Atlas of Urologic Surgery, 2nd Edition

Atlas of

UROLOGIC SURGERY SECOND EDITION

FRANK HINMAN, JR., MD, FACS, FAAP, FRCS ENG ( H O N ) Clinical Professor of Urology Department of Urology University of California School of Medicine San Francisco, California

Illustrated by

PAUL H. STEMPEN, MA, CMI

WB. SAUNDERS COMPANY A

Philadelphia

Harcourt

London

Health

Sciences

New York

Company

St. Louis

Sydney

Toronto

To all urologists in the world Present to you by

Feb 2010

Nalduro et al Editors

Nalduro, MD University of Downloading and Cracking Pasteur, RSHS

3

W.B. SAUNDERS C O M P A N Y

A Harcouri Health Sciences Company The Curtis Center Independence Square West Philadelphia, Pennsylvania 19106

Library of Congress Cataloging-in-Publlcatlon Data Hinman, Frank Atlas of urologlc surgery / Frank Hinman, Jr.; illustrated by Paul H. Stempen.— 2nd ed. p.

cm.

Includes bibliographical references and index. ISBN 0-7216-6404-0 1. Genitourinary organs—Surgery—Atlases. [DNLM: 1.

t. Title.

Urogenital System—surgery—atlases. WJ 17 H663a 1998]

RD571.H55 1998

617.4 6—dc21

DNLM/DLC

96-38015

Certain illustrations from this book have appeared previously in the Atlas of Pediatric Urologic Surgery and the Atlas of UroSurgical Anatomy by Frank Hinman, Jr., published by W.B. Saunders Company, 1994, and 1993. ATLAS OF UROLOGIC SURGERY

ISBN 0-7216-6404-0

Copyright © 1998, 1992 by W.B. Saunders Company. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the publisher. Printed in the United States of America. Last digit is the print number:

9

8

7

6

5

4

To the well over 100 residents of the University of California and Children's Hospitals in San Francisco, who, by their inquiring minds and their manual help, have allowed me to develop my interests as a urologic surgeon. To my teachers in Cincinnati: Mont Reid, my professor of surgery, and Rollo Hanlon, my counselor in residency To my father, Frank Hinman, who advised, directed, and taught me the craft of urologic surgery.

Foreword When, in 1989, the Royal College of Surgeons of England presented its Honorary Fellowship to Frank Hinman, Jr.—a rare honor indeed for a urologic surgeon—the late Dr. Harry Spence of Dallas, who was then widely regarded as the current "Father of Urology," wrote, specially for inclusion in the citation, "His pre-eminence in all facets of urology, including its surgical writings and organizational activities, plus versatility in his many interests, entitle Frank Hinman, Jr. to be known as a Man for all Seasons.'" For more than 80 years "The Hinmans of San Francisco"—father and son—have together created an era of outstanding contribution and devotion to urology that has virtually spanned the duration of its history. Frank Hinman, Sr. was appointed Founder Chairman of the Department of Urology at the University of California in 1916 and his book. The Principles and Practice of Urology, was a pioneer urologic text. Like Frank, Jr., he was an insatiable clinical investigator. It is recorded that, as a junior physician, Frank found his father working in an attic laboratory on a fine summer day; when Frank asked him why he was not out playing golf, or some such, his father's response was, "A man is entitled to some fun, isn't he?" One of the hallmarks of the pinnacle of success in the urologic world—in the sense of peer review, approbation, and appreciation—is election to the presidency of the American Association of Genitourinary Surgeons. Frank, Sr. was president of this august body in 1937, and Frank, Jr. was its president in 1981. Frank, Jr. qualified in 1937 and his personal catalog of appointments, contributions, and honors has spanned an extraordinarily active 60 years—and still there is no sign of its waning. His career was punctuated by military service in the Pacific as a surgeon on the much-hit aircraft carrier Intrepid. In 1962, like his father, he became Chief of Urology at San Francisco General Hospital. In the course of time he was elected President of the Society of Pediatric Urologists, a Regent of the American College of Surgeons, and, eventually, Vice President of the American College of Surgeons. He was awarded the Barringer Medal of the GU Surgeons, the Guiteras Medal of the American Urological Association, and in 1991, the St. Paul's Medal of the British Association of Urological Surgeons.

Frank Hinman, Sr.

Frank Hinman, Jr

xiii

xiv

FOREWORD

The demand for a second edition of the Atlas of Urologic Surgery with updating of its excellent instructional details of more than 200 operations, together with comments on each by national or international authorities, every one a personal friend, is a fine tribute in itself. But such things do not just happen, they have to be made to happen. The accomplishment of this reflects not only Frank's immense surgical experience in both adult and pediatric urology and his personal innovative contributions, but also his outstanding talent as a teacher and his immense enthusiasm—always tempered, wise, and enduring. The creation of such an atlas is naturally dependent upon a particularly skilled and devoted medical artist, and Frank certainly regards himself as most fortunate in his association with Paul Stempen. However, the special key is his own ability as an artist that has enabled him to select and sketch the illustrations that best demonstrate the critical stages of every operation he describes—a formidable accomplishment indeed. But what of the man? Outstandingly kind and a friend of all who know him, an accomplished skier, an ardent duck hunter, a fine carpenter, a talented artist of "one-man show" caliber, and national yacht racing champion in the Triton Class on three occasions. In 1948, he met and married Marion Modesta Eaves, herself a fine sailor, a skier, a duck hunter, a gardener, and subsequently a civic organizer—equal in caliber to Frank and a constant companion. Frank is clearly the modern equivalent of the ever-youthful Peter Pan and just as surely our current "Father of Urology." We are all immensely grateful to him for his latest offspring—Atlas of Urologic Surgery—its gestation and his prolonged labor will be greatly appreciated worldwide. RICHARD TURNER-WARWICK

Preface to the Second Edition In the eight years since the first edition of the Atlas of Urologic Surgery was published, two companion volumes, one on urosurgical anatomy and one on pediatric urologic surgery, have been published that may be used to supplement this surgical atlas. The original Atlas was translated into Spanish, German, Italian, and Chinese. The basic premise for this Atlas has not changed. It is to give you, the urologic surgeon, a practical book that instructs, guides, reminds, and warns. New procedures, improvements in standard techniques, and entirely new methodologies have made a second edition necessary. For example, when the first edition was being prepared in the mid-1980s, laparoscopic methods were still experimental. Now these new techniques are being applied generally. As a consequence, much of the text has been either rewritten or revised. Many of the illustrations have been modified or redrawn, and over 200 new illustrations have been added, bringing the number of figures to over 1800. To provide a more anatomic approach, we have placed illustrations of the relevant structures before the description of the operation. As a result, we think the contents of the Atlas have changed for the better. I have gone over each of the standard operations to amplify and modernize it and have asked a different Commentator to review the steps of the operation and give another point of view. New technical developments that are just now coming into general use have been inserted in the operative instructions. Because urologic surgery has progressed, many new operations have been added, described in detail, and given focus by a knowledgeable Commentator. You will find that you will use this edition of the Atlas, as the first one, in several ways. When confronted with a new operation or one performed infrequently, you can review it and orient it in your mind step-by-step the night before. In this way, the operation not only will flow smoothly without wasted time but also will be improved by the addition of important fine points and the avoidance of pitfalls. We expect in the near future to have the book on a CD ROM so that the relevant page can be displayed over the operating table for the education of assistants and students, if not for the surgeon. Even for a familiar operation, the Atlas can provide the opportunity to branch out and discover a better way to do it. However the book is used, Paul and I trust it will improve the practice of urologic surgery. FRANK H I N M A N , JR.

dr. Charles Martamba

Preface to the First Edition Soon after completing residency training, I began to record with sketches and brief notations the techniques I was learning and teaching to the residents, as we worked in the operating rooms of the University of California (UC) and the old San Francisco General Hospitals. At that time, I intended to put together a "how-to" atlas, modeled after that of my fourth year surgery teachers, Cutler and Zollinger. Soon I became busy with other academic pursuits. It wasn't until later when my private practice was cut back that time was found. Today, as more urologists do fewer operations, a ready source of technical review before some operations is needed. Many procedures that have been routine will now be only occasionally performed. Changes in methods of reimbursement for care of patients may make fewer cases available for resident teaching. Remarkable advances, such as the lithotriptor, have already greatly reduced the frequency of several open operations; more are liable to be done rarely, except in remote areas. Still, they must be done well. This atlas is written primarily for review by the trained urologist. I trust residents and registrars as well as the operating room staff will also make good use of it. There are many excellent texts on urologic surgery. However, most are multi-authored; thus, the quality of the chapters varies greatly. Space is given to matters such as descriptions of diseases, "work-ups," and indications for operations, at the expense of the precise description of technique that this atlas provides. The fortunate confluence of a long-considered format, enough time, an enthusiastic publisher, and the availability of the most promising graduate of our UC medical illustration program, who is also accomplished in the fine arts, made possible this single-authored atlas of urologic operations. The method of constructing this atlas was complex but logical. First, I made a list of the important operations that should be described, a list that became longer as the work progressed. I reviewed my sketches and postoperative notes made over the last 35 years. Current and classic publications were then consulted to be sure that each important step of every operation was covered. References are not cited in the text, but all are included in the reference section and listed separately for each operation. By combining this previously published information with my notes, made at urologic meetings, and conceptions from my own experiences, I was able to compose written protocols. In these, I described the operation step by step, just as I would tell you how to do it at the operating table, "Cut here, suture there." I hope the user won't take offense at this approach. A deliberate attempt was made to use the simplest words possible to make each segment of the text easy to follow for all readers, including those surgeons who do not speak English as their native language. Each of the steps of the operation was

numbered. For each, I either made a rough sketch, as painting is my avocation, or pasted an appropriately revised photocopy alongside my surgical instructions. Illustrator Paul Stempen reviewed each protocol before witnessing the selected operation so that he could appreciate which steps were important. He photographed each procedure, using a Nikon single-lens reflex camera with a 35-105 mm zoom lens and Ektachrome 160 film with ambient light. For supplementation, he worked from still frames of movies made by accomplished urologic surgeons and from cadaver dissections in our laboratory. At the drawing board, Mr. Stempen made a series of realistic, yet still generally applicable, pencil drawings of the operation from the viewpoint of the surgeon to coincide with the steps described in the protocol. Every attempt was made to have each drawing an original one. At 4 o'clock in the afternoon I joined him in our workroom and checked his sketches against the protocol. We reviewed the day's work for accuracy and clarity. It was similar to teaching a new resident, yet at the same time I learned from him by being forced to clarify my concepts. As in the operating room, we learned together. Early samples of operations were prepared, taken to the W.B. Saunders Company in Philadelphia, and reviewed with the staff. The protocol text was processed into an IBM-XT computer by Miss Mary Jane Still and then edited by Miss Aileen Andrus. As the work proceeded, a great many notes on new ideas were obtained at meetings and from current journals. These and previously overlooked points were filed to be added to the protocols in due course. Photocopies of the drawings and text were sent to almost 200 friends and colleagues whom I knew to have contributed, usually to a particular operation. These authorities included not only urologists, but also general, plastic, vascular, pediatric, and gynecologic surgeons. I asked each of them to use a red pencil liberally on both text and drawings to eliminate inaccuracies and ambiguities. I also asked them to write a personal Commentary to follow the text. When these were returned to me, the text and drawings were revised appropriately. Mr. Stempen then redrew the corrected pencil drawings in the clear pen-and-ink technique required for publication. The team at Saunders composed the pages from the text and drawings, for continuity and readability. The effort was very successful, as you can see. In this atlas you will find precautions on the preparation of the patient and on the surgical procedure itself and assistance with the management of problems in the immediate postoperative period. Long-term follow-up and management of late complications are left to other sources. A list of instruments specific to the procedure is included for the use of the operating room staff as well as the surgeon. xvii

xviii

PREFACE T O T H E FIRST E D I T I O N

You will not find the history of operations or much discussion of the diseases requiring surgery. The diagnostic steps and assessments and the indications and contraindications are only briefly touched upon; this information can be found in the bibliography, where articles and texts cover these aspects thoroughly. Advice: It is safer to read the appropriate references before attempting an unfamiliar procedure. Finally, an atlas can't teach judgment, yet this is the most important ingredient of a successful operation. The illustrations depict a right-handed surgeon but can be adapted by any surgeon who is left-handed or ambidextrous. Warnings have been inserted wherever there seemed a possibility for going astray. There are other ways of performing many of the operations. However, after some 5600 operations, I have taken the prerogative of telling others how I would do it. In these instances, I have the support of published surgical descriptions of hundreds of surgeons, for whom credit is given in the reference section, along with the backing of my collaborators who reviewed the individual protocols and sketches. These open operations are as close to "standard" as they can be described. (Endoscopic procedures are not included.) Some operations that appeared to me to be no longer useful are omitted, but some older operations based on useful principles are included. As John Duckett has pointed out, it is important to know about historical techniques when you have to operate on a patient who was subjected to such a procedure in the past. Newer operations that have yet to prove themselves are in-

cluded; some will be out of date by the time of publication, others may be discredited, to be deleted in a future edition. Certain incisions and approaches appear more than once but with different drawings in order to make a particular operation clear without the need to refer repeatedly to other procedures. The space devoted to several operations is not proportional to the frequency of their performance. Although I believe all descriptions and directions in the atlas have been "kitchen tested" and are correct, it does not mean that one can read the book and then perform the operation. Thorough training in urologic surgery is a prerequisite before trying any operation, including those described here. Even then, experience with similar operations or performing these operations under supervision is necessary if the patient is not to be at risk of harm. Complicated or difficult operations that occur infrequently in general urologic practice, such as neonatal procedures, repair of severe hypospadias or complicated urethral strictures, and radical excisions for cancer, might best be referred to a subspecialist who has performed enough of these types of operations to have gained special expertise. You may use this atlas in several ways. Usually, review the appropriate protocol just before doing an infrequently performed operation, thus obtaining a refresher course. You can use the atlas to discover if there is a better way to do a routine operation, expanding your surgical horizon. I hope that each procedure will contain at least a few suggestions or precautions that you have not yet encountered and so provide solutions to immediate problems, before they become insoluble. FRANK H I N M A N . JR.

Acknowledgments The author and the illustrator appreciate the generous cooperation of the members of the Department of Urology and the support of our past chairman, Emil A. Tanagho, and of the editorial and secretarial staffs who have provided a fine environment for the preparation of this atlas. The organizational assistance of the staff at W.B. Saunders has made for an attractive, readable volume. The authenticity of each set of verbal and visual instructions derives from the collaboration of nearly 200 of our national and international colleagues. These experts have reviewed the text and the figures and not only have made valuable suggestions for additions and changes but also have written the practical Commentaries that bring the details of the procedures into focus.

Introduction When Frank Hinman, Jr. invited me to write an introduction to the second edition of his Atlas of Urologic Surgery, I was pleased and flattered. One glance at the condition of the cover and pages of the library copy of the Atlas confirmed that this specialized book had been subjected to heavy use, and with good reason. The critical anatomic and technical aspects of operative procedures are detailed with remarkable clarity. The line drawings reflect the unusual combined expertise in surgery and artistic presentation of the author. His regular interaction with his collaborating artist, Paul Stempen, undoubtedly helped to target and illustrate the important technical considerations of the procedures selected for presentation. Accuracy and clarity were enhanced by the process of utilizing almost 200 colleagues with special expertise for critical review and comments before finalizing the content of the Alias. Maintaining single author responsibility for the manuscript, however, has undoubtedly maximized communication and minimized duplication and contradiction. That book, resulting from this combination of experience and effort by a very talented surgeon, presents an accurate, easily understood recipe for operations in urology that were in use when it was published. In the foreword to the first edition of the Atlas, Willard Goodwin predicted that this "is the kind of book that every urologic resident will want to review just before trying a given operation for the first time and that every urologic surgeon will want to review before beginning an infrequently done procedure." In my opinion, time has proven this assessment accurate. However, in the past few years, an expanding array of alternative procedures, especially those employing minimally invasive or alternative tissue or pathology destructive approaches, have been developed and are utilized to accomplish our surgical goals. As a result, the original Atlas had gaps that needed to be filled. Fortunately, Frank, Jr. has undertaken this task with a new edition. To those w h o know Frank, the effort he made in producing the first edition of the Atlas of Urologic Surgery and the results achieved are expected. He was

blessed and possibly burdened by being the son of a famous urologist who made many contributions to Urology. His urologic text Principles and Practice of Urology, published in 1935 by W.B. Saunders, was a gold mine of information and practical insights that were very helpful to many of us during and after our residency. Frank and his father seem to share many characteristics. He has persistently demonstrated a very inquisitive attitude and commitment to excellence and hard work. Frank, Jr. has established his own identity and niche. I recently watched with admiration as one urologist after another came forward to thank him for various types of help he had given them. Although Frank and I are of the same generation, he was always sufficiently far ahead of my development as a urologist to have his big foot firmly imprinted into what was new ground to me. I gradually recognized that his talents were not limited to the diverse abilities he displayed in urology but were complemented by a host of others, such as sailing and art. He has clearly added luster to the Hinman name. Frank accepted the challenge to produce a needed revision of the Atlas of Urologic Surgery at a time in life when most choose not to take on additional chores. I think we are fortunate that he did. The newly developed operative approaches needed to be added to the Atlas and presented side by side with the established ones. As alternatives to open surgery take an increasingly prominent place in the treatment of urologic problems, the classic surgical approaches and procedures will be utilized less often overall. Furthermore, the proportion of complex problems in which they will be employed will very probably increase. If this scenario is correct, the importance of this Atlas in refreshing and preserving the accumulated open surgical experience for the urologists to come is likely to increase. I still utilize Frank Hinman, Sr.'s book to look up specific information and I find it detailed and referenced often enough to continue the practice. In my opinion, the Alias of Urologic Surgery has the same permanency as an invaluable reference source. This book expands the debt of gratitude urology, urologists, and their patients o w e the Hinman clan for their many contributions. JOHN T .

GRAYHACK

Abbreviations, Sutures CCG

Chromic catgut

NAS

Nonabsorbable suture

PCG

Plain catgut

PDS

Polydioxanone suture

SAS

Synthetic absorbable suture

Contents SECTION 1 Surgical Basics Strategy and Tactics

1

Total Penectomy

154

Ilioinguinal Lymphadenectomy

158

2

Preoperative Evaluation

3

Preparation for Surgery

4

Anesthesia

8

Correction of Penile Defects

166

Operative Management

9

Circumcision

167

Penile Curvature

174

Postoperative Management

SECTION 2 The Urologist at Work

16

19

SECTION 5 Penis: Correction

SECTION 6 Penis: Reconstruction

165

177

Basic Surgical Techniques

20

Principles for Penile Reconstruction

178

Basic Laparoscopy

21

Insertion of Flexible Prosthesis

179

Suture Techniques

32

Insertion of Inflatable Prosthesis

185

Plastic Surgical Techniques

41

Penile Arterial Revascularization

194

Microsurgical Techniques

60

Correction of Penile Venous Leakage

198

Bowel Stapling Techniques

64

Procedures for Peyronie's Disease

201

Ureteral Stents

68

Operations for Priapism

207

Mobilization of the Omentum

71

Repair of Genital Injuries

211

Methods of Nerve Block

75

Construction of Penis

220

Repair of Vascular Injuries

81

Excision of Male Urethral Diverticulum

226

Closure of Bowel Lacerations

87

Excision of Utricular Cyst

228

Vascular Access

90

SECTION 3 Penis: Plastic Operations Basic Instructions for Hypospadias Repair Meatotomy Meatoplasty and Glanuloplasty (MAGPI) (Duckett) Perimeatal-Based Flap Repair (Mathieu)

95 96 114 116

SECTION 7 Female Genitalia: Reconstruction

229

Reconstruction of the Female Genitalia

230

Vaginal Reconstruction

231

Urethrovaginal Fistula Repair

242

Female Urethral Diverticulectomy

246

Neourethral Construction

251 252 254

124

Perimeatal-Based Tube Repair (Mustardé)

Excision of Urethral Caruncle and Urethral Prolapse

126

Hysterectomy

Onlay Preputial Island Flap (Duckett)

130

Tubed Preputial Island Flap (Hodgson III-Asopa-Duckett)

134

Double-Faced Transverse Island Flap (Hodgson XX-Asopa) .

137

SECTION 8 Urethra: Reconstruction

261

General Considerations for Urethral Strictures

262

Strictures of the Fossa Navicularis

266

Ventral Tube Repair (Thiersch-Duplay)

140

Strictures of the Penile Urethra

271

Free Tube Graft and Partial Island Flap

142

Strictures of the Bulbar Urethra

282

Bulbomembranous Urethral Strictures

292

148

SECTION 9 Testis: Repair and Reconstruction

303

150

Principles of Operations on the Testis

304

SECTION 4 Penis: Excision Anatomic Basis for Penile Excision Partial Penectomy

147

xxiii

xxiv

CONTENTS

Testis Biopsy inguinal Orchiopexy

305

Gibson Incision

495

308

Suprapubic V-Incision (Turner-Warwick)

497

Orchiopexy with Vascular Division (Fowler-Stephens)

318

Two-Stage Orchiopexy

321

Microvascular Orchiopexy

323

Orchiopexy for the Nonpalpable Testis

326

Laparoscopic Techniques for Impalpable Testes

331

Inguinal Hernia Repair

338

Preperitoneal Inguinal Herniorrhaphy

342

Reduction of Testis Torsion

347

Correction of Hydrocele

349

Varicocele Ligation

352

Laparoscopic Varicocele Ligation

359

Vasoligation

362

Vasovasostomy and Vasoepididymostomy

365

SECTION 10 Testis: Excision

373

SECTION 13 Bladder: Excision

500

Partial Cystectomy

501

Radical Cystectomy

505

Urethrectomy

513

Pelvic Lymphadenectomy

517

Pelvic Exenteration

525

Excision of Vesical Diverticulum

535

Cystolithotomy

542

SECTION 14 Bladder: Reconstruction

544

Cystourethropexy (Marshall-Marchetti-Krantz)

545 549

374

Simple Orchiectomy

375

Colposuspension (Burch)

379

Laparoscopic Colposuspension

Radical Orchiectomy

380

(Vancaille-Schuessler)

Retroperitoneal Lymph Node Dissection

385

...

Laparoscopic Modified Retroperitoneal Lymph Node Dissection (Stone, Waterhouse) Spermatocelectomy

406

Epididymectomy

409

557

Vaginal Needle Suspension Pubovaginal Sling

404

543

Principles of Bladder Reconstruction

Anatomy of Testicular Excision Laparoscopic Orchiectomy

499

Anatomy and Principles for Excision of the Bladder

558 .

565

Trigonal Tubularization (Guy Leadbetter)

570

Vesical Neck Tubularization (Tanagho-Flocks)

573

Intravesical Urethral Lengthening (Kropp-Angewafo)

SECTION 11 Prostate: Excision

576

Insertion of Artificial Sphincter

580

411

Vesicovaginal Fistula Repair

587

Closure of Vesicosigmoid Fistula

601

412

Closure of Female Vesical Neck

609

Suprapubic Prostatectomy

414

Excision of Urachus

614

Retropubic Prostatectomy

422

Total Retropubic Prostatectomy

431

Sacral Laminectomy and Dorsal Rhizotomy for Placement of Pacemaker

617

.

Anatomy and Principles of Excision of the Prostate

..

Perineal Prostatectomy

446

Total Perineal Prostatectomy

451

Modified Pelvic Lymph Node Dissection

465

SECTION 15 Noncontinent Urinary Diversion

623

Laparoscopic and Minilaparotomy Pelvic

Principles of Noncontinent Diversion

624

Lymph Node Dissection

469

Cystostomy

625

Closure of Rectourethral Fistula

476

Perineal Urethrostomy

630

Seminal Vesiculectomy

481

Vesicostomy Cutaneous Ureterostomy and

SECTION 12 Bladder: Approaches

485

Principles for Bladder Incisions

486

Midline Lower Abdominal Extraperitoneal Incision

487

Transverse Lower Abdominal Incision (Pfannenstiel)

490

633 Pyelostomy

642

Ileal Conduit (Bricker)

647

Laparoscopic Ileal Conduit

663

Sigmoid Conduit

664

Transverse Colon Conduit

667

Loop Ileostomy and Colostomy

669

Gastrostomy

673

CONTENTS

Appendectomy

675

SECTION 16 Continent Diversion

XXV

Calicoureterostomy

840

Ileal Ureteral Replacement

842

Ureterolithotomy

847

677 SECTION 20 Surgical Approaches to the Kidney

Principles of Continent Diversion

678

Ileal Reservoir (Kock Pouch)

686

Anatomic Basis for Renal Incisions

854

Ileocecal Reservoir

693

Anterior Subcostal Incision

856

Gastric Reservoir (Mitchell)

705

Pediatric Extended Anterior Incision

863

Appendicovesicostomy (Mitrofanoff)

708

853

Anterior Transverse (Chevron) Incision

865

Midline Transperitoneal Incision

867 869

Ileal Hydraulic Valve Conduit (Benchekroun)

715

Paramedian Incision

Ureterosigmoidostomy

717

Subcostal Incision

871

Transcostal Incision

875

Supracostal Incision

879

Foley Muscle-Splitting Incision

885

SECTION 17 Bladder Augmentation

727

Principles of Bladder Augmentation

728

lleocystoplasty

729

Sigmoidocystoplasty

735

Cecocystoplasty and Antireflux Ileocecocystoplasty

742

Ileocecocystoplasty (Mainz)

753

Dorsal Flap Incision (Nagamatsu)

887

Thoracoabdominal Incision

890

Dorsal Lumbotomy

896

Repair of Pleural Tear

902

Splenorrhaphy and Splenectomy

903

Repair of Incisional Hernia

908

Gastrocystoplasty (Mitchell)

757

Ureterocystoplasty

763

Autoaugmentation

765

SECTION 18 Bladder Substitution

SECTION 21 Kidney: Reconstruction

911

Principles of Renal Reconstruction

912

Pyeloureteroplasty

913

Surgery for the Horseshoe Kidney

924

767

Nephrostomy and Ureterostomy

928

Principles of Bladder Substitution

768

Open Renal Biopsy

931

Ileal Bladder Substitution

769

Repair of Renal Injuries

933

Ileocecal Bladder Substitution

776

Renal Artery Reconstruction

Colonic Bladder Substitution

778

Renal Transplant Recipient

956

Living Donor Nephrectomy

974

781

Cadaver Donor Nephrectomy

979

Gastric Bladder Replacement (Mitchell)

.

SECTION 19 Ureteral Reconstruction and Excision

783

Principles of Ureteral Reconstruction

784

Ureteroneocystostomy

786

Ureteroneocystostomy with Tailoring

803

Operations for Ureteral Duplication

809

Repair of Ureterocele

815

Psoas Hitch Procedure

818

Bladder Flap Repair (Boari)

822

Ureteral Stricture Repair and Ureterolysis

826

Renal Displacement and Autotransplantation

.

830

Repair of Ureterovaginal Fistula

832

Ureteroureterostomy and Transureteroureterostomy

834

..

SECTION 22 Kidney: Excision

937

983

Anatomy and Principles of Kidney Excision ........ 984 Simple Nephrectomy

987

Laparoscopic Nephrectomy Subcapsular Nephrectomy

....

993

..

998

Partial Nephrectomy

1000

Heminephrectomy

1005

Nephroureterectomy

.

1008

Radical Nephrectomy

1016

Extracorporeal Renal Surgery

1027

Vena Caval Thrombectomy

1031

Pyelolithotomy Nephrolithotomy (Smith-Boyce)

.........................

.......

1041 1048

xxvi

CONTENTS

Caliceal Diverticulectomy and Excision of Renal Cyst

Posterior Approach to the Adrenal Gland

SECTION 24

SECTION 23 Adrenal Excision

1075

1055

1057

Preparation and Approaches for Adrenal Excision

1058

Lateral Approach to the Adrenal Gland

1061

Anterior Approach to the Adrenal Gland

1065

Instruments

1081

GU Cart Contents

1081

Standard Instrument Sets

1082

References

1085

Index

1149

NOTICE Medicine is an ever-changing field. Standard safety precautions must be followed, but as new research and clinical experience broaden our knowledge, changes in treatment and drug therapy become necessary or appropriate. Readers are advised to check the product information currently provided by the manufacturer of each drug to be administered to verify the recommended dose, the method and duration of administration, and contraindications. It is the responsibility of the treating physician relying on experience and knowledge of the patient to determine dosages and the best treatment for the patient. Neither the Publisher nor the editor assumes any responsibility for any injury and/or damage to persons or property. THE PUBLISHER

SECTION

1

Surgical Basics

Strategy and Tactics Racing a yacht is a lot like performing a surgical operation. For yacht racing, the winning skipper develops a strategy before going out to race: What is the game plan? Competition may disrupt the plan; how can competitors be thwarted? What will the winds be, so that the most efficient sails can be set? How much will the boat be set by the tides and in what direction? What will be the shortest course around the buoys? Are the skipper and crew well trained and practiced, and do they have a winning attitude? Is the boat well equipped and able to go fast? Once on the course, how can the strategy be adapted to the conditions, using the tactics developed for going fast: starting with the gun in clear air; obtaining boat speed; covering the moves of the adversaries; applying the rules to gain advantages and keep out of trouble; staying out of shoals and calms; and, most important, finishing the winner? For operations, too, the surgeon must have a strategy in order to win: What is the game plan and what are the steps to achieve it? Does the surgeon understand the problem to be treated and know the structure and function of the body? "If you know how it works, you can fix it." Tactics at the operating table are as important as strategy. Has the surgeon learned the manual and mental skills required to execute the successive steps of the operation, acquired the basic surgical rules, and learned the maneuvers needed to get to the finish? In this book, the surgeon can first understand the overall scheme of the operations. Then, by following step by step the detailed instructions that arc illustrated and described in this atlas, the operation can be steered to a rapid and successful finish. It is axiomatic that no exploratory operations are done in urology. The reason is that instrumental and imaging techniques define the problem before the operation starts and make the approach, exposure, and procedure straightforward. For surgery, strategy comes first. Select the optimal operation, plan the steps of the procedure before starting, have the operating room well equipped and well staffed, and assemble a capable and experienced crew who can work as a team. Then use tactics. Apply surgical techniques that are appropriate to the overall strategy to the different conditions that are encountered. Start with good exposure; fend off difficult planes and vascular traps; and avoid becoming becalmed by making ineffective movements or running into obstructions off the course. And persist with a winning attitude even when you seem to be coming in last because the race isn't over until the finish line is reached in the recovery room. Tactics, of course, have to be learned at the operating table; only general precepts can be given in this book.

2

This atlas describes the steps of an operation, asks some questions, and provides some warnings. Use one of the good urology textbooks to review the pathophysiology of the disease and the necessary diagnostic steps. If possible, read the description of the operation written by its originator, and obtain details and alternatives from other authors in the selected bibliographic list given for each type of operation.

EQUANIMITY Surgery is very intense work. You get keyed up and can't understand why everyone else at the table isn't equally attentive. Don't lose your temper. You are the captain, but the crew has to work along with you. Tension causes a lot of water to evaporate during an operation. It's surprising how thirsty you are when you finish. Of course, antidiuresis may allow you to finish a long operation without leaving the table.

SUMMARY Surgery is much more than dissecting. Know the anatomy and function involved before starting the operation. Review the operation in your mind the night before, and picture each step ahead of time. Know the details of your patient's abnormalities, and review the findings before you go to the operating room. Attention to detail before, during, and after the operation makes good results possible. Be compulsive about detail. Act logically for each move. Control yourself, and don't fall apart under stress. Become adept at manipulating instruments and tissues. Don't hesitate, and don't waste motion. Have a good team, with enough trained hands, and be the leader of your crew. Be sure all the needed pieces of equipment are available, and know that you have available consultants and back-up facilities. Use delicate surgical technique, irrigate debris, obtain good hemostasis, close dead spaces, and provide adequate drainage. Be gentle but not indecisive. Tie sutures only to approximate the tissues. Dissect and follow the natural tissue planes. Work from the known to the unknown. Fulgurate or ligate only those vessels involved and do it accurately. Avoid blind dissection with either instruments or fingers. Keep tissues moist and covered. Ensure adequate exposure and proper lighting. A sufficiently large incision, good help, and retraction are basic. Finally, your responsibility to the patient continues through recovery and convalescence.

Preoperative Evaluation The patient is best served if you—rather than a member of the house staff—take the history and perform the physical examination. In children this is essential to establish rapport. For the patient who is well, few tests are needed before most operations other than complete blood tests and urinalysis, and these may be done within a month of the procedure. For collection of urine specimens, midstream samples are needed. To obtain a specimen from an indwelling catheter, clamp the tubing, wipe the wall with an alcohol sponge, and aspirate a sample with a syringe and fine needle. Avoid disconnecting the sterile pathway.

EVALUATION OF RISKS First, assess the operative risk. It influences the preparation, procedure, and outcome. Use a checklist for risk factors (Table 1) to help determine the degree of risk. Place the patient in one of four categories in the Physical Status Scale proposed by the American Society of Anesthesiologists: Class 1, a normal, healthy individual; Class 2, a patient with mild systemic disease; Class 3, a patient with severe systemic disease that is not incapacitating; and Class 4, a patient with an incapacitating systemic disease that is a constant threat to life. Consider age, morbid obesity, and nutritional status in the evaluation. Cardiac status is particularly important. The chance of death in the first 48 hours after operation averages about 0.3 percent, principally from cardiac dysfunction. Ten percent of that risk is during induction of anesthesia, 35 percent during the operation, and the rest in the following 2 days. Demand for oxygen may be excessive from tachycardia, hypertension, increased peripheral resistance, fever, or fluid overload. Or oxygen delivery may be inadequate from hypotension, pulmonary disease, hypoxia, anemia, hypovolemia, or dysrhythmia. Because cardiac functional status determines how well the patient withstands the operation, it must be carefully evaluated preoperatively by history and physical examination. Postoperative risk is related to evidence of heart failure, rhythm disturbances, the type of surgical procedure, age greater than 70 years, significant aortic stenosis, and the appearance of a patient in generally poor condition. Delay operation for 6 months after a myocardial infarction. Also in the postoperative period, realize that infarction not infrequently occurs within the first 7 days, and in half of the patients it takes place without chest pain. This necessitates postoperative serial screening of high-risk patients with electrocardiograms (ECGs) and enzyme determinations.

bronchospasm with these agents preoperatively. Have the patient stop smoking at least 2 weeks before surgery. Assess nutrition Patients having a weight loss greater than 10 percent are at increased risk for complications, as are those who have a serum albumin level of less than 3.2 g/dl, a transferrin level greater than 220 mg/dl, or skin test anergy. These chronically ill patients coming to operation require restoration of their nutritional deficit to avoid poor wound healing, immunologic deficiencies (total lymphocyte count should be above 1500), and organ malfunction. Hyperalimentation alone can reduce morbidity and mortality significantly. Treat the patient for at least 1 or 2 weeks before operation with tube feedings to bring the child or elderly patient into positive nitrogen balance. Give supplemental vitamins, particularly vitamin C. For the chronically ill patient, often with marginal renal function, obtain consultations to look for immunologic or hematologic abnormalities secondary to the disease or to the treatment for it. Correct electrolyte imbalances, especially hyperkalemia (greater than 7 mmol/L) or uncompensated metabolic acidosis (capillary blood pH less than 7.30), with oral solutions if possible because intravenous administration is harder to control. Correct any defects in coagulation. Restore blood volume with donor-designated blood. Look for defects in coagulation, detected by platelet count, bleeding time, prothrombin time, and partial thromboplastin time. Restore blood volume and give packed cells to obtain a level of hemoglobin of 13 or 14 g/dl, even though 10 g/dl has been considered a safe lower level for anesthesia. Be sure that the protein level is at least 5 g/dl. Patients with reduced renal function should be admitted to the hospital to allow evaluation. There the intake and output may be monitored and abnormalities in serum electrolytes corrected.

It is advisable to have patients stop taking aspirin 1 to 2 weeks before operation, especially if bleeding may be a problem. For major operations on older patients, consider digitalization, giving digoxin, 0.5 mg, in the morning of the day before operation; 0.25 mg that afternoon; and 0.125 mg that evening. It is well to hydrate the patient overnight with lactated Ringer's solution. Evaluate pulmonary function by measuring maximum midexpiratory flow rate, related to the ability to cough and thus avoid pneumonia. If the patient retains carbon dioxide, ventilatory support will be needed postoperatively. Perform spirometry with and without bronchodilators to test the reversibility of

EVALUATION BY THE ANESTHESIOLOGIST Discuss the projected procedure with the anesthesiologist, and give any information about the patient's status that was gained from your history and physical examination. In particular, discuss details about drugs that may cause intraoperative hypotension and provide data from previous operations, such as hyperpyrexia, drug reactions, and bleeding problems. Do not hesitate to cancel an elective operation if the anesthesiologist believes that the patient has an upper respiratory infection. Be certain to have the patient arrive with an empty stomach, having taken nothing by mouth in the previous 2 hours.

PROCEDURE REVIEW The night before the operation, go over the steps of the operation in your mind. Be sure to review the operation from an atlas or journal article, especially if it is a procedure done infrequently. More important than reading through the steps in a book, however, is visualizing the procedure step by step in your mind's eye. This allows the actual operation to progress easily and with greater accuracy.

Table 1. Checklist of Risk Factors (Gapta)

Anemia Creatinine >2 mg/dl Cerebrovascular accidents Diabetes Hypertension Heart block Myocardial infarction Dyspnea from airway obstruction

Low Risk

Moderate Risk

High Risk

11 to 12 g/dl Reversible > 6 mo Mild 150/90 mm Hg Incomplete > 6 mo Unusual exertion

8 to 10 g/dl

< 8 g/dl Irreversible < 6 mo Uncontrolled 280/150 mm Hg Pacemaker < 3 mo At rest

3 to 6 mo Moderate 200/120 mm Hg 3 to 6 mo Moderate exertion

3

Preparation for Surgery PREOPERATIVE PREPARATION Manage hypertension preoperatively to stabilize the blood pressure so that it does not swing during anesthetic induction and intubation. Try to achieve normal blood pressure, or at least reduce the diastolic blood pressure below 100 mm Hg. Consider hydrating the patient overnight with lactated Ringer's solution. If blood loss is anticipated, arrange for the patient to store blood prior to the operation to reduce the risk of viral acquisition. Autologous donations are suitable for cystectomy, pelvic and retroperitoneal lymph node dissection, nephrectomy and nephroureterectomy, radical penectomy, open and transurethral prostatectomy, and urethroplasty. Reinfusion of recovered blood may be indicated if the loss is large. Hypokalemia, seen in older patients preoperatively, is usually due to depletion of total body potassium. For blood levels above 3 mEq/L, oral supplementation is sufficient, but replacement is slow and may delay the operation. For lower levels, intravenous potassium administration may be resorted to, but the rate should not exceed 10 mEq/hr. Rescheduling the procedure may be the wiser course.

OUTPATIENT SURGERY Operations in a "come-and-go" setting are becoming the standard, one reason being economic. Procedures such as inguinal, penile, and scrotal surgery and many endoscopic procedures may be done as same-day surgery with the expectation of few postoperative hospitalizations and very few complications, either surgical or anesthetic. Such operations are clearly better in pediatric urology because they are well tolerated by children and they keep children and parents together. Prior to the day of surgery, arrange for the adult patient or the child and parents to be interviewed by the anesthesiologist and, if feasible, examined by a member of the house staff.

1

Two useful tools that can be made are the Rumel tourniquet ( A ) and a pair of 12-inch intrarenal retractors (B).

A B

4

Admit the patient to the same-day surgery unit at least 1 hour before the operation. If the procedure is to be done with local anesthesia, provide sedoanalgesia (page 8) at this time. After stopping by the same-day surgery waiting room to reassure the patient's family, go to the operating room before the patient is put to sleep (thereby providing more reassurance). After the operation and the necessary stay in the recovery room, the patient can be transferred to a less supervised room to recover fully before discharge. A subsequent telephone call to the patient or family from the unit nurse allows immediate detection of any problems.

INSTRUMENTS With the help of the operating room nurse or technician, make out a card for each operation you commonly do, listing the position of the patient, the instruments you need, and the sutures to have ready. In this atlas, lists of instruments are provided with the descriptions of many operations, and the composition of the basic specialty sets is listed in the back of the book under "Instruments" (page 1081). Make your own instrument cards by photocopying the appropriate list, revising it to suit your own technique, and then having it typed on a card to be filed in the operating room. Have the appropriate card out on the counter in the operating room while the patient is being anesthetized. Check the cards and keep them up to date. In some cases, go over the card with the scrub nurse at the instrument table to be sure everything is at hand A "GU cart" is a necessity. Obtain a roll-around cart with five or six drawers of the type that mechanics use to hold tools. Paint it a color that prevents it from being mistaken for an emergency cart. Outfit it with catheters, sounds, stents, and special instruments and have it parked in your operating room during the operation. Suggested contents are found in the "Instruments" section (page 1081). A separate cart for sutures is also useful, especially for procedures on infants and children which require special sutures and needles.

PREPARATION FOR SURGERY

Table 1. Preparation of Coagulum 1. Cryoprecipitate from Blood Bank, 2 b a g s of 15 ml e a c h . (Call a h e a d to thaw for 30 minutes.) 2. 3. 4. 5. 6. 7. 8. 9.

CaCl2 10%; 1 amp. Methylene blue. 18-gauge angiocatheter; cut off extra length, add stopcock. 35-ml syringe. IV extension tubing without stopcock. Attach to angiocatheter. 60-ml syringe for irrigation. 8 F infant f e e d i n g tube. 200-ml bowl.

10. Saline irrigation solution.

Draw cryoprecipitate into the 60-ml syringe, add 6 ml CaCI2 tinted with methylene blue, and mix in a bowl. Draw the mixture into a 35-ml syringe and instill it into the pelvis through an angiocatheter. After removal of the clot, flush the ureter with saline via the 8 F infant feeding tube.

For coagulum pyelolithotomy, assemble the requisites before the operation (Table 1). Proper retractors are necessary. Perineal prostatectomy, for example, requires a special set of posterior and lateral retractors, as well as prostatic tractors with blades that open to elevate the gland. Ring retractors arc needed for pediatric procedures and for work on the urethra. A Balfour retractor with malleable blades is useful for adults, but a self-retaining retractor, with universal joints and detachable disposable blades, fastened to the table top, such as the Omni-Tract, is better for major cases.

PREOPERATIVE CHECKLIST To avoid missing important orders, refer to a preoperative checklist (Table 2).

PREPARATION OF THE OPERATIVE SITE Shaving increases bacterial colonization and should be done as near to the time of operation as feasible. A razor with a recessed blade causes the least damage. Shave only those areas where the hair would get in the way; use scissors for the rest. Follow this with a brief mechanical wash to expose bacteria so that they can be reached by topical antiseptic agents. An iodophor, such as povidone-iodine (Betadine), in which iodine is complexed with a surfactant compound, releases iodine slowly to act on contaminants. Wash the area for 5 to 10 minutes with such a solution, then paint it with concentrated iodophor. Avoid spreading these solutions on the delicate skin of the genitalia.

Table 2. Preoperative Checklist A s s e s s Operative Risk Nutrition (serum albumin , Pcschel R, Reissigl A, Bartsch G: laparoscopic dismembered pyeloplasty. J Endourol 8:S83, 1994. Johnston JH, Evans JP, C.lassberg KI, et al: Pelvic hydronephrosis in Children: A review of 9 personal cases. J Urol 117:97, 1977. Kadir S, White RI Jr, Engel R: Balloon dilatation of a ureteropelvic junction obstruction. Radiology 143:263, 1982. Kaneto H, Orikasa S, Chiba T, Takahashi T: Three-D muscular arrangement at t h e ureteropelvic junction and its changes in congenital hydronephrosis: A sterco-morphometric study. J Urol 1 4 6 : 9 0 9 , 1991. Kark RM: Renal biopsy. JAMA 105:220, 1968. Karlin GS, Badlani GH, Smith AD: Endopyelotomy versus open pyeloplasty: Comparison in 88 patients. J Urol 140:476, 1988. Karsburg W, Leary TJ: Nephrostomy tube replacement. Urology 13:301, 1979. Kaylor WM, Novick AC, Ziegelbaum M, et al: Reversal of end stage renal failure with surgical revascularization in patients with atherosclerotic renal artery occlusion. J Urol 141:46, 1989. Khauli R, Noyick AC, Ziegelbaum M: Splenorenal bypass in the treatment of renal artery stenosis: Experience with 69 cases. J Vase Surg 2 : 5 4 7 , 1985. Kul F: T h e Function of the Ureter and Renal Pelvis. Oslo, Oslo University Press, 1957. King LR: Management of multicystic kidney and ureteropelvic junction, obstruction. In King LR (ed): Urologic Surgery in Neonates and Young Infants. Philadelphia, WB Saunders, 1988, p 140. Koff SA, Hayden LJ, Cirulli C, Shore R: Pathophysiology of ureteropelvic obstruction: Experimental and clinical observations. J Urol 1 3 6 : 3 3 6 , 1986. Koff SA, Thrall JH, Keyes JW J r : Diuretic radionuclide urography: A non-invasive method for evaluating nephroureteral dilatation. J Urol 1:153, 1979. KooSee Lin LC, Bewick M, Koffman CG: Primary use of a double J silicone ureteral stent in renal transplantation. Br J Urol 72:697.1993. Kumar S, Bhandari M, Mohapatra TP: A simple ureteric function test: Intraoperative and post-operative uses in pyeloplasty. Br J Urol 7 1 : 6 2 5 , 1 9 9 3 . Landau R, Botha J R , Mvburgh JA: Pyeloureterostomv or ureteroneocystostomy in renal transplantation? Br J Urol 58:6, 1986. Lawson RK: Extracorporeal renal surgery. J Urol 123:301, 1980. Lawson RK, Hodges CV: Extracorporeal renal artery repair and autotransplantation. Urology 4:532, 1974. Leadbetter GW Jr, Monaco AP, Russell PS: A technique for reconstruction of the urinary tract in renal transplantation. Surg Gynecol Obstet 123:839, 1966. Lee WJ, Badlani GH, Karlin GS, et al: Treatment of ureteropelvic

strictures with percutaneous pyelotomy: Experience in 62 patients. AJR 151:515, 1988. Lerner SE, Griefer I, Taub HC, et al: A single c e n t e r experience with renal transplantation in young children. J Urol 149:549, 1993. Libertino JA, Zinman L: Surgery for renovascular hypertension. In Libertino JA (ed): Pediatric and Adult Reconstructive Urologic Surgery, 2nd ed. Baltimore, Williams & Wilkins, 1987, p 119. Libertino JA, Zinman L, Breslin DJ, et al: Renal artery revascularization. Restoration of renal function. JAMA 2 4 4 : 1 3 4 0 , 1980. Liebermann-Meffert D, White H (eds): The Greater Omentum. Berlin, Springer-Verlag, 1983. Linke CA, Cockett ATK, Lai MK, Youseff AM: The use of pedicled grafts of omentum in the repair of transplant-related urinary tract problems. J Urol 120:532, 1978. Linke CA, May AG: Autotransplantation in retroperitoneal fibrosis. J Urol 107:196, 1972. Maatman TJ, Montie JE: Complications of renal surgery. In Marshall FF (ed): Urologic Complications. Chicago, Year Book Medical Publishers, 1986, p 10.3. Madaio MP: Renal biopsy. Kidney Int 38:529, 1990. Maizels M, Stephens FD: The induction of urologic malformations: Understanding the relationship of renal ectopia and congenital scoliosis. Invest Urol 17:209, 1979. Margreit R, Steiner E, Aigner F, Hoyer J: A safe technique for renal transplantation in patients with severely infected bladders. Surg Gynecol Obstet 159:487, 1984. Marshall FF: Intraoperative localization of renal calculi. Urol Clin North Am 10:629, 1983. Marshall FF, Smolev J K , Specs EK, et al: The urological evaluation and management of patients with congenital lower urinary tract anomalies prior to renal transplantation. J Urol 127:1078, 1982. Marshall VR, Singh M, Tresidder GO, Blandy JP: The place of partial nephrectomy in the management of renal calyceal calculi. Br J Urol 4 7 : 7 5 9 , 1976. Masaki Z, Iguchi A, Kinoshita N. et al: Intrasinusal pyelolithotomy with lower pole nephrotomy for removal of renal stones. Urology 2 6 : 4 6 1 , 1985. McAninch JW, Carroll PR: Renal trauma: Kidney preservation through improved vascular control—a refined approach. J Trauma 22:285, 1982. McAninch JW Carroll PR, Klosterman PW, et al: Renal reconstruction after injury. J Urol 145:9.32, 1991. McClure CFW, Butler EG: T h e development of the vena cava inferior in man. Am J Anat 3 5 : 3 3 1 , 1925. McCowan RE: Bilateral renal ectopia. J Urol 2 2 : 6 5 3 , 1929. McCullough CS, Soper NJ, Clayman RV, et al: Laparoscopic drainage of a posttransplant lymphocele. Transplantation 51:725, 1991McDougal WS, Persky LI (eds): Traumatic Injuries of the Genitourinary System. Baltimore, Williams & Wilkins, 1981. McDougall EM, Clayman RV, Fadden PT: Rctroperitoneoscopy: The Washington University Medical School experience. Urology 4 3 : 4 4 6 , 1994. McLean PA, Gawley WF, Gorey TP: Technical modifications of Anderson-Hynes pyeloplasty for congenital pelviureteric junction obstruction. Br J Urol 5 7 : 1 1 4 , 1985. McLoughlin MG, Williams GM, Stonesifer GL Ex vivo surgical dissection. JAMA 2 3 5 : 1 7 0 5 , 1976. McQuitty DA, Boone TB, Preminger GM: Lower pole calicostomy for the management of iatrogenic ureteropelvic junction obstruction. J Urol 153:142, 1995. Merkel FK, Straus AK, Andersen O, et al: Microvascular techniques for polar artery reconstruction in kidney transplants. Surgery 7 9 : 2 5 3 , 1 9 7 6 . Merklin RJ, Michels NA: The variant renal and suprarenal blood supply with data on the inferior phrenic, ureteral and gonadal arteries. J Int Coll Surg 29:41, 1958. Milloy FJ, Anson BJ, Cauldwell EW: Variations in the inferior caval veins and in their renal and lumbar communications. Surg Gynecol Obstet 115:131, 1962. Milsten R, Neifield J, Koontz WW: Extracorporeal renal surgery. J Urol 112:425, 1974.

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Guazzoni G, Montorsi F, Bocciardi A, et al: Transperitoneal laparoscopic versus open adrenalectomy for benign hyperfunctioning adrenal tumors: A comparative s&dy. J Urol 153:1597,1995. Hume DM: Pheochromocytoma in the adult and in the child. Am J Surg 99:458, I960. Hureau J, Hidden G, Thanh Minh TA: The vascularisation of the suprarenal glands. Anat Clin 2:127, 1980. Jovenich JJ: Anesthesia in adrenal surgery. Urol Clin North Am 16:583, 1989. Kaufman BH, Telander RL, van Heerden JA, et al: Pheochromocytoma in the pediatric age group: Current status. J Pediatr Surg 18:879, 1983. Koyle MA: Neuroblastoma. In Vaughan ED Jr, Carey RM (eds): Adrenal Disorders. N e w York, Thieme Medical Publishers, 1989, p 275. Libertino JA, Novick AC (eds): Adrenal surgery. Urol Clin North Am 16:417, 1989. Mahoney EM, Crocker DW, Friend DG, et al: Adrenal and extraadrenal pheochromocytomas: Localization by vena cava: A sampling and observations on renal juxtaglomerular apparatus. J Urol 108:4, 1972. Malone MJ, Libertino JA, Tsapatasaris NP, et al: Preoperative and surgical management of pheochromocytoma. Urol Clin North Am 16:567, 1989. Nakada T, Kubota Y, Sasagawa I, et al: Therapeutic outcome of primary aldosteronism: Adrenalectomy versus enucleation of aldosterone-producing adenoma. J Urol 153:1775, 1995. Novick AG, Straffon RA, Kaylor W: Posterior transthoracic approach for adrenal surgery. J Urol 141:254, 1989. O'Neal LW: Surgery of the Adrenal Glands. St. Louis, CV Mosby, 1968. Reckler JM, Vaughan ED Jr, Tjeuw M, Carey RM: Pheochromocytoma. In Vaughan ED Jr, Carey RM (eds): Adrenal Disorders. New York, Thieme Medical Publishers, 1989, p 259. Revillon Y, Daher P, Jan D, et al: Pheochromocytoma in children: 15 cases. J Pediatr Surg 27:910, 1992. Schiund JF, Kenney PJ, Brown ED, et al: Adrenocortical carcinoma: MR imaging appearance with current techniques. J MR Imaging 5:171, 1995. Scott HW Jr The pituitary and adrenals. In Sabiston DC Jr(ed): Textbook of Surgery: The Biological Basis of Modern Surgical Practice, 11th ed. Philadelphia, WB Saunders, 1977, p 776. Scott HW Jr, Dean RH, OatesJA, et al: Surgical management of pheochromocytoma. Am Surg 47:6, 1981. Shandling B, Wesson D, Filler RM: Recurrent pheochromocytoma in children. J Pediatr Surg 25:1063, 1990. Shulkin BL, Wieland DM, Schwaiger M, et al: PET scanning with hydroxyephedrine: An approach to the localization of pheochromocytoma. J Nucl Med 33:1125, 1992. Siragy HM, Vaughan ED Jr, Carey RM: Cushing's syndrome. In Vaughan ED Jr, Carey RM (eds): Adrenal Disorders. New York, Thieme Medical Publishers, 1989, p 147. Suzuki K, Kageyama S, Ueda D, et al: Laparoscopic adrenalectomy: Clinical experience with 12 cases. J Urol 150:1099, 1993. Vaughan ED Jr, Phillips H: Modified posterior approach for right adrenalectomy. Surg Gynecol Obstet 165:453, 1987. Vaughan ED Jr, Carey RM: Adrenal carcinoma. In Vaughan ED Jr, Carey RM (eds): Adrenal Disorders. N e w York, Thieme Medical Publishers, 1989, p 231. Whalen RK, Althausen AF, Daniels GH: Extra-adrenal pheochromocytoma. J Urol 147:1, 1992. Young HH: A technique for simultaneous exposure and operation on the adrenals. Surg Gynecol Obstet 54:179, 1936.

Audiovisual Cerny JC: Adrenalectomy via the Transabdominal Approach: A Differential Diagnosis of Cushing's Syndrome. Wilkes-Barre, PA, Karol Media, 1983 (15 minutes). AUA #919-1111.

Index Note: Page numbers in italics refer to illustrations; page numbers followed by t refer to tables.

A Abbe-Mclndoe procedure, for vaginal reconstruction, 231-233, 231-233, 241 Abdomen, blood supply to, 30, 486, 486. 854 dehiscence in, 868 kidney in, surgical approaches to, 853 packing of contents of, technique of, 11 renal incisions in, anatomic basis of, 854855 wall of, bladder incisions and, 486, 486 in laparoscopy, 30 Abscess(es), omental mobilization and, 74 pelvic, pelvic lymphadenectomy and, 521, 524 radical cystectomy and, 511 ureterosigmoidostomy and, 725 pelvic exenteration and, 534 penile, urethral carcinoma and, 153 renal injuries and, 936 Acidosis, hyperchloremic, continent reservoirs and, 684, 692 ileal conduit and, 662 ileocecal bladder substitution and, 777 rectourethral fistula repair and, 480 ureterosigmoidostomy and, 725, 726 hypochloremic, gastric reservoir and, 706, 707 metabolic, ileocecocystoplasty and, 754. 756 sigmoidocystoplasty and, 741 Adductor longus muscle, 149 Adenocarcinoma, ureterosigmoidostomy and, 725 Adenomas, localization of, 1058 prostatic, blood supply to, 420 Adhesions, abdominal, in laparoscopy, 28. 30 lysis of, 27 circumcision and, 171, 173 prostatectomy and, 418, 418 radical cystectomy and, 511 sigmoidocystoplasty and, 741 Adhesive tape dressings, adherence of, 57 Adrenal gland, anatomy and blood supply of, 1057 anterior approach to, incision for, 861, 861 laparoscopic, 862 excision of. See Adrenalectomy. Adrenal insufficiency, adrenalectomy and. 1064, 1080 Adrenal vein(s). See Vein(s), adrenal Adrenalectomy, dorsal lumbotomy for, 901 imaging for, 1059 laparoscopic, transperitoneal approach to, 1060 left, anterior approach to, 1065-1067, 1065-1067 lateral approach to, 1061-1062, 10611062 posterior approach to, 1075-1077, 10751077 indications for, 1075 partial, 1058, 1062 posterior transcostal transdiaphragmatic incision for, 1075-1078, 1075-1078 preparation for, 1058-1059 renal carcinoma and, 1016 right, anterior approach to, 1068, 1068 lateral approach to, 1063-1064, 10631064

Adrenalectomy (Continued) posterior approach to, 1078, 1078 simultaneous bilateral exposure for, 10791080, 1079-1080 surgical approach(es) to, 1059, 1059t, 1060 anterior, 1065-1068, 1065-1068 lateral, 1061-1064, 1061-1064 posterior, 1075-1078, 1075-1078 modified, 1079, 1079 surgical technique of, 1060 thoracoabdominal incision for, 892 with nephrectomy, 1069-1071, 1069-1071 Adrenocorticotropic hormone, in Cushing's disease, 1058 Air embolism, in vena caval thrombectomy, 1040 Albumin, scrum, preoperative risk evaluation and, 3 Alcock's canal, 223 circumcision and, 170, 173 Aldosterone, adrenal tumors and, 1058, 1071 Alexander periosteal elevator, 875, 875 Alkalosis, metabolic, gastrocystoplasty and, 762 Allen's test, for radial or ulnar artery patency, 223-224 Allis clamp, in bowel stapling technique, 64, 66-67 Alpha-fetoprotein, radial orchiectomy and, 380 5-Alpha-reductase, chordee and, 129 Amplatz dilator, 28 Analgesia. See also Nerve(s), block of. ketorolac, pelvic lymphadenectomy and, 521 patient-controlled, 18 postoperative, for hypospadias repair, 106 for pain, 17t, 18 sedoanalgesia and, 4, 8 Anastomoses, bowel, end-to-end, 64-65, 64-65 ileal end-to-side, 67, 67 ileocolic end-to-side, 66, 66 stapling techniques for, 64-67, 64-67 techniques of, 683, 683t bowel-bladder, suture technique for, in sigmoidocystoplasty, 738-739, 738-739, 741 colon-colon, suture technique for, in sigmoidocystoplasty, 736-737, 736-737, 741 ileovesical, in ileal ureteral replacement, 843-845, 843-845, 846 in aortorenal bypass graft, 942-943, 942943 in pyeloureteroplasty, patency of, 922 microsurgical techniques of, arterial, 60-62, 60-62 neural, 63, 63 venous, 62 of dorsal penile artery with epigastric artery, 196, 196-197 of internal and external iliac arteries, in renal transplantation, 959, 959-960, 966-967 pyelocaliceal, 841 pyeloileal, 843 ureteral, in ureteroneocystostomy, 790, 790 of retrocaval ureter, 837, 837 Sagalowsky method of, 659 ureterocaliceal, 840-841, 840-841

Anastomoses (Continued) ureterocolonic, Goodwin technique of, 720-723 in ureterosigmoidostomy, 726 ureterointestinal, 683t, 683-684, 770, 770 Camey-LeDuc technique of, 770, 770 ureteroureteral, technique of, 835-837, 835-837 vascular, after renal transplantation, 966967 vesicourethral, in total retropubic prostatectomy, 445 Anderson-Hynes technique, in dismembered pyeloplasty, 914-918, 914-918 in pyeloplasty for horseshoe kidney, 924925, 924-925 in retrocaval ureteral anastomosis, 837, 83 7 Anesthesia, continuous epidural regional, technique of, 17-18 fluid and electrolyte replacement during, 8 for adrenalectomy in pheochromocytoma patients, 1058-1059 for circumcision, 167, 170 for laparoscopy in children, 28 for nerve block, topical, 75 for same-day surgery, 8 for ureterocystoplasty, 764 local, 8 toxic reactions to, 8 malignant hyperthermia during, 8, 8t monitoring of, 8 Anesthesiologist, outpatient surgery preparation and, 4 patient preoperative evaluation by, 3 Aneurysm, inflatable testicular prosthesis and, 192 Angioplasty, patch graft, endarterectomy with, 950-951, 950-951 Anorexia, retroperitoneal lymph node dissection and, 403 Antibiotics, for artificial sphincter placement, 585 for hypospadias repair, 96, 102 for ilioinguinal lymphadenectomy, 158, 164 for partial penectomy, 150 for penile prosthesis insertion, 179, 185 for penile reimplantation, 215 for prostate excision, 413 for total penectomy, 157 preoperative, 6, 6t Anticoagulation. See also Heparin. for flap survival, 58 Anuria, ileal conduit and, 661 ureteroneocystostomy and, 794, 801 ureterosigmoidostomy and, 725 Aorta, access to, through retroperitoneal incision, 864, 864 in ureterolysis, 827, 829 repair of, 84, 84 Aortic punch, 966, 967 Aortorenal bypass graft, for renal artery reconstruction, 940-943, 940-943 Aortorenal reimplantation, for renal artery reconstruction, 952-953,952-953 Appendectomy. 675-676, 675-676 concurrent, 675-676, 675-676 in retroperitoneal lymph node dissection, 402 indications for, 676 1149

1150

INDEX

Appendectomy (Continued) laparoscopic, 676 urinary diversion and, 683 Appendicocecostomy, for antegrade colonic enema (ACE procedure), 713 Appendico vesicostomy (Mitrofanoff procedure), 708-714 implantation into bladder in, 710, 710 implantation into bowel in, 711, 711 incision for, 708 postoperative problems with, 713-714 Appendix, blood supply to, 679, 679 in gastrocystoplasty, 762 in Mitrofanoff procedure, 708-714 Mitrofanoff valve of. See also Appendicovesicostomy (Mitrofanoff procedure). in gastric reservoir, 706, 706 stoma of, implanted into bowel or bladder continent reservoir, 710-711, 710-711 in Mainz pouch, 698 in Penn pouch, 699, 699 stump of, in ileocecal bladder substitution, 777 inversion of, in appendectomy, 676 Arap procedure, for modification of MAGPI procedure, 120, 120, 726 Arcuate line, in inferior rectus abdominis flap, 54-55, 55 Argon-beam coagulator, 936 in polar partial nephrectomy. 1001 Argon-fibrin glue, in laparoscopic partial nephrectomy, 996 Arteriography, renal, with vena caval thrombectomy, 1031, 1040 Arteriosclerosis, autotransplantation and. 831 renal artery reconstruction and, 937-948 Arteriovenous fistula(s), with renal injuries, 936 Artery(ies). See also named artery, e.g., Aorta; Vessels. adventitia of, in forming anastomoses, 60 anastomoses of, microsurgical techniquefor, 60-62, 60-62 patency of, tests for, 62, 223-224 appendiceal, 679, 679 axial, in island flaps, 48 branches of, disease of, extracorporeal renal surgery for, 1027-1028 bulbourethral, of penis, 196, 196 cavernous, of penis. 777, 178, 196, 196, 271, 271 colic, 680, 680, 681, 681, 767 sigmoid conduit and, 664 dorsal penile, 177, 178, 196, 196-197, 271, 271 epigastric, anastomosis of, 197 in microvascular orchiopexy, 324, 324325 in pelvic lymphadenectomy, 519, 519520 in penile arterial revascularization procedure, 194-196, 194-197 inferior, 486, 486, 956, 956 in orchiopexy, 311, 311 inferior rectus abdominis flap and, 54 55, 56, 59 superior, 486, 486 inferior rectus abdominis flap and, 55, 56 femoral, common, in inferior rectus abdominis flap, 54 median circumflex, in musculocutaneous flaps, 50, 50 supplying gracilis muscle, 50, 50 gastroepiploic, 758, 758, 762 and, 707 gastric content reservoir gluteal, 819 hemorrhoidal, rectal, superior and middle, 682 hepatic, in hepatorenal bypass graft, 948 hypogastric, in extracorporeal renal surgery, 1029, 1029

Artery(ies) (Continued) hypogastric (obliterated), 500, 500 ileal, 679, 679, 681, 681 ileocolic, 679, 679, 680, 680 in cecocystoplasty, 742, 742 sigmoid conduit and, 664 iliac, 767 common, 819 external, after renal transplant, 966-967 laceration of, 85, 85 in pelvic lymphadenectomy, 519, 519520 internal, 819 in renal transplantation, 959, 959-960 laceration of, 85, 85 injuries of, repair of, 84-86, 84-86 intercostal, 486, 486 longitudinal, supplying skin, 41,41 lumbar, in nephroureterectomy, 1011, 1011 marginal, 681, 681 in sigmoidocystoplasty, 735, 735 mesenteric, inferior, 681, 681 continent urinary diversion and, 678 in sigmoidocystoplasty, 735, 735 superior, 679, 679, 681, 681 continent urinary diversion and, 678 in nephroureterectomy, 1009, 10111012 radical nephrectomy and, 1026 obturator, 499-500, 767, 819 in pelvic lymphadenectomy, 520 pelvic plexuses of, 912,912 penile, 98, 177, 196, 196-197, 271, 271. 1778 reduced flow from, diagnosis of, 194, 197 revascularization for, 194-197 perineal, 292, 293 pudendal, 196, 196, 819 radial, Allen's test for patency of, 223-224 cephalic vein shunt with, in renal transplantation, 968-969, 968-970 in forearm flap for penile construction, 220-222, 220-223 rectal, 767 superior, sigmoid conduit and, 664 recurrent, 679, 679 renal, anatomy of, 912, 912 in donor nephrectomy, 978 aneurysm of, 954, 955 emboli of, renal artery reconstruction and, 954, 954, 955 in nephroureterectomy, 1010, 10101011 in repair of renal injury, 933, 933 in subcapsular nephrectomy, 999 in transperitoneal approach to kidney. 862 in transperitoneal laparoscopic nephrectomy, 996 ligation of, in nephrectomy, 992 loss of control of, 86, 86 mapping of segmental distribution of. 1053 multiple, in donor nephrectomy, 977-978 reconstruction of, 937-955 aortorenal bypass graft for, 940-943, 940-943 alternatives to, 944-948, 944-948 aortorenal reimplantation of, right, 952-953, 952-953 choice of technique for, 937 diagnostic evaluation for, 937 embolectomy in, 954, 954 endarterectomy for, aortorenal, 948950, 948-950 with patch graft angioplasty, 950951,950-951 exposure for, 938-940, 938-940 hepatorenal bypass for, 948 incision for, 937, 937 indications for, 955 position for, 937, 937

Artery(ies) (Continued) postoperative problems with, 954-955 preoperative preparation for, 937 splenorenal bypass for, 944-948, 944948 repair of, 86, 86, 933, 933, 935, 935 segmental, in renal resection, 984, 984 stenosis of, 966-967 renal artery reconstruction and, 955 renal transplantation and, 966-967 temporary occlusion of, 1053 in partial nephrectomy, 1004 thrombosis of, autotransplantation and, 831 renal artery reconstruction and, 954 traumatic, 935, 935 resection of, 86, 86 sigmoid, 681, 681, 767 sigmoid conduit and, 664 sigmoidocystoplasty and, 735, 735-736 spermatic, in Fowler-Stephens orchiopexy, 319 in varicocele ligation, 355, 355, 359-360, 359-360 spiral, 912, 912 splenic, 904, 904 in splenorenal bypass graft, 948, 948 straight, 681, 681 subperitoneal, 784, 785 testicular, 358, 374 in Fowler-Stephens orchiopexy, 320 in microvascular orchiopexy, 324, 324325 in varicocele ligation, 358 umbilical, obliterated, 767 uretero-subperitoneal, 784, 785 uterine, in hysterectomy, 259, 259 vesical, 500, 500, 767, 784, 785, 819 Ascites, chylous, retroperitoneal lymph nodedissection and, 403 Aspirin, flap survival and, 58 preoperative risk evaluation and, 3 Atelectasis, retroperitoneal lymph node dissection and, 403 Atherosclerotic disease, autotransplantation and, 831 renal artery reconstruction and, 937-948 Autoaugmentation, for bladder augmentation, 765, 765-766 laparoscopic, 766 Autostaplers, for bowel stapling, 64 Autotransplantation, kidney, 831 Avitene, for hemostasis, in laparoscopy, 28 Avulsion, of penis or scrotum, repair of, 211, 217-218, 217-218 of ureter, 785 Axial artery, in island flaps, 48 Azoospermia, testicular biopsy for, 307 Azotemia, prostatectomy and, 414

B Bacteremia, ileal bladder substitution and, 775 Bacteriuria, continent reservoirs and, 684, 703 noncontinent urinary diversion and, 624 Balanitis xerotica obliterans, fossa navicularis stricture repair and, 266, 270 Balloon dissector, in extraperitoneal laparoscopic surgery, 994-995, 996 in laparoscopy, 29 Barcat technique, 125, 141 Barotrauma, in laparoscopy, 30 Barry technique, in priapism, 210, 210 in ureteroneocystostomy, 786, 797-798, 797-798 vs. transvesical technique, 964 Basilic vein(s), cutdown catheterization of, 92 Baskin and Duckett procedure, in dissection of chordee, 100 Benchekroun procedure, for ileal hydraulic valve conduit, 715, 715-716

INDEX Benzoin, tincture of, 57 Berger's technique, of Z-plasty (four-flap), 45, 45 Biopsy, basic instrument sets for, 1082 gonadal, for intersex conditions, 307, 337 inadvertent, of epididymis, 307 penile, before partial penectomy, 150 before total penectomy, 154 prostate, total retropubic prostatectomy and, 431 renal, laparoscopic, retroperitoneal, 932 transperitoneal, 932 open, 931. 931-932 indications for, 931 postoperative problems with, 931 sentinel node, in penile carcinoma, 158, 158 testicular, 305-306, 305-307 in inguinal orchiopexy, 311 percutaneous needle, 307 ureteral, in radical cystectomy, 507 Bladder, anatomy of, 499-500, 500, 507 appendix implanted into, in Mitrofanoff procedure for continent reservoir, 708714 approaches to, 485-498. See also Incision(s), for bladder surgery. abdominal wall blood supply and, 486, 486 linea alba and, 486, 486 principles of, 486 augmentation of, 727-766 blood supply relevant to, 727 complications of, 728 enuresis with, 728 eponyms for, 62t indications for, 728 principles of, 728 procedure(s) for, 678t, 728t antireflux ileocecocystoplasty, 748-751 autoaugmentation, 765, 765-766 cecocystoplasty, 742-748 gastrocystoplasty, 757-762 ileocecocystoplasty, 753-756 dissection for, 753-754, 753-754 incision for, 753, 753 postoperative problems with, 754, 756 ileocystoplasty, 729-734, 729-734 sigmoidocystoplasty, 735-741 ureterocystoplasty, 763, 763-764 reflux and, 714 renal transplantation with, 967 sources of tissue for, 728 vs. substitution, 728 calculi of, appendicovesicostomy and, 714 Mitrofanoff procedure and, 713 capacity of, vesicostomy and, 641 diversion of. See Urinary diversion. dysfunctional, unrecognized, ureteroneocystostomy and, 801 empyema of, cutaneous ureterostomy and, 646 epithelial eversion of, vesicostomy and, 641 excision of, 499-542. See also Cystectomy. principles of, 500 ileal. See Ileocecocystoplasty; Ileocystoplasty; Ileum, for bladder substitution. in psoas hitch procedure, 818-821 injury to, in laparoscopic pelvic node lymphadenectomy, 473 laceration of, in laparoscopy, 30 low outlet resistance in, trigonal tubularization and, 572 neck of. See Bladder neck. neurogenic, artificial sphincter placement in. 586 augmentation procedures and, 714 in children, vesicostomy and, 636-6.37, 636-637, 641 non-neurogenic syndrome of, ureteroneocystostomy and, 801

Bladder (Continued) sigmoidocystoplasty and, 741 vesical lithotomy and, 628 vesical neck tubularization and, 575 prolapse of, vesicostomy and, 637, 641 reconstruction of, 543-622 anatomy relevant to, 543 artificial sphincter insertion in, 580-585, 580-586. See also Bladder, sphincter of, artificial. colposuspension for, 549-555, 549-556 cystourethropexy for, 545-548, 545-548 intravesical urethral lengthening for, 576-578, 576-579 principles of, 544 pubovaginal sling procedure for, 565568, 565-569 sacral laminectomy and pacemaker placement and, 617-622 trigonal tubularization for, 570-571, 570572 urachal excision and, 614-616 vaginal needle suspension for, 558-563, 558-564 vesical neck closure for, 609-613 vesical neck tubularization for, 573-574, 573-575 vesicosigmoid fistula repair and, 601-608 vesicovaginal fistula repair and, 587-600. See also Fistula(s), vesicovaginal, repair of. reflex activity in, artificial sphincter placement and, 586 reservoirs for, eponyms for, 62t rupture of, repair of, 544 spasms in, hypospadias repair and, 106, 107 ureteroneocystostomy and. 807 sphincter of. See also Detrusor. artificial, AS 800 model, 580 bladder neck placement of, 580-582, 580-582 bulbar urethral placement of, 583-585, 583-585 cuff of, in women-alternate technique for, 586 problems with, 585-586 in cecocystoplasty, 748 in gastric continent reservoir, 705 in ileocecal bladder replacement, 777 in ileocecocystoplasty, 754-756, 754756 in ileocystoplasty, 731, 734 indications for, 752 instruments needed for, 580 neurologic stimulation of, 617-622 postoperative problems with, 585 preoperative preparation for, 580 testing of, 582, 585 transvaginal approach for, 586 substitution for, 767-782 eponyms for, 62t principles of, 768 procedures used for, 678t, 768t colon substitutes, 778-780 left colon, 779-780, 779-780 postoperative care for, 780 right colon, 778, 778-779 sigmoid (stapled), 780 ileal substitutes, 769-775, 769-775. See also Ileocystoplasty; Ileum, for bladder substitution. ileocecum, 776-778. See also Ileocecocystoplasty. female 777 male, 776, 776-777 postoperative problems with, 777 stomach, 781-782, 781-782 superior vesicle pedicle of, in psoas hitch procedure, 819, 819 thick-walled, ureteral techniques of repair for, 786 Bladder flap (Boari flap), 822-825, 822-826

1151

Bladder flap (Boari flap) (Continued) for ureteral injury, 785 psoas hitch procedure and, 821 Bladder neck. See also Vesical neck. closure of, enterocystoplasty and, 714 in females, 609-613 Mitrofanoff procedure and, 708, 709 stricture at, total retropubic prostatectomy and, 445 suspension of, 564 vaginal needle suspension and, 558-560, 558-561 tubularization of, neurogenic bladder and, 575 Bladder urothelial graft(s), 103, 103 Blandy-Tresidder technique, of urethral stricture repair, 266, 266, 270, 290 Bleeding. See also Hemorrhage; Hemostasis. autotransplantation and, 831 circumcision and, 171 delayed, 936 epididymectomy and, 410 hypospadias repair and, 107 ilioinguinal lymphadenectomy and, 164 intraoperative, 8, 11 laparoscopy and, 30 massive, in vena caval thrombectomy, 1040 nephrectomy and, 992 open renal biopsy and, 931 partial cystectomy and, 504 pelvic exenteration and, 534 pelvic lymphadenectomy and, 524 postoperative, 16-17 preoperative risk evaluation and, 3 prostatectomy and, 419-421, 420-421, 421t, 428, 430, 463 pyeloureteroplasty and, 922 radical cystectomy and, 511 radical nephrectomy and, 1026 renal artery reconstruction and, 954 renal injury repair and, 933-936 renal transplantation and, 965 retroperitoneal, lymph node dissection and, 403 radical orchiectomy and, 384 test for, in Fowler-Stephens orchiopexy, 319, 320 urethral reconstruction and, 263 vesicovaginal fistula repair and, 600 Bleomycin, retroperitoneal lymph node dissection and, 403 Blood, autologous, preoperative donation and storage of, 3-4 total retropubic prostatectomy and 431 coagulation of. See Coagulopathy. Blood transfusion, requirements for, 11, 11t Boari flap, 822-825, 822-826 alternatives to, 822, 826 in ureteral reimplantation in ureterovaginal fistula repair, 833 postoperative problems with, 826 psoas hitch and, 821, 826 Borges technique, of contracture release, skin flaps for, 49 Bowel, anastomoses of, stapling techniques of. See Bowel, stapling techniques in. suture techniques in, 37-40, 37-40 techniques of, 683, 683t to bladder, 738-739, 741 appendix implanted into, in Mitrofanoff procedure for continent reservoir, 711, 711 blood supply to, 623, 677, 678 herniation, of, laparoscopic pelvic node lymphadenectomy and, 469 in ileocecal valve reconstruction, for continent reservoir, 703 in incisional hernia repair, 910 in Mainz pouch, 698 in Mitrofanoff procedure, 711, 711, 712 in urinary diversion, 682, 683 in vaginal reconstruction, 240, 241

1152

INDEX

Bowel (Continued) in vesicosigmoid fistula repair, 602-608, 602-608 Injury to, in laparoscopic techniques, 30, 473 in radical cystectomy, 510 repair of, 87-88, 87-89 Urge. See also Colon. vs. small, circulation of, 678 leak from, with laparoscopy, 30-31 obstruction of, gastrocystoplasty and, 762 in Ileal bladder substitution, 775 in ileocecal bladder substitution, 777 in laparoscopic pelvic node lymphadenectomy, 473 retroperitoneal lymph node dissection and, 403 sigmoidocystoplasty and, 741 preoperative preparation of, 6 for laparoscopic pelvic node lymphadenectomy and, 469 for laparoscopy, 21, 28, 993 for radical cystectomy, 504 for total perineal prostatectomy, 463 short. See Short bowel syndrome. stapling techniques in, advantages of, 67 in colocolostomy, 66, 66 in end-to-end anastomosis, 64-65, 64-65 in end-to-end triangulation, 65, 65 in ileal end-to-side anastomosis, 67, 67 in ileocolic end-to-side anastomosis, 66, 66 suture types used in, 33, 34 Bricker's ileal conduit, 647-663 Brindley nerve stimulation device, sacral laminectomy and placement of, 617-622 Broviac catheter, 92, 94 Buccal mucosal graft(s). See Grafl(s), buccal mucosal. Buchwalter retractor, 494 adrenalectomy and, 1064 Buck s fascia, 150, 154, 166, 166, 271, 283, 283 in correction of penile curvature, 174 Bulbocavernosus muscle. See Muscle(s), bulbocavernosus. Bulbospongiosus muscle, anatomy of, 292, 293 vesicovaginal fistula repair and, 590, 590 Bulbourethral artery, of penis, 196, 196 Bupivacaine, for hypospadias repair, 98, 106 for local anesthesia, 8 for nerve block, 15, 80 for postoperative nerve block, 15 for postoperative pain, 17-18, 98, 106 Burch procedure, of colposuspension, 549-555, 549-556 Bums, of penis or scrotum, repair of, 211-212, 211-212 Burns-Mitchell procedure, of appendicovesicostomy with gastric bladder augmentation, 762 Byers flaps, 141 in hypospadias repair, 104 in Mathieu procedure, 125, 125

C Calculi, bladder, 713, 714 Mitrofanoff procedure and, 713 neurogenic bladder and, 628 renal. See also Pyelolithotomy. cystostomy and, 629 cystourethropexy and, 548 Foley muscle-splitting incision and, 885, 886 Gibson incision and, 496 ileal conduit and, 662 in continent reservoirs, 684, 703 infected, 1041 Kock pouch and, 692

Calculi (Continued) nephrostomy and ureterostomy and, 930 partial nephrectomy and, 1000 radical cystectomy and, 512 removal of, 843, 843 vesical lithotomy for, 628 residual, nephrolithotomy and, 1053 subcostal incision for, 874 ureteral autotransplantation for, 831 ureteral stents in, 68,70 ureterolithotomy for, 847-851 xanthine, ileal ureteral replacement with, 843, 843 ureteral. See also Ureterolithotomy. laparoscopic ureterolithotomy for, 996997 Caliceal diverticulectomy, and excision of renal cysts, 1055-1056, 1055-1056 Calicocutaneous fistula(s), renal transplantation and, 965 Calicoplasty, 1051-1052, 1051-1052 Calicopyelostomy, vs. partial nephrectomy, 1000 Calicoureterostomy, 840-841, 840-841 alternatives to, 840 indications for, 840, 841 Calyx, ureteral anastomosis to, 840-841 Camey procedure, of bladder substitution, detubularized U-shaped bladder in, 769-771, 769-77/ Camey-LeDuc procedure, of ureterointestinal anastomosis, in ileal bladder substitution. 770, 770 Camper's fascia, 148, 148 Cancer. See Carcinoma; specific type. Carbon dioxide, extraperitoneal leakage of, in laparoscopy, 30 Carcinoma, bladder, partial cystectomy for, 501, 504 extracorporeal renal surgery for, 10271030, 1029 indications for, 1029 penile, choice of procedure for, 153 ilioinguinal lymphadenectomy for, 158164 surgery for, 157 total penectomy for, 154-157 preoperative evaluation of, 1015 prostate, prostate-specific antigen determination and, 468 renal, bilateral, 1016 choice of incision for, 1016 partial nephrectomy and, 1016 tumor thrombus removal from vena cava and, 1016 renal cell, partial nephrectomy for, 1004 testicular, radical orchiectomy and, 380-384 transitional cell, evaluation and localization of, 1008, 1015 nephroureterectomy for, 1008 of renal pelvis, laparoscopic nephrectomy for, 993, 996 of solitary kidney, extracorporeal renal surgery and, 1029-1030 urachal, excision of, 616 ureteral, selection of procedure for, 1015 urethral, choice of procedure for, 150, 153 posterior, urethrectomy for, 515 radical cystectomy and, 511 Cardiac status, in risk assessment, 3 laparoscopy and, 30 radical cystectomy and, 511 Cardiopulmonary bypass, in vena caval thrombectomy, 1034, 1039-1040 Cardiovascular problems, adrenalectomy for pheochromocytoma and, 1074 Carrel patch, in renal transplantation, 960-961,960-961 Carter-Thomason device, in laparoscopy, 31 Cartilage, costal, in thoracoabdominal incision, 895 Cartwright-Snow technique, of laparoscopic ureteroneocystostomy, 801

Cartwright-Snyder technique, of repeat orchiopexy, 316, 316 Caruncle, urethral, excision of, 252, 252 Catecholamines, plasma, adrenal tumors and, 1058, 1080 Catheters), balloon, 14 in total penectomy, 155 Broviac, 92, 94 central vein, 92-93, 92-93, 94 cutdown, of peripheral vein, 90-91, 90-91 for chronic peritoneal dialysis, insertion of, 970-972, 970-973 postoperative problems with, 972-973 Hickman, 92, 94 in continent reservoir procedures, 685, 703, 707 in hypospadias repair, 102, 113, 146 in ileocecal bladder substitution, 777 in perineal prostatectomy, 450 in retropubic prostatectomy, loss of, 429, 429, 430, 443 in total perineal prostatectomy, 464 in total retropubic prostatectomy, 445 in ureteroneocystostomy, 790, 794 in urethral reconstruction, 263 intermittent use of, ileovesicostomy and, 641, 641 Kock pouch and, 686, 692 Mitrofanoff procedure and, 708 with bladder substitution, 768 with gastric continent reservoir. 707 with intravesical urethral lengthening procedure, 578 with pubovaginal sling procedure, 569 KISS, 918 Malecot, suprapubic drainage with, 14 method of securing. 14 Robinson, 14, 429, 429 specimen collection from. 3 surgical techniques with, 13-14, 13-14 transvesical anchor suture of, 14 uses of, 13 Catheterization, self, cecocystoplasty and, 752 ileocystoplasty and. 729. 734 Cavernosometry, 194, 197 Cecocystoplasty. 742-748 antireflux, 749-751. 749-752 bladder anastomosis in. 751-752 bladder preparation for. 751, 751 ileal closure in, 751 ileocecal valve in. 749-750, 749-750 postoperative care in. 752 ureteral implantation in. 751, 751 bladder pathology and, 752 complications of, 752 detubularization of ileocecal segment in, 746-748, 746-748 end-to-end sutured ileocolic anastomoses in, 744-745, 744-745 incision for, 742, 742 indications for, 752 postoperative care in, 748-749 preoperative preparation for, 752 self-catheterization and, 752 Cecum, blood supply to, 623, 677, 678, 679, 679 in cecocystoplasty, 742, 742 in transureteroureterostomy, 838, 838 in vaginal reconstruction, 238-240, 238240, 241 Cell Saver, in vena caval thrombectomy, 1040, Cephalic vein(s). See Vein(s), cephalic. Chemotherapy, laparoscopic retroperitoneal lymph node dissection and, 405 retroperitoneal lymph node dissection and, 403 total penectomy and, 154 Child(ren). See also Infant(s). gastrocystoplasty in. 762 gastrostomy in, 674 ileal conduit in, 647 laparoscopic surgery in, 28-29

INDEX

Child(ren) (Continued) operative site preparation in, 5 outpatient surgery and, 4 perineal repair In, 299 postoperative nerve block in, 15 preoperative evaluation of, 3 sigmoid conduits in, 666 suture cart for, 4 ureterocele repair in, cystoscopic, 817 ureterosigmoidostomy in, 717 ureterostomy in, 646 urethral stricture repair in, 282, 287 vesicostomy in, 636-637, 636-63 7 with neurogenic bladder, preoperative bowel preparation in, 6 Chordee, circumcision and, 171 in hypospadias, correction of, 97, 99, 99100, 129 persistent, 112, 113 minimal, Mathieu procedure and, 124 Mustarde procedure and, 126 onlay preputial island flap for, 130 tunica albuginea plication (TAP) for, 132, 132 persistent, corporal rotation for, 133 in hypospadias repair, 112, 113 urethral stricture repair and, 281 ventral, elliptical excision technique for, 174-175, 174-175 without hypospadias, causes of, 129 correction of, 100, 129 Chronic illness, preoperative risk evaluation and, 3 Chylous ascites, retroperitoneal lymph node dissection and, 403 Circumcision, 167-173 alternative technique in small bovs, 169, 169 anesthesia for, 167, 173 double-incision technique of, 167-168, 167-168 dressing for, 173 Gomco clamp technique for, 171 indications for, 148, 150, 153 planning incisions for; 173 Plastibell technique of, 170, 170 postoperative problems with, 171 preparation for, 167 revision of, 171 CIS (intracavernous injection and stimulation test), 194, 197 Clayman-Kavoussi technique, of laparoscopic nephroureterectomy, 993, 996 Clips, types of, in laparoscopy, 28 Cloacal malformations, gastric bladder substitution and, 782 Clomidine suppression test, 1058 Cloquet's node, 148-149, 149, 465, 465 Clostridium difficile infection, continent reservoirs and, 685 postoperative, 18 radical cystectomy and, 511 Coagulator, argon beam, 936, 1001 bipolar, in laparoscopic partial nephrectomy, 996 Coagulopathy, blood loss and, 11 in radical cystectomy, 510 preoperative risk evaluation and, 3 prostatectomy and, 421, 421t Coagulum technique, in pyelolithotomy, 1042-1043, 1042-1043 preparation of coagulum for, 5, 5t Cocaine, flap survival and, 58 Cohen technique, for ureteral reimplantation, ureterocele repair and, 816 in ureteroneocystostomy, 786, 793, 793 Colic artery(ies). Sec Artery(ies),colic. Collagen hemostatic substance, in laparoscopy, 28 Colles' fascia, 148, 148, 166, 166, 271, 283, 283 Collodion, in ilioinguinal lymphadenectomy, 164

Colocolostomy, bowel stapling technique in, 66, 66 Colon. See also Bowel; Cecum; Ileum. ascending, in cecocystoplasty, 742-743,

743

bladder substitution with, 778-780 left, 779-780, 779-780 postoperative care for, 780 right, 778, 778-779 Valtrec ring for anastomosis of, 780 blood supply to, 623, 664, 666, 680, 680, 767 in cecocystoplasty, 751 in ileocolic end-to-side anastomosis, 66, 66 sigmoid. See Sigmoid colon. Colon conduit, function of, 624 Colonic enema, appendicocccostomy for (ACE procedure), 713 Colostomy, for noncontinent fecal diversion, 670-671, 670-672 Colposuspension, 549-555, 549-556 advantages of, over cystourethropexy, 549 anatomy relevant to, 551 enterocele repair in, 555, 555 laparoscopic, extraperitoneal, 556 transperitoneal, 556 postoperative problems with, 555 Computed tomography, for staging of testis cancer, 385 retroperitoneal fibrosis and, 829 Conduit(s), colon, function of, 624 ileal. See Ileal conduit. ileal hydraulic valve, 716 for continent reservoirs, 7/5, 715-716 ileocecal, 702-703, 702-703 sigmoid, 664-665, 664-666 urinary, 624 Constipation, total perineal prostatectomy and, 464 Contamination, prevention of, 5 Contracture, release of, by skin flaps, 49, 49 Cooper's ligament, in colposuspension, 549, 551, 553 in hernia repair, 338-341, 339-340 in inguinal hernia repair, 342, 342, 345-346 Cordonnier method, of ureteral anastomosis in ileal conduit, 658-659, 658-659 Corona, formation of, 223 Coronal fistula(s), 110, 110 Corpora cavernosa, 166, 166 in correction of persistent chordee, 133 in distal shunt for priapism, 207 in penile prosthesis insertion, 186-188, 193 in proximal shunt for priapism, 208, 208210, 209-210 Corpus spongiosum, in proximal shunt for priapism, 208 Corticosteroids, ureterolysis and, 829 Cortisone acetate, adrenalectomy and, 1058 Cremaster muscles, in hernia repair, 341 in orchiopexy, 309-310, 309-311 Cremasteric vein(s), anatomy of, 352, 352 Cryoprecipitate, in simple pyelolithotomy, 1042-1043, 1042-1043 Cryptorchidism, orchiopexy for, 308 Culp-DeWeerd pelvic flap pyeloplasty, 920, 920 Cushing's disease, and Cushing's syndrome, preoperative preparations for adrenalectomy with, 1058 Cutter clamp, for placement of artificial sphincter in women, 586 Cyst(s), ejaculatory duct, 228 epidermoid, testis-sparing excision of, 384 genital duct, 228 inclusion, with circumcision, 171 mullerian duct, excision of, .228, 228 renal, excision of, 1056. laparoscopic unroofing of, 993, 996 urachal, excision of, 6l6 utricular, diagnostic studies of, 228 excision of, 228, 228

1153

Cyst(s) (Continued) symptoms with, 228 Cystectomy, partial, 501-503, 501-504 chemotherapy with, 504 closure of bladder in, 503, 503, 504 dissection in, 502-503, 502-503 extraperitoneal approach to, 504 indications for, 501, 504 position for, 501, 501 postoperative problems with, 504 transperitoneal approach to, 501-503, 501-503 radical, 505-512 bowel preparation with, 505 commentary on, 512 en bloc excision with pubectomy in, 510 in females, 510 in males, 505-509, 505-510 division of lateral pedicle in, 507, 507 division of posterior pedicle in, 508, 508 incision for, 505-506, 505-506 position for, 505, 505 triangulation technique in, 506, 506 urethral division in, 509, 509 urethrectomy in, 510 instruments needed for, 505 intraoperative problems in, 510 perineal cystoprostatcctomy for salvage and,510-511 postoperative care in, 510 postoperative problems with, 511-512 preoperative preparation for, 505 sutures used with, 505 Cystocath, in hypospadias repair, 146 Cystocele, vaginal needle suspension for, indications for, 564 Cystography, retrograde, total retropubic prostatectomy and, 443 ureterovaginal fistula repair and, 833 Cystolithotomy, 542 indications for, 542 Cystometries, in bladder autoaugmentation, 766 Cystoprostatectomy, perineal, for salvage, in radical cystectomy, 510-511 Cystoscopy, instruments needed for, 1084 ureteroneocystostomy and, 786, 794 Cystostomy, function of, 624 in patients with prior pelvic surgery, 629 indications for, 629 percutaneous placement of suprapubic tube in, 629 postoperative problems with, 629 suprapubic, alternative method of inserting tube into empty bladder, 627 antegrade approach to, 625-627, 625627 retrograde approach to, 628, 628 vesical lithotomy and, 628 trocar, 628 types of, 625 vaginal, 628-629, 629 Cystourethrography, for evaluation of injuries of prostatomembranous urethra, 292 Cystourethropexy, 545-548, 545-548 alternative procedures for, 545 diagnostic procedures for, 545 incision for, 545 instruments used for, 545, position for, 545, 545 postoperative problems with, 548 revision of, for inability to void:, 548

D Dartos fascia, 148, 148, 166, 166, 312, 313 release of, for correction Of penile curvature, 174 Dartos flap, for bulbar urethral stricture repair, 290

1154

INDEX

Dartos flap (Continued') for urethrocutaneous fistula repair, 112 Dartos pouch, for testicular fixation, 348 for testis, in orchiopexy, 327, 327, 336 subdartos, for testis after hydrocele repair, 349 Datta shunt, for priapism, 207 Davis procedure, of intubated ureterotomy, 920, 921 Denis-Browne retractor, 228 in megaureter correction, 808 Dental procedures, antibiotic coverage with, artificial sphincter placement and, 585 Depilation, of scrotal skin, for urethral stricture flap repair, 282 Dermatitis, ileal conduit and, 662 vesicostomy and, 641 Dermatomes, graft harvesting and, 59 Detrusor. See also Madder, sphincter of. compliance of, artificial sphincter placement and, 586 instability of, pubovaginal sling procedure and, 569 vaginal needle suspension and, 564 neurologic stimulation of, sacral laminectomy and pacemaker placement for, 617-622 Devine technique, of urethral stricture repair. 267, 267, 270 Devine-Horton tube graft, for hypospadias repair, 142-144, 142-144 Dexamethasone suppression lest, 1058 Dexon sutures, uses of, 34 Dialysis, chronic peritoneal, catheter insertion for, 970-972, 970-973 postoperative problems with, 972 temporary, vascular access for, 968-969, 968-970 Diarrhea, cecocystoplasty and, 752 postoperative, 18 radical cystectomy and, 511-512 Digitalization, preoperative risk evaluation and, 3 Dilator(s), Amplatz, 28 fascial, 629 Kollman, noncontincnl urinary diversion and, 624 Diverticulectomy, caliceal, 1055-1056, 1055-1056 Diverticulum, urachal, excision of, 616 urethral (female), correction of, 246-250. 246-250 marsupialization technique for, 246247, 246-247 stress urinary incontinence and, 250 transurethral unroofing for, 246 transvaginal excision of, 248-249, 248-250, 250 preoperative preparation for, 246 urethral (male), excision of, 226-227, 226227 onlay island flap technique and, 133 vesical, diagnostic techniques for, 535 excision of, 535-540, 535-541 alternatives to, 535 extravesical, 539-541, 539-541 extravesical excision of diverticular lining, 535-537, 535-537 indications for, 541 intravesical inversion technique of, 538-539, 538-539 laparoscopic, 541 postoperative problems with, 541 Doppler imaging, for assessing arterial flow, 62,194,197 for penile venous drainage, 198 for testis torsion, 347 in varicocele ligation, 353-354, 360 Dorsal slit, for correction of phimosis, 171, 172, 172 Doyen rib stripper, 876, 876 Drain(s). See also Catheter(s); Stent(s).

Drain(s) (Continued) cystostomy and, 629 hypospadias repair and, 102, 105, 105, 113 Jackson-Pratt, 105, 159 Penrose, 155 suturing and removal of, 12, 12 suction, for prevention of lymphoceles, 159 in hypospadias repair, 105 in ilioinguinal lymphadenectomy, 164 in inferior rectus abdominis flap, 57 total retropubic prostatectomy and, 445 types of, 12 ureterolithotomy and, 850 urethral reconstruction and, 263 uses of, 12 Draping, preoperative, 5 Dressings, adherence of, 57 basic techniques of, 15, 15 for flaps and grafts, 57 for hypospadias repair, 102, 106, 113 Duckett pouch (Penn pouch), 699, 699 Duckett procedure, for megameatus repair with hypospadias, 120 of onlay preputial island flap, for hypospadias repair, 130-133 of transverse island flap, for penile urethral strictures. 275 Durham Smith procedure, for urethrocutaneous fistula repair, 109. 109 of de-epithelialized skin, in ventral tube repair of hypospadias, 141 Dysuria, with ureteral stents, 70

E Ebbehoj shunt, for priapism, 207 Edema, hypospadias repair and. 107 of legs, pelvic lymphadenectomy and. 524 Ejaculation, retroperitoneal lymph nodedissection and. 385, 403 Ejaculatory duct cysts, 228 Elastic stockings, ilioinguinal lymphadenectomy and, 158, 159. 164 Elder procedure, for nephrectomy in children. 991 Electrocautery, in laparoscopy, injury from. 30 Electrolyte imbalance. See also Acidosis; Alkalosis. continent reservoirs and. 684 intraoperative, 8 preoperative risk evaluation and. 3 Electrosurgical unit, technique of use of, 10. 10-11 El-Ghorab shunt, for priapism, 207 Embolization, ethanol, in renal carcinoma, 1016 gas, in laparoscopy, 30 in vena caval thrombectomy, 1040 Emphysema, preperitoneal, in laparoscopy. 29 End. ureterostomy, 930 Endarterectomy, aortorenal, for renal artery reconstruction, 948-950, 948-950 with patch graft angioplasty, 950-951, 950951 Endo-Avitene, 28 Endocrine therapy, trial of, 308 Endopyelotomy, in pyeloureteroplasty, 922, 923 Endoscopy, for transanal repair of rectourethral fistula, 480 for ureterocele management, 815 EndoStitch device, 663 in laparoscopy, 27 Enterocele, colposuspension and, prevention of, 555 repair of, 555, 555 Enterostomal therapist, 647 Enuresis, 768 Epidermoid cyst, excision of, 384 Epididymis, excision of, 409, 409-410 in vasoepididymostomy, 369-372, 369-372

Epididymis (Continued) inadvertent biopsy of, 307 obstruction of, with spermatocelectomy, 408 orchiectomy sparing, 377, 377, 378 tail of, blood supply and, 304 Epididymitis, rectourethral fistula repair and, 480 Epigastric artery(ies). See Artery(ies), epigastric. Epigastric vein(s). See Vein(s), epigastric. Epilation, for urethral reconstruction, 262 preoperative, 5 Epinephrine, for local anesthesia, 8 Epineurium, in microsurgical nerve repair, 63 Erection(s), after total penectomy, 156 artificial, in dissection of chordee, 100 in hypospadias repair. 98 in Peyronie's disease, 205-206 penile artery revascularization and, 197 spontaneous, in correction of chordee, 100 in urethral reconstruction, 263 tunica albuginea in, 166 Exstrophy, cloacal, gastric bladder substitution and, 782 gastrocystoplasty and, 757 Extracorporeal renal surgery, 1027-1029, 1027-1030 advantages of, 1027 ice slush for kidney in, 1028 incisions used in. 1027 preoperative studies for, 1027 renal carcinoma and, 1016 uses of, 1027 vs. partial nephrectomy, 1000 workbench needed for, 1027

F Facial vein(s), 92. 92 Fallopian tube, as substitute for appendix, in Mitrofanoff procedure, 712 Fascia(s), Camper's, 148. 148 dartos. 148, 148. 166, 166. See also Flap(s). dartos; Pouch(es), dartos. in inguinal orchiopexy, 312-313, 312313 Denonvilliers', in prostatectomy, 436-437, 437. 439 perineal, 447, 447 total perineal, 456-457, 457 external oblique, in orchiopexy, 308-309, 308-309, 317 in radical orchiectomy, 380, 380 Gerota's, hematoma in, 934, 934 lateral spermatic, in inguinal orchiopexy, 312,312 layers of, 283, 283, 304 of penis, 148, 148, 166, 166 rectal, in perineal prostatectomy, 447, 447 retroperitoneal, colonic-peritoneal fusionfascia, 854, 854 Gerota's, 854, 854-855 in transverse oblique view, 854, 854-855 lateroconal, 854, 854 renal, 854, 854 laminae of, 854, 854 transversalis, 854, 854-855 Scarpa's, 148, 148 spermatic, in varicocele ligation, 355, 355 suture techniques in, 36-37, 36-37 suture types used in, 33, 34 transversalis, in anterior subcostal incision, 857, 857 in hernia repair, 338, 338, 341 in inguinal orchiopexy, 312, 312, 314, 314, 317 retroperitoneal, 854, 854-855 Fat, in flap preparation, 43 Fat pad, in urethrovaginal fistula repair, 243-245, 243-245

INDEX Fecal diversion, noncontinent, colostomy for, 670-671, 670-672, 671, 671 vs. loop ileostomy, 672 loop Ileostomy for, 669, 669 Fecal fistula(s). See Fistula(s), fecal Femoral artery, common, in inferior rectus abdominis flap, 54 median circumflex, in musculocutaneous flaps, 50, 50 supplying gracilis muscle, 50, 50 Femoral neuropathy, radical cystectomy and, 511 Femoral triangle, 149 Fentanyl, for postoperative pain, 18 Fertility, persistent, vasoligation and, 364 Fibrin glue, in repair of renal injuries, 936 Fibrosis, cavernous, insertion of penile prosthesis and, 186 retroperitoneal, diagnostic procedures for, 826 idiopathic, 829 limited (aortoiliac involvement), 826-827, 826-827 monitoring of, 829 ureterolysis for, 827-829, 827-829 Fibrous dysplasia, renal artery reconstruction and, 937 Fish-mouth method, of ureteroneocystostomy, 794 Fistula(s), arteriovenous, with renal injuries, 936 calicocutaneous, renal transplantation and, 965 coronal, 110, 110 fecal, perineal prostatectomy and, 450 radical cystectomy and, 511 total retropubic prostatectomy and, 445 hypospadias repair and, 107 ileourethral, for ileal bladder substitution, 775 intestinal, ileal conduit and, 661 onlay island flap technique and, 133 pelvic exenteration and, 534 penile construction and, 223 perineal, repair of. 111, 111 rectourethral, closure of, perineal approach to, 476-477, 476-477 postoperative problems with, 480 transanal endoscopic repair of, 480 transanorectal repair of, 479-480, 479480 transrectal transsphincteric repair of, 478, 478 scrotal, repair of, 111, 111 suprapubic, in retropubic prostatectomy, 430 ureterocutaneous, renal transplantation and, 965 ureterovaginal, diagnostic procedures for, 832 repair of, 832-833, 832-833 ureteral mobilization in, 832, 832 urethral reconstruction and, 263 urethrocutaneous, circumcision and, 171 diverticula excision and, 227 hypospadias repair and, 107-109, 107109, 113 prevention of, 146 repair of, advancement flap closure for, 108, 108 complex procedures for, 112 de-epithelialized flap closure of, 109, 109 simple procedures for, 107-109, 107109 urethrorectal, total perineal prostatectomy and, 464 urethrovaginal, repair of, 242-245, 242-245 urinary, with Mitrofanoff procedure, 713 valve, in ileal hydraulic valve conduit, 716 vesicocutaneous, renal transplantation and, 965

Fistula(s) (Continued) vesicosigmoid, causes of, 608 closure of, 601-608, 601-608 diagnostic procedures for, 601, 608 repair of, colorectal anastomosis for, 606608, 606-608 incision for, 601, 601 large inflammatory masses and, 604606, 604-606 minimal inflammatory reaction and, 602-603, 602-603 postoperative problems with, 608 vesicourethral, appendicovesicostomy and, 714 vesicovaginal, localization of, 600 repair of, 587-600 abdominal placement of gracilis flap in, 599 approach to, 587 inverted U-incision flap, 589, 589 transperitoneal transvesical, 597598, 597-599 transvaginal, 587-589, 588 transvesical, 595-595, 595-596 colpocleisis for (Latzko procedure), 589 colposuspension and, 555 commentary on, 600 diagnostic procedures for, 587 during vaginal hysterectomy (Hernandez), 600 flap insertion in, bulbospongiosus flap, 590 gracilis myocutaneous flap, 590-592 abdominal placement of, 599 island flap, 590 labial fat pad flap, 590 rectus abdominis flap, 599 seromuscular flap, 592 incision for, Schuchardt perineal, 593594, 593-594 localization of, 600 of complex fistulas, 600 position for, 593, 593 postoperative problems with, 600 timing of, 587 uncorrectable, continent vesicostomy bladder tubularization for, 640, 640, 641 Flap(s), axial peninsula, 59 blood supply of, flap failure and, 58 Boari. See Boari flap. bulbospongiosus, 590, 590 Byers, 104, 125, 125, 141 dartos, 112, 290 definition of, 43 donor sites for, 59 double-faced transverse island, 137-139, 137-139 failure of, 58 fasciocutaneous, 59 for bulbar urethral stricture repair, preputial island, 288-290, 288-290 roof strip, 290 scrotal skin island, 290 for hypospadias repair, Byers, 104 double-faced transverse island, 137-139, 137-139 longitudinal island, 136 onlay, 97 onlay preputial island, 130-133, 130-133 partial island and free tube graft, 142-146 perimeatal, 112 perimeatal-based (Mathieu), 97, 124-125, 124-125 tubed preputial island, 134-136, 134-136 tubularized island, 97 tunica vaginalis, 97 for penile construction, radial forearm, 220222, 220-222 redesign of, 223-224 for urethrocutaneous fistula repair, scrotal dartos, 112

1155

Flap(s) (Continued) for urethrovaginal fistula repair, Martius, 243-245, 243-245 for vaginal reconstruction, 235, 237, 237, 238, 241 pudendal thigh, 234-235, 234-235, 241 for vesicovaginal fistula repair, 590-592, 590-592 bulbospongiosus, 590, 590 gracilis myocutaneous, 590-592, 591592 island (Lehoczky), 590 labial fat pad, 590 rectus, 599 seromuscular, 592 labia minora, 235 labial fat pad, 590 Langer's lines and, 44, 44 Lehoczky, for vesicovaginal fistula repair, 590 local anesthesia with, 43 longitudinal island, 136 Orandi's technique of, 275-278, 275-278 McAninch, 268, 268, 270, 289-290, 289291 microvascular free transfer, 59 musculocutaneous, 50-57, 59 gluteal thigh, 57 gluteus maximus, 57 gracilis, 50-53, 50-53, 515 applications of, 59 for vaginal reconstruction, 237, 23 7, 241 for vesicovaginal fistula repair, 590592, 591-592 for vesicovaginal reconstruction or perineal coverage, 52 incisions for, 51, 51 orientation of, 59 patient position for, 51 possible errors in, 52 technique of, 52-53, 52-53 uses of, 50 posterior thigh, 57 rectus abdominis, inferior, 54-57, 54-57 applications of, 59 blood supply to, 54 tensor fasciae latae, 57 uses of, 50, 50 V-Y thigh, 57 , omental, 71. Sec also Omentum, mobilization of. in pyelolithotomy, 1047 preparation of, 43 preputial island, 146 rhomboid, 46, 46 skin, advancement of, 47-48, 47-48 Burow triangle excision and, 47, 47 contracture release with, 49, 49 Borges' technique of, 49 dog ears in, 47-49, 47-49 in ilioinguinal lymphadenectomy, 159, 159 ischemia of, 107 island, 48, 48 peninsula, 47, 47 axial, 48,48 rhomboid (Limberg's technique), 46, 46 rotation and transposition of, 47, 47 V-Y advancement, 46, 46 Y-V advancement, 46, -46 Z-plasty, four-flap (Berger's technique), 45, 45 Horner's technique, 44, 44 terminology of, 43, 59 thigh, for scrotal coverage, 218, 219 transfer of, problems following, 58 trunk, preparation of, 43 tunica vaginalis, 97 types of, 43 uses of, 43 vascularized, 282

1156

INDEX

Flocks closure method, for total perineal prostatectomy, 461, 461 Florida pouch, for ileocecal reservoir, 700, 700 in colonic bladder substitution, 779 Fluid(s), imbalances of, blood loss and, 11 intraoperative, 8 postoperative requirements for, 17 Foley muscle-splitting incision, 885-886, 885-886 Foley Y-plasty, for horseshoe kidney correction, 926, 926 Foley YV-plasty, in pyeloureteroplasty, 919, 919 Forceps, types of, 10 Forearm, veins in, for radial forearm flap for penile construction, 220-221, 220-221 Forearm vein(s), for radial forearm flap for penile construction, 220-221, 220-221 Formalin, in bladder, 512 Fossa navicularis, strictures of, 266-270, 266-270 Fournier's gangrene, 210 Fowler-Stephens orchiopexy, 318-320, 318-520 laparoscopic vessel ligation in, 333 nonpalpable testis search and, 330 second stage of, 333-337, 334-337 Fracture(s), pelvic, bulbomembranous urethral stricture with, 292 penile, repair of, 213, 213 Frenuloplasty, 172 Frenulum, blood supply to, 98

G GAP procedure, for hypospadias repair, 121, 121, 123 Gas embolization, in laparoscopy, 30 Gastrocystoplasty, 757-762 appendicovesicostomy with gastric bladder augmentation in, 762 incision for, 757, 757 Indications for, 757 left pedicle in. 760-762, 760-762 postoperative problems with, 762 right pedicle in. 758-759, 758-759 Gastroepiploic artery(ies), 758, 758, 762 gastric continent reservoir and, 707 in omental mobilization, 71-72, 71-72 Gastroileal pouch, for urinary continence, 704 Gastrostomy, 673-674, 673-674 ' postoperative problems with, 674 preoperative, 5 Gauer balloon procedure, for direct extraperitoneal access, in laparoscopy, 29, 31 Gauer technique, of laparoscopic renal biopsy, 932 Gecelter procedure, for rectourethral fistula closure, 479-480, 479-480 Genital area, female, anatomy of, 229 reconstruction of, 229-260 male, superficial anatomy of, 283, 283 Genital duct cysts, 228 Genital Injuries, repair of, 211-219 Gerota's fascia, hematoma in, in renal injury repair, 934, 934 Ghoneim technique, for ileal bladder substitution, 775, 775 Gibson incision, 485, 494-496, 495-496 for renal transplantation, 956 Gil-Vernet plane, in heminephrectomy, 1007 Gil-Vernet technique, in extended pyelolithotomy, 1043-1046, 1043-1046 in ureteroneocystostomy, 794 PET laparoscopic adaptation of, 801 Gittes-McLaughlin technique, of artificial erection for hypospadias repair, 98 Glans, anesthesia of, after correction for Peyronie's disease, 205

Glans (Continued) blood supply to, 98 hypospadias repair and, 113 in circumcision, 171 in distal shunt for priapism, 207 in penile artery revascularization procedures, 197 MAGPI procedure and, 123 Mohs chemosurgery for, 153 penile prostheses and, 186, 192 Glans approximation procedure (GAP), for hypospadias repair, 121, 121, 123 Glanular reconstruction and preputioplasty (GRAP) procedure, for hypospadias repair, 122, 122 Glenn-Anderson technique, in ureteroneocystostomy, 786, 792, 792 Gloves, protection from HIV and, 9 Glucocorticoids, excess, adrenal tumors and, 1058, 1071 Gluteal artery, 819 Goldwasser procedure, for colonic bladder substitution, 778, 778-779 Gonadal biopsy, for intersex conditions, 307, 337 Gonadal dysgenesis, gonadal biopsy for, 307 Gonadal vein(s). See Vein(s), gonadal. Goodwin technique, of ileocystoplasty, 729-731, 729-731 of ureterocolonic anastomosis, 720-723 Gore-Tex, 57, 81 Goulding shunt, for priapism, 207 Gowns, protection from HIV and, 9 Gracilis muscle. See Muscle(s), gracilis. Graft(s), bladder urothelial, 103, 103 buccal mucosal, 100-102, 101-102, 112 advantages of, 100 formation of urethral tube with, 102, 102 harvesting of, 101, 101 donor sites of, dressings for, 57 fixation of, 57 for bulbar urethral stricture repair, 282, 286-288, 286-288, 290-291, 290-291 for chordee repair, 100, 113 for hypospadias repair, 97, 100-103, 100103, 112, 142-146, 142-146 for renal artery reconstruction, 935, 944948, 944-948 for vaginal reconstruction, 231-233, 231233, 238, 241 free tube, and partial island flap, 142-146, 142-146 hepatorenal bypass, 948 meshed, 218, 218, 219, 271, 290-291, 291 penile, for injury repair, 217, 217, 218, 218, 219 for Peyronie's disease, 201-203, 201-204 dermal graft for, 203, 203, 204, 206 incision and vein graft for, 203, 203 synthetic graft for, 204 for stricture repair, 271, 275, 275 skin, 41-42, 41-42 for vaginal reconstruction, 231-233, 231233, 238, 241 full-thickness, 41-42, 42, 282, 287 properties of, 59 loss of, 58 meshed, 42, 42, 217-219, 218 problems with, 58, 238 requirements for success of, 42, 59 split-thickness, 41, 42 application of, 42, 42 for hypospadias repair, 97 for penile injury, 211-212, 211-212, 217-218, 217-219 ilioinguinal lymphadenectomy and, 164 properties of, 59 thick, 41, 42 thickness of, 41, 41-42 ventral, for chordee repair without hypospadias, 100 terminology of, 59

Graft(s) (Continued) tubed, 112, 288, 288 tunica vaginalis, for chordee repair, 113 vascular, for renal artery thrombosis repair, 935 Granuloma, sperm, 364, 369, 372 GRAP procedure, for hypospadias repair, 122, 122 Grayhack shunt, for priapism, 209-210, 209-210 GU cart, contents of, 4, 1081 Gum mastic, 57 Gunshot injuries, 936 Guy Leadbetter procedure (trigonal tubularization), for urinary stress incontinence, 570-571, 570-572

H Haemophilus influenzae, immunization against, 907 Hair, contamination from, prevention of, 5 epilation of, 5 in urethral reconstruction, 262-263 in urethral stricture flap repair, 282 full-thickness grafts and, 42 residual, hypospadias repair and, 107, 112 Hashmat-Waterhouse shunt, for priapism, 207 Hasson cannula, 25, 25 Hasson port insertion, in extraperitoneal laparoscopic surgery, 994 Hasson technique, laparoscopic, 25-26, 25-26 diagnostic, 332 in children, 29 in nephrectomy, 993 in pelvic node dissection, 474 Hautmann technique, in W-shaped ileal neobladder construction, 772, 772 Heineke-Mikulicz incision, for plication of penile curvature, 205 Hematoma(s), adrenalectomy and, 1080 epididymectomy and, 410 hydrocele repair and, 351 laparoscopic nephrectomy and, 995 orchiectomy and, 375, 378, 384 pelvic, total retropubic prostatectomy and. 445 Peyronie's disease correction and, 205 rectus sheath, in laparoscopy, 30 renal injury repair and, 934, 934 retroperitoneal, open renal biopsy and, 931 skin graft loss and, 58 urethral reconstruction and, 263 urethrovaginal fistula repair and, 245 vasoepididymostomy and, 372 vasoligation and, 364 vasovasostomy and, 369 Hematuria, dysuria and, gastric reservoir and, 706, 707 nephrostomy and ureterostomy and, 930 open renal biopsy and, 931 Hematuria-dysuria syndrome, gastrocystoplasty and, 762 Hemiacidrin, in extended pyelolithotomy, 1046 Hemi-Kock pouch, for ileal bladder substitution, 773, 773 for ileocystoplasty, 732, 732-733 ureterosigmoidostomy and, 724, 726 Heminephrectomy, 1001-1002, 1001-1003, 1005-1007, 1005-1007 for duplicated upper pole, 812, 812 indications for, 813-814 in ureterocele repair, 815, 817 Hemopneumothorax, repair of, 902, 902 Hemorrhage. See also Bleeding; Hemostasis. in adrenalectomy, 1080 in laparoscopic pelvic node lymphadenectomy, 473 in nephrolithotomy, 1053

INDEX Hemorrhage (Continued) In orchiectomy, 378, 384 in radical orchiectomy, 384 in renal artery reconstruction, 954 in total perineal prostatectomy, 464 in total retropubic prostatectomy, 445 massive, in vena caval thrombectomy, 1040 Hemostasis. See also Bleeding; Hemorrhage. in hypospadias repair, 99 in ileal bladder substitution, 771 in laparoscopic partial nephrectomy, 996 in laparoscopy, 28 in prostatectomy, 419-421, 420-421, 430, 434 technique of, 11 Hendren-King technique, of sphincter plication, in ileocecocystoplasty, 755-756, 755-756 Heparin. See also Anticoagulation. ilioinguinal lymphadenectomy and, 164 pelvic lymphadenectomy and, 521 penile reimplantation and, 215 Heparinized saline, in microsurgical techniques, 62 Hepatic artery, in hepatorenal bypass graft, 948 Hepatic vein(s), injury to, adrenalectomy and, 1080 Hepatitis B virus, protection of surgical team from, 9 Hepatorenal bypass graft, for renal artery reconstruction, 948 Hermaphrodite, gonadal biopsy in, 307 Hernandez approach, to vesicovaginal fistula repair, 600 Hernia, in laparoscopic nephrectomy, 995 in noncontinent urinary diversion, 624 in orchiopexy, 310, 310, 335, 337 in urethrectomy, 515 incisional, repair of, 908-909, 908-910 darning method of, 909, 910 imbricated, 908-909, 908-910 inversion method of, 909 postoperative problems with, 909 with synthetic materials, 909, 910 with subcostal incision, 874 inguinal indirect, anatomy relevant to, 342, 342 repair of, 338-341, 338-341 laparoscopic, 345-346, 345-346 open, 342-344, 342-345 repair of, nerve blocks for, 76-77, 76-77 Hickman catheter, 92, 94 HIV (human immunodeficiency virus), protection of surgical team from, 9 Hodges closure method, for total perineal prostatectomy, 462, 462 Hodgson III-Asopa-Duckett procedure, for tubed preputial island flap, 134-136 Hodgson technique, for ureteral incisionexcision tailoring, in ureteroneocystostomy, 806, 806 Hodgson XX-Asopa procedure, for doublefaced transverse island flap, 137-139 Hodgson-Firlit-Zaontz procedure, in ureteroneocystostomy, 799, 799 Hodgson-Zaontz modification, of Lich-Gregoir technique, for extravesical ureteral implantation, 806 Homer's technique, of Z-plasty, 44, 44 Hosiery, compression, venous patch grafts and,83 Human chorionic gonadotropin, radical orchiectomy and, 380 trial of, 308 Human immunodeficiency virus (HIV), protection of surgical team from, 9 Hyaluronidase, with skin flaps, 43 Hydrocele, correction of, 349-351, 349-351 plication technique for (Lord's), 349-351, 349-351 in vasoepididymostomy, 372

Hydrocele (Continued) orchiopexy and, 315 varicocele ligation and, 358 Hydronephrosis, calicoureterostomy and, 840, 841 repair of, 912 Hyperaldosteronism, primary, preoperative preparations for adrenalectomy with, 1058 Hypercarbia, in laparoscopy, in children, 29 Hyperkalemia, preoperative risk evaluation and, 3 Hypertension, preoperative management of, 4 renal artery reconstruction and, 955 renal injury and, 936 Hypertensive crisis, in adrenalectomy, 1058 Hyperthermia, malignant, during anesthesia, 8, 8t Hypogastric artery, 500, 500 in extracorporeal renal surgery, 1029, 1029 Hypoglycemia, adrenalectomy for pheochromocytoma and, 1074 intraoperative, 8 Hypokalemia, preoperative management- of, 4 Hyponatremia, hypotonic, postoperative, 17 Hypospadias repair. See also Meatoplasty and glanuloplasty (MAGPI) procedure. age for, 113 age of patient for, 96 anesthesia for, 96 circumcision and, 171 complications of, early, 107 late, 107-112 coronal fistula, 110, 110 persistent chordee, 112, 113 psychosocial maladjustment, 112 reoperation for, 112 repair of late defects with, 112 scrotal and perineal fistulas, 111, 111 scrotal dartos flap for, 112 strictures, 107 urethral diverticulum excision, 112 urethrocutaneous fistulas, 107-109, 107-109, 113 objectives of, 96 outpatient surgery for, 96 performance of, by residents, 106 postoperative care for, 106 preoperative preparations for, 97-98 preparation for, 96 procedures used for, for distal lesions, 123 free tube graft and partial island flap, 142-146, 142-146 onlay preputial island flap, 130-133, 130-133 perimeatal-based flap (Mathieu), 124-125, 124-125 perimeatal-based tube repair (Mustarde), 126-129, 126-129 preferred, 113 tubed preputial island flap, 134-136, 134-136 ventral tube (Thiersch-Duplay), 140-141, 140-141 prophylactic antibiotics for, 96 secondary operations for, 97 selection of operative technique for, 96t, 96-97, 97t subcoronal, pyramid MAGPI (Duckett) procedure for, 120 surgical technique in, 98-99 bladder urethelial graft in, 103, 103 buccal mucosal grafts in, 100-102, 101102 catheter use in, 113 chordee correction in, 99, 99-100, 113 diversion of urine, 105, 105 drains with, 113 dressings for, 106, 113 hemostasis in, 99 skin coverage after urethral repair in, 104 spontaneous erections in, 100

1157

Hypospadias repair (Continued) tests of prior to skin closure, 104, 104 traction on glans with, 113 suture technique in, 99-100 urethral stricture repair in, 270 Hypotension, in adrenalectomy, 1064, 1074, 1080 management of, 1058-1059 in laparoscopy, 30 total perineal prostatectomy and, 464 Hypothermia, in extended pyelolithotomy, 1045 renal, 1048 in extracorporeal renal surgery, 10271028, 1039 with circulatory arrest, in vena caval thrombectomy, 1039-1040 Hysterectomy, 254-260 abdominal, reperitonealization in, 257-260, 257-260 vaginal, 254-257, 254-257 division of ligaments in, 255, 255, 256, 256 entry into cul-de-sac, 255, 255 incision for, 254, 254 incision of peritoneum in vesicouterine pouch, 254, 254 incision of rectouterine pouch, 255, 255 ligation of uterine pedicle, 256, 256 reperitonealization in, 257, 257 vesicovaginal fistulas and, 600

I Ileal artery, 679, 679, 681, 681 Ileal conduit, 647-663 alternatives to, 647 commentary on, 662 conjoined ureter techniques in, 661, 661 disadvantages of, 647 high, 624 hydraulic valve in, for continent reservoir, 7/5, 715-716 ileoileal anastomosis in, stapled, 650, 653654, 653-654 sutured, 650-654, 650-654 single-layer closed, 650-651, 650-651 single-layer open, 651, 651 two-layer, 652, 652 testing of, 662 laparoscopic, 673 loop preparation in, 649-650, 649-650. postoperative problems with, 661-662 stoma formation in, 654-655, 654-655 , nipple variations in, loop (Turnbull), 657, 657 Z-incision, 656, 656 umbilical, 655 stoma revision in, 662 stoma site selection for, 647, 647 , trimming and closure of proximal loop end, 660, 660 ureteral anastomosis in, 658-659, 658-659 direct right (Cordonnier), 658-659, 658659 split-cuff nipple (Sagalowsky), 659 stent insertion in, 659 ureteral mobilization in, 648, 648 with cross-folded bladder substitute, 774, 774 Ileocecal area, blood supply to, 679, 679, 742 Ileocecal reservoir, 693-703, 693-704. See also Reservoir(s), continent, ileocecal Ileocecal valve, in cecocystoplasty, 752 in ileocecocystoplasty sphincter plication technique, 754-755 preparation of, 704 tests of competence of, 753 Ileocecocystoplasty, 753-756 advantages of, 756 dissection for, 753-754, 753-754

1158

INDEX

Ileocecocystoplasty (Continued) incision for, 753, 753 postoperative problems with, 754, 756 sphincter plication in, ileocecal plication technique in, 754-755, 754-755 internal fixation technique in (HendrenKing), 755-756, 755-756 Ilcocecum, for bladder substitution, female, 777 male, 776, 776-777 postoperative problems with, 777 Ileocolic artery, 679, 679, 680, 680 Ileocystoplasty, 729-734, 729-734 bladder preparation in, 734 cup patch method of (Goodwin), 729-731, 729-73 postoperative care for, 731 hemi-Kock procedure for, 732, 732-733 ileal conduit conversion for bladder augmentation in, 733-734, 733-734 indications for, 734 patient's motivation and, 734 postoperative care with, 734 preoperative planning for, 729 self-catheterization and, 729 types of, 734 Ileostomy, loop, for noncontinent fecal diversion, 669, 669 Ileourethral fistula(s), for ileal bladder substitution, 775 Ileum, blood supply to, 623, 677, 678, 679, 679 for bladder substitution, 769-775, 769-775 cross-folded bladder with proximal ileal conduit, 774, 774 detubularized U-shaped bladder (Camey), 769-771, 769-77/ hemi-Kock pouch for, 773, 773 postoperative problems with, 775 reanxstomosis of, of pouch to urethra, 775 S-pouch, 774, 774 W-shaped, stapled, 773, 773 sutured, 772, 772 with extramural tunnel implantation, 775, 775 for ureteral replacement, 842-845, 842-846 for vaginal reconstruction, 240 in calicoureterostomy, 841 in cecocystoplasty, 742, 742, 751 in ileal conduit formation, 649, 649 in ileocolic end-to-side anastomosis, 66, 66 in ileocolic side-to-side anastomosis, 67, 67 Ileus, ileal conduit and, 661 in sigmoidocystoplasty, 741 in ureteroneocystostomy, 794 laparoscopic pelvic node lymphadenectomy and, 469 nephrectomy and, 992 radical cystectomy and, 511 retroperitoneal lymph node dissection and, 403 vaginal reconstruction and, 240 Iliac artery(ies). See Artery(ies), iliac. Iliac vein(s). See Vein(s), iliac. Iliopubic tract, in inguinal hernia repair, 342, 342-343, 344-345-346 Imbibition, definition of, 41 Immobilization, skin graft loss and, 58 Immunization, after splenectomy, 906, 907 Impotence, Peyronie's disease correction and, 205 priapism and, 210 retropubic prostatectomy and, 430 total perineal prostatectomy and, 464 total retropubic prostatectomy and, 445 urethral reconstruction and, 263 urethral stricture repair and, 302 Incision(s), for adrenalectomy, choice of, 1059, 1065, 1080 for bladder surgery, 485 Gibson, 485, 494-496, 495-496

Incision(s) (Continued) midline lower abdominal extraperitoneal, 485, 487-489, 487-489 transpubic approach with, 489 midline transperitoneal, 485 paramedian, 485 Pfannenstiel, 490-493, 490-494 Cherney modification of, 493, 493 suprapubic V (Turner-Warwick), 497498, 497-499 transverse lower abdominal (Pfannenstiel), 490-493, 490-494 Turner-Warwick, 497-498, 497-499 for gracilis myocutaneous flap, 51,51 for hypospadias repair, 99 for nephrectomy, selection of, 986 for renal carcinoma surgery, 1016 Gibson, 485, 494-496, 495-496 Heineke-Mikulicz, 205 hernia and, repair of, 908-910, 908-909 horseshoe, 515, 515 Langer's lines and, 44, 44 Mercedes-Benz, 513, 513, 515 Pfannenstiel, 485, 490-493, 490-494 renal. 855, 855t anatomic basis of, 854-855 anterior extended pediatric, 855, 855t, 863-864, 863-864 hyperextension for, 863, 863-864 indications for, 863 position for, 863. 863-864 anterior subcostal, 855, 855t, 856-861, 856-862, 986 approach to adrenal gland in, 861, 861 closure of. 862 extraperitoneal approach in, 855, 855t, 856-858, 856-858 indications for, 862 transperitoneal approach in, 855, 855t, 859-860, 859-860 anterior transverse (chevron), 855, 855t, 865-866, 865-866 closure of, 866 indications for, 865 thoracoabdominal approach and, 865 anterolateral extraperitoneal approach for, 855, 855t dorsal (lap (Nagamatsu), 887-889, 887889 closure of, 889, 889 indications for, 889 dorsal lumbotomy, 855, 855t, 896-901, 896-901 bilateral posterior, 901, 901 extended, 900, 900 unilateral posterior, 896-899, 896-899 anatomy for, 897 indications for, 896 dorsal rib flap for, 855, 855t Foley muscle-splitting, 885-886, 885-886 indications for and contraindications to, 885, 886 lumbar approach for, 855, 855t midline (vertical), 855, 855t midline transperitoneal, 485, 867-868, 867-868 closure of, 868 postoperative problems with, 868 paramedian, 485, 869-870, 869-870 advantages of, 869 vs. midline incision, 869, 870 paramedian vertical transrectal, 868 subcostal, 855, 855t, 871-874, 871-874 bilateral, with cephalic T extension, 855, 855t closure of, 874, 874 extension of, 873 indications for, 871, 874 patient position for, 871, 871 supracostal, 855, 855t, 879-884, 879884, 986 anatomy for, 879-880, 879-880

Incision(s) (Continued) closure of, 883-884, 883-884 thoracoabdominal, 855, 855t, 890-895, 890-895 closure of, 895, 895 extension of, 890, 890, 892 extrathoracic 11th rib approach, 893894, 893-894 indications for, 890, 895 transthoracic approach to, 890-892, 890-892 vs. dorsal flap incision, 887 transcostal, 875-877, 875-878 closure of, 877, 877, 878 disadvantages of, 878 indications for, 875, 878 instruments needed for, 875. 875 Rutherford-Morrison, 489, 826 surgical technique of, 10, 10 Incontinence. See also Urine, leakage of. artificial sphincter and, 585-586, 752 bladder reconstruction for. See Madder, reconstruction of. continent reservoir revision and, 685 gastric bladder substitution and. 782 ileal bladder substitution and, 775 intrinsic sphincter deficiency and, 586 Kock pouch and, 692 partial cystectomy and. 504 prostatectomy and, 586 retropubic, 430 total perineal, 464 total retropubic, 445 radical cystectomy and, 512 repair of, neurologic treatment for, 617-622 procedures for, 544-545 pubovaginal sling procedure for, 565-569 vesical neck closure for. 613 stress urinary, 564 trigonal tubularization and. 572 urethral reconstruction and. 263 urethral stricture repair and, 299, 302 vaginal needle suspension and, 564 vesicovaginal fistula repair and. 600 Indiana pouch. 704 for ileocecal reservoir. 698. 698 in colonic bladder substitution. 779 Infant(s). See also Child(ren). circumcision in, 170, 170 cutaneous end ureterostomy in, 624 hypospadias in, repair of, 113 inguinal region in vs. adult anatomy, 308 newborn, pyeloureteroplasty in, 913 renal pelvic dilation in. evaluation of, 913 testicular torsion in, 348 orchiopexy in, 308-317 ureterocele repair in, cvstoscopic, 817 ventral meatotomy in, 114-115, 114-115 vesicostomy in, 636-637, 636-637, 641 Infection, artificial sphincter placement and, 585-586 circumcision and, 171 cystourethopexy and, 548 epididymectomy and, 410 hypospadias repair and, 102, 106, 107 ilioinguinal lymphadenectomy and, 164 incisional hernia and, 909 inflatable penile prosthesis and, 184, 192, 193 noncontinent urinary diversion and, 624 omental mobilization and. 74 partial penectomy and, 152 pelvic lymphadenectomy and, 521, 524 peritoneal dialysis and, 972 Peyronie's disease and, 205 postoperative, management of, 18 prevention of, 6, 6t dissection technique and, 10 electrosurgical unit and, 11 in surgical team, 9 wound closure and, 11 prostatectomy and, 421

INDEX Infection (Continued) total retropubic, 445 radical cystectomy and, 511 retroperitoneal lymph node dissection and, 403 skin graft loss and, 58 urethral reconstruction and, 263 urinary, Boari flap repair and, 826 cystostomy and, 629 with Kock pouch, 692 with ureteral stents, 70 vasoepididymostomy and, 372 vasoligation and, 364 wound, ileal bladder substitution and, 775 vesicosigmoid closure and, 608 Inflammation, vesicosigmoid fistulas and, 604-606, 608 Informed consent, for circumcision, 167, 170 for orchiectomy, 308, 312 for pubovaginal sling procedure, 569 Inguinal ligament, 149 Inosculation, definition of, 41 Instruments), Alexander periosteal elevator, 875, 8875 Allis clamp, 64, 66-67 Amplatz dilator, 28 aortic punch, 966, 967 argon beam coagulator, 936 autostapler, 64 basic set(s) of, 1082-1084 cystoscopy, 1084 fine, 1082 GU chest, 1083 GU long, 1082 GU micro, 1083 GU vascular, 1082 on GU cart, 4, 1081 plastic, 1082 renal transplant recovery, 1084 retropubic prostatectomy, 1084 standard laparotomy, 21 vasovasostomy, 1083-1084 Buchwalter retractor, 494 Cutter clamp, 586 dilator(s), fascial, 629 Koliman, 624 Doyen rib stripper, 876, 876 electrosurgical unit, 10, 10-11 EndoStitch device, 27, 663 forceps, 10 instrument cards for, 4 intrarenal retractors, 4 laparoscopic, 21, 28 Matson rib stripper, 875, 875 needed for hypospadias repair, 97 on suture cart, 4 preoperative preparation of, 4-5 Rummel tourniquet, 4 vascular, 86 Intercostal artery(ies), 486, 486 Intersex disorders, gonadal biopsy for, 307, 337 Intestinal fistula(s), ileal conduit and, 661 Intestines. See Bowel; specific part, e.g., Colon; Ileum. Intracavemous injection and stimulation (CIS) test, 194, 197 Intracytoplasmic sperm injection, 307 Intravenous pyelography, in repair of renal injuries, 936 Intussusception, continent reservoir revision with, 685 Irrigation, in laparoscopy, 27 Ischemia, flap failure and, 58 hypospadias repair and, 107 penile, with urethrectomy, 515 peripheral, postoperative, 17 renal, nephrolithotomy and, 1053 sigmoidocystoplasty and, 741 Ischial tuberosity, pudendal nerve block and, 78 Ischiocavernosus muscles, anatomy of, 292, 293

Isthmus, division of, in horseshoe kidney correction, 927, 927 Itrel Two nerve stimulation device, sacral laminectomy and placement of, 617-622 Ivanissevich approach, to varicocele ligation, 354-356, 354-356

J Jejunostomy, preoperative, 5 Johanson's technique, of urethroplasty, for penile urethral stricture repair, 279-280, 279-280 Joint(s), injury to, in laparoscopy, 30 Jordan flap technique, of repair of urethral strictures, 269-270, 269-270 advantages of, 270 Jugular vein(s), catheterization of, 92-93, 92-93

K Kalicinski technique, for ureteral folding, in ureteroneocystostomy, 807, 807, 808 Kavoussi-Clayman technique, of laparoscopic nephrectomy, 993, 996 Ketorolac, for postoperative pain, 18 Kidney. See also Renal entries. acute failure of, with renal artery reconstruction, 954-955 anatomy of, 911-912 autotransplantation of, 831, 851, 954 in extracorporeal renal surgery, 1030 biopsy of, open, 931, 931-932 with cutaneous pyelostomy, 646 blood supply to, 912, 912 renal resection and, 984, 984-985 displacement of, for ureteral repair, 830831, 830-831 choice of incision for, 831 indications for, 830 patient evaluation for, 831 ureteral stents for, 831 donor, pediatric, in adult renal transplant recipients, 967 excision of, 983-1056 anatomy for, 983-985, 984-986 heminephrectomy for, 1005-1007, 10051007. See also Heminephrectomy. laparoscopic, 993-997 nephroureterectomy for, 1008-1014, 1008-1015. See also Nephroureterectomy. partial nephrectomy for, 1000-1004. See also Nephrectomy, partial. principles of, 984-985, 984-986 incision for, 986 instruments for, 986 Kocher maneuver for, 986 preoperative assessment for, 985-986 surgical planes in, 985, 985 subcapsular nephrectomy for. See also Nephrectomy, subcapsular. horseshoe, surgery for, 924-927 approach to, 924, 924 nephrectomy for, 926, 926 pyeloplasty for, 924-926, 924-926 hypothermia of, in extended pyelolithotomy, 1045 in extracorporeal renal surgery, 10271028, 1039 in nephrolithotomy, 1048 in polar partial nephrectomy, 1001 injuries to, autotransplantation for, 831 repair of, 933-935, 933-936 incision for, 933, 933 postoperative management of, 936 postoperative problems with, 936 staging of, 933 lithiasis of. See Calculi, renal.

1159

Kidney (Continued) native, renal transplantation and, 966 procedures in, laparoscopically assisted, 29 reconstruction of, 911-982 je anatomy for, 911-912 indications for, 912 pyeloureteroplasty for, 913-923 rejection of, in renal transplantation, 965 solitary, extracorporeal renal surgery and, 1029-1030 surgical approaches to, 853, 853-910, 855, 855t. See also Extracorporeal renal surgery; lncision(s), renal. anatomic basis of, 854-855 transplanted. See also Nephrectomy, cadaver donor; Nephrectomy, living donor; Renal transplantation. rejection of, 965 rupture of, 965 upper pole of, in heminephrectomy, 10051007 Kinlinc shunt, for priapism, 207 Klauber posterior flap tube, for bladder tubularization in vesicostomy, 638-639, 638-639 Kocher maneuver, for dissection of duodenum and pancreas, 864 in approaching renal hilum, 859, 859 in radical nephrectomy, 1017 technique of, 986, 986 Kock pouch, 686-691, 686-692. See also Hemi-Kock pouch. advantages of, 682 diagnostic procedures with, 686 dissection for, 686-691, 686-691 for bladder substitution, 691 ileal hydraulic valve conduit for, 716 incision for, 686, 686 postoperative care for, 692 postoperative problems with, 692 Kock-Ghoneim technique, of ureterosigmoidostomy with augmented and valved rectum, 724-725 Kosminski method, of suturing, 27 Kropp technique, for correction of female urethral diverticula, 248 Kropp-Angewafo procedure, for intravesical urethral lengthening, 576-578, 576-579

L Laplace relation, 682 Labia minora flap, for vaginal reconstruction, 235 Lactic acid dehydrogenase, radial orchiectomy and, 380 Laminectomy, sacral, pacemaker placement and, 618-621, 618-621 Langer's lines, flap orientation.and,'44, 44 Laparoscopy, appendectomy with, 676 basic technique(s) in, clipping and stapling, 28 dissection, 27 hemostasis, 28 in children, 28-29 insertion of primary ports in, 23-24, 2324, 29 insertion of secondary ports in, 27, 29 instrumentation for, 21 irrigation in, 27 leaving the abdomen, 28 lysis of adhesions, 27 minilaparotomy, 29 monitoring equipment, 21 morcellation, 28 open Hasson technique, 25 26, 25-26 organ entrapment, 28 patient preparation, 21 pneumoperitoneum, 21 postoperative care, 21 precautions with, 27

1160

INDEX

Laparoscopy (Continued) retractors used in, 27 suture technique as, 27 training for, 21 Veress needle technique as, 21, 22 complications of, intraoperative, 29-30 postoperative, 30-31 components of, 31 contraindications to, 21 extraperitoneal, colposuspension and, 556 direct access in, 29, 31 surgical techniques with, 994-996 balloon dissector for, 994, 995, 996 clamp insertion in, 994 Hasson port insertion in, 994 for adrenalectomy, 1060 for bladder autoaugmentation, 766 for catheter insertion, in peritoneal dialysis, 970 for colposuspension, 556 for dismembered pyeloplasty, 918, 995, 997 for drainage of pelvic lymphocele, 524 for ileal conduit, 673 for lymphocele excision, 468 for nephrectomy, 993-997 complications with, 995, 996 partial, 994, 996 transperitoneal, 993, 996 for nephroureterectomy, 993, 996 for nonpalpable testis, 326, 330-337 anatomy related to, 332, 332 diagnostic, 332, 332 trocar insertion for, 331, 331 for orchiectomy, 379,379 for orchiopexy, 308, 325 for pelvic lymphadenectomy, 524 dissection for, 471-472, 471-472 extraperitoneal approach to, 473-474 incision for, 470, 470 instruments for, 469 insufflation for, 469 intraoperative emergencies in, 473 minilaparotomy for, 474-475 postoperative problems in, 473 preoperative preparation for, 469 seminal vesicle mobilization and removal in, 472-473 transperitoneal approach to, 469-473 trocar insertion for, 469, 469 for retroperitoneal lymph node dissection in testis, 404, 404-405 for unroofing of renal cyst, 994, 996 for ureterolithotomy, 851, 995-997 retroperitoneal, 851 transperitoneal, 851 for ureteroneocystostomy, 800, 800-801 for varicocele ligation, 359-360, 359-361 for vesical diverticulectomy, 541 for vessel ligation in Fowler-Stephens orchiopexy, 318. retroperitoneal, contraindications to, 994 for lymph node dissection in testis, 404, 404-405 for ureterolithotomy, 851 nephrectomy with, 995, 996 Lapides technique, for correction of female urethral diverticula, 246 Laser therapy, in laparoscopy, 28 in microsurgery, 60 in total penectomy, 157 of penis, indications for, 148, 150 Latzko procedure, for vesicovaginal fistula repair, 589 Lavage, preoperative, 6 Leadbetter technique, of ureterocolonic anastomosis, 717 of ureterosigmoidostomy, 717-726 Lehoczky flap, for vesicovaginal fistula repair, 590 Leydig cells, residual, 378 Lich-Gregoir technique, Hodgson modification of, for extravesical ureteral implantation, 806

Lich-Gregoir technique (Continued) of ureteroneocystostomy, 786, 795-796, 795-796 laparoscopic, 800, 800 vs. transvesical technique, 964 Lidocaine, for local anesthesia, 8 for skin flaps, 43 nerve block and, 80 Ligaclips, 86 Ligament(s), broad, in hysterectomy, 256, 256, 258r 258 cardinal, in hysterectomy, 255, 255 Cooper's, in colposuspension, 549, 551, 553 in hernia repair, 338-341, 339-340 in inguinal hernia repair, 342, 342, 345346 costovertebral, in subcostal incision, 873, 873 in supracostal incision, 882 infundibulopelvic, in hysterectomy, 256 inguinal, in orchiopexy, 314-315, 314-315 lumbocostal, in dorsal flap incision, 889 of Treitz, in anterior subcostal incision, 862 ovarian, in hysterectomy, 256, 258, 258 round, 26, 26 in hysterectomy, 257, 257 suspensory, in perineal repair, 297, 297 umbilical, 26, 26 uterosacral, in hysterectomy, 255, 255, 257, 257, 259, 259 Light, on surgical field, 10 Limberg's technique, of skin flap, 46, 46 Linea alba, bladder incisions and, 486, 486 in midline lower abdominal extraperitoneal incision, 487, 487 in midline transperitoneal incision, 867, 867 Liver, excision of, kidney harvest and, short right renal vein and, 961 in radical nephrectomy, 1021 Lockhart pouch (Florida pouch), 700, 700, 779 gastroileoileal, 702 Lord plication technique, for correction of hydrocele, 349-351, 349-351 Loupe, magnifying, in urethral reconstruction, 262 Lumbar artery(ies), in nephroureterectomy, 1011, 1011 Lumbar vein(s). See Vein(s), lumbar. Lung(s). See also Pulmonary entries. collapsed, radical nephrectomy and, 1026 Luteinizing hormone, 308 Lymph nodes, Cloquet's node, 148-149, 149, 465, 465 dissection of, Sec also Lymphadenectomy. in nephroureterectomy (left kidney), 1008-1013, 1008-1014 in renal carcinoma, 1016 iliac, 500, 500 in ilioinguinal lymphadenectomy, 162, 162 pelvic, dissection of. See also Lymphadenectomy, pelvic. in radical cystectomy, 507 in total retropubic prostatectomy, 432 incision for, 465 indications for, 465 laparoscopic-extraperitoneal approach, 473-474 laparoscopic-transperitoneal approach, 469-473 minilaparotomy for, 474-475 modified, 465-468 postoperative problems with, 468 preoperative preparation for, 465 with partial cystectomy, 504 with radical cystectomy, 512 penile, 148-149, 148-149 ilioinguinal lymphadenectomy and, 158 sentinel node and, 158, 158

Lymph nodes (Continued) retroperitoneal, anatomy of, 386, 386 dissection of, for testicular cancer, 385-403, 386-402. See also under Testis(es). laparoscopic, 404, 404-405 Lymphadenectomy, extracorporeal renal surgery and, 1030 ilioinguinal, bilateral dissection for, 163 closure for, 163-164, 163-164 for penile carcinoma, 158-164 incision for, 164 ligation of subcutaneous lymphatics in, 164 patient position for, 159, 159 postoperative problems with, 164 precautions with, 164 unilateral dissection for, 158-162 inguinal component of, 158-161, 158161 pelvic component of, 161-162, 161162 of penis, indications for, 148 pelvic, 517-524. See also Lymph nodes, pelvic, dissection of. laparoscopic, 524 open technique of, in females, 522-524, 522-524 incision for, 522, 522 in males, 517-520, 517-520 incision for, 517, 5/7 position for. 517 postoperative problems with, 521, 524 regional, for left renal tumors, 1025, 1025 for right renal tumors, 1021-1022, 10211022 Lymphatic drainage, of testis, 373, 374 radical cystectomy and, 511 Lymphedema, circumcision and. 171 ilioinguinal lymphadenectomy and, 164 pelvic lymphadenectomy and, 521 pelvic node dissection and, 468 Lymphoceles, ileal bladder substitution and, 775 ileocecal bladder substitution, 777 ilioinguinal lymphadenectomy and, 164 pelvic, laparoscopic drainage of, 524 pelvic lymphadenectomy and, 521, 524 pelvic node dissection and. 468, 473, 474 prevention of, 159, 164 renal transplantation and, 966 retroperitoneal lymph node dissection and, 403 total retropubic prostatectomy and, 445 Lvmphorrhea, ilioinguinal lymphadenectomy and, 164

M Magnesium deficiency, continent reservoirs and, 685 radical cystectomy and, 512 Magnetic resonance imaging, with vena caval thrombectomy, 1031, 1040 Magnification, in hypospadias repair, 98 in surgical technique, 10 MAGPI procedure. See Meatoplasty and glanuloplasty (MAGPI) procedure. Mainz pouch, advantages of, 682 dissection for, 693-694, 693-694 for continent urinary diversion, 693-697, 693-697 incision for, 693, 693 intussusception through ileocecal valve in, 696-697, 696-697 with appendiceal stoma, 698 procedure for, 711, 711 with in situ tunneled bowel flap, tubes, 698 Mainz pouch II, 724 Mainz procedure, of ileocystoplasty for bladder augmentation, 753-756

INDEX

Malament purse-string partition closure, in prostatectomy, 420, 420 Malignant hyperthermia, during anesthesia, 8, 8t Mannitol, in preoperative bowel preparation, Marmar approach, to varicocele ligation, 353, 353 Marshall-Marchetti-Krantz procedure, for cystourethropexy, 545-548, 545-548 Marshall-Marchetti-Krantz (MMK) test, 545, 549 Martius flap, in urethrovaginal fistula repair, 243-245, 243-245 Masses, identification of, prior to nephrectomy, 986 Mathicu procedure, for hypospadias repair, 97, 124-125, 124-125 Matson rib stripper, 875, 875 Maxon sutures, uses of, 34 McAninch flap, for urethral stricture repair, 268, 268, 270, 289-290, 289-290, 291 Meatoplasty and glanuloplasty (MAGPI) procedure, 116-123 basic principles of, 116 Duckett variant of, 120 for hypospadias repair, 97 method of, 116-119, 116-119 modified (Arap procedure), 120, 120 postoperative problems with, 119, 123 pyramid procedure for megameatus repair and, 120 Meatotomy, cutaneous ureterostomy and, 646 dorsal, in adults, 115, 115 ventral, no-suture method for infants, 114115,114-115 suture method for older boys, 115, 115 Meatus, in hypospadias repair, choice of operation for, 97 Mathieu procedure and, 124-125, 124-125 regression of, with MAGPI procedure, 119 stenosis of, radial forearm flap and, 223, 224 with hypospadias repair, 102, 106 with repair of partial amputation of penis, 219 tumor of, 150 Medic-Alert bracelets, splenectomy and, 907 Medications, for vasovasostomy, basic set of, 1083 preoperative, dosages of, 6, 6t Medina tube, in Kock pouch formation, 689-691, 689-692 Megaureter, assessment of, 803 characteristics of, 807 for bladder augmentation, ureterocystoplasty for, 763 hiatus for, 808 mobilization of, 808 surgical correction of, 807-808 tapering of, 808 ureteral techniques of, 786 ureteroneocystostomy for, Barry technique in, 797-798, 797-798 detrusorrhaphy in, 799, 799 with tailoring, 803-807, 803-808 tortuous, 807-808 types of, 803, 803 Meningocele, sigmoid conduits in, 666 Meningomyelocele, in children, vesicostomy and, 636-637, 636-637 urethral lengthening procedures and, 578 Mesenteric artery(ies). See Artery (ies), mesenteric. Metabolic acidosis. See Acidosis, metabolic. Metabolic disorders, adrenal tumors and, 1058, 1071 continent reservoirs and, 684, 692 gastrocystoplasty and, 762 ileal conduits and, 662 Metanephrine, adrenalectomy for pheochromocytoma and, 1074

Metastases, from bladder carcinoma, spread of, 500 Metoclopramide, in preoperative bowel preparation, 6 Metronidazole, in preoperative bowel preparation, 6 MIBG scan, for localization of adrenal tumor, 1058, 1072 Michal procedure, for anastomosis of epigastric artery with dorsal penile artery, 196, 196 Microsurgical techniques, 60-63 for varicocele ligation, 353 in extracorporeal renal surgery, 1028, 1030 instruments used for, 60 miscellaneous points of, 60 of arterial anastomoses, 60-62, 60-62 of nerve repair, 63, 63 of neural anastomoses, 63 of venous anastomoses, 62 vasovasostomy instruments for, 1083 Midazolam, for same-day surgery, 8 Millin technique, of retropubic prostatectomy, 423-425, 423-425 Minilaparoscopy, Foley muscle-splitting incision and, 885 Minilaparotomy, 29 for laparoscopic pelvic node dissection, 474-475, 475 nephrectomy with, 995 Mitchell procedure, of gastrocystoplasty, 757-762 Mitchell (gastric) reservoir, 705-706, 705-707 Mitrofanoff procedure, for continent reservoir with appendix, 708-713, 708-714 in ureteroneocystostomy, Barry technique and, 798 other applications of, 712, 712 Mitrofanoff valve, for gastric continent reservoir, using appendix, 706, 706-707 MMK test, 545, 549 Mohs chemosurgery, of penis, 148, 150, 153 Montgomery straps, application of, 15 Montie technique, in W-shaped ileal neobladder construction, 773, 773 Morphine, for postoperative pain, 18 Mraz and Sutory seromuscular flap, for vesicovaginal fistula repair, 592 Mucus, collection of, cecocystoplasty and, 752 in continent reservoirs, 684, 703 gastric bladder substitution and, 782 gastric continent reservoir and, 707 ileal bladder substitution and, 771 sigmoidocystoplasty and, 740, 741 Mullerian duct cysts, excision of, 228, 228 Mundy procedure, for vesicovaginal fistula repair, 595-596, 595-596 Muscle(s), adductor longus, 149 in gracilis myocutaneous flap, 52 bulbocavernosus, artificial sphincter placement in, 583-585, 583-585 in bulbar urethral stricture repair, 284, 284, 286, 286 in perineal repair, 296, 296 in urethrovaginal fistula repair, 243-245, 243-245 bulbospongiosus, 292, 293 vesicovaginal fistula repair and, 590, 590 cremaster, in hernia repair, 341 in orchiopexy, 309-310, 309-311 gluteus maximus, musculocutaneous flaps with, 57 gracilis, anatomy and blood supply of, 50, 50 flap of, musculocutaneous, 50-53, 50-53See also Flap(s), musculocutaneous, gracilis. in rectourethral fistula repair, 477 in vaginal reconstruction, 237, 237, 241 in vesicovaginal fistula repair, 590-592, 591-592 myocutaneous flaps with, 50-53, 50-53

1161

Muscle(s) (Continued) latissimus dorsi, in Foley muscle-splitting incision, 885, 885 levator ani, in total perineal prostatectomy, 456, 456 6 oblique, external and internal, in orchiopexy, 314-315, 314-315, 317 psoas, in renal displacement for ureteral repair, 831, 831 in retroperitoneal laparoscopic nephrectomy, 996 psoas minor, in psoas hitch procedure, 820, 820 rectourethralis, in prostatectomy, 436-437, 437, 439, 456, 456 rectus abdominis, catheter placement for peritoneal dialysis and, 973 in anterior subcostal incision, 856-857, 857 in bladder incisions, 486, 486 in ilioinguinal lymphadenectomy, 163, 163 in inguinal hernia repair, 342, 342 in midline lower abdominal extraperitoneal incision, 487, 487 in musculocutaneous flaps, 50, 50, 5457, 54-57 in paramedian incision, 869 in vesicovaginal fistula repair, 599 sheath of, in inferior rectus abdominis flap, 55, 55, 57 in transverse lower abdominal (Pfannenstiel) incision, 490, 490-491 rectus femoris, musculocutaneous flaps with, 57 sartorius, 149 in gracilis myocutaneous flap, 52 in ilioinguinal lymphadenectomy, 163, 163 tensor fasciae latae, in musculocutaneous flaps, 57 transversus abdominis, in anterior subcostal incision, 857, 857 in inguinal hernia repair, 342-344, 342345 urogenital, anatomy of, 292, 293 Mustarde procedure, for hypospadias repair, 126-129, 126-129 Myelodysplasia, children with, ileal conduit in, 647 Myelomeningocele, infection in, artificial sphincter placement and, 585 Myocardial infarction, postoperative risk and,3

N Nagamatsu incision, 887-889, 887-889 Narcotics, for postoperative pain, 18 preoperative, 6 Nash and Shinohara, prostatic nerve, block of, under ultrasound guidance, 80, 80 Naude anterior flap tube, for bladder tubularization in vesicostomy, 640, 640, 641 Necrosis, acute tubular, renal transplantation and, 966 glanular, with circumcision, 171 in sigmoidocystoplasty, 741 of skin or shaft, with circumcision, 171 Needles, on GU cart, 1081 protection from HIV and, 9 Neomycin, in preoperative bowel preparation, 6 Neonates. See Infant(s), newborn. Neourethra, construction of, in hypospadias repair, 99 construction of female, 251, 251 in urethral reconstruction, 263 Nephrectomy, adrenalectomy with, 1069-1071, 1069-1071, 1080

1162

INDEX

Nephrectomy (Continued) after failed transplantation, 966 cadaver donor, 979-981, 979-982 donor selection in, 979 in situ approach to, 979-981, 979-981 multiple organ retrieval and, 982 team approach for multiple organ removal, 982 for horseshoe kidney, 926, 926 Incision in, choice of, 992, 1004, 1016, 1016-1017 laparoscopic, 993-997 complications with, 995, 996 retroperitoneal, 995, 996 transperitoneal (Kavoussi-Clayman), 993, 996 living donor, 974-976, 974-978 commentary on, 977-978 postoperative care for, 977 postoperative problems with, 977 subcostal transperitoneal approach to. 976-977 supracostal approach to, 974-976, 974976 minilaparotomy with, 995 partial, 985, 1000-1004 disadvantage of, 1004 for tumors, 1000, 1000 in extracorporeal renal surgery, 10281029, 1029 in renal injury repair, 934 incisions for. 1004 indications for. 1000 polar, 1001-1012, 1001-1003, 1046 postoperative problems in, 1004 preoperative preparation for, 1004 renal carcinoma and. 1016 temporary renal artery occlusion with. 1004 wedge resection in. for tumors in midportion, 1003. 1003 postoperative problems with. 992. 997. 1004, 1026 radical, 1016-1025, 1016-1026 anterior transabdominal approach for, 1016-1021. 1016-1021 incision in, 1016, 1016-1017 approaches for. 1026 left, lateral approach for, 1022-1025, 1022-1025 lymphadenectomy with, 1021-1022, 1021-1022, 1025, 1025 postoperative problems with, 1026 renal artery injury and. 86, 86, 934 secondary, 992 simple, 987-992 flank or kidney position for. 987, 987 in children, 991 midline transperitoneal approach for, 991 subcostal approach for, 987-991, 987991 closure of, 991 dissection in. 987-988, 987-988 loss of control of pedicle in, 991 pedicle ligation-clamp and individual method, 990, 990 pedicle ligation-clamp method, 989990, 989-990 pedicle ligation-individual method, 991, 991 securing of pedicle in, 989 subcapsular, 998-999 Nephrolithotomy, 985, 1048-1053, 1048-1054. See also Calculi, renal. chemolysis in, 1053 dissection in, 1049-1051, 1049-1051 intraoperative problems in, 1053 localization of stones in, 1048, 1051, 10531054 postoperative problems in, 1053 preoperative studies for, 1048 Nephropexy, in pyeloureteroplasty, 922, 922

Nephropexy (Continued) stitch used in, 841 technique of, 11 Nephrostography, 846 Nephrostomy, 928-929, 928-929 alternative technique of, 929, 929 function of, 624 in extended pyelolithotomy, 1046 in extracorporeal renal surgery, 1029, 1029 in nephrolithotomy, 1053 in pyeloureteroplasty, 918, 922, 923 pediatric loop, function of, 624 percutaneous, function of, 624 postoperative problems with, 9.30 renal transplantation and, 965 uses of, 928, 930 Nephrotomography, intravenous, for renal injury staging, 933 Nephroureterectomy, 1008-1014, 1008-1015 choice of technique for, 1008 incision for, 1008, 1008, 1015 laparoscopic, Clayman-Kavoussi technique for, 993, 996 indications for, 996 position for, 1008, 1008 postoperative problems with, 1014 purpose of, 1008 single-incision thoracoabdominal approach in. left kidney. 1008-1013. 1008-1014 right kidney, 1014 ureterectomy, right ureter, 1013-1014 two-incision approach in. 1014, 1015 Nerve-(s). anastomoses of. microsurgical technique for, 63 block of. advantages of. 80 caudal, 18 continuous epidural regional anesthesia as, 17-18 dorsal. 18 equipment needed for. 75 genitofemoral. 76-77. 76-77 iliac crest regional. 77. 77 iliohypogastric, 18. 76-77, 76-77 ilioinguinal, 18. 76-77. 76-77 in hypospadias repair, 98 intercostal, 75, 75 methods of, 75-80 penile, 76, 76 postoperative, 17-18 technique of, 15 prostatic, under ultrasound guidance, 80. 80 pudendal, 78, 78 sacral, 79. 79 testis. 77 topical anesthesia for, 75 transsacral, 79, 79 femoral, injury to, in urethral reconstruction, 262 genitofemoral, anatomy of, 76 in ilioinguinal lymphadenectomy, 162, 162 in pelvic lymphadenectomy, 519, 519 in ureterovaginal fistula repair, 833 psoas hitch procedure and, 821 iliohypogastric, 18, 76-77 anatomy of, 76 ilioinguinal, 18, 76-77 anatomy of, 76 entrapment of, vaginal needle suspension and, 564 in radical orchiectomy, 380, 380 injury of, in laparoscopy, 30 in urethral reconstruction, 262 in urethral stricture repair, 302 ot obturator nerve, 30, 262, 521, 524 total perineal prostatectomy and, 464 intercostal, anatomy of, 75 in supracostal incision, 882, 882 lumbar-sympathetic, in retroperitoneal lymph node dissection, 391, 391 obturator, 500, 819

Nerve(s) (Continued) in ilioinguinal lymphadenectomy, 162, 162 in pelvic node dissection, 467, 467, 468 injury of, 30 injury to, 262, 521, 524 parasympathetic, 500, 500 penile dorsal, 76 perineal, pudendal nerve block and, 78 peroneal, injury to, in urethral reconstruction, 262 prostatic, anatomy of, 80, 80 block of, under ultrasound guidance, 80, 80 pudendal, anatomy of, 78, 78 repair of, microsurgical technique for, 63, 63 retroperitoneal, anatomy of, 386, 386 autonomic, 385 sacral (S2, S3), laminectomy and dorsal rhizotomy of, for pacemaker placement, 617-622, 618-621 saphenous, injury of, in urethral reconstruction, 262 vesical plexus, 500, 500 Neuritis, ulnar, in vasoepididymostomy, 372 Neurogenic bladder. See Bladder, neurogenic. Neurovascular bundle(s). 12th rib, 876 anatomy of, 80, 80 buccal, in hypospadias repair, 101-102 in heminephrectomy, 1007 in ileocystoplasty, 734 in perineal prostatectomy, 447, 447, 450 in prostatectomy, 434-435, 434-435, 437, 438, 443 in radical cystectomy, 508, 509 Nissan-Zinman technique, of sphincter plication, in ileocecocystoplasty, 754-755, 754-755 Nutrition, preoperative preparation of, 5 preoperative risk evaluation and, 3 radical cystectomy and, 511

O Obturator artery(ies), 499-500, 767, 819 in pelvic lymphadenectomy, 520 Obturator vein(s). See Vein(s), obturator. O'Conor procedure, for vesicovaginal fistula repair, 597-599, 597-599 Oliguria, ureterosigmoidostomy and, 725 Olsson technique, for stapled sigmoid neobladder, 780 Omentum, 26, 26 anatomy of, 71,71 blood supply to, 71,71 flaps of, in pyelolithotomy, 1047 mobilization of, 71-74 for use as graft or interposition in pelvis, 73, 73, 936 for use as wrap around kidney or upper ureter, 74, 74, 836 postoperative problems with, 74 technique of, 72-74, 72-74 Omeprazole, for metabolic acidosis, with gastric reservoir, 706 Onlay island flap, urethroplasty with, 132 Onlay preputial island flap, for hypospadias repair, 130-1.33, 130-133 postoperative problems with, 133 Operating room, preoperative preparation of, 7 Orandi's technique, of longitudinal island flap, for penile urethral strictures, 275-278, 275-278 Orchiectomy, epididymis-sparing, 377, 377, 378 insertion of testicular prosthesis with, 378 intracapsular, 376-377, 376-377; 378 postoperative problems with, 378 radical, 380-383, 380-384

INDEX

Orchiectomy (Continued) incision for, 380, 380, 384 simple, 375-378 postoperative problems with, 375 trans-scrotal, 37, 375 Orchiopexy, for nonpalpable testes, 326-329, 326-330 extended inguinal approach to, 330 extraperitoneal approach to, 328-329, 328-329 laparoscopic localization for, 326 transperitoneal approach to, 326-327, 326-327 Fowler-Stephens, 318-320, 318-320 laparoscopic vessel ligation in, 333 second stage of, 333-337, 334-337 inguinal, 308-317 complications with, 315, 315 preoperative preparation for, 308 microvascular, 323-325, 323-325 nerve blocks for, 76-77, 76-77 repeat (Cartwright-Snyder), 316, 316 testicular blood supply and, 304 two-stage, indications for, 322 problems with, 322 silicone sheath technique of, 321-322, 321-322 vascular division with (Fowler-Stephens procedure), 318-320, 318-320 Osteomalacia, continent reservoirs and, 684 Osteoporosis, ileocecocystoplasty and, 754, 756 Outpatient surgery, preoperative preparation for, 4 Overhydration, in laparoscopy, 30

P Pacemaker (neurologic), placement of, 617-622 dorsal rhizotomy for, 621, 621 position for, 617, 617 postoperative problems with, 622 sacral laminectomy for, 618-621, 618621 Pain, flank, with ureteral stents, 70 in laparoscopy, 30 mild to moderate, analgesics for, I7t perineal, gastric bladder replacement and. 782 Peyronie's disease correction and, 205 postoperative, nerve blocks for, 17-18 pubovaginal sling procedure and, 569 scrotal, in vasoepididymostomy, 372 ' severe, analgesics for, 17t shoulder, in laparoscopy, 30 with penile prosthesis insertion, 184 Palomo approach, to varicocele ligation, 356-357, 356-357 Pampiniform plexus vein(s), anatomy of, 352, 352 Pancreas, injury to, in radical nephrectomy, 1026 in radical nephrectoomy, 1023 tail of, in splenectomy, 906 in splenorenal bypass graft, 947, 947 in transperitoneal approach to kidney, 862 Pancreatitis, retroperitoneal lymph node dissection and, 403 Pantographic expansion and cutbacks, for flap advancement, 48, 48 Paquin technique, in ureteroneocystostomy 799 of ureteral implantation, in ileal ureteral replacement, 846 Paramedian incision, 485, 869-870, 869-870 Paraphimosis, dorsal slit for, 172, 172 with penile prosthesis insertion, 184 Patient(s). See also Child(ren); infant(s). positioning of, 9

Patient(s) (Continued) preoperative evaluation of, 3, 4 preparation of, for laparoscopy, 21 wheelchair-bound, bulbar urethral placement of artificial sphincter in, 584, 584 Paulson's wide-field total prostatectomy, 462, 462 Pelvic exenteration, 525-535 in females, anterior, 525-527, 525-527 anatomy relevant to, 525, 525 position for, 525, 525 total, 528-529, 528-529 rectal resection in, 529, 529 in males, total, 530-533. 530-534 alternative procedures for, 534 incision for, 530-531, 531 indications for, 530 position for, 530 postoperative care for, 534 postoperative problems with, 534 Pelvic vein(s), repair of injuries of, 82, 82 Pelvis, blood supply to, 519. 530-531, 530-531, 783 Penectomy, partial, indications for, 148, 153 procedure of, 150-153, 150-153 total, extended incision in, 156 indications for, 148 perineal approach to, 156, 156 postoperative problems with, 156 procedure for, 154-157 urethrectomv in, 156 Penicillin, splenectomy and, 907 Penile artery, dorsal, 177, 178, 196, 196-197, 271, 271 Penile graft(s). See Graft(s), penile. Penile tumescence test, nocturnal, 194, 197 Penis, abscess of, 153 anatomy of, 95, 147-149, 148-149, 166, 166 avulsion of, repair of, 211, 217-218, 217218 blood supply to, 97-98, 98, 148, 148, 165. 166, 177. 178, 196, 196, 271,271 burn injury of, repair of, 211-212, 211-212 circumcision of, 167-173. See also Circumcision. construction of, 220-225, 220-225 alternative flaps for, 222, 222-223 radial forearm flap for, 220-222, 220-222 scrotal flap for, with baculum, 224-225, 224-225 sexual function in, 224 vascularized extended groin flap for, 225 correction of defects in, 166, 166 curvature of. See Chordee; Peyronie's disease. excision of, 147-164. See also Lymphadenectomy, ilioinguinal; Penectomy, partial; Penectomy, total. choice of procedure for, 148, 150 partial, 150-153, 150-153 repair of, 215-216, 215-216, 219 fracture of, repair of, 213, 213 hypospadias repair in. See Hypospadias repair. in Peyronie's disease. See Peyronie's disease. lengthening of, 152 nerves of, dorsal, 76 block of, 18 reconstruction of, 177-228 arterial revascularization in, 194-196, 194-197 correction of priapism in, 207-210, 207210. See also Priapism, correction of venous leakage in, 198-200. 198-200 excision of urethral diverticulum in, 226227, 226-227 excision of utricular cyst in, 228, 228 insertion of flexible prosthesis in, 179183, 179-184

1163

Penis (Continued) insertion of inflatable prosthesis in, 185192, 185-193 Peyronie's disease treatment in, 201-205, 201-206. See also Peyronie's disease. principles of, 178 repair of genital injuries in, 211-219, 211-219 reimplantation of, 213-215, 213-215 skin grafts for, 42, 42 skin grafts from, for urethral stricture repair, 287, 287 venous leakage from, correction of, 198200, 198-200 Penn pouch, advantages of, 682 for ileocecal reservoir, with appendiceal stoma, 699, 699, 711, 711 Percutaneous endoscopic trigonoplasty, of laparoscopic ureteroneocystostomy, 801 Pereyra-Raz procedure, of vaginal needle suspension, 558-560, 558-561 Perimeatal-based flap (Mathieu) procedure, for hypospadias repair, 124-125, 124-125 Perimeatal-based tube repair (Mustarde) procedure, for hypospadias repair, 126-129, 126-129 Perineal artery(ies), 292, 293 Perineal body, anatomy of, 292, 293 Perineal fistula(s), repair of. 111, 111 Perineal space, fistula of, repair of, 111, 111 injury of, repair of, 295-298, 295-299 positioning for, 295, 295 urethral mobilization in, 295, 296, 296 structures in, 533, 533 superficial anatomy of, 283, 283, 293, 293 Perineurium, in microsurgical nerve repair, 63 Peritoneum, excision of, in orchiopexy, 334-335, 334-335 in midline lower abdominal extraperitoneal incision, 488, 488 in peritoneal dialysis, ureterocystoplasty and, 764 in search for nonpalpable testis, 330 in transcostal incision, 876, 878 Peritonitis, cystostomy and, 629 laparoscopy and, 31 peritoneal dialysis and, 972 ureterosigmoidostomy and, 725 Periumbilical area, 54, 59 inferior rectus abdominis flap and, 59 PET procedure, of laparoscopic ureteroneocystostomy, 801 Peyronie's disease, 166 causes of, 205-206 correction of, 201-205, 201-206 commentary on, 205-206 complications with, 205 criteria for success of, 206 graft techniques in, 201-303, 201-204 plication techniques in, '204, 204-206 procedures for, 201 prosthesis implantation in, 185, 205, 206 vascular function testing for, 206 Pfannenstiel incision, 485 for bladder approach, 490-493, 490-494 Phalloarteriography, 194, 197 Pheochromocytoma, adrenalectomy for, 1072-1074, 1072-1074 anterior approach for, 1065-1067, 10651067 malignant, 1073 preoperative preparations for adrenalectomy with, 1058 Phimosis, correction of, 171, 172, 172 with circumcision, 171 Phlebothrombosis, nephrolithotomy and, 1053 Physical status scale, 3 Plastibell technique, of circumcision in infants, 170, 170 Pleura, in nephrouretectomy, 1015 in transcostal incision, 877, 877, 878 tears of, 902, 902

1164

INDEX

Pleura (Continued) in dorsal flap incision, 889 in transcostal incision, 878 Pneumococcal vaccine, after splenectomy, 906, 907 nephrectomy and, 1016 Pneumodissection, in laparoscopy, 27 Pneumomediastinum, in laparoscopy, 29, 30 Pneumopericardium, in laparoscopy, 29 Pneumoperitoneum, in laparoscopy, 21, 28, 31,474 Pneumothorax, in adrenalectomy, 1080 in laparoscopy, 29, 30 in nephrolithotomy, 1053 tension, in radical nephrectomy, 1026 with intercostal nerve block, 75 Politano-Leadbetter technique, of ureteroneocystostomy, in psoas hitch procedure, 820, 820 transvesical, 786, 789-791, 789-791 ureterocele repair and, 817 Polvtetrafluoroethylene graft, for repair of vena caval laceration, 81 Portal vein(s), in adrenalectomy, 1080 Position, of patient, 9 in laparoscopy, 21 in children, 29 protection during, 7 of surgeon, 9-10 Postoperative management, after laparoscopy, 28 avoidance of problems in, 5, 16-17 fluid requirements in, 17 late complications in, 18, 18t management of pain in, 17-18 principles of, 16-18 recovery room in, checklists for, 16, I6t wound management in, 18 Potassium, adrenal tumors and, 1058, 1071 Pouch(es), continent, in ureteroneocystostomy, Barry technique and, 798 dartos, 327, 327, 336, 348 Florida, in colonic bladder substitution, 779 Florida (Lockhart), 700, 700, 702 gastroileal, 704 gastroileoileal (Lockhart), 700, 700, 702 hemi-Kock, in ileal bladder substitution, 773, 773 ureterosigmoidostomy and, 724, 726 ileal bladder, in treatment of urethral stricture, 775 Indiana, 698, 698, 704 in colonic bladder substitution, 779 Kock, in continent urinary diversion. See Kock pouch. Mainz, See also Mainz pouch. in continent urinary diversion, 693-697, 693-697 Penn (Duckett pouch), 682, 699, 699, 711, 711 S, in ileal bladder substitution, 774, 774 subdartos, 349 thigh, for scrotal coverage, 218, 218, 219 Pouch of Douglas, in enterocele repair, 555, 555 Preputial island flap, for bulbar urethral stricture repair, 288-290, 288-291 for hypospadias repair, 137 Priapism, correction of, 207-210, 207-210 preparation for, 207 distal shunts for, glans-corpora-cavernosa, 207, 207 ischemic, 207 risks with, 210 nonischemic, 207 penile prosthesis insertion and, 184 proximal shunts for, cavernosospongiosum, 208, 208 cavernous vein-dorsal vein, 210, 210 sickle cell anemia and, 207 Procaine, for local anesthesia, 8

Processus vaginalis, in orchiopexy, 308 in search for nonpalpable testis, 332 Prochlorperazine maleate, in preoperative bowel preparation, 6 Prostate, anatomy of, 411-412, 412 blood supply and, 411, 412, 420, 420, 422, 422 capsule of, 421, 421 excision of, 411-484. See also Prostatectomy. Prostatectomy, antibiotics for, 413 approaches to, 413 incontinence with, 421, 445, 464, 586. See also Incontinence; Urine, leakage of. perineal, 446-450, 446-450 advantages of, 450 postoperative problems with, 450 position for, 413 preoperative management of, 413 retropubic, 422-430 alternative catheter technique for, 429, 429 incision for, 423 indications for, 430 position for, 423 postoperative problems with, 430 transverse capsular (Millin) technique of, 423-425, 423-425. 430 vesicocapsular technique of, 426-428, 426-428 YV-plasty technique of, 429, 429 suprapubic, 414-421 bleeding in, 419-421, 420-421 incision for, 414-416. 415-416 position for, 414, 414 postoperative care for, 421 postoperative problems with, 421, 421t total perineal, 451-464 anatomy relevant to, 452, 452 approaches to, 451 Belt approach to, 452-462, 452-462 commentary on, 463 incision for, 453, 453 instruments needed for, 451, 451 intraoperative complications in, 462 methods of closure in, 461-462. 461-462 pelvic node dissection with, 465 modified, 465-468 position for, 453, 453 postoperative care in, 462 postoperative problems with, 463 preoperative preparation for, 451 rectal injury in, 462 Young vs. Belt approach entry point, 452, 452 total retropubic, 431-445 incision for, 431-432, 431-432 nerve-sparing (Walsh) technique of, 432440, 432-440 position for, 431 posterior closure techniques in. 441-444, 441-444 postoperative care in, 445 postoperative problems with, 445 standard closure in, 441-442, 441-442 tennis-racket closure in, 441-443, 442443 tubularized neourethra in, 444, 444 wide-field radical perineal, 462, 462 Prostate-specific antigen (PSA), pelvic node lymphadenectomy and, 465, 468 prostatectomy and, 431 Prosthesis(es), penile, AMS 700CX, 185-189, 185-189, 205, 223 flexible, approaches used for, 179, 185 dorsal penile shaft, 183, 183 perineal, 182, 182 pubic, 183 subcoronal, 182, 182 ventral, 183, 183 ventral penile, 179-181, 179-181 available types of, 179t

Prosthesis(es) (Continued) choice and fitting of, 184 insertion of, 179-183, postoperative problems with, 184 preparation for, 179 for correction of Peyronie's disease, 205 inflatable, available types of, 185 complications with, 192 drains for, 193 incision for, 185, 189, 192, 193 infection of, 192, 193 infrapubic approach to, 193 insertion of. 185-192, 185-193 infrapubic approach to, 193 penoscrotal approach to, 190-191, 190-191 pubic approach to, 185-189, 185189 positioning and sizing of, 187, 189, 193. 223-224 preparation for, 185 reoperation for, 192 testicular, in orchiopexy, 308, 312, 317 insertion of, 317, 378 silicone, 312, 317 Protamine, 831 Proteus mirabilis, continent reservoirs and, 684 Prune-belly syndrome, 327, 330, 807, 808 Psoas hitch procedure, 818-821, 818-821 dissection for, 818-821, 818-821 for ureteral injury, 785 importance of, 821 in ureteroneocystostomy, 807 Barry technique and, 798 in ureterovaginal fistula repair. 833. 833 indications for, 818 PTA, for renovascular abnormalities, 955 Pubectomy, en bloc, in radical cystectomy, 510 partial, 489 Pubic tubercle, in gracilis myocutaneous flap. 51 Pubovaginal sling procedure, 565-568. 565-569 alternatives to, 568 commentary on, 569 for closure of female vesical neck, 613 indications for, 569, 752 intermittent catheterization with, 569 obstructive fascial sling needle suspension and, 569 patient position for, 565 postoperative problems with, 569 preoperative diagnostic procedures for, 565 tightening of sling in, 568 voiding dysfunction with, 569 Pudendal artery(ies), 196, 196, 819 Pulmonary. See also Lung(s). Pulmonary embolism, pelvic lymphadenectomy and, 521 total retropubic prostatectomy and, 445 vena caval thrombectomy and, 1040 Pulmonary function, nephrolithotomy and, 1053 preoperative risk evaluation and, 3 radical cystectomy and, 504, 511 Pyelolithotomy, 1041-1046, 1041-1047 coagulum technique in, 5, 5t, 1042-1043, 1042-1043 extended (Gil-Vernet technique), 10431046,1043-1046 contraindications for, 1043 incision for, 1041, 1041 indications for, 1041 localization of stones in, 1047 omental flaps in, 1047 postoperative problems with, 1046 simple, 1041-1042, 1041-1042 Pyelonephritis, continent reservoirs and, 684 ileal conduit and, 662 radical cystectomy and, 511

INDEX

Pyelonephritis (Continued.) ureterosigmoidostomy and, 725 Pyelonephrolithomy, 1046 postoperative problems with, 1046 radiographic technique in, 1046 Pyeloplasty, dismembered, laparoscopic, 995, 997 dismembered (Anderson-Hynes), 914-918, 914-918 for horseshoe kidney, 924-926, 924-926 Anderson-Hynes, 924-925, 924-925 Foley Y-plasty, 926, 926 isthmus division in, 927, 927 incision for, 864 pelvic flap, 920, 920 reoperative, 923 Scardino-Prince, 920 Pyelostomy, cutaneous, 646, 646 function of, 624 indications for, 646 Pyelotomy, endoscopic, vs. laparoscopic dismembered pyeloplasty, 997 Pyeloureteroplasty, 913-923 alternatives to, 913 choices in, 913, 914 closure of, 916-917, 916-917 in newborn, 913 incision for, 913-914, 913-914 intubated ureterotomy in, 920, 921 nephropexy in, 922 position for, 913, 913 postoperative care in, 922 pyeloplasty in, dismembered (AndersonHynes), 914-918, 914-918 dismembered (laparoscopic), 918 pelvic flap, 920, 920 stenting in, 918, 918 YV-plasty in, 919, 919 Pyocystitis, cutaneous ureterostomy and, 646 noncontinent urinary diversion and, 624 Pyohydronephrosis, ureterosigmoidostomy and, 725

Q Quartey flap, for urethral stricture repair, 288, 288

R Race, priapism and, 207 Radial artery(ies). See Artety(ies), radial. Radiation injury, gastric bladder substitution and, 782 gastrocystoplasty and, 757 vesicosigmoid fistulas and, 608 Radiographic technique, for locating residual stones, 1046, 1051, 1051, 1053-1054 Ranitidine, gastrocystoplasty and, 762 Recovery room, checklists for, 16, l6t operative report in, 16 Rectal artery(ies), 767 superior, sigmoid conduit and, 664 Rectal bladder bypass, ileal hydraulic valve conduit for, 716 Rectourethral fistula(s). See Fistula(s), rectourethral. Rectum, blood supply to, 682, 767 injury of, in perineal prostatectomy, 450 in radical cystectomy, 509, 512 in total perineal prostatectomy, 463 in total retropubic prostatectomy, 445 repair of, 89, 89 resection of, in total pelvic exenteration (female), 529, 529 valved augmented, in hemi-Kock procedure of ileocystoplasty, 732, 732-733 Reddy procedure, for colonic bladder substitution, 779-780, 779-780 Reflux, bladder augmentation and, 714

Reflux (Continued) continent reservoirs and, 703 correction of. See also Ureteroneocystostomy. in duplicated ureters, 809 choice of procedure in, 809, 813 ureterectomy for, 813, 813 ureteroneocystostomy for, 809-810, 809810 ureteropyelostomy for, 812, 812 ureteroureterostomy for, 810-811, 810811 Mitrofanoff procedure and, 713 persistent, reoperation for, 801 prevention of, in ileal ureteral replacement, 845, 845, 846 primary, grading of, 786 secondary, assessment of, 786 ureteral stents and, 70 ureteroneocystostomy for, 786, 801. 807, 809-810, 809-810. vesicoureteral, laparoscopic nephroureterectomy for, 996 vesicovaginal fistula repair and, 6(K) Renal. See also Kidney. Renal artery(ies). See Artery(ies), renal. Renal calculi. See Calculi, renal. Renal failure, acute, in partial nephrectomy, 1004 in vena caval thrombectomy, 1040 indications for, l6t radical cystectomy and, 512 Renal pelvis, carcinoma of, nephroureterectomy for, 1008 preoperative evaluation of, 1008. 1015 Renal system(s), duplex, heminephrectomy for, 1005 in laparoscopic partial nephrectomy, 996 Renal transplantation, donor. Sec Nephrectomy, cadaver donor; Nephrectomy, living donor instruments needed for, 1084 recipient, 956-973 failed, nephrectomy after, 966 renal artery stenosis after, 966-967 in adults, 956-961 anastomosis to iliac vessels in, 958959, 958-960 children's kidneys in, 962, 962 incision for, 956, 956 multiple renal arteries in, 960-961, 960-961 position for, 956, 956 short right renal vein in, 961 in children, 962-963 anastomoses in, 962-963, 963 preoperative studies in, 962 surgical approach in, 962 operative support for, 965 peritoneal dialysis in, catheter insertion for, 970-973, 971-972 postoperative problems in, 965-966 radial artery-cephalic vein shunt in. 968970 ureteral implantation in, 964-965 transvesical technique in, 964-965, 964-965 ureteroneocystostomy in, 798 rejection in, 965 Renal vein(s). See Vein(s), renal. Renography, retroperitoneal fibrosis and. 829 Renovascular disease, extracorporeal renal surgery for, 1027-1029, 1029 indications for, 1029 Rcservoir(s), continent, bowel adhesions and, 704 catheterization of, 703 detubularization and closure of, 704 follow-up for, 704 gastric (Mitchell), 705-706, 705-707 indications for and contraindications to, 707

1165

Reservoir(s) (Continued) Mitrofanoff adaptation of, 706, 706 patient selection for, 707 postoperative problems with, 706-707 stomach tube conduit for, 705-706, 705-706 ileal, 686-691, 686-692 ileocecal, 693-704 conduits for, 702-703, 702-703 ileal hydraulic valve for, 715, 715716 stapled, 703, 703 sutured, 702, 702-703 Florida pouch for, 700, 700 gastroileoileal pouch for, 702 ileocecal valve reconstruction with, 703 Indiana pouch for, 698, 698 Mainz pouch for, 693-697, 693-697 Penn pouch for, 699, 699 stapled (Olsson) procedure for, 701, 701-702 Mitchell (gastric), 705-707, 705-707 postoperative problems with, 703 right colonic, adhesions with, 704 transverse colon, ileal hydraulic valve conduit for, 716 Respiratory complications, with retroperitoneal lymph node dissection, 403 Retractor(s), Balfour, 5 Buchwalter, 494, 1064 for total perineal prostatectomy, 451, 451 in laparoscopy, 27 intrarenal, 4 Omni-Tract, 5 ring, 5 self-retaining, 5 uses of, 9 surgeon's assistants and, 9 Retroperitoneal procedures, laparoscopically assisted, 29, 31 Retroperitoneal space, anterior-pararenal, 854, 855 in transverse oblique view, 854, 854-855 layers of, 854, 854 perirenal, 854. 855 posterior pararenal, 854, 855 Rhabdomyolysis, total perineal prostatectomy and, 464 urethral stricture repair and, 302 Rhizotomy, dorsal, pacemaker placement and, 621, 621 Rhomboid flap (Limberg's technique), 46, 46 Ribs, in supracostal incision, 879-882, 879-882 in thoracoabdominal incision, 893-894, 893-894 in transcostal incision, 875-876, 875-876 supracostal approach through, in living donor nephrectomy, 974-976; 974-976 Richards method, of suturing, 27 Ring, external inguinal, in orchiopexy, 308-309, 308-309 in radical orchiectomy, 380, 380 internal inguinal, 26, 26 in orchiopexy, 328, 328, 330 in preperitoneal hernia repair, 343-346 in varicocele laparoscopic ligation, 359, 359-360 Valtrec, for colonic anastomosis, 780 Rink-Retik technique, of ileocecal ureterosigmoidostomy, 723 Risk factors, 3, 3t Roof strip, for penile stricture repair, 271, 274-275, 274-275 for urethral stricture repair, 282 Rumel tourniquet, 4 Rutherford-Morrison incision, 489 as alternative to boari flap, 826

S Sacculation, urethral reconstruction and, 263

1166

INDEX

Sacral laminectomy, pacemaker placement and, 618-621, 618-621 Sacral roots, identification of, 620-621, 620-621 Sagalowsky method, of ureteral anastomosis in ileal conduit, 659 Saphenous vein(s). See Vein(s), saphenous. Scardino-Prince pyeloplasty, 920 Scarpa's fascia, 148, 148 Schuessler technique, of dismembered laparoscopic pyeloplasty, 918 Scleroderma, penile prosthesis insertion and, 184 Scrotum, avulsion of, 211, 217-218, 217-218 burn injury of, 211-212, 211-212 fistula of. 111, 111 flap of, for penile construction, 224-225, 224-225 formation of, by tissue expansion, 218 hydrocele correction and, 349-351, 349351 insertion of pump of penile prosthesis into, 188-189, 188-189, 191, 191 island flap from, for bulbar urethral stricture repair, 290 layers of, 304 skin grafts for, 42, 42, 211-212, 211-212 swelling of, in orchiopexy, 315 Scrubbing, preoperative, 5 Sedoanalgesia, for outpatient surgery, 4 for same-day surgery, 8 Seminal vesicles, excision of, 481-484, 481-484 in laparoscopic pelvic node lymphadenectomy, 472-473 perineal approach to, 483, 483 transperitoneal approach to, 481-482, 481-482 transvesical transtrigonal approach to, 483-484, 483-484 Sepsis, ureterocele management and, 815, 817 ureteroneocystostomy and. 801 Septic shock, acute, indications for, I6t treatment of, 17t ileal bladder substitution and, 775 Seromas, ilioinguinal lymphadenectomv and, 164 skin graft loss and, 58 Serous drainage, with pelvic exenteration, 534 Sexual function, radical cystectomy and, 511 Shaving, preoperative, 5 Short bowel syndrome, 703 continent reservoirs and, 685 gastric bladder substitution and, 782 gastrocystoplasty and, 757 radical, cystectomy and, 512 Shunt(s), for priapism, Barry, 210, 210 Datta, 207 distal, 207, 207 Ebbehoj, 207 El-Ghorab, 207 Goulding, 207 Hashmat-Waterhouse, 207 Kinlinc, 207 ventriculoureteral, in ureteroneocystostomy, 802, 802 Sickle cell anemia, and black patients with priapism, 207 Sigmoid artery(ies), 681, 681, 767 sigmoid conduit and, 664 sigmoidocystoplasty and, 735, 735-736 Sigmoid colon, blood supply to, 666 for bladder substitution, 780 for vaginal reconstruction, 240, 241 Sigmoid conduit, for noncontinent urinary diversion, 664-665, 664-666 incision for, 664 postoperative problems with, 666 sigmoid colon selection in, 664 function of, 624 indications for, 666 Sigmoidocystoplasty, for bladder augmentation, 735-741

Sigmoidocystoplasty (Continued) Gonzalez technique of, 740, 740 position and incision for, 735, 735, 741 postoperative care for, 740 postoperative problems with, 741 selection of segment for, 735-736, 735-736 Silicone, for ureteral stents, 68, 69 Sinus, urachal, excision of, 616, 616 Skin, blood supply to, 41, 41 eversion and inversion of, 43 in circumcision, 171 infiltration of, before nerve block procedures, 80 marks in, from tension on flap sutures. 43 preoperative preparation of, 5 scrotal, in urethral stricture flap repair. 282 suture techniques in, 35-36, 35-36 suture types used in, 33, 34 Skin clips, techniques with, 43 Skin graft(s). See Graft(s), skin. Skin preparation, for laparoscopy, 21 Skin tape, techniques with, 43 Skin test anergy, preoperative risk evaluation and, 3 Smith-Lee-Middleton procedure, for ventriculoureteral shunt. 802. 802 Smoking, flap survival and, 58 Sodium barcarbonate, for preblock skin infiltration, 80 Spence-Duckett technique, for correction of female urethral diverticula. 246-247. 246-247 Sperm granuloma, in vasoepididymostomy. 372 vasoligation and, .364 vasovasostomy and, 369 Spermatic artery(ies), in Powler-Stephens orchiopexy. 319 in varicocele ligation, 355, 355. 359-360, 359-360 Spermatic cord, anatomy of, 304 in Powler-Stephens orchiopexy. 319 in hernia repair, 341, 343-344 in orchiopexy, 309-311, 317 ligation of, in radical orchiectomy, 383. 384 Spermatic vein(s), in retroperitoneal lymph node dissection, 390, 390. 392-393 in varicocele ligation, 355, 355. 359-360. 359-360 Spermatocele, excision of, 406-408, 407 Sphincter, bladder. See Bladder, sphincter of. Spirometry, preoperative risk evaluation and, 3 Spleen, in renal artery reconstruction, 955 injury to, during nephrectomy. 1016. 1026 prevention and treatment of, 907 Splenectomy, 904-906, 904-906 partial, 904, 904 postoperative problems with, 906-907 Splenic artery(ies), 904, 904 in splenorenal bypass graft, 948. 948 Splenic vein(s), 906 Splenorenal bypass graft, for renal artery reconstruction, 944-948, 944-948 anterior approach to, 944-948, 944-948 thoracoabdominal approach to, 946-948, 946-948 Splenorrhaphy, 903, 903 after intraoperative injury, control of, 903 Splent, in hypospadias repair, 105, 105 Squadrito-Coletta technique, of laparoscopic renal biopsy, 932 SST deformity, 186, 189 Staphylococcus epidermidis, antibiotics for. in penile prosthesis insertion, 185 artificial sphincter placement and, 585 Stapler(s), ENDO GIA-30, for laparoscopic ileal conduits, 673 GIA, absorbable staples with. 701, 702 in gastrocystoplasty, 759-760, 759-760, 762 laparoscopic vascular, 993

Stapler(s) (Continued) GIA-30, for ileal conduits, 653-654, 653654 PolyGIA, in ileal neobladder construction, 773, 773 TA 55, 688-689, 688-689 Staples, absorbable, 701, 702, 704 for gastric continent reservoir, 707 technique of, 683 uses of, in laparoscopy, 28 Stenosis, anastomotic, urethral stricture repair and, 302 cutaneous ureterostomy and, 646 ileourethral, for ileal bladder substitution, 775 in ureterovaginal fistula repair, 833 meatal, hypospadias repair and, 107 MAGPI procedure and, 119 onlay island flap technique and, 133 partial penectomy and, 152 total penectomy and, 156 Mitrofanoff procedure and, 713 renal artery, renal transplantation and, 966967 repair of, 938-940, 938-940 ureteral, choice of procedure for. 786 ureterosigmoidostomy and, 725 Stent(s), double-J, 68, 68, 918 in cecocystoplasty, 731. 751 in colonic bladder substitution. 778. 778779. 779 in extracorporeal renal surgery. 10.30 in ileal bladder substitution, 771. 774, 775 in ileal conduit, 659 in ileal conduit conversion, 734 in ileocecal bladder substitution. 776. .777 in pyeloplasty, 918, 918 in renal transplantation, 965-966 in urethral reconstruction, 263 silicone, nephrolithotomy and, 1053 ureteral, 624, 83.3. 839 breakage of, 70 endoscopic placement of, 70 for intraoperative repairs, 785, 837. 839 forgotten, 70 in calicoureterostomy, 841 in ileocecocystoplasty, 754, 756 in intubated ureterotomy, 8.35, 921, 921. 922-923 in renal displacement, 831 in stone formers, 68, 70 in transureteroureterostomy, 839 in ureteral autotransplantation. 831 in ureteroneocystostomy, 790, 790, 794, 798 in ureterosigmoidostomy, 723 in ureteroureterostomy, 69, 69 migration of, 70 monitoring of, 68 problems with, 70 psoas hitch procedure and, 821 surgical techniques with, 68-70 symptoms with, 70 Stoma, appendiceal, with Mainz pouch, 698 with Penn pouch, 699, 699 in continent urinary diversion, in creation of Kock pouch, 690-691, 690-691 in continent urinary diversion, 683 in end cutaneous ureterostomy, 642, 642, 646 in ileal conduit, 662 in transureteroureterostomy, 839 problems with, in ileal conduit, 662 in noncontinent urinary diversion, 624 in radical cystectomy, 512 stenosis of, in continent reservoirs, 703 in ileal conduit, 662 in vesicostomy, 637, 641 Turnbull loop, in ileal stoma formation, 649 Stomach, blood supply to, 727, 758, 758 dilation of, in retropubic prostatectomy, 430

INDEX

Stomach (Continued) for bladder replacement, 781-782, 781-782 advantages of, 782 indications for, 782 postoperative problems with, 782 for Mitchell (gastric) reservoir, 705-706, 705-707 for urethral replacement, 782, 782 in gastrostomy, 673-674, 675-674 Streem and Bretan technique, of cadaver donor kidney retrieval, 979-981, 979-981 Stress urinary incontinence, urethral diverticulum correction and, 250 Stricture(s), hypospadias repair and, 107 ileocecal bladder substitution and, 777 total perineal prostatectomy and, 445, 464 ureteral, continent reservoirs and, 684 intubated ureterotomy for, 835 repair of, 826-829 ureterolithotomy and, 850 ureteroureterostomy for, 834-835, 834835 urethral, bulbar, 282-291 choice of procedure for, 282 excision and reanastomosis of, 282, 285-286, 285-286 grafts for, 282 patch grafts for, 286-287, 286-287 roof strips for, 282 vascularized flaps for, 282 bulbomembranous, 263, 265 patch graft urethroplasty for, 293-295, 293-295 perineal repair of, 295-298, 295-299 abdominoperineal approach to, 299 incision for, 296, 296 incontinence and, 299 indications for alternative approaches to, 299 position for, 295, 295 repair of, 292-302 transpubic excision and anastomosis for. 300-302, 300-302 transpubic excision of, postoperative problems with, 302 bulbospongiosus, 263 diverticulum excision and, 227 ileocecal bladder substitution and, 777 of fossa navicularis, 266-270, 266-270 glans split technique for, 269-270, 269-270 glans tunnel technique for, 268, 268, 270 rotation onlay flap for, 268-270, 268270 skin flap technique for, 266, 266, 270 skin graft technique for, 267, 267, 270 pendulous, 263 penile, 271-281 augmented roof strip graft for, 274275, 274-275 choice of procedure for, 271, 271t, 281 end-to-end spatulated anastomosis for, 272-273, 272-273 longitudinal island flap for (Orandi's technique), 275-278, 275-278 penis construction and, 223 preoperative preparation for, 281 staged linear urethroplasty for, 279280, 279-280 transverse island flap for (Duckett's technique), 275 vascular considerations in, 271, 271 repair of 262t, 262-265 choice of procedure for, 262, 262t complications with, 263 diversion and stenting for, 263 immediate urethral realignment for, 264-265, 264-265 instruments needed for, 262

Stricture(s) (Continued) length of, 265 technicial considerations with, 262263 urethral reconstruction for, 262-263 Studer technique, for ileal bladder substitution, 774, 774 Subclavian vein(s), percutaneous puncture of, 91 Subdartos pouch, for testis after hydrocele repair, 349 Suprapubic fistula(s), in retropubic prostatectomy, 4.30 Surgeon(s), equanimity of, 2 general guidelines for, 2 position of, during procedure, 9-10 Surgery, basic techniques in, bowel stapling, 64-67 closure of bowel lacerations, 87-89 flaps and grafts, 41 -59. See also Flap(s); Graft(s). microsurgery, 60-63. See also Microsurgical techniques. nerve block methods, 75-80. See also Nerve(s), block of. omentum mobilization, 71-74 suturing techniques, 32-41. See also Suture(s); Suture techniques. ureteral stents, 68-70. See also Stent(s), ureteral. vascular access, 90-94 vascular injury repair, 81-86 intraoperative management of, blood loss in, 11, 11t catheters in, 13-14, 13-14 drains in, 12, 12 dressings in, 15, 15 patient positioning in, 9 postoperative nerve block in, 15 principles of, 9-15 protection of surgical team in, 9 surgeon's assistants in, 9 surgeon's position in, 9-10 surgical techniques in, basic, 10-11 patient preparation for, 3t, 3-6, 5t postoperative management of, 16-18 preoperative preparation for, 4-7 avoidance of postoperative complications and, 5 checklist for, 5, 5t for outpatient surgery, 4 medications for, 6 of bowel, 6 of instruments, 4-5 of operative suite, 5 of patient, 4, 5t of vascular access, 6 operating room survey and, 7 patient protection during, 7 prevention of infection and, 6 procedural review for, 3, 7 strategy and tactics in, 2 Surgiport, 25 Suture(s), in flaps, 43, 58 in nephrectomy, 992 in psoas hitch, 833 in tube grafts for urethra, hypospadias repair, 146 in ureteroneocystostomy, mattress anchoring in, 798 on GU cart, 4, 1081 stapling for, in bowel stapling technique, 67 stay, 9 transvesical anchor, using Robinson catheter, 14 types of, 32-33, 33t absorbable and nonabsorbable, 33. 33t, 967 catgut, 32-33, 331 Dexon, 34 for fascial closure, 34

1167

Suture(s) (Continued) Maxon, 34 polydioxanone, 34 polyglycolic acid, 33, 33t, 777 Prolene, 34 vascular, 86, 378 Vest, 292, 444 Suture technique(s), EndoStitch device and, in laparoscopy, 27 in arterial anastomoses, 61-62, 61-62 in bowel, 37-40, 37-40 Connell, 37, 37, 40 figure-eight, 39, 39 Gambee inverting suture with near-far suture, 40, 40 Lembert, 38, 38, 87-89, 87-89 lock-stitch, 39, 39 Parker-Kerr, 39, 39 purse-string, 39, 39 tissue sealer for, 40 in colposuspension, 552-553, 552-553 in correction of chordee, 100, 176 in cystourethropexy, 546-548, 546-548 in fascia, 28, 36-37, 36-3 7 far-and-near, 36, 36 Gambee stitch, 37, 37 interrupted, 36, 36, 40 near-and-far, 37, 37, 40 Smead-Jones fascial closure technique, 37, 37 vertical mattress, 37, 37 in bowel, 37 in hypospadias repair, 99, 146 in laparoscopy, 27, 31 in nephrectomy, 992 in pyeloplasty, long suture technique in, 917 in renal transplantation, 1084 in skin, 35-36, 35-36 everting interrupted, 36, 36 for subcuticular closure, 35, 35, 40 Halstead mattress, 36, 36 skin clips for, 36 vertical mattress suture, 35, 35, 40 in total retropubic prostatectomy, alternative techniques for, 443 for closure, 441-444, 441-444 tying of, 443 vest, 444 in urethral stricture repair, 262 in vaginal needle suspension, 561, 561, 563, 563 in vascular structures, 378 in vasovasostomy, basic set of, 1083 knot tying, 32, 32 in microsurgical vessel anastomoses, 62 purse-string, in prostatectomy,419, 420, 420 tension on flap and, 58

T Tanagho-Flocks procedure, for vesical neck tubularization, 573-574, 573-575 Tegaderm, 106, 173 Tela subfascial, 283, 283 Telfa pad, 106 Temperature, monitoring of, during anesthesia, 8 Tendon(s), adductor longus, in gracilis myocutaneous flap, 51 conjoined, in inguinal hernia repair, 342, 342 . Testicular artery(ies). See Artery(ies), testicular. Testicular vein(s), anatomy of, 352, 352 Testis(es), abdominal, Fowler-Stephens orchiopexy and, 320 laparoscopic identification and removal of, 325, 337, 379 microvascular orchiopexy and. 325

1168

INDEX

Testis(es) (Continued) anatomy of, 303, 304 atrophy of, Fowler-Stephens orchiopexy and, 320 vasoepididymostomy and, 372 biopsy of, 305-306, 305-307, 382, 384 complications with, 307 in inguinal orchiopexy, 311 Indications for, 307 percutaneous needle, 307 blood supply to, 303, 304 Fowler-Stephens orchiopexy and, 318, 320 circulation of, 304 devascularization of, orchiopexy and, 315 epididymectomy and, 409, 409-410 excision of, 373-410 anatomy relevant to, 373, 374 orchiectomy for, 375-378 testicular torsion and, 347 extrusion of, orchiopexy and, 315 fixation of, with testis torsion, 348 hydrocele correction and, 349-351, 349351 injury of, complications with, 219 ischemia of, orchiopexy and, 315 lymphatic drainage of, 373, 374 nonpalpable, Fowler-Stephens procedure and, 330 laparoscopy and, .308, 330, 331-337. 376 orchiopexy for, 315, 326-329, 326-330 possible locations of, 332 salvage-ability of, 3.30 principles of operations on, 304 prostheses for, insertion of following orchiectomy, 378 replacement of, in growing child, 378 retroperitoneal, in orchiopexy, 329 retroperitoneal lymph node dissection and, 385-403, 386-402 approaches to, 385 thoracoabdominal, 394-402, 394-402 transabdominal, 387-393, 387-393 closure of, 393, 402, 402 commentary on, 403 dissection in, 390-393, 390-393, 396401, 396-401 incision in, 387-389, 387-389, 394, 394 intraoperative management of, 402 laparoscopic, 404, 404-405 complications with, 405 limited template technique of, 405 nerve sparing in, 385-386, 386 postoperative management of, 402-403 preparation for, 385 salvage surgery for, 403 staging of tumor and, 385 rupture of, repair of, 219, 219 spermatocelectomy in, 406-407, 406-408 torsion of, reduction of, 347-348, 347-348 tumors of. See Tumor(s), testicular. varicocele ligation and, 352-358 vasoligation and, 362-364 Testosterone, hypospadias repair and, 96 scrum, 308 Thermal injuries, in laparoscopy, 30 Thiersch-Duplay procedure, for hypospadias repair, 140-141, 140-141 Thigh flaps, for scrotal coverage, 218, 219 for vaginal reconstruction, 234-235, 234235, 241 Thigh pouches, for scrotal coverage, 218, 218, 219 Thrombectomy, vena caval, 1031-1039, 1031-1040 classification of, 1032 diagnostic studies with, 1031 incisions for, 1032 thrombus with left renal tumor and, 1039, 1039 thrombus with right renal tumor and, 1032

Thrombectomy (Continued) with infradiaphragmatic intrahepatic extension, 1032-1034, 1032-1034 with supradiaphragmatic intracardiac extension, 1039-1040 with supradiaphragmatic suprahepatic extension, 1034-1039, 1034-1039 Thrombophlebitis, in total retropubic prostatectomy, 445 Thrombosis, arterial, renal transplantation and, 966 deep vein, ileocecal bladder substitution and, 777 ilioinguinal lymphadenectomy and, 164 laparoscopy and, 30, 473 pelvic lymphadenectomy and, 468, 473, 521, 524 radical cystectomy and, 511 pelvic exenteration and, 534 renal artery, autotransplantation and, 831 traumatic, 935, 935, 936 renal vein, radical nephrectomy and, 1018, 1024 venous, renal transplantation and, 966 Thrombus, tumor, removal of, from vena cava, 1016 Tincture of benzoin, 57 Tissue, reactivity of, to suture material, 32-33 Tissue expansion, for scrotal formation, 218 for vaginal reconstruction, 236, 236, 241 Tissue sealer, for bowel sutures, 40 Toldt, while line of, 673, 735, 741, 742, 854. 854, 993 Tomography, computed, retroperitoneal fibrosis and, 829 whole lung, for staging of testis cancer, 385 Transitional cell carcinoma, evaluation and localization of, 1008, 1015 nephroureterectomy for, 1008 of renal pelvis, laparoscopic nephrectomy for, 993, 996 of solitary kidney, extracorporeal renal surgery and, 1030 Transureteroureterostomy, 838-839, 838-839 left-to-right, 838-839, 838-839 with cutaneous stoma, 839 indications for, 839 Transverse colon conduit, function of, 624 Trauma, Peyronie's disease and, 205-206 renal, penetrating, 935, 935, 936 Trigonal tubularization (Guy-Leadbetter), for urinary stress incontinence, 570-571, 570-572 in children, 572 incision for, 570 Mitchell disassociation technique of, 572 position for, 570 postoperative problems with, 572 preoperative preparation for, 570 Trigonoplasty, percutaneous endoscopic, in laparoscopic ureteroneocystostomy, 801 Trocar(s), defined, 23 in laparoscopy, 23, 23, 27, 30 types of, 31 Trunk, flaps on, preparation of, 43 Tube(s), Firlit-Kluge, 105 Medina, in Kock pouch formation, 689691, 689-692 Tube graft(s), complications with, 146 for repeat hypospadias repair, 112 Tubed grafts), 112, 288, 288 Tubed preputial island flap, for hypospadias repair, 134-136, 134-136 Tuberculosis, epididymectomy and, 410 Tubes. See also Catheter(s). method of securing, 14 nephrostomy. See Nephrostomy. suprapubic drainage with, 14 Tumor(s). See also Carcinoma. adenoma, in adrenalectomy, 1058-1059

Tumor(s) (Continued) adrenal, extracapsular, adrenalectomy with nephrectomy for, 1069-1071, 10691071 aldosterone-secreting, adrenalectomy with nephrectomy for, 1071 bilateral, 1000 cells spilled from, in partial cystectomy, 504 extracorporeal surgery for, 1000 identification of, prior to nephrectomy, 986 partial nephrectomy for, 1000, 1000 preoperative preparation for, 1000 testicular, benign, 384 bilateral, 384 evaluation of, 385 lymph node dissection in, 385-403, 386402. See also Testis(es), retroperitoneal lymph node dissection in. malignant, 380-384 preparation for lymph node surgery with, 385 radical orchiectomy and, 380-384 staging of, 385 Tunica albuginea, 166, 166 in correction of penile curvature, 174-175, 174-175 in erection, injury of, 166 in testicular biopsy, 306, 306 Peyronie's disease and, 205-206 plication procedure in, in dissection of chordee, 100, 132, 132 vessels in and outside of, Fowler-Stephens orchiopexy and, 320 Tunica vaginalis, in hydrocele repair, 349-351, 349-351 testis in. in orchiopexy, 309-310, 309-311 Tunica vaginalis graft(s), for chordee repair, 113 Tumbull loop stoma, in ileal conduit, 657, 657 Turner-Warwick incision, for bladder surgery, 497-498, 497-498 Turner-Warwick urethroplasty, for urethral stricture repair, 290

U Ulcers, gastric, radical cystectomy and, 511 Ultrasonography, retroperitoneal fibrosis and, 829 with vena caval thrombectomy, 1031, 1040 Umbilical artery(ies), obliterated, 767 Umbilicus, in inferior rectus abdominis flap, 54 in stoma formation, for Kock pouch, 690 Uncircumcision, 173, 173 Undiversion, 726 Urachus, 26, 26 excision of, 614-616, 614-616 of patent urachus, 614-616, 614-616 of urachal carcinoma, 616 of urachal cyst, 616 of urachal diverticulum, 616 of urachal sinus, 616, 616 postoperative problems with, 616 Ureter(s), anastomosis of, in ileocecocystoplasty, 754, 756, 756 in Kock pouch formation, 690 with continent pouch, technique of, 683 with intestines, in ileal bladder substitution, 770, 770 reflux and, 771 as substitute for appendix, in Mitrofanoff procedure, 712, 712 autotransplantation for, 831 blood supply to, 783 in donor nephrectomy, 978 ureterocystoplasty and, 764 cancer of, 1015 devascularization of, ureterolithotomy and, 850

INDEX

Ureters) (Continued) duplicated, correction of, 809-814 diagnostic procedures for, 809 reflux in, choice of procedure for, 809, 813 ureterectomy for, 813, 813 ureteroneocystostomy for, 809-810, 809-810 ureteropyelostomy for, 812, 812 ureteroureterostomy for, 810-811, 810-811 upper pole, heminephrectomy for, 812, 812 implantation of, ileal hydraulic valve conduit and, 716 in colon bladder substitution, 778-779, 779 in gastric bladder replacement, 781 in renal transplantation, 964-965, 964965 in Mitrofanoff procedure, 708 in nephroureterectomy, 1013-1014, 10131014, 1015 in radical nephrectomy, 1019, 1019 in transperitoneal laparoscopic nephrectomy, 996 in vesical diverticulectomy, 541 injury of, bilateral, 822 choice of procedure for, 786 in retroperitoneal lymph node dissection, 402-403 intraoperative, 30, 402, 445, 463-464, 473, 785, 837, 839 signs of, 785 with ureterolysis and ureteral stricture repair, 829 intramural, in nephroureterectomy, 1014 obstruction of, colposuspension and, 555 continent reservoirs and, 684, 703 in renal transplantation, 966 in retropubic prostatectomy, 430 in total retropubic prostatectomy, 445 partial cystectomy and, 504 ureteral stents and, 70 ureterolysis and ureteral stricture repair and, 829 ureteroneocystostomy and. 801, 802, 807 occlusion of, total perineal prostatectomy and, 464 reconstruction of, principles of, 784, 784785 reimplantation of, gastric continent reservoir and, 707 in refluxing duplicated ureters, 813 in ureterocele repair, 817 in ureterovaginal fistula repair, 832-833 procedures for, 787-802. See also Ureteroneocystostomy. psoas hitch procedure for, 821, 833, 833 removal of, in laparoscopic nephroureterectomy, 996 repair of, autotransplantation for, 831 intraoperative, 837 psoas hitch procedure for, 818 renal displacement for, 830-831, 830831 ureteroureteral anastomosis in, technique of, 835-836, 835-836 replacement of, ileal, 842-845, 842-846 bilatdral total and subtotal, 845, 845 dissection and anastomoses in, 843845; 843-845 incision for, 842, 842 mobilization of segment in, 842, 842 postoperative problems with, 846 retrocaval, anastomosis of 837, 837 short, calicoureterostomy and, 840-841 psoas hitch procedure and, 818 reimplantation of, in ureterovaginal fistula repair, 833 renal mobilization for, 836, 836 stenosis of, choice of procedure for, 786

Ureter(s) (Continued) ileal conduit and, 662 sigmoid conduit and, 666 stents for, 68-70 stricture of, repair of, 826-829 stripping of, in laparoscopic nephroureterectomy, 996 wall of, adventitia of, 784, 785 blood vessels of, 784, 785 structure of, 784, 784-785 ureteral sheath of, 784, 784-785 Ureterectomy, for duplicated refluxing ureters, 813, 813 in nephroureterectomy, 1013-1014, 10131014 Ureteroceles, asymptomatic, cystoscopic incision of, 817 repair of, 815-817 diagnostic procedures for, 815, 817 ectopic, 815 excision of ureterocele in, 817 heminephrectomy for, 815 intravesical, 815-817, 815-817 residual ureteral stump and, 817 management choices for, 815, 815t postoperative problems with, 817 ureteral dilation in, 815 Ureterocutaneous fistula(s), renal transplantation and, 965 Ureterocystoplasty, 763, 763-764 Ureteroileostomy, function of, 624 Ureterointestinal anastomoses, Camey-LeDuc technique of, 770, 770 techniques of, 683, 683t Ureterolithotomy, 847-851 approaches to, 847 for nonpalpable stone, 849 in lower third, 847-848, 847-848 laparoscopic, 995-997 retroperitoneal, 851 transperitoneal, 851 postoperative problems with, 850 secondary, 850 transvesical, 849 vaginal, 849-850, 849-850 Ureterolysis, for retroperitoneal fibrosis, 826-829 excision and reanastomosis of ureter for, 829 extraperitoneal placement of ureter in, 828, 828 intraperitoneal displacement of ureter in, 828, 828 omental sleeve for extensive fibrosis, 829, 829 postoperative problems with, 829 with extensive fibrosis, 827, 827 with limited fibrosis, 826-827, 826-827 Ureteroneocystostomy, 786-802 choice of technique for, 786 extracorporeal renal surgery and, 1030 extravesical approach to, 964 detrusorrhaphy in, 799, 799 external tunnel (Barry technique), 786, 797-798, 797-798 extravesical tunnel (Lich-Gregoir), 786, 795-796, 795-796 Hodgson-Firlit-Zaontz procedure in, 799, 799 in renal transplantation, 964, 967 intra-extravesical technique (Paquin technique) in, 799 for refluxing duplicated ureters, 809-810, 809-810 indications for, 786 laparoscopic techniques in, 800, 800, 801 Politano-Leadbetter technique of, in transvesical approach, 786, 789-791. 789791 psoas hitch procedure with, 820, 820, 821, 833 postoperative problems in, 801

1169

Ureteroneocystostomy (Continued) psoas hitch with, 820, 820, 821 in ureterovaginal fistula repair, 833, 833 reoperation for, 801, 802 transvesical approach to, 787-794 anastomoses in, 790, 790 Glenn-Anderson technique in, 786, 792, 792 in renal transplantation, 964-965, 964965 incision in, 787, 787 intra-extravesical technique in, 786, 789791, 789-791 Politano-Leadbetter technique in, 786, 789-791, 789-791 sheath approximation technique (GilVernet) in, 794 spatulated nipple technique in, 784, 794 transtrigonal technique (Cohen) in, 786, 793, 793 ureteral advancement technique in, 786, 792, 792 ureteral mobilization in, 786-788, 787788 ureterocele repair and, 816, 817 ventriculoureteral shunt for, 802, 802 Ureteroneocystostomy with tailoring, for megaureter, 803-807, 803-808 alternative folding techniques for, 807, 807, 808 alternative tailoring techniques for, 806, 806 alternative technique for (HodgsonZaontz), 806 duplex systems in, 805 incision for, 803, 803 postoperative problems, 807 Ureteropelvic junction, obstruction of, correction of, 924 pyeloureteroplasty and, 922, 923 Ureteropyelostomy, for duplicate refluxing ureters, 812, 812 indications for, 813 for ureteroceles, 817 Ureterosigmoidostomy, 717-726 alternatives to, ileocecal (Rink-Retik procedure), 723 Mainz pouch II with (sigma rectum pouch) and, 724, 724 modified rectal bladder (Kock, Ghoneim), 725, 725 others, 725 rectum in, 724 closed technique of (Leadbetter), 717 closed technique with ureteral spatulation (Kelalis modification), 720, 720 ileal hydraulic valve conduit for, 716 in children, 717 postoperative care for, 723 postoperative problems with, 725 revision of ureterocolic anastomosis in, 726 stents in, 723, 723 transcolonic technique of (Goodwin), 720723, 720-723 Ureterostomy, end cutaneous, 642-643, 642-643, 930 and pyelostomy, 642-646, 642-646 double-barreled, with Z-plasty, 645, 645 function of, 624 incision in, 642 indications for, 646 postoperative problems with, 646 stoma formation in, 642-643, 642-643 transureteroureterostomy with cutaneous stoma in, 644, 644, 646 in situ, 642, 930, 930 function of, 624 uses of, 928, 930 Uretero-subperitoneal artery(ies), 784, 785 Ureterotomy, intubated (Davis procedure), 920, 921 Ureteroureterostomy, 834-836, 834-836

1170

INDEX

Ureteroureterostomy (Continued) Boari flap and, 826 for bladder augmentation, 763 for duplicate refluxing ureters, 810-811, 810-811, 813 indications for, 813, 834 renal mobilization for, 836, 836 retroperitoneal approach to, 834-835, 814835 transperitoneal approach to, 835 ureteroureteral anastomosis in, technique of, 835-836, 835-836 Uterovaginal fistula, Boari flap in, 833 repair of, 832-833, 832-833 Ureterovaginal fistula(s). Sec Fistula(s), ureterovaginal. Urethra, bulbar, exposure of, 283-284, 283-284 mobilization of, 296-298, 296-298 calibration of, in hypospadias repair, 106 in Mathieu procedure, 125 carcinoma of, choice of procedure for, 150, 153 continent vesicostomy for, 641 diverticulum of. Sec Diverticulum, urethral. female, caruncle of, excision of, 252, 252 construction of, 251, 251 prolapse of, excision of, 253 gastric replacement of, 782, 782 gray, 262 in partial penectomy, 151-152 in prostatectomy, 436 in ventral lube repair of hypospadias, 141 injury to, in circumcision, 171 in correction of priapism, 210 in penile fracture, 213, 213 in penile prosthesis insertion, 186, 193 severe, immediate management of, 292 intravesical lengthening of, Kropp-Angewafo procedure for, 576-578, 576-579 Pippi Salle procedure for, 579, .579 loss of, penile construction and, 223 male, anatomy of, 261 penile, blood supply to, 271, 271 prostatomembranous, disruption of, immediate urethral realignment for. 265 distraction defect of, evaluation of, 292 immediate management of, 292 principles of treatment of, 292 surgical approaches to, 292 severe injuries of, immediate management of, 292 strictures of. See Strictures, urethral, bulbomembranous. reconstruction of. See also Stricture(s), urethral rupture of delayed repair of, 265 strictures of. See also Strictures, urethral. complications with, 263 diversion and stenting for, 263 selection of operation for, 262, 262t technical considerations for, 262-263 tube grafts for, in hypospadias repair, 146 Urethral plate, definition of, 133 in correction of chordee, 100, 134 Urethrectomy, 513-515, 513-516 in males, 513-514, 513-514 as separate procedure, 515, 516 in radical cystectomy, 510 incision for, 513, 513 indications for, 513 position for, 513 postoperative problems with, 515 Urethrocutaneous fistula(s). See Fistula(s), urethrocutaneous. Urethrolysis, transvaginal, for revision of cystourethropexy, 548 Urethroplasty, flap roof-strip, 290 for urethral stricture repair, 279-280, 279280, 290 onlay island flap and, 132

Urethroplasty (Continued) patch graft in, for bulbomembranous urethral stricture repair, 293-295, 293295 substitution, in perineal repair, 299 Urethrorectal fistula(s), total perineal prostatectomy and, 464 Urethrostomy, perineal, 630-631, 630-632 complications with, 632 function of, 624 grooved sound technique of, 630-631, 630-632 in obese patients, 632 indications for, 632 permanent, 632 vs. Otis urethrotomy, 632 Urethrotomy, for urethral stricture repair, 282 Urethrovaginal fistula, repair of, 242-245, 242-245 Urethrovaginal fistula(s), repair of, 242-245, 242-245 Urinary bladder. Sec Bladder. Urinary conduits, function of, 624 Urinary diversion, continent, 677-726 blood supply of bowel and, 677, 678 elements of, 678, 682, 692 gastric reservoir for, 705-707 ileal hydraulic valve conduit for, 7/5, 715-716 ileal reservoir for (Kock pouch), 686691, 686-692 ileocecal reservoir for, 693-703. 693-704 indications for and contraindications to, 682 postoperative problems with, 684-685 preoperative assessment for, 683 principles of, 678-685 procedures for, 678t reflux from, prevention of, 683 revisions of, 684 rupture of pouch with, 684 selection of procedure for, 682 stoma in, positioning of, 683 take-down of, 682-683 ureterosigmoidostomy for, 717-726 drippy-tube method of, 113, 129 in hypospadias repair, 105, 105, 113, 146 in urethral reconstruction, 263 noncontinent, 623-676 anatomy relevant to, 623 appendectomy and, 675-675, 675-676 ascending colon conduit and, 668 complications from, 624 cutaneous ureterostomy and pyelostomy for, 642-646, 642-646 cystostomy for, 625-629 follow-up for, 624 gastrostomy for, 673-674, 673-674 ileal conduit for, 647-663 ileocecal antirefluxing conduit for, 668 perineal urethrostomy for, 630-632 principles of, 624 procedures for, 678t sigmoid conduit for, 664-665, 664-666 transverse colon conduit for, 667-668, 667-668 types of procedure for, 624 vesicostomy for, 633-641 subcutaneous, 928 suprapubic, in urethral reconstruction, 263 with radical cystectomy, 511-512 Urinary fistula(s), with Mitrofanoff procedure, 713 Urinary tract, contamination of, rectourethral fistula repair and, 480 deterioration of, continent reservoirs and, 684 suture types used in, 33, 34 Urination, painful, gastric bladder replacement and, 782 Urine, collection of, preoperative evaluation and, 3

Urine (Continued) drainage of, psoas hitch procedure and, ureterolithotomy and, 850 with renal injuries, 936 leakage of, appendicovesicostomy and, 71 autotransplantation and, 831 cystourethropexy and, 545 from continent reservoirs, 684 from Kock pouch, 692 ileal conduit and, 662 ileal ureteral replacement and, 846 ileocecal bladder substitution and, 777 partial cystectomy and, 504 partial nephrectomy and, 1004 perineal urethrostomy and, 632 peritoneal dialysis and, 972 prostatectomy and, 421 pyeloureteroplasty and, 922 radical cystectomy and, 511 renal transplantation and, 965 sigmoidocystoplasty and, 741 total perineal prostatectomy and, 464 total retropubic prostatectomy and, 445 ureteral reimplantation in ureterovaginal fistula repair and, 833 ureteral repair and, 839 ureteroneocystostomy and, 801 ureterosigmoidostomy and, 725 vesical diverticulectomy and, 541 vesical neck closure and, 613 vesicovaginal fistula repair and, 600 obstruction of, ileal bladder substitution and, 775 nephrostomy and ureterostomy and, 930 with ileal ureteral replacement, 846 retention of, circumcision and, 171 ileal bladder substitution and, 775 in continent reservoirs, 684 penile prosthesis insertion and, 184 pubovaginal sling procedure and, 569 trigonal tubularization and, 572 vaginal needle suspension and, 564 Urinoma(s), Kock pouch and, 692 partial nephrectomy and, 1004 pyeloureteroplasty and, 922 renal injuries and, 936 ureteral repair and, 839 ureterolithotomy and, 850 Urography, intravenous, for renal injury staging, 933 Urology residents, hypospadias repair by, 106 Uterine artery(ies), in hysterectomy, 259, 259 Uterine tube, in hysterectomy, 258, 258 Uterine vein(s), in hysterectomy, 259 Utricle, prostatic, excision of, 484, 484 Utricular cyst, excision of, 228, 228 posterior sagittal resection of, 228 transtrigonal approach to, 228, 228

V Vagina, cystostomy approach through, 628-629, 629 in abdominal hysterectomy, 260, 260 in vesicovaginal fistula repair. See Fistula(s), vesicovaginal, repair of. reconstruction of, 231-240, 231-241 candidates for, 241 cecum for, 238-240, 238-240, 241 complications with, 238 formation of perineal cavity for neov. in, 231 gracilis myocutaneous flap for, 237, 23. 241 labia minora flaps for, 235 male-to-female transformation and, 241 perineal pressure technique for, 240 pudendal thigh flap for, 234-235, 234235, 241 sigmoid for, 240, 241 skin graft inlay for (Abbe-Mclndoe), 231 233, 231-233, 241

INDEX Vagina (Continued) tissue expansion technique for, 236, 236, 241 vulvovaginoplasty for, 235 short blind, perineal pressure technique for, 240 Vaginal needle suspension, anterior vaginal wall sling in, vaginal sutures in, 559 bladder neck suspension (Pereyra-Raz) and, 558-560, 558-561 vaginal sutures in, 559 cystocele repair with, major, 562-563, 562563 minimal, 560, 560 vaginal sutures in, 559 for urinary stress incontinence, 558-563, 558-564 needle suspension in, 560, 560 postoperative problems with, 564 Vaginal wall sling procedure, indications for, 564 Valtrec ring, for colonic anastomosis, 780 Valve(s), afferent and efferent, malfunction of, with Kock pouch, 692 ileocecal, in ileocecocystoplasty sphincter plication technique, 754-755 reconstruction of, 703 tests of competence of, 753 Valve fistula(s), in ileal hydraulic valveconduit, 716 Vanillylmandelic acid levels, adrenalectomy for pheochromocytoma and, 1059, 1074 Varicocele, ligation of, 352-357, 352-358 anatomy relevant to, 359 anesthesia for, 353, 358 approaches to, 352, 352 abdominal (Palomo), 356-357, 356357 choice of, .358 inguinal (Ivanissevich), 354-356, 354356 subinguinal (Marmar), 353, 353 subinguinal mini-incision microsurgical (Goldstein), 353 bilateral, 361 identification of testicular artery in, 358 laparoscopic, 359-360, 359-361 left and right, 361 postoperative problems with, 358 recurrence of, 358 Vas deferens, 26, 26 blind ending, laparoscopy and, 326 location of, in orchiopexy, 329, 330 nonpalpable testis and, 332 congenital absence of, 364 in inguinal hernia repair, 344 in orchiopexy, blind ending, 329-330 division of, 315 in Fowler-Stephens procedure, 318-320, 319 laparoscopic, 335 ligation of, 362-364, 362-364 no-scalpel technique for, 364, 364 postoperative problems with, 364 scalpel technique for, 362-363, 362-364 with radical orchiectomy, 383, 384 long-loop, 318, .320 vasoepididymostomy of, 369-372, 369-372 vasovasostomy of, 365-368, 365-369 Vascular access, by radial artery-cephalic vein strum, for temporary dialysis, 968-969 968-970 catheter insertion in, for chronic ambulatory peritoneal dialysis, 970-972 970973 preoperative preparation for, 6 techniques of, 90-94 complications with, 94 for central venous catheterization, 92-93, 92-93, 94 cutdown peripheral vein catheterization, 90-91, 90-91

Vascular access (Continued) for percutaneous cephalic vein cannulation, 90, 94 Vascular graft(s), for renal artery thrombosis repair, 935 Vasoepididymostomy, 369-372, 369-372 end-to-end anastomosis in, 369-370, 369370 end-to-side anastomosis in, 370-372, 370372 Vasovasostomy, 365-368, 365-369 anastomosis of convoluted vas in, 369 anastomotic failure with, 369 modified one-layer closure in, 366-368, 366-368 position of surgeon and patient for, 365, 365 postoperative problems with, 369 repeat, 369 two-layer closure in, 368, 368-369 Vein(s), adrenal; in adrenalectomy, 1064, 1080 in renal resection, 984, 984 in retroperitoneal lymph node dissection, 390, 390 in splenorenal bypass graft, 947, 947 radical nephrectomy and, 1026 anastomoses of, after renal transplantation, 966-967 microsurgical technique for, 62 basilic, cutdown catheterization of, 92 cavernous, in correction of penile venous leakage, 200 in proximal shunt for priapism, 210, 210 of penis, 177, 178 central, catheterization of, 92-93, 92-93 cephalic, cutdown catheterization of, 9091, 90-91 identification of, 90 percutaneous cannulation of, 90 radial artery shunt with, in renal transplantation, 968-969, 968-970 cremasteric, anatomy of, 352, 352 dorsal, in correction of penile venous leakage, 199, 199 in prostatectomy, 433, 433, 434 in proximal shunt for priapism, 210, 210 of penis, 177, 178 epigastric artery anastomosis with, 197 for penile graft, 203, 203 draining testis and vas deferens, anatomy of, 352, 352 epigastric, in microvascular orchiopexy, 324, 324-325 in pelvic lymphadenectomy, 519, 519520 inferior, in orchiopexy, 311,311 inferior rectus abdominis flap and, 59 superficial, penile lymph nodes near, 158, 158 facial, 92, 92 forearm, for radial forearm flap for penile construction, 220-221, 220-221 gonadal, in radical nephrectomy, 1019, 1019, 1024, 1024, 1026 in renal resection, 984, 984 in transperitoneal laparoscopic nephrectomy, 996 hepatic, injury to, adrenalectomy and, 1080 iliac, common, repair of, 82-84, 82-84 external, anastomoses of, in renal transplantation, 958, 958, 966-967 pelvic lymphadenectomy and, 521 repair of, 82-84, 82-84 injuries of, repair of, 81-84, 81-84, 475 jugular, catheterization of, 92-93, 92-93 lumbar, in radical neplucctomy, 10i8, 1024, 1024 in renal resection, 984, 984 in retroperitoneal lymph node dissection, 390, 390, 392-393 injuries of, repair of, 84, 84

1171

Vein(s) (Continued) obturator, in pelvic lymphadenectomy, 520 injury to, in laparoscopic pelvic node dissection, 475 pampiniform plexus, anatomy of, 352, 352 pelvic, repair of injuries of, 82, 82 penile. See also Vein(s), dorsal, of penis. anatomy of, 198, 198 leakage from, 198-200, 198-200 peripheral, cutdown catheterization of, 9091, 90-91 portal, in adrenalectomy, 1080 renal, in nephrectomy, ligation of, 992 in nephroureterectomy, 1010, 10101011 in partial nephrectomy, 1004 in radical nephrectomy, 1018, 1024, 1024 in renal injury repair, 933, 933 in subcapsular nephrectomy, 999 left, in retroperitoneal lymph node dissection, 390, 390 right, in renal resection, 984, 984 in renal transplantation, 961 saphenous, for penile graft, 203, 203 harvest of, 953, 953 in gracilis myocutaneous flap, 52 in ilioinguinal lymphadenectomy, 160161, 160-161, 164 in patch graft angioplasty, for renal artery reconstruction, 951, 951 in penile construction, 223 in proximal shunt for priapism, 209-210, 209-210 in renal artery reconstruction, 954 of penis, 148, 148 patch graft of, 81, 83, 83 tube graft of, 84, 84 spermatic, in retroperitoneal lymph node dissection, 390, 390, 392-393 in varicocele ligation, 355, 355, 359-360, 359-360 splenic, 906 subclavian, percutaneous puncture of, 91 testicular, anatomy of, 352, 352 uterine, in hysterectomy, 259 Vena cava, access to, through retroperitoneal incision, 864, 864 in radical nephrectomy, 1016, 1018, 1026 in ureterolysis, 827, 829 inferior, temporary occlusion of, in-vena cava thrombectomy, 1040 injury to, in adrenalectomy, 1080 repair of laceration of, 81, 81 right renal vein patch of, in renal transplantation, 967 thrombus of, removal of, 1031-1039, 1031-1040 Venacavography, with vena caval thrombectomy, 1031, 1040 Ventilation, artificial, indications for, l6t Veress needle, for laparoscopy, 30-31 in children, 29, 38 laparoscopic technique with, 21, 22 Vesical artery(ies), 500, 500, 767, 784, 785, 819 Vesical neck. See also Bladder neck. contracture of, in prostatectomy, prevention of, 428, 430 treatment of, 429, 429 female, closure of, 609-613 approaches to, transvaginal, 611-612, 611-612 urethral, 610-611, 610-611 vesical with urethral inversion, 609610, 609-610 postoperative problems with, 613 pubovaginal sling for, 613 male, closure of, 613 tubularization of (Tanagho-Flocks), 573574, 573-575 indications for, 575

1172

INDEX

Vesical neck (Continued) postoperative problems with, 575 rationale for, 575 requirements for, 573 Vesicocutaneous fistula(s), renal transplantation and, 965 Vesicosigmoid fistula, closure of, 601-608, 601-608 Vesicosigmoid fistula(s). See Fistula(s), vesicosigmoid. Vesicostomy, 633-641 bladder tubularization with, 638-640, 638640 with anterior flap in continent vesicostomy, 640, 640 with posterior flap tube, 638-639, 638639 closure of, 635, 635, 637 continent, incomplete continence in, 641 continent revision of, 639, 639, 640, 640, 641 function of, 624 ileovesicostomy, for absent intermittent catheterization, 641, 641 in adults, 633-634, 633-634 in children, 636-637, 636-637 postoperative problems with, 637, 641 Vesicourethral fistula(s), appendicovesfcostomy and, 714 Vesicovaginal fistula(s), See Fistula(s), vesicovaginal. Vessel(s). See also Artery(ies); Vein(s). arcuate, in polar partial nephrectomy, 1001 celiac, in radical nephrectomy, 1026 crossing, dismembered pyeloplasty and, 997 epigastric, in microvascular orchiopexy, 324, 324-325 inferior, in inguinal hernia repair, 344, 344-345, 346 in laparoscopy, 26, 26-27 in musculocutaneous flaps, 50, 50 gonadal, in ureterocystoplasty, 764 iliac, external, anastomoses with renal artery, 966-967 in inguinal Hernia repair, 344, 344 injury to, in laparoscopic procedures, 30, 473 in radical cystectomy, 510 in retroperitoneal lymph node dissection, 402 intraoperative, 86 repair of, 81-86

ISBN 0-7216-6404-0 90071

Vessel(s) (Continued) mesenteric, division of, 683 obturator, in pelvic node dissection, 467, 467, 468 patency of, tests for after microsurgical anastomoses, 62 penile, 148-149, 148-149 exposure of, 195, 195 pudendal, Hodgson III flap and, 139 spermatic, in inguinal hernia repair, 344 in orchiectomy, 375 in orchiopexy, Fowler-Stephens, 318, 320 location of, 329, 330 microvascular, 324, 324-325 splenic, anatomy of, 904, 904 compression of, 903 suture types used in, 33, 34 testicular, 304 laparoscopic localization of, 326 ureteral, in donor nephrectomy, 978 vasal, in Fowler-Stephens orchiopexy, 318 Vest closure method, for total perineal prostatectomy, 462, 462 Vitamin B12 deficiency, cecocystoplasty and, 752 continent reservoirs and, 685 ileocecocystoplasty and, 754 Kock pouch and, 692 radical cystectomy and, 512 sigmoidocystoplasty and, 741 Voiding, delayed, colposuspension and, 555 difficulty with, 768 cystourethopexy and, 548 retropubic prostatectomy and. 430 sacral laminectomy for pacemaker placement and, 617-622 vaginal needle suspension and. 564 perineal control of, with biofeedback, 768 Volume depletion, postoperative signs of, 17 Vulvovaginoplasty, for vaginal reconstruction, 235 VY advancement flap, technique of. 46, 46

W Waldeyer's sheath, 784, 785 Walsh technique, of total retropubic prostatectomy, 432-440, 432-440 Warfarin, ilioinguinal lymphadenectomy and,

164

Webster procedure, of perineal repair, 295-298,295-299 Weyrauch procedure, of rectourethral fistula closure, 476-477, 476-477 Whitaker test, 913, 922 White line of Toldt, 673, 735, 74I, 742, 854, 854 in laparoscopic nephrectomy, 993 Wilbert procedure, of rectourethral fistula closure, 480 Wilms' tumor, anterior extended pediatic incision for, 864 identification of, 986 Winfield and Donovan, laparoscopic unroofing of renal cyst and, 993, 996 Winter shunt, for priapism, 207 Wound, closure of, 11 prevention of contamination of, 11 Wound healing, delayed, with pelvic exenteration, 534 Wound implant, in perineal urethrostomy, 632 Wound infection, adrenalectomy and, 1080 ileal conduit and, 661 partial nephrectomy and, 1004 postoperative, 18 renal transplantation and, 966 Wylie procedure, for aortorenal endarterectomy, 948-950, 948-950 Y York-Mason procedure, of rectourethral fistula closure, 478, 478 Young-Stone procedure, of rectourethral fistula closure, 477 YV advancement flap, technique of, 46, 46 YV-plastv, in calicoplasty, 1051, 1051 in pyeloureteroplasty, 919, 919 in retropubic prostatectomy, 429, 429

Z Zingg technique, in ileal bladder substitution, 774, 774 Z-plasty, in burn injury of penis or scrotun 212,212 in correction of phimosis, 171 in double-barreled cutaneous ureterostomy 645 techniques of, 44-45, 44-45