msdrea32208
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The Pt has united healthcare and this is the op note...I would appreciate any assistance..
The patient was prepped and draped in lithotomy position and we attempted to
insert the Laserscope but were held up in the midurethra where we had
tightening of the urethra. We then attempted dilatation with male sounds and
this was unsuccessful due to a very tight area in the bulbous urethra. We
then attempted to visualize the urethra with an urethrotome, however,
examination of this could demonstrate no sign of the urethra opening and
unfortunately at this point there was bleeding that prevented us from
visualizing where the urethra was in order to make the incision. We even
attempted examination of the urethra with a urethroscope and this was also
unsuccessful. At this point, it was felt that we had to go in an antegrade
manner. So, an incision was made in the suprapubic area approximately 5 cm in
size. We went through the subcutaneous tissue with Bovie cauterization until
the fascia was identified. The fascia was incised with Bovie cauterization
and the rectus muscles were observed. The muscles were then retracted
laterally and the bladder surface was seen. Two stay sutures of 2-0 Vicryl
were placed in the bladder and the bladder was opened with Bovie
cauterization and drained with suction. Several other stay sutures were
placed in the bladder and we then inserted a flexible cystoscope into the
suprapubic opening and identified the bladder neck. Once this was identified,
we were able to move into the prostatic urethra with the flexible scope and
pass a 0.035 glidewire through the urethra and out the end of the penis. Once
this was completed, a 20-French Councill catheter was put through the
glidewire. It was held taut on both the distal and proximal end and the
20-French Councill catheter was then placed through the urethra and into the
bladder. Once this was in the bladder, it was draining without any difficulty
and the bladder was closed with a double-layer closure of 2-0 Vicryl. A
0.25-inch Penrose drain was then placed around the bladder closure and
secured to the skin with a 2-0 silk suture. The fascia was closed with a
running 2-0 Vicryl and the skin was closed with skin staples. The catheter
was irrigated and the drainage was clear. The patient tolerated the procedure
well and returned to the recovery room in good condition.
The patient was prepped and draped in lithotomy position and we attempted to
insert the Laserscope but were held up in the midurethra where we had
tightening of the urethra. We then attempted dilatation with male sounds and
this was unsuccessful due to a very tight area in the bulbous urethra. We
then attempted to visualize the urethra with an urethrotome, however,
examination of this could demonstrate no sign of the urethra opening and
unfortunately at this point there was bleeding that prevented us from
visualizing where the urethra was in order to make the incision. We even
attempted examination of the urethra with a urethroscope and this was also
unsuccessful. At this point, it was felt that we had to go in an antegrade
manner. So, an incision was made in the suprapubic area approximately 5 cm in
size. We went through the subcutaneous tissue with Bovie cauterization until
the fascia was identified. The fascia was incised with Bovie cauterization
and the rectus muscles were observed. The muscles were then retracted
laterally and the bladder surface was seen. Two stay sutures of 2-0 Vicryl
were placed in the bladder and the bladder was opened with Bovie
cauterization and drained with suction. Several other stay sutures were
placed in the bladder and we then inserted a flexible cystoscope into the
suprapubic opening and identified the bladder neck. Once this was identified,
we were able to move into the prostatic urethra with the flexible scope and
pass a 0.035 glidewire through the urethra and out the end of the penis. Once
this was completed, a 20-French Councill catheter was put through the
glidewire. It was held taut on both the distal and proximal end and the
20-French Councill catheter was then placed through the urethra and into the
bladder. Once this was in the bladder, it was draining without any difficulty
and the bladder was closed with a double-layer closure of 2-0 Vicryl. A
0.25-inch Penrose drain was then placed around the bladder closure and
secured to the skin with a 2-0 silk suture. The fascia was closed with a
running 2-0 Vicryl and the skin was closed with skin staples. The catheter
was irrigated and the drainage was clear. The patient tolerated the procedure
well and returned to the recovery room in good condition.