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Electrosurgical Principles In Gastrointestinal Endoscopy
Published in John P. Papp, Endoscopie Control of Gastrointestinal Hemorrhage, 2019
There are three basic electrosurgical modes; cut, fulgurate, and desiccate. The word “coagulation” or “coag” can mean either fulguration or desiccation. Electrosurgical cutting is defined as sparking to tissue with a cutting effect. Fulguration is defined as sparking to tissue to produce necrosis without a cutting effect. Electrosurgical desiccation is defined as necrosing tissue by directly applying the electrosurgical electrode to the tissue so that there is no sparking and no cutting effect.
Sexually Transmitted Diseases
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Lester Gottesman, Christina Cellini
Treatment of condyloma is influenced by size/number/location of lesions, cost, side effects, patient preference and provider experience. Excision, cryotherapy and fulguration of small lesions can be done in the outpatient setting. Larger or multiple lesions may necessitate a deeper level of sedation. Overall clearance rates for surgical techniques range from 60%–90% with recurrence rates of 20%–30%.19,68 Eradiation of visible condyloma may reduce but probably does not eliminate HPV infectivity. A variety of topical agents are currently used to treat condyloma including podophyllin, fluorouracil, imiquimod and sinecatechins. Imiquimod modifies the local immune response by increasing the local production of interferon and sequestration of activated T lymphocytes into the infected area. It is applied three nights per week to the perianal area. Treatment is typically for 16 weeks. The main side effect is local skin irritation that may result in patient non-compliance. Use of imiquimod following destruction of lesions has been shown to decrease recurrence.69,70 Podofilox is an antimitotic drug that destroys the lesions with clearance rates from 28% to 74%.71 Although used, no agents have been approved for intra-anal canal use as results so far have not been as favourable as for perianal use.72
Posterior urethral valves
Published in Prem Puri, Newborn Surgery, 2017
Paolo Caione, Michele Innocenzi
It is the treatment most widely utilized, thanks to appropriate neonatal cystoscopes and resectoscopes now available, which may reduce the risk of secondary urethral damage and strictures in the newborn.51 Fulguration can be undertaken once the infant’s overall condition and renal function have stabilized. The development of smaller endoscopic equipment, as well as improved fiber optics, has permitted transurethral endoscopic incision or fulguration of posterior urethral obstruction in virtually all but the most premature patients. In most cases, primary ablation is sufficient to decompress the bladder and upper renal tracts.
The diagnostic challenge of suspicious or positive malignant urine cytology findings when cystoscopy findings are normal: an outpatient blue-light flexible cystoscopy may solve the problem
Published in Scandinavian Journal of Urology, 2021
Marie Andersson, Marthe Berger, Karsten Zieger, Per-Uno Malmström, Mats Bläckberg
Fifty millilitres of HAL was instilled in the urinary bladder 1 hour before cystoscopy. At two of the centres, 10 ml 2% lidocaine (w/v) was included in the instillation as an anaesthetic. At one centre, a local anaesthetic was injected submucosally in the case of fulguration. Otherwise, only gel-anaesthesia including lidocaine was instilled into the urethra. Cystoscopy was performed by a urologist specialising in bladder cancer and with long experience of PDD. Flexible high-definition videoscopes were used with a blue and white light source from Richard Wolf or Karl Storz, Germany. The urethra and the bladder were first examined in white light, and tumours and any suspicious areas were recorded. The examination was then carried out in blue light, and fluorescing lesions were documented. Biopsies were obtained through the flexible cystoscope with oval cup biopsy forceps (EndoJaw, Olympus) with a working diameter of 1.9 mm. The biopsies were histologically examined by the local pathologist. Small tumours or localised CIS were fulgurated by electrocautery or diode laser in the same session. In the case of negative BLFC, it was possible to obtain selective cytology from the upper urinary tract using ureteral catheters 5 Charrier, length 100 cm (Boston Scientific). Any adverse events were recorded. After cystoscopy, the patients were asked to describe their individual experience as either ‘Painful’ or ‘Not painful’. They were also asked whether they would have preferred to do the BLFC procedure at the outpatient clinic or the TURB procedure in the operating theatre under general anaesthesia.
Villous adenoma of the urethra
Published in Baylor University Medical Center Proceedings, 2021
Katherine E. Dowd, Derek Yang, Harry Papaconstantinou, Erin T. Bird
Villous adenoma is commonly encountered in the colorectal practice but is rarely seen by the urologic surgeon. Fibroepithelial urethral polyps are more readily seen by the urologist; they are generally benign and can be treated with local resection/ablation to resolve irritative voiding symptoms. Other encountered benign urethral lesions include hemangiomas, leiomyomas, urethral diverticulum, and cowpers gland or skenes gland duct cysts. Due to the variability of presentation of suspicious lesions, most urologists opt for biopsy at the time of resection or fulguration to rule out underlying malignancy. Villous adenomas of the genitourinary tract have been reported, but generally in small case series or reviews of case reports.1 They present similarly to other urethral lesions—with gross hematuria, dysuria, or irritative voiding symptoms—and a histopathologic diagnosis is usually needed.1 Because reports of association with adenocarcinoma exist, most authors recommend full resection of the lesion and consideration of magnetic resonance imaging (MRI) and colonoscopy to rule out coexisting adenocarcinoma or malignancy.2 The tumor is more commonly encountered at the bladder dome, trigone, and urachus if present.3
Post vasectomy chronic pain: are we under diagnosing vasitis? A case report and review of the literature
Published in The Aging Male, 2020
Adam Jones, Mahmood Vazirian-Zadeh, Yih Chyn Phan, Wasim Mahmalji
What is unique to this case is that the patient had a reversal of vasectomy and subsequent re-do vasectomy. To our best knowledge, no previous case reports of acute vasitis have had a vasectomy. Vasectomy is one of the most common urological procedures performed, there are around 500,000 performed in the United States each year [5], Trinick et al. [6] reported rates of vasectomy at 34% in patients in their 60s. It is the most effective male contraceptive method and has a success rate of 98% [7]. The procedure is typically performed under local anaesthesia and involves excision of at least 1 cm of the vas deferens. Electrocautery fulguration to the remaining ends of the vas deferens, or placement of sutures, is a technique used to prevent recanalization [5]. Complications associated with vasectomy include infection, symptomatic hematoma, vasectomy failure and post-vasectomy pain syndrome (PVPS) [8].