DOCSLIB.ORG

Laparoscopic Radical Cystourethrectomy in a Patient with Adenocarcinoma of the Female Urethral Diverticulum

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Laparoscopic Radical Cystourethrectomy in a Patient with Adenocarcinoma of the Female Urethral Diverticulum www.kjurology.org DOI:10.4111/kju.2010.51.2.145 Case Report Laparoscopic Radical Cystourethrectomy in a Patient with Adenocarcinoma of the Female Urethral Diverticulum Hong Koo Ha, Wan Lee, Sang Don Lee, Jeong Zoo Lee, Moon Kee Chung Department of Urology, Pusan National University Hospital, Pusan National Universtiy School of Medicine, Busan, Korea Adenocarcinomas arising in the female urethra have been rarely reported. Here we re- Article History: port a case of laparoscopic radical cystourethrectomy with incontinent urinary di- received 27 October, 2009 3 January, 2010 version in a patient with adenocarcinoma in the urethra and bladder. A 60-year-old accepted female presenting with a history of recurrent cystitis and painless hematuria was re- Corresponding Author: ferred to our facility with voiding difficulty and a urethral mass. Radiologic evaluation Hong Koo Ha showed an enhanced mass in the urethra and bladder neck. Cystoscopic biopsy of the Department of Urology, Pusan National mass in the bladder neck revealed an adenocarcinoma. Laparoscopic radical cystour- University School of Medicine, 305, Gudeok-ro, Seo-gu, Busan 602-739, ethrectomy with anterior vaginal wall excision followed by extracorporeal incontinent Korea urinary diversion was performed. TEL: +82-51-240-7351 FAX: +82-51-247-5443 Key Words: Adenocarcinoma; Laparoscopy; Urethra E-mail: [email protected] This work was supported by clinical research grant from Pusan National University Hospital 2010. Primary carcinomas arising in a urethral diverticulum normal limits. During cystourethroscopy, a papillary have rarely been reported and account for only 5% of all ure- growing tumor was found at the bladder neck (Fig. 1). We thral malignancies [1]. Most of these tumors arise from found no definite mass lesion during urethrography; how- squamous or transitional cells, and only 20% are ad- ever, a urethral narrowing was revealed. Magnetic reso- enocarcinomas of unknown origin. nance imaging (MRI) showed a urethral mass invading the Because of the rarity of such tumors, a treatment strat- base of the bladder and the anterior vaginal wall with no egy has not been established, but radical cystourethrec- pelvic lymph node enlargement. The mass showed homoge- tomy with pelvic lymph node dissection and urinary di- neous, low signal intensity on T1-weighted images and in- version appears to be the most beneficial modality for non- homogeneous contrast enhancement after gadolinium metastatic disease. Many authors have reported on an administration. On T2-weighted images, the mass showed open approach; however, we performed laparoscopic radi- high signal intensity surrounded by a low signal intense cal cystourethrectomy with bilateral pelvic lymph node rim (Fig. 2). dissection and anterior vaginal wall excision followed by A fan-shaped four-port laparoscopic transperitoneal ap- ileal urinary diversion with a minimal abdominal incision. proach was performed (one 10 mm port placed at 10 mm above the umbilicus [camera], one 12 mm right pararectal CASE REPORT trocar, one 12 mm trocar placed laterally in the right lower quadrant [assistant port], and one 5 mm trocar placed be- A 60-year-old female with a history of recurrent cystitis and tween the left anterior iliac spine and the umbilicus). painless gross hematuria for 3 years was referred to our in- Mild adhesion was observed around the ureter. After stitution complaining of intermittent urinary retention. ureteral dissection, we clamped the ureter close to the ure- The patient had undergone a radical hysterectomy with bi- terovesical junction by using a Hem-o-Lok clip and per- lateral salpingo-oophorectomy due to squamous cell type formed a frozen biopsy. The results of the frozen biopsy cervical cancer 20 years ago. Physical examination re- were negative and right side pelvic lymph node dissection vealed a firm mass on the anterior vaginal wall. Urine cytol- was performed. Left side ureteral dissection and pelvic ogy was nonspecific. Serum CEA and CA 19-9 were within lymph node dissection were also performed as right side Korean Journal of Urology Ⓒ The Korean Urological Association, 2010 145 Korean J Urol 2010;51:145-148 146 Ha et al maneuvers. men was placed into a specimen retrieval bag for removal. The peritoneum was incised at the vesicovaginal cul- Urethral and vaginal sutures were made with Vicryl 2-0 de-sac and the lateral pedicles of the bladder were clamped laparoscopically. by using Hem-o-Lok clips. The bladder and vagina were dis- A 5 cm midline incision was made and the specimen was sected around carefully with a finger inserted into the vagi- extracted. A 20 cm ileal segment was chosen and an ileal na because gas leakage was possible via the vaginal conduit procedure was performed by using an open-as- opening. A large prostate-like mass was identified in front sisted technique. The total operative time was 405 mi- of the bladder. nutes, and the estimated intraoperative blood loss was 580 We incised the peritoneum along the medial umbilical lig- ml. aments and dissected the anterior perivesical space. The In the pathologic gross examination, an exophytic friable urethral mass similar to a large prostate was revealed in mass measuring 5.6x5.3 cm was found at the urethra and front of the bladder and we incised the endopelvic fascia. bladder neck. Clear cell adenocarcinoma was found at the The dorsal vein complex was coagulated. As my assistant drew the bladder in the cephalic direction and compressed the vestibule to protect against air leakage, I performed a urethrectomy with anterior vaginal resection. The speci- FIG. 2. The urethral mass invaded to the bladder neck and anterior vaginal wall, but there was no pelvic lymph node enlargement. Gadolinium-enhanced magnetic resonance imag- FIG. 1. Cystoscopy showed an exophytic mass at the bladder ing (MRI) showed an irregular enhanced mass that invaded the neck. bladder neck (white arrows). FIG. 3. Gross findings were of an exophytic friable mass at the urethra and the bladder neck, measuring 5.6x5.3 cm. The lesion invaded the periurethral connective tissues (A). Microscopic examination of the tumor (H&E, x40) revealed clear cell adenocarcinoma (B). Korean J Urol 2010;51:145-148 Urethral Adenocarcinoma: Laparoscopic Approach 147 urethra and bladder neck, and the tumor had invaded the 73% of patients treated with local excision only, treatment periurethral connective tissues (Fig. 3). However, all surgi- failed, with either local recurrence or distant metastasis cal margins and both pelvic lymph nodes were free of [6]. When only radiation treatment was administered, dis- tumors. In the immunohistochemical study, the tumor ease-free survival was about 33%. Anterior exenteration cells showed positive immunoreactivity to CK7 and were with urinary diversion showed more promising results, negative to CK20, CEA, and CD10. Drop infusion pyelog- with 87% of patients being disease-free at 6 months to 2 raphy performed at postoperative day 14 showed no leak- years [7]. age at the uretero-conduit anastomosis sites, and the pa- Laparoscopic radical cystectomy has recently become tient was discharged without complications. After 3 and 6 the accepted gold standard treatment modality for patients months with no adjuvant treatment, computed tomog- with muscle-invasive bladder cancer [8]. With the develop- raphy showed no local recurrence or distant metastasis. ment of laparoscopic equipment, laparoscopic radical cys- tectomy with urinary diversion has become feasible and DISCUSSION provides many intraoperative and postoperative advan- tages over the traditional open approach [9]. A review of the Urethral carcinomas are uncommon, and make up less literature found only one reported case of the laparoscopic than 0.02% of all female carcinomas [1]. Although squ- approach in patients with a urethral tumor [9]. However, amous cell carcinomas are usually identified in female ure- laparoscopic surgery in this setting of adenocarcinoma thral carcinomas, more than half of carcinomas in the ure- arising from the urethral diverticulum has not previously thral diverticulum are adenocarcinomas. been reported in the English literature. Although the onco- Carcinoma arising in the female urethral diverticulum logic outcome of the laparoscopic approach is still being was first reported by Hamilton and Leach in 1951 [2], and evaluated, many reports have shown that oncologic safety about 100 cases of female urethral carcinoma associated and functional outcome of laparoscopic cystectomy are sim- with urethral diverticulum have been reported. Although ilar to those of the traditional open approach. Castillo et al the histogenesis of urethral adenocarcinoma is con- first reported on laparoscopic radical surgery in male pa- troversial, it occurs in the urethral diverticulum and may tients with urethral cancer [10]. He performed a laparo- arise in the paraurethral ducts and Skene glands [3]. scopic radical cystoprostatectomy and en bloc urethrec- Patients usually complain of difficulty in voiding and tomy by additional perineal incision, and this maneuver hematuria, and the most common sign is a palpable sub- was a feasible method for the treatment of urethral cancer urethral mass [4]. The patient in this case had a history of in men [10]. However, in the current case, the female ure- recurrent urinary tract infections and symptoms of diffi- thral cancer did not require an additional incision. culty in voiding. There are several key findings in this case. Urethral ad- In magnetic resonance imaging,
Load more

Recommended publications
  • Bladder Cancer
    Clinical Practice in Urology Series Editor: Geoffrey D. Chisholm Titles in the series already published Urinary Diversion Edited by Michael Handley Ashken Chemotherapy and Urological Malignancy Edited by A. S. D. Spiers Urodynamics Paul Abrams, Roger Feneley and Michael Torrens Male Infertility Edited by T. B. Hargreave The Pharmacology of the Urinary Tract Edited by M. Caine Forthcoming titles in the series Urological Prostheses, Appliances and Catheters Edited by J. P. Pryor Percutaneous and Interventional Uroradiology Edited by Erich K. Lang Adenocarcinoma of the Prostate Edited by Andrew W. Bruce and John Trachtenberg Bladder Cancer Edited by E. J. Zingg and D. M. A. Wallace With 50 Figures Springer-Verlag Berlin Heidelberg New York Tokyo E. J. Zingg, MD Professor and Chairman, Department of Urology, Univ~rsity of Berne, Inselspital, 3010 Berne, Switzerland D. M. A. Wallace, FRCS Consultant Urologist, Department of Urology, Queen Elizabeth Medical Centre, Birmingham, England Series Editor Geoffrey D. Chisholm, ChM, FRCS, FRCSEd Professor of Surgery, University of Edinburgh; Consultant Urological Surgeon, Western General Hospital, Edinburgh, Scotland ISBN -13: 978-1-4471-1364-5 e-ISBN -13: 978-1-4471-1362-1 DOI: 10.1007/978-1-4471-1362-1 Library of Congress Cataloging in Publication Data Main entry under title: Bladder Cancer (Clinical Practice in Urology) Includes bibliographies and index. 1. Bladder - Cancer. I. Zingg, Ernst J. II. Wallace, D.M.A. (David Michael Alexander), 1946- DNLM: 1. Bladder Neoplasms. WJ 504 B6313 RC280.B5B632 1985 616.99'462 85-2572 ISBN-13:978-1-4471-1364-5 (U.S.) This work is subject to copyright.
    [Show full text]
  • A Comprehensive Review of a Rare Subclass of Mucosal Melanoma with Emphasis on Differential Diagnosis and Therapeutic Approaches
    cancers Review Urological Melanoma: A Comprehensive Review of a Rare Subclass of Mucosal Melanoma with Emphasis on Differential Diagnosis and Therapeutic Approaches Gerardo Cazzato 1,*,† , Anna Colagrande 1,†, Antonietta Cimmino 1, Concetta Caporusso 1, Pragnell Mary Victoria Candance 1, Senia Maria Rosaria Trabucco 1, Marcello Zingarelli 2, Alfonso Lorusso 2, Maricla Marrone 3 , Alessandra Stellacci 3 , Francesca Arezzo 4, Andrea Marzullo 1, Gabriella Serio 1, Angela Filoni 5, Domenico Bonamonte 5, Paolo Romita 5, Caterina Foti 5, Teresa Lettini 1 , Vera Loizzi 4, Gennaro Cormio 4 , Leonardo Resta 1 , Roberta Rossi 1,‡ and Giuseppe Ingravallo 1,‡ 1 Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; [email protected] (A.C.); [email protected] (A.C.); [email protected] (C.C.); [email protected] (P.M.V.C.); [email protected] (S.M.R.T.); [email protected] (A.M.); [email protected] (G.S.); [email protected] (T.L.); [email protected] (L.R.); [email protected] (R.R.); [email protected] (G.I.) 2 Section of Urology, Deparment of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; [email protected] (M.Z.); [email protected] (A.L.) 3 Section of Legal Medicine, Interdisciplinary Department of Medicine, Bari Policlinico Hospital, Citation: Cazzato, G.; Colagrande, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Italy; [email protected] (M.M.); A.; Cimmino, A.; Caporusso, C.; [email protected] (A.S.) Candance, P.M.V.; Trabucco, S.M.R.; 4 Section of Ginecology and Obstetrics, Department of Biomedical Sciences and Human Oncology, Zingarelli, M.; Lorusso, A.; Marrone, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Italy; [email protected] (F.A.); M.; Stellacci, A.; et al.
    [Show full text]
  • Glickman Urological & Kidney Institute
    C L E V E GLICKMAN UROLOGICAL L A N D C L I N I C & KIDNEY INSTITUTE | G L I C K 2019 Year in Review M The Cleveland Clinic Foundation A N 9500 Euclid Ave. / AC311 U R O Cleveland, OH 44195 L O G I C A L & K I D N E Y I N S T I T U T E | 2 0 1 9 Y E A R I N R E V I E W 19-URL-5068 22877_CCFBCH_19URL4030_19URL5068_ACG.indd 29-31 2/6/20 3:06 PM CONTENTS 3 Glickman Kidney & Urological Institute at a Glance 7 Message from the Chairman 9 Two Clinical Trials, One Ambitious Goal to Personalize Kidney Medicine 11 A New Paradigm for Advanced Prostate Cancer Clinical Trials 13 Another Landmark Year for Cleveland Clinic’s Kidney Transplant Program 15 Getting It Right: Nephrologists Are Working to Minimize the ‘White-Coat Effect’ for Patients with Hypertension 17 ‘A FitBit for the Bladder’: UroMonitor Takes Monitoring Out of the Clinic 19 Virtual Reality Tool to Offer New Way of Understanding Renal Physiology 21 First Kidney Transplant Performed Using Single-Port Robot 22 2019 Achievements 28 Resources for Physicians ON THE COVER Georges Nakhoul, MD, Director of the Center for Chronic Kidney Disease, launched a virtual reality program to enhance the renal physiology learning experience for trainees. 22877_CCFBCH_19URL4030_19URL5068_ACG.indd 32-34 2/6/20 3:06 PM CLEVELAND CLINIC GLICKMAN UROLOGICAL & KIDNEY INSTITUTE | 3 Glickman Urological AT A GLANCE & Kidney Institute The Glickman Urological BY THE NUMBERS & Kidney Institute’s (2019) activities encompass a unique combination of high- 132,663 volume and challenging OUTPATIENT VISITS clinical cases, extensive basic and translational scientific efforts, and 14,098 innovative laboratory SURGICAL CASES research conducted in an environment that nurtures the future leaders of its 21,255 DIALYSIS TREATMENTS specialties.
    [Show full text]
  • Invasive Bladder Cancer After Cyclophosphamide Administration for N Ephrotic Syndrome- a Case Report
    121 Hiroshima J. Med. Sci. Vol. 49, No. 2, 121-123, June, 2000 HIJM49-18 Invasive Bladder Cancer after Cyclophosphamide Administration for N ephrotic Syndrome- A Case Report Takahisa NAKAMOTO, Yoshinobu KASAOKA, Yoshihiko IKEGAMI and Tsuguru USUI Department of Urology, Hiroshima University School of Medicine, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551 Japan ABSTRACT We report a case of invasive bladder cancer after cyclophosphamide administration for nephrotic syndrome, and briefly discuss the association of bladder cancer and cyclophos­ phamide. A 6-year-old boy, who was diagnosed as having neph!otic syndrome, was treated with oral administration of prednisolone and cyclophosphamide for 4 years, receiving a total dose of 49.5 g cyclophosphamide. At age 27, a gross hematuria with bloody clots appeared and he presented with postrenal renal failure. He underwent a radical cystourethrectomy and ileal conduit for stage a pT3a pNO MO transitional cell carcinoma of the bladder. He was not given any adjuvant treatments because of his renal insufficiency, and he died from the disease 14 months after rad­ ical surgery. Key words: Bladder cancer, Cyclophosphamide, Nephrotic syndrome Cyclophosphamide, a cytotoxic alkylating agent, at the Department of N ephrology, Hiroshima is widely used in various malignancies, immune University Hospital on April 25, 1997. An abdomi­ disorders and organ transplantation1i. Cyclophos­ nal ultrasound revealed bilateral hydronephrosis phamide is known to cause hemorrhagic cystitis and a large mass on the posterior of the bladder. and, rarely, bladder fibrosis and has also been He was presented to our Department and immedi­ associated with urothelial malignancies, both ately underwent right percutaneous nephrostomy.
    [Show full text]
  • EAU Guidelines Primary Urethral Carcinomas V2
    Guidelines on Primary Urethral Carcinoma G. Gakis, J.A. Witjes, E. Compérat, N.C. Cowan, M. De Santis, T. Lebret, M.J. Ribal, A. Sherif © European Association of Urology 2013 TABLE OF CONTENTS PAGE 1. INTRODUCTION 3 2. METHODOLOGY 3 3. LEVEL OF EVIDENCE AND GRADE OF RECOMMENDATION 3 4. EPIDEMIOLOGY 4 5. ETIOLOGY AND RISK FACTORS 4 6. HISTOPATHOLOGY 5 7. CLASSIFICATION 5 7.1 TNM staging system 5 7.2 Tumour grade 6 8. SURVIVAL 6 8.1 Long-term survival after primary urethral carcinoma 6 8.2 Predictors of survival in primary urethral carcinoma 6 9. DIAGNOSIS AND STAGING 7 9.1 History 7 9.2 Clinical examination 7 9.3 Urinary cytology 7 9.4 Diagnostic urethrocystoscopy and biopsy 7 9.5 Radiological imaging 7 9.6 Regional lymph nodes 7 10. TREATMENT OF LOCALISED PRIMARY URETHRAL CARCINOMA 8 10.1 Treatment of localised primary urethral carcinoma in males 8 10.2 Treatment of localised urethral carcinoma in females 8 10.2.1 Urethrectomy and urethra-sparing surgery 8 10.2.2 Radiotherapy 8 11. MULTIMODAL TREATMENT IN ADVANCED URETHRAL CARCINOMA 9 11.1 Preoperative cisplatinum-based chemotherapy 9 11.2 Preoperative chemoradiotherapy in locally advanced squamous cell carcinoma of the urethra 9 12. TREATMENT OF UROTHELIAL CARCIMONA OF THE PROSTATE 10 13. FOLLOW-UP 10 14. REFERENCES 10 15. ABBREVIATIONS USED IN THE TEXT 15 2 PRIMARY URETHRAL CARCINOMAS - MARCH 2013 1. INTRODUCTION The European Association of Urology (EAU) Guidelines Group on Muscle-invasive and Metastatic Bladder Cancer has prepared these guidelines to deliver current evidence-based information on the diagnosis and treatment of patients with primary urethral carcinoma (UC).
    [Show full text]
  • Princess Margaret Cancer Centre Clinical Practice Guidelines
    PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES GENITOURINARY UROTHELIAL CANCER GU Site Group – Urothelial Cancer Date Guideline Created: March 2012 Author: Dr. Charles Catton 1. INTRODUCTION 3 2. PREVENTION 3 3. SCREENING AND EARLY DETECTION 3 4. DIAGNOSIS 3 5. PATHOLOGY 5 6. MANAGEMENT 6 6.1 PRIMARY PRESENTATION NON-MUSCLE INVASIVE BLADDER DISEASE 6 6.2 RECURRENT PRESENTATION NON-MUSCLE INVASIVE BLADDER DISEASE 6 6.3 MUSCLE INVASIVE BLADDER DISEASE 7 6.4 METASTATIC TCC 10 6.5 MANAGEMENT OF PROGRESSION AFTER INITIAL THERAPY 10 6.6 EXRAVESICAL TCC 11 6.7 ADENOCARCINOMA OF THE BLADDER 12 6.8 ONCOLOGY NURSING PRACTICE 13 7. SUPPORTIVE CARE 13 7.1 PATIENT EDUCATION 13 7.2 PSYCHOSOCIAL CARE 13 7.3 SYMPTOM MANAGEMENT 13 7.4 CLINICAL NUTRITION 14 7.5 PALLIATIVE CARE 14 7.6 OTHER 14 8. FOLLOW-UP CARE 14 9. APPENDIX 1 – PATHOLOGICAL CLASSIFICATION 16 10. APPENDIX 2 – BLADDER CANCER STAGING 19 2 Last Revision Date – March 2012 1. INTRODUCTION Urothelial cancers arise in the urothelium of the renal collecting systems, the ureters, bladder, prostate and urethra. The bladder is the most frequent site of disease accounting in Canada for 5.8% of new cancers and 3.3% of cancer deaths in males, and 2.1% of new cancers and 1.5% of cancer deaths in females (Canadian Cancer Statistics 2008). This difference in incidence is attributed in part to the smoking patterns seen between Canadian men and women. The most common histology is transitional cell carcinoma (TCC). An important feature of transitional cell malignancy is the propensity to behave as a field defect with multifocal disease in primary and recurrent presentations.
    [Show full text]
  • Bladder and Kidney Function After Cure of Pelvic Rhabdomyosarcoma in Childhood
    Br. J. Cwwer 1000 1003 Macmifan Press 1994 Br. J. Cancer (I(1994),994), 79,70, 1000-1003 C)( Macmillan Ltd., Bladder and kidney function after cure of pelvic rhabdomyosarcoma in childhood C.K. Yeung', H.C. Ward2, P.G. Ransley', P.G. Duffy' & J. Pritchard3 'Department of Paediatric Urology, Hospitalfor Sick Children, Great Ormond Street, London WCIN 3JH, UK; 2Department of Paediatrics, St Thomas' Hospital, Lambeth Palace Road, London SE) 7EH, UK, 3Department ofHaematology and Oncology, Hospital For Sick Children, Great Ormond Street, London WCIN 3JH, UK. Sa_y EEkven survivors of pelvic rhabdomyosarcoma underwent bladduer function studies and upper urnary tract evaluation at a mean of 6.6 years after completion of therapy, which induded a conservative, bladder-spang surgial polcy. Pnmary tumour sites were: bladder base/prostate, 6; bladder dome, 1; vagina, 2; and pelc side wall, 2. Seven chidren (five bladder base/prostate, one vagna and one pelvic side wall tumours) had receivd irradiation to the pehlis with extenal beam alone, brachytherapy or both. Al seven of these patients had markedly reduced functional badder capacity (11-48% of mean expected value for age) and abnormal voiding patters, though bladder complance was not reduced and bladder emptying was almost complete in five cases. Four of these chidren also had upper tract dilatation and two required reconstructive bladder surgery because of severe bilateral hydronephrosis. By contrast, each of four childr treated without radiotherapy had a normal functional bladder capacity and a normal voiding pattern. All survivors of pelvic rhabdomyosarcoma, especially those who have received radiotherapy, should be carefully monitored for dysfunction of both lower and upper urinary tracts.
    [Show full text]
  • Urology Surgery
    The Intercollegiate Surgical Curriculum Educating the surgeons of the future Urology Surgery From August 2015 (Updated 2016) Approved 06 September 2016 Syllabus contents Page No. Syllabus contents 3 Core Surgical Training 25 Early Years Urology 46 Intermediate Stage 48 Final Stage Topics for all trainees 68 Final stage modular curricula 75 Professional Behaviour and Leadership Syllabus 117 Page 2 of 195 Approved 06 September 2016 Introduction The intercollegiate surgical curriculum provides the approved UK framework for surgical training from completion of the foundation years through to consultant level. In the Republic of Ireland it applies from the completion of Core Surgical Training through to consultant level. It achieves this through a syllabus that lays down the standards of specialty-based knowledge, clinical judgement, technical and operative skills and professional skills and behaviour, which must be acquired at each stage in order to progress. The curriculum is web based and is accessed through www.iscp.ac.uk. The website contains the most up to date version of the curriculum for each of the ten surgical specialties, namely: Cardiothoracic Surgery; General Surgery; Neurosurgery; Oral and Maxillofacial Surgery (OMFS); Otolaryngology (ENT); Paediatric Surgery; Plastic Surgery; Trauma and Orthopaedic Surgery (T&O); Urology and Vascular Surgery. They all share many aspects of the early years of surgical training, but naturally diverge further as training in each discipline becomes more advanced. Each syllabus will emphasise the commonalities and elucidate in detail the discrete requirements for training in the different specialties. Doctors who will become surgical trainees After graduating from medical school doctors move onto a mandatory two-year foundation programme in clinical practice (in the UK) or a one year Internship (in the Republic of Ireland).
    [Show full text]
  • Maximum Surgical Blood Ordering Schedule (MSBOS) Updated April 2018
    HA/BB/POL/2 V2 Maximum surgical blood ordering schedule (MSBOS) Updated April 2018 These are guidelines for ordering blood pre-operatively for all operations. Please state the planned date and type of surgery on the request form. If the lab has received a valid Group & Save sample within the last 5 days (or less if patient recently transfused – please contact lab for advice) and the antibody screen is negative, group confirmed blood can be made available within 15-20 minutes by the lab (this does not include transport time). 1st EITHER OR Operations Group & 2nd G&S 2 Units Special Cell salvage Save XMatch requirements POAC On admission / immediately preop General surgery Laparotomy / Laparoscopic Yes Yes Request 1 unit Consider Anterior resection if Hb <100 g/dl AP resection Total colectomy Hemi colectomy Gastrectomy partial Yes Yes Consider Gastrectomy total Yes Yes Consider Splenectomy Yes Yes Consider Cholecystectomy Exploration CBD: Yes Yes Consider Open Cholecystectomy Exploration CBD: Yes Laparoscopic Other Laparoscopic Yes gastrointestinal surgery e.g. Nissen’s / gastric banding Lymph Node Dissection: see under Yes Yes Plastics Obstetric and gynaecological surgery All Hysterectomies Yes Yes Consider in open surgery Placenta Praevias Yes XM 4 units Consider 1 | P a g e Produced: J Ashby Styles / C Laxton Ratified by: Trust Transfusion Committee, June 2018 Last updated: 26/04/2018 For Review: 01/05/2020 HA/BB/POL/2 V2 1st EITHER OR Operations Group & 2nd G&S 2 Units Special Cell salvage Save XMatch requirements POAC On admission / immediately preop Orthopaedic surgery Total knee replacement Yes Consider if no tourniquet Revision total knee replacement Yes Yes Consider if no tourniquet Total hip replacement Yes Yes Request Consider if 2 units if Hb <115 g/dl Hb <115 g/dl Revision total hip replacement Yes Yes Consider Total shoulder replacement Yes Yes Pelvic surgery e.g.
    [Show full text]
  • Summary of Services and Availability (By Location)
    UPMC | University of Pittsburgh Medical Center For Reference Only UROLOGY 2013 Summary of Services and Availability (by location) Each location has sufficient space, equipment, staffing and financial resources in place or available in sufficient time as required to support each requested privilege. On an ongoing basis, the organization consistently determines the resources necessary for each requested privilege related to the facility's scope of service. Please review the following Summary of Services and Availability by Location prior to making your selections. If a facility is specifically identified below as NOT having a privilege/service available, you will NOT be considered for that privilege at that individual facility. Any request made that is identified as not available at an individual site will be considered Not Applicable for that site(s), and will be identified as such on your final approved Delineation of Privileges form. “x” means Privilege is Available at that location. “C” means contractual arrangement restricts granting this privilege. “N/A” means Privilege Not Available at that location. Facility Codes: UHOC= UPMC St. Margaret Harmar Outpatient Center Privilege UHOC Core privileges X Consultation Privileges N/A SURGERY OF THE KIDNEY, ADRENAL, URETER, AND BLADDER Biopsy, all techniques X Nephrotomy/pyelotomy/ureterotomy/ cystotomy for X stent placement, stone extraction, drainage abscess, biopsy, fulgeration, insertion of radioactive material Percutaneous nephroscopy, and other percutaneous X catheter techniques Nephrectomy,
    [Show full text]
  • Surgical Site Infection Surveillance in Northern Ireland OPCS Code Lists
    Surgical site infection surveillance (N. Ireland), codes for procedures and microorganism list November 4, 2014 Surgical Site Infection Surveillance in Northern Ireland OPCS code lists for relevant procedures and list of microorganisms Last updated 4 November 2014 1 | Public Health Agency (Northern Ireland) Surgical site infection surveillance (N. Ireland), codes for procedures and microorganism list November 4, 2014 This page is blank 2 | Public Health Agency (Northern Ireland) Surgical site infection surveillance (N. Ireland), codes for procedures and microorganism list November 4, 2014 Contents Section 1 – Surgical Site Infection Surveillance ......................................................................................................................................................................................................... 4 1.0 Contact Details ................................................................................................................................................................................................................................................. 4 1.1 Major procedure categories and description (detailed codes for each procedure category are listed in Section 2) ................................................................................... 5 Section 2 – OPCS procedure categories for surgical site infection surveillance ....................................................................................................................................................... 8 2.1.1
    [Show full text]
  • Dataset for Tumours of the Urinary Collecting System (Renal Pelvis, Ureter
    Dataset for histopathological reporting of tumours of the urinary collecting system (renal pelvis, ureter, urinary bladder and urethra) August 2021 Authors: Dr Murali Varma, University Hospital of Wales, Cardiff Dr Jonathan H Shanks, The Christie NHS Foundation Trust, Manchester Dr Ashish Chandra, Guys and St Thomas’ NHS Foundation Trust, London Dr Lorna McWilliam, Central Manchester University Hospitals NHS Foundation Trust Unique document number G044 Document name Dataset for tumours of the urinary collecting system (renal pelvis, ureter, urinary bladder and urethra) Version number 3 Produced by Each of the authors is a consultant histopathologist with a special interest in urological pathology. Dr Murali Varma is a founder member and Chairman of the British Association of Urological Pathologists (BAUP), organises biannual uropathology courses on prostate and bladder pathology, and has published several original and review papers related to urological pathology. Dr Jonathan H Shanks regularly speaks at national and international meetings and has co- authored over 95 publications, mostly in the field of urological pathology. Dr Ashish Chandra is co-author of ACP Best Practice: Cut up and reporting of bladder cancer specimens and is on the NICE Clinical Guidelines Group for diagnosis and clinical management of bladder cancer. Dr Lorna McWilliam is a founder member of BAUP and speaks on bladder and prostate pathology at their biannual courses. She helped to develop national and regional guidelines for best practice in urological pathology. Date active August 2021 (to be implemented within three months) Date for review August 2024 Comments This document will replace the 2nd edition published in 2013. In accordance with the College’s pre-publications policy, this document was on the Royal College of Pathologists’ website for consultation from 27 May to 24 June 2021.
    [Show full text]