General Information for Surgical Patients

Preexisting Conditions

Any patients with one of the following preexisting medical conditions that require preoperative antibiotics, should inform our office:

Heart murmur Heart stent Heart valve replacement

Hip or knee replacements Mitral valve prolapse

Procedures

Our practice performs the following office and hospital surgical procedures:

Office - Please eat a light breakfast prior to your procedure.

• Cystoscopy
• No-scalpel Vasectomy
• Transrectal Ultrasound/Prostate Needle Biopsy
• Urodynamics

Hospital - Please fast 8 hours prior to your procedure.

• Collagen Implant
• Cystoscopy/Bilateral Retrograde
• Extracorporeal Shockwave Lithotripsy (ESWL)
• Radical Prostatectomy

Cystoscopy

Cystoscopy is a diagnostic test that allows the doctor to look into the urethra and bladder with a telescope. This is an outpatient procedure that can be done without anesthesia either in the office or at the hospital. The doctor will decide which option is best for you. You will go home shortly after the procedure.

Anesthesia. Local anesthetic. The doctor will determine which anesthesia is right for you.

Pretesting. No pretesting is required.

No-scalpel Vasectomy

No-scalpel vasectomy is one of the safest and most effective methods of birth control. The procedure is done by making a small puncture in the scrotum at the base of the penis. The vas deferens is then brought up through the opening and is clipped and cauterized. Both vas deferens are then placed back into the scrotum and the opening is covered with a Band-Aid. Ice should be applied to the area to reduce any swelling. For more information, please see the Patient Information Sheet.

Anesthesia. Local anesthetic. The doctor will determine which anesthesia is right for you.

Pretesting. If your procedure is scheduled at a hospital and pretesting is required, you will be given the necessary instruction sheet at your office visit.

Preoperative instructions. If your procedure has been scheduled in our Aspinwall office, the preparation is no aspirin or aspirin products 10 days prior without prior medical approval. Shave the scrotum the day prior from the front of the scrotum below the penis. For more information, please see our Preoperative Instruction Sheet.

Postoperative instructions. Please see the Postoperative Instruction Sheet.

Transrectal Ultrasound/Prostate Needle Biopsy

Transrectal ultrasound/prostate needle biopsy is a procedure used to diagnose prostate cancer. A scan of the bladder is done to make sure the bladder is as empty as possible. The doctor then will place a small probe into the rectum to visualize the prostate. The prostate is measured to determine the size. A small needle is then placed through the probe to biopsy the prostate under direct visualization. Multiple biopsies of the prostate are taken and sent for pathological evaluation. This usually takes about 10 days to obtain a result. This test can be done very quickly in the office with very little discomfort.

Location. The procedure is done only in our Aspinwall office.

Anesthesia. A localized gel anesthetic is used (no shots) to numb the prostate. You are able to leave the office immediately after the procedure.

Pretesting. You will be given instructions at your office visit.

Preoperative instructions. Please see the Preoperative Instruction Sheet.

Postoperative instructions. Please see the Postoperative Instruction Sheet.

Urodynamics

Urodynamics is the study of the holding or storage of urine in the bladder, the way the bladder empties, and the rate of movement of urine out of the bladder during urination. This is an outpatient procedure that can be done in the office or at the hospital. The doctor will decide which option is best for you. The procedure lasts approximately 1 hour when done in the doctor's office. This study is done for patients with a variety of urinary symptoms including urine frequency, incontinence (leakage), and nocturia (getting up at night).

There are several parts to the urodynamic study:

Cystometrogram. This involves the insertion of a small catheter and sensor into the bladder. Through the catheter, sterile water will be instilled. A record of the pressures in the bladder at the varying stages of filling will be monitored.

Leak point pressure. This involves the removal of the catheter. The sensor will remain in the bladder for the study. The results will reveal the pressure at which urine leakage, if any, occurs.

Urethral pressure profile. This will be done as the last stage of the urodynamics. The sensor will be removed slowly as the urethral pressure will be recorded.

Uroflowmeter. This study may also be performed with the urodynamics. The purpose is to record the urine flow, helping to measure obstruction of the urine flowing from the bladder.

Your results will be available at the end of the testing.

Collagen Implant

Collagen implant is used to help control incontinence. Collagen is injected into the walls of the urethra to add bulk. More than one injection may be required to reach the desired effect. This procedure can be done on both men and women.

Anesthesia. Anesthesia is required and the doctor will determine which anesthesia is right for you.

Pretesting. In order to assure that there is no allergic reaction to the collagen, you will need to get a collagen skin test at least 28 days prior to the surgical procedure. A small amount of the collagen is injected under the skin on your forearm. The site must be monitored for 72 hours. You must record observations on a card and mail this back to the office. This card becomes a permanent part of your chart. This skin test needs to be performed only once to determine if you are allergic to the collagen.

Cystoscopy/Bilateral Retrograde

Cystoscopy/bilateral retrograde is a diagnostic test that allows the doctor to look into the urethra and bladder. Dye is then injected into the ureters and an x-ray is taken. This is an outpatient procedure and is usually done with a mild form of anesthesia. The patient will go home shortly after the procedure.

Anesthesia. The doctor will determine which anesthesia is right for you.

Pretesting. You will be given the necessary pretesting information at the time of the visit.

Extracorporeal Shockwave Lithotripsy (ESWL)

ESWL is the most frequently used surgical procedure for the treatment of kidney stones. Lithotripsy uses shockwaves that travel through the skin and body tissues until they hit the dense stones. The stones become sand-like and are able to be passed through the urinary tract with the urine. Sometimes, a stone is not completely shattered with one treatment and additional treatments will be required.

Anesthesia. The doctor will determine which anesthesia is right for you.

Pretesting information. You will be given the necessary pretesting instructions at the time of your office visit.

Preoperative instructions. Mylanta Gas, twice a day, starting the day prior to the procedure; Dulcolax suppository, twice a day, starting the day prior to the procedure. Both are available over the counter at your local pharmacy.

Radical Prostatectomy

A radical prostatectomy is the complete surgical removal of the prostate due to cancer. This is done at a hospital and requires a 3 to 5 day hospital stay. The preparation for this procudure is very important. You will return to the office about 2 weeks after your surgery to have the staples and catheter removed.

Anesthesia. The doctor will determine which anesthesia is right for you.

Pretesting. You will be given instructions at your office visit.

Preoperative instructions. For detailed preoperative instructions, please see the Preoperative Instruction Sheet.

You will need to donate blood prior to your surgery. This can be done in two ways: autologous donation, which means giving your own blood, or directed donation, which means having friends or family donate blood for you. If you are donating your own blood, you may be given iron supplements. You should continue the supplements until your surgery date. For more information on blood donation, please see either the Autologous Blood Donation Information Sheet or the Directed Blood Donation Information Sheet.

Postoperative instructions. Please see the Postoperative Instruction Sheet.