Urology

Shared operative foundations taught once, the room they happen in, the instruments on the tray, and the anaesthetic that makes it possible.

• The obstructed kidney

  The specialty's version of a universal surgical law: obstruction raises pressure, infection turns pressure septic, and drainage is the treatment. The same logic runs cholangitis and the abscess; here it runs the on-call.

  1. 01Pressure physiology. An obstructed collecting system backs pressure into the nephrons: function falls, the system dilates, and given time an obstructed kidney quietly dies. Bilateral or solitary-kidney obstruction adds renal failure to the bill.
  2. 02Adding infection. Stagnant urine above a blockage breeds organisms under pressure, injecting them into the bloodstream: the obstructed infected kidney is undrained sepsis with a deadline.
  3. 03The two drains. Retrograde stent from below or percutaneous nephrostomy from above: different routes to the same decompression, chosen by stability, anatomy and what the hospital can mobilise fastest.
  4. 04Sequence discipline. Drain now, define later, treat definitively after: stone surgery in an infected system spreads sepsis, so the definitive operation waits for a cooled, cultured, recovered patient.

  Used byPercutaneous nephrostomy

• Transurethral surgery

  The specialty's signature approach: operating through the urethra with irrigating endoscopes, resecting under vision. TURBT and TURP share the platform, the physiology and the complications.

  1. 01The platform. A resectoscope passed along the urethra: irrigation keeps the view clear and distends the field, diathermy loops resect and coagulate, and chips are washed out for the pathologist.
  2. 02Two jobs, one tool. TURBT resects bladder tumours and stages them by sampling muscle; TURP channels the obstructing prostate: same instrument, different organs, different endpoints.
  3. 03The irrigation physiology. Fluid under pressure in an open venous field can be absorbed by the litre: modern bipolar systems use saline and have defanged classic TUR syndrome, but the vigilance it taught remains.
  4. 04After the resection. Catheters and irrigation manage the bleeding raw surface; haematuria, clot retention and infection are the early watch, and the histology report is where the next decision lives.

  Used byTransurethral resection of bladder tumourTURP (transurethral resection of the prostate)

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  Percutaneous nephrostomy

  The interventional radiology teaching: posterior calyx puncture, wire, dilatation and the pigtail.

  Watch for

  • Why the puncture is through a posterior lower-pole calyx
  • Seldinger steps on the kidney
  • What to send from the first drainage

  Source: IR Education · Watch on YouTube
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  Your nephrostomy or nephroureteral drain

  Caring for the tube afterwards: flushing, the bag, and when to call.

  Source: Cleveland Clinic · Watch on YouTube
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  Bladder cancer treatment: TURBT

  The society's explainer of resecting a bladder tumour through the resectoscope.

  Watch for

  • Resecting to detrusor for staging
  • Obturator jerk and why the leg kicks
  • The single instillation afterwards

  Source: European Association of Urology · Watch on YouTube
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  TURBT: transurethral resection of a bladder tumour

  Endoscopic footage of the resection, narrated by the surgeon.

  Source: Professor Mohamed H Khadra, urological surgeon · Watch on YouTube
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  TURP: transurethral resection of the prostate

  The resection loop at work: landmarks, the verumontanum, and haemostasis.

  Watch for

  • The verumontanum as the distal limit
  • Resecting the lateral lobes in order
  • Capsular fibres: the sign you are deep enough

  Source: Professor Mohamed H Khadra, urological surgeon · Watch on YouTube
• Watch

  TURP tips and tricks with Dr John Gore

  A full teaching session from the urology education charity.

  Source: IVUmed · Watch on YouTube

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