through the urine channel (the urethra),
and using very small instruments, your doctor carefully removes the
tissue from the bladder. The length of the procedure varies depending
on the size of the tumor, but many patients usually go home on the day
of their procedure without a catheter. If the tumor is particularly
large or grows deep into the bladder wall, you may go home with a
catheter in your bladder, or you may have to spend a night in the
hospital.
Preparing for the Procedure: Do not eat or drink anything after midnight the night
before the procedure. You should take your usual medications as you
normally would the morning of your procedure with a small sip of water
only (avoid juice, milk, coffee, etc.). Starting 5 to 10 days prior to your procedure (ask your
doctor for a specific time), it is important to stop taking medications
that might increase your risk of bleeding. For a list of blood-thinning
medications that should be avoided, click
here or ask you doctor. Make arrangements for someone to drive you home on the
day of your procedure.
After the Procedure: You may experience some increased urgency to urinate, as
well as increased frequency of urination for the first few days after
your procedure. Blood may also appear in the urine. This is normal and
expected. Drink plenty of fluids to help dilute the urine, and these
symptoms should resolve in a few days. Some patients will require a catheter for a few days
after their procedure. The catheter should only be removed by your
Urologist. Drink 6 to 8 glasses (1500cc) of fluid daily until the
catheter is removed. If blood appears in your urine (red fluid in the
tubing of the catheter), increase your fluid intake and decrease your
activity level until it clears. While at home, keep the catheter connected to the large
drainage bag. It is OK to use the smaller drainage bag if you plan on
going out of the house. It is normal for your catheter to have pink to
reddish urine, especially with increased activity or bowel movements.
Decreasing your activity and increasing fluids will usually make the
urine clear. Men with a catheter may notice pink discharge at the tip
of the penis—this is normal. Applying over-the-counter
antibacterial ointment (e.g. Neosporin or Bacitracin) 2 to 4 times
daily to the tip of the penis will help decrease irritation. On the second day after your surgery, it is OK to
shower, but baths and soaking in a tub should be avoided for 2 weeks
after the procedure. The incision should be kept clean and dry to allow
it to heal, so it is important to shower once a day. The incision
generally heals in five to seven days, and the stitches will dissolve
and their own and do not need to be removed. Avoid any strenuous
activity, exercise, or heavy lifting for 4 to 6 weeks after the
procedure. You should abstain from sexual intercourse for 6 weeks
following the procedure. It is usually OK to resume your blood-thinning
medications the day after your procedure, but check with your
doctor to be sure. Take all the medications prescribed by your doctor
(including any antibiotics and pain medications), and schedule an
appointment to follow up with him within the first 2 weeks after the
procedure (ask your doctor if you are unsure when to follow up).
TRANSURETHRAL RESECTION OF THE PROSTATE (TURP) – TRADITIONAL AND
LASER About the Procedure: Some men with lower urinary tract symptoms as a result
of an enlarged prostate or BPH will require a surgical
procedure to reduce the size of the prostate. This is not done through
an incision in the skin, but rather by passing a telescope into the
penis while the patient is under general or spinal anesthesia. Using
the telescope, a heated element is used to remove the excess prostate
tissue. After this traditional method, you should expect to stay in the
hospital for at least one night with a catheter in you bladder. Some
patients may go home with the catheter, but most will have it removed
the next day to try to urinate without it.
Preparing for the Procedure: Do not eat or drink anything after midnight the night
before the procedure. You should take your usual medications as you
normally would the morning of your procedure with a small sip of water
only (avoid juice, milk, coffee, etc.). Starting 5 to 10 days prior to your procedure (ask your
doctor for a specific time), it is important to stop taking medications
that might increase your risk of bleeding. For a list of blood-thinning
medications that should be avoided, click
here or ask you doctor. Make arrangements for someone to drive you home on the
day of your procedure.
After the Procedure: Some patients will require a catheter for a few days
after their procedure. The catheter should only be removed by your
Urologist. Drink 6 to 8 glasses (1500cc) of fluid daily until the
catheter is removed. If blood appears in your urine (red fluid in the
tubing of the catheter), increase your fluid intake and decrease your
activity level until it clears.
URETEROSCOPY AND LASER LITHOTRIPSY About the Procedure: This treatment involves the use of a very small, fiber-optic instrument called a ureteroscope, which allows access to stones in the ureter or kidney. The ureteroscope allows your urologist to directly visualize the stone by progressing up the ureter via the bladder. No incisions are necessary but general anesthesia is used. Once the stone is seen through the ureteroscope, a small, basket-like device can be used to grasp smaller stones and remove them. If a stone is too large to remove, a laser, spark-generating probe or air-driven (pneumatic) probe can be passed through a channel built into the ureteroscope and the stone can be fragmented. A straightforward case is complete once the stone has
been shattered appropriately. However, if extensive manipulation was
required to reach and/or treat the stone, your urologist may choose to
place a stent within the ureter to allow the post-operative swelling to
subside. Preparing for the Procedure: Do not eat or drink anything after midnight the night before the procedure. You should take your usual medications as you normally would the morning of your procedure with a small sip of water only (avoid juice, milk, coffee, etc.). Bring any copies of films or CDs of any radiology studies (X-rays or CT scans) with you on the day of your procedure. Make arrangements for someone to drive you home on the
day of your procedure.
After the Procedure: Most patients will be discharged home on the day of
their procedure without a catheter in their bladder. If your doctor has
left a stent in your kidney, you may experience an increased urge to
urinate, as well as increased frequency of urination. Additionally,
some patients experience mild to moderate discomfort in their back or
lower abdomen, especially during urination. Finally, some blood in the
urine may appear after the procedure, as well as some burning with
urination. These symptoms are normal and may last as long as you have
the stent in your body. Your doctor may prescribe you medication to
help lessen these symptoms, so it is important to take the medications
prescribed to you. Increasing your fluid intake will also help dilute
the urine and lessen these symptoms. It is very important to follow up with your
doctor to schedule to have the stent removed, as leaving the stent in
for prolonged periods of time may lead to infections, further stone
formation, and/or permanent kidney damage.
BLADDER BIOPSY About the Procedure: A bladder biopsy is done during a cystoscopy
in order to obtain a tissue sample from the lining of the inside of the
bladder. During the cystoscopy, your doctor will pass a small forceps
through the cystoscope in order to obtain the tissue sample Preparing for the Procedure: The preparation for a bladder biopsy is similar to that
for a cystoscopy.
Additionally, your doctor may ask you to stop taking blood-thinning
medications for a few days prior to your procedure. After the Procedure: You may experience temporary burning and possibly a small amount of blood in the urine. Don't be alarmed - these will usually clear within 24 hours. If you develop fever, chills, or heavy bleeding, notify
your doctor immediately. CIRCUMCISION About the Procedure: Circumcision is the surgical removal of the
foreskin—the tissue covering the head of the penis. During a
circumcision, the foreskin is freed from the head of the penis (glans),
and then removed. The remaining cut ends of the skin are then sutured
together using stitches that will dissolve by themselves. Circumcision
can be done using just local anesthetic, but sedation or deeper
anesthesia may be required in some cases (check with your doctor). The
procedure usually takes about one hour. Preparing for the Procedure: If you are to get sedation or general anesthesia for the
procedure (check with your doctor), do not eat or drink anything after
midnight the night before the procedure. You should take your usual
medications as you normally would the morning of your procedure with a
small sip of water only (avoid juice, milk, coffee, etc.). Starting 5
to 10 days prior to your procedure (ask your doctor for a specific
time), it is important to stop taking medications that might increase
your risk of bleeding. For a list of blood-thinning
medications that should be avoided, click
here or ask you doctor. After the Procedure: There will be a dressing on the incision that can be removed on the second day after the procedure. After that, it is OK to shower (let soap and water run over the incision, then pat dry), but baths and soaking in a tub should be avoided for 2 weeks after the procedure. The incision should be kept clean and dry to allow it to heal, so it is important to shower once a day. The incision generally heals in five to seven days, but avoid any strenuous activity and exercise or heavy lifting for 4 to 6 weeks after the procedure. The stitches will dissolve and fall off on their own usually within the first week or two after the procedure. It is usually OK to resume your blood-thinning medications the day after your procedure, but check with your doctor to be sure. Take all the medications prescribed by your doctor (including any antibiotics and pain medications), and schedule an appointment to follow up with him within the first 2 weeks after the procedure (ask your doctor if you are unsure when to follow up). Make arrangements for someone else to drive you home
after the procedure if you are to have sedation or general anesthesia. CYSTOSCOPY About the Procedure: Cystoscopy is a diagnostic procedure during which you bladder and urethra are examined with an instrument called a cystoscope. The instrument has a light and a fiber optic lens, and allows your doctor to directly view the lower part of your urinary tract. The cystoscopic exam is one of the most commonly performed urological procedures. It is brief, very safe, and simple and provides the doctor with immediate, valuable diagnostic information. The best way to prepare for your cystoscopy is to RELAX.
For most of us, the thought of an instrument, even a small one, being
placed into the urethra is naturally somewhat freighting. However, with
the use of a local anesthetic, most patients experience only mild
discomfort. When other procedures, such as biopsies, are performed
through the cystoscope, an intravenous sedative may also be needed.
Your cystoscopy may be performed either in a hospital or an outpatient
facility. Just before the procedure, you'll be asked to empty your bladder. A urine sample may be obtained. You'll then be asked to remove your clothing, and you will be given a gown or drape to use. Men undergo cystoscopy either lying on their back, or with their legs in stirrups, depending on the type of cystoscope being used. Women will have their legs in stirrups, similar to the gynecologist's office. Once you are comfortable in the exam table, a betadine solution will be used to cleanse the genital area. Then, xylocaine jelly will be applied as a local anesthetic. The procedure itself takes no more than 3 or 4 minutes.
Once the cystoscope is inserted, your bladder will be filled with
sterile irrigating fluid, allowing the doctor to distend your bladder
and see the walls more clearly. As the bladder fills, it is normal to
start to feel the urge to urinate. Tell the doctor when this occurs. DIAGNOSTIC PROCEDURES FOR MALE INFERTILITY
(Testis/Epididymis Biopsy) About the Procedure: A testicular biopsy is a procedure during which a small
sample of tissue from one or both testicles is removed and examined
under a microscope to evaluate a man's ability to father a child. It is
not usually done to detect cancer of the testicles. It involves an
incision in the scrotum and then into the testicle itself. The
procedure is usually done under sedation or deeper anesthesia and takes
about one hour to complete. Preparing for the Procedure: If you are to get sedation or general anesthesia for the
procedure (check with your doctor), do not eat or drink anything after
midnight the night before the procedure. You should take your usual
medications as you normally would the morning of your procedure with a
small sip of water only (avoid juice, milk, coffee, etc.). starting 5
to 10 days prior to your procedure (ask your doctor for a specific
time), it is important to stop taking medications that might increase
your risk of bleeding. For a list of blood-thinning
medications that should be avoided, click
here or ask you doctor. You should bring an athletic supporter or snug jockey
shorts to wear home after the procedure. After the Procedure: There will be a dressing on the incision that can be removed on the second day after the procedure. After that, it is OK to shower (let soap and water run over the incision, then pat dry), but baths and soaking in a tub should be avoided for 2 weeks after the procedure. The incision should be kept clean and dry to allow it to heal, so it is important to shower once a day. The incision generally heals in five to seven days, but avoid any strenuous activity and exercise or heavy lifting for 4 to 6 weeks after the procedure. The stitches will dissolve and fall off on their own usually within the first week or two after the procedure. It is usually OK to resume your blood-thinning medications the day after your procedure, but check with your doctor to be sure. Take all the medications prescribed by your doctor (including any antibiotics and pain medications), and schedule an appointment to follow up with him within the first 2 weeks after the procedure (ask your doctor if you are unsure when to follow up). Make arrangements for someone else to drive you home
after the procedure if you are to have sedation or general anesthesia.
About the Procedure: Hydroceles may require surgical repair if they cause
symptoms, such as growing large, or causing pain or discomfort. An
incision is made in the scrotum, and the hydrocele sac is cut out,
removing the tissues that create the fluid that surrounded the testicle. If you are to get sedation or general anesthesia for the
procedure (check with your doctor), do not eat or drink anything after
midnight the night before the procedure. You should take your usual
medications as you normally would the morning of your procedure with a
small sip of water only (avoid juice, milk, coffee, etc.). Starting 5
to 10 days prior to your procedure (ask your doctor for a specific
time), it is important to stop taking medications that might increase
your risk of bleeding. For a list of blood-thinning
medications that should be avoided, click
here or ask you doctor. You should bring an athletic supporter or snug jockey
shorts to wear home after the procedure. After the Procedure: There will be a dressing on the incision that can be removed on the second day after the procedure. After that, it is OK to shower (let soap and water run over the incision, then pat dry), but baths and soaking in a tub should be avoided for 2 weeks after the procedure. The incision should be kept clean and dry to allow it to heal, so it is important to shower once a day. The incision generally heals in five to seven days, but avoid any strenuous activity and exercise or heavy lifting for 4 to 6 weeks after the procedure. The stitches will dissolve and fall off on their own usually within the first week or two after the procedure. It is usually OK to resume your blood-thinning medication the day after your procedure, but check with your doctor to be sure. Take all the medications prescribed by your doctor (including any antibiotics and pain medications), and schedule an appointment to follow up with him within the first 2 weeks after the procedure (ask your doctor if you are unsure when to follow up). Make arrangements for someone else to drive you home
after the procedure if you are to have sedation or general anesthesia. PROSTATE BIOPSY Transrectal prostatic ultrasound is a diagnostic tool which allows the urologist to examine the prostate gland in great detail. It is an excellent way to guide specifically directed biopsies of the prostate. Transrectal ultrasound is done by inserting a slender probe into the rectum to visualize the prostate and adjacent structures. Once the prostate has been thoroughly examined, local anesthetics can be injected. The ultrasound is then used to guide the slender needle which will remove a very small piece of tissue to be examined by the pathologist. Multiple biopsies can easily and safely be obtained in this fashion. Patients can experience slight discomfort but is it is usually not painful. You should inform your doctor if you have experienced any prior rectal problems including hemorrhoids, fissures or any type of prior rectal surgery. Preparation for the Procedure: Your doctor will provide with you specific instructions regarding a mild bowel prep to be performed prior to the procedure. If you are given antibiotics take these exactly as you are instructed. If you are taking any aspirin, arthritis medications, Coumadin, Plavix or blood-thinning medication, please inform your doctor. These medications will generally need to be discontinued seven days before the procedure. If you are unsure about which medications may cause bleeding, click here or ask your doctor. After the Procedure: After your biopsy you may temporarily notice a small amount of blood in your urine, stool or semen. This is a very common occurrence and not a cause for alarm. If you should develop heavy bleeding or are unable to urinate then you should call your doctor immediately. If you experience fever or chills anytime after the exam, notify you physician immediately. Take any antibiotics that are prescribed to you for the entire course of treatment. Your physician will give you information at the time of the biopsy for the procedure for obtaining the results of the biopsy. SHOCK WAVE LITHOTRIPSY About the Procedure: Many stones in the kidney or ureter (tube between the
kidney and bladder) can be treated with a noninvasive treatment known
as shock wave lithotripsy or SWL. This procedure uses high energy shock
waves to break up urinary stones into sand like particles. During the
treatment, shock waves are focused precisely on the stone. Up to 3,000
shock waves are administered to the stone causing it to disintegrate.
These smaller fragments of stone can then be passed in your urine with
little discomfort. The procedure is performed under sedation
administered by your anesthesiologist and takes approximately thirty
minutes. Unlike other treatments, no incisions or catheters are
required. Patients are usually able to return to the comfort of their
own home within an hour or two following the procedure. If your doctor has recommended SWL for your stone then there are a few things you should know. Your doctor?s office will provide you with information regarding the date, time and location of your treatment. You will be required to have a preoperative history and physical as well as laboratory work completed several days prior to your procedure. You will be asked to bring all of your x-rays and CT scans with you including your most recent KUB x-ray. You will not be allowed to eat or drink anything after midnight the night before your procedure. Check with your doctor about taking heart medicines or medications for diabetes or high blood pressure on the morning of the procedure. You may be instructed to take these medicines with a small sip of water. If you are taking any aspirin, arthritis medications, Coumadin, Plavix or blood-thinning medications, please inform your doctor. These medications will generally need to be discontinued seven days before the procedure. If you are unsure about which medications may cause bleeding, click here or ask your doctor. Your doctor will use a real time x-ray called fluoroscopy to precisely locate your stone during the treatment. For this reason it is important to follow a few simple procedures to minimize the amount of gas or stool in the bowel which might make visualization of your stone more difficult.
After the Procedure: The recovery period following SWL is usually only a few
days. The small stone particles are passed from your body in the urine
over the next several days or weeks. You should drink plenty of
liquids, especially water in the days and weeks following the
procedure. You will be asked to strain your urine following the
procedure and bring the small pieces of gravel to your doctor for
analysis. You may experience some discomfort when passing larger
fragments. You will be provided with a prescription for pain medicine
to take if you need it. In the unlikely event you experience more
severe pain or a fever you should call your doctor at once. You will
typically have another x-ray several weeks later and you will need to
bring this x-ray and the preoperative x-rays to your doctor's office to
be sure the stone has completely cleared. URODYNAMIC TESTING About the Procedure: Urodynamics testing is a series of procedures designed
to provide information about a bladder problem. They can measure the
bladder's ability to hold and release urine and usually involve placing
a small catheter into the bladder. It provides a more advanced way to
check bladder function, and it does not require anesthesia. You may be
asked a series of questions about the sensations you feel in your
bladder during the test to help you doctor better understand your
problem. The procedure usually takes approximately 15 minutes and may
be combined with a cystoscopy
or other procedures. Preparing for the Procedure: The most important thing to do is to relax. The testing
is most accurate when we can recreate your symptoms during the test.
The procedure will not be painful, and by staying relaxed, you can help
ensure that the information obtained during the test is as accurate as
possible. After the Procedure: You may experience temporary burning and possibly a small amount of blood in the urine. Don't be alarmed - these will usually clear within 24 hours. If you develop fever, chills, or heavy bleeding, notify
your doctor immediately VARICOCELE REPAIR About the Procedure: Varicocele repair is performed to improve male
fertility. It can usually be done surgically on an outpatient basis
using local anesthetic, but some cases may require sedation or deeper
anesthesia. A small incision is made in the lower abdomen, on the side
of the varicocele. The veins that produce the varicocele are identified
and cut to eliminate the swelling in these vessels. The procedure
usually takes about 60 to 90 minutes. Preparing for the Procedure: If you are to get sedation or general anesthesia for the
procedure (check with your doctor), do not eat or drink anything after
midnight the night before the procedure. You should take your usual
medications as you normally would the morning of your procedure with a
small sip of water only (avoid juice, milk, coffee, etc.). starting 5
to 10 days prior to your procedure (ask your doctor for a specific
time), it is important to stop taking medications that might increase
your risk of bleeding. For a list of blood-thinning
medications that should be avoided, click
here or ask you doctor. After the Procedure: There will be a dressing on the incision that can be removed on the second day after the procedure. After that, it is OK to shower (let soap and water run over the incision, then pat dry), but baths and soaking in a tub should be avoided for 2 weeks after the procedure. The incision should be kept clean and dry to allow it to heal, so it is important to shower once a day. The incision generally heals in five to seven days, but avoid any strenuous activity and exercise or heavy lifting for 4 to 6 weeks after the procedure. The stitches will dissolve and fall off on their own usually within the first week or two after the procedure. It is usually OK to resume your blood-thinning medication the day after your procedure, but check with your doctor to be sure. Take all the medications prescribed by your doctor (including any antibiotics and pain medications), and schedule an appointment to follow up with him within the first 2 weeks after the procedure (ask your doctor if you are unsure when to follow up). Make arrangements for someone else to drive you home
after the procedure if you are to have sedation or general anesthesia.
Although the vast majority of patients make a smooth,
uneventful recovery from their procedure, the chances of any problem
occurring can be minimized by following a few simple instructions.
MEDICATIONS TO AVOID BEFORE SURGERY Medications Which May Cause
Bleeding Many common medications including prescription drugs and
over the counter medicines are strong anticoagulants and may cause
bleeding problems in normal individuals undergoing surgery. Please
review the following list to see if you are taking any of these
medications which need to be discontinued for up to seven days before
your surgical procedure. This list is not a complete listing but show
many of the common drugs which may contain aspirin or other
anti-inflammatory medication or other blood thinners. DO NOT STOP TAKING any medication including those on the list below without first consulting your doctor. Inform your doctor if you are taking any prescription or over the counter medications obtained in another country as they may contain some of the listed medications. If you must take something for a headache or other minor
aches or pains you may take acetaminophen unless directed otherwise by
your doctor.
Coumadin (Warfarin) and Plavix are two potent
anticoagulants. Consult with your doctor for specific instructions on
when to discontinue these medications. |
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