Medical Specialty: Urology
Sample Name: Laparoscopic Pyeloplasty

PREOPERATIVE DIAGNOSIS:  ,Right ureteropelvic junction obstruction.,POSTOPERATIVE DIAGNOSES:,1.  Right ureteropelvic junction obstruction.,2.  Severe intraabdominal adhesions.,3.  Retroperitoneal fibrosis.,PROCEDURES PERFORMED:,1.  Laparoscopic lysis of adhesions.,2.  Attempted laparoscopic pyeloplasty.,3.  Open laparoscopic pyeloplasty.,ANESTHESIA:,  General.,INDICATION FOR PROCEDURE:  ,This is a 62-year-old female with a history of right ureteropelvic junction obstruction with chronic indwelling double-J ureteral stent.  The patient presents for laparoscopic pyeloplasty.,PROCEDURE: , After informed consent was obtained, the patient was taken to the operative suite and administered general anesthetic.  The patient was sterilely prepped and draped in the supine fashion after building up the right side of the OR table to aid in the patient's positioning for bowel retraction.  Hassan technique was performed for the initial trocar placement in the periumbilical region.  Abdominal insufflation was performed.  There were significant adhesions noted.  A second 12 mm port was placed in the right midclavicular line at the level of the umbilicus and a Harmonic scalpel was placed through this and adhesiolysis was performed for approximately two-and-half hours, also an additional port was placed 12 mm in the midline between the xiphoid process and the umbilicus, an additional 5 mm port in the right upper quadrant subcostal and midclavicular.  After adhesions were taken down, the ascending colon was mobilized by incising the white line of Toldt and mobilizing this medially.  The kidney was able to be palpated within Gerota's fascia.  The psoas muscle caudate to the inferior pole of the kidney was identified and the tissue overlying this was dissected to the level of the ureter.  The uterus was grasped with a Babcock through a trocar port and carried up to the level of the ureteropelvic junction obstruction.  The renal pelvis was also identified and dissected free.  There was significant fibrosis and scar tissue around the ureteropelvic junction obliterating the tissue planes.  We were unable to dissect through this mass of fibrotic tissue safely and therefore the decision was made to abort the laparoscopic procedure and perform the pyeloplasty open.  An incision was made from the right upper quadrant port extending towards the midline.  This was carried down through the subcutaneous tissue, anterior fascia, muscle layers, posterior fascia, and peritoneum.  A Bookwalter retractor was placed.  The renal pelvis and the ureter were again identified.  Fibrotic tissue was able to be dissected away at this time utilizing right angle clamps and Bovie cautery.  The tissue was sent down to Pathology for analysis.  Please note that upon entering the abdomen, all of the above which was taken down from the adhesions to the abdominal wall were carefully inspected and no evidence of bowel injury was noted.  Ureter was divided just distal to the ureteropelvic junction obstruction and stent was maintained in place.  The renal pelvis was then opened in a longitudinal manner and excessive pelvis was removed reducing the redundant tissue.  At this point, the indwelling double-J ureteral stent was removed.  At this time, the ureter was spatulated laterally and at the apex of this spatulation a #4-0 Vicryl suture was placed.  This was brought up to the deepened portion of the pyelotomy and cystic structures were approximated.  The back wall of the ureteropelvic anastomosis was then approximated with running #4-0 Vicryl suture.  At this point, a double-J stent was placed with a guidewire down into the bladder.  The anterior wall of the uteropelvic anastomosis was then closed again with a #4-0 running Vicryl suture.  Renal sinus fat was then placed around the anastomosis and sutured in place.  Please note in the inferior pole of the kidney, there was approximately 2 cm laceration which was identified during the dissection of the fibrotic tissue.  This was repaired with horizontal mattress sutures #2-0 Vicryl.  FloSeal was placed over this and the renal capsule was placed over this.  A good hemostasis was noted.  A #10 Blake drain was placed through one of the previous trocar sites and placed into the perirenal space away from the anastomosis.  The initial trocar incision was closed with #0 Vicryl suture.  The abdominal incision was also then closed with running #0 Vicryl suture incorporating all layers of muscle and fascia.  The Scarpa's fascia was then closed with interrupted #3-0 Vicryl suture.  The skin edges were then closed with staples.  Please note that all port sites were inspected prior to closing and hemostasis was noted at all sites and the fascia was noted to be reapproximated as these trocar sites were placed with the ________ obturator.  We placed the patient on IV antibiotics and pain medications.  We will obtain KUB and x-rays for stent placement.  Further recommendations to follow.
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DESCRIPTION: Laparoscopic lysis of adhesions, attempted laparoscopic pyeloplasty, and open laparoscopic pyeloplasty.  Right ureteropelvic junction obstruction, severe intraabdominal adhesions, and retroperitoneal fibrosis.

urology, retroperitoneal, fibrosis, pyeloplasty, laparoscopic, lysis of adhesions, ureteropelvic junction obstruction, laparoscopic pyeloplasty, ureteropelvic junction, junction, ureteropelvic, intraabdominal, adhesions,

The procedure described involves a complex surgical operation where serious complications could occur, such as significant bleeding, injury to surrounding organs, and infections, particularly given the patient's pre-existing conditions like severe adhesions and retroperitoneal fibrosis. This was originally a laparoscopic surgery but had to be converted to an open surgery due to complications, indicating the procedure involved complex decision-making and potential risks. Additionally, the involvement of general anesthesia, potential postoperative care requirements, and possible impact on patient's future quality of life further increase the stakes. Thus, the stakes are relatively high due to the complexity and risks involved.


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Medical Specialty: Urology
Sample Name: Inguinal Herniorrhaphy - 2

PROCEDURE PERFORMED: , Bassini inguinal herniorrhaphy.,ANESTHESIA: , Local with MAC anesthesia.,PROCEDURE: , After informed consent was obtained, the patient was brought to the operative suite and placed supine on the operating table.  The patient was sedated and an adequate local anesthetic was administered using 1% lidocaine without epinephrine.  The patient was prepped and draped in the usual sterile manner.,A standard inguinal incision was made, and dissection was carried down to the external oblique aponeurosis using a combination of Metzenbaum scissors and Bovie electrocautery.  The external oblique aponeurosis was cleared of overlying adherent tissue, and the external ring was delineated.  The external oblique was then incised with a scalpel and this incision was carried out to the external ring using Metzenbaum scissors.  Care was taken not to injure the ilioinguinal nerve.  Having exposed the inguinal canal, the cord structures were separated from the canal using blunt dissection, and a Penrose drain was then used to retract the cord structures as needed.  Adherent cremasteric muscle was dissected free from the cord using Bovie electrocautery.,The cord was then explored using a combination of sharp and blunt dissection, and the sac was found anteromedially to the cord structures.  The sac was dissected free from the cord structures using a combination of blunt dissection and Bovie electrocautery.,Once preperitoneal fat was encountered, the dissection stopped and the sac was suture ligated at the level of the preperitoneal fat using a 2-0 silk suture ligature.  The sac was excised and sent to Pathology.  The stump was examined and no bleeding was noted.  The ends of the suture were then cut, and the stump retracted back into the abdomen.,The floor of the inguinal canal was then strengthened by suturing the shelving edge of Poupart's ligament to the conjoined tendon using a 2-0 Prolene, starting at the pubic tubercle and running towards the internal ring.  In this manner, an internal ring was created that admitted just the tip of my smallest finger.,The Penrose drain was removed.  The wound was then irrigated using sterile saline, and hemostasis was obtained using Bovie electrocautery.  The incision in the external oblique was approximated using a 2-0 Vicryl in a running fashion, thus reforming the external ring.  Marcaine 0.5% was injected 1 fingerbreadth anterior to the anterior and superior iliac spine and around the wound for postanesthetic pain control.  The skin incision was approximated with skin staples.  A dressing was then applied.  All surgical counts were reported as correct.,Having tolerated the procedure well, the patient was subsequently taken to the recovery room in good and stable condition.
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DESCRIPTION: Bassini inguinal herniorrhaphy.  A standard inguinal incision was made, and dissection was carried down to the external oblique aponeurosis using a combination of Metzenbaum scissors and Bovie electrocautery.

urology, ilioinguinal nerve, adherent cremasteric muscle, bassini inguinal herniorrhaphy, external oblique aponeurosis, inguinal herniorrhaphy, metzenbaum scissors, external ring, blunt dissection, cord structures, bovie electrocautery, inguinal, electrocautery

The scenario involves a surgical procedure for an inguinal hernia repair, specifically a Bassini inguinal herniorrhaphy. While it is a routine and common procedure in urology, it is still a surgical intervention. Surgical procedures inherently carry risks such as infection, bleeding, or complications from anesthesia. However, the stakes are not considered extremely high compared to more complex or emergency surgeries. The procedure is usually planned, as indicated by the informed consent and preparation details, and the report mentions the patient tolerated the procedure well and was stable afterward. Thus, it is not a critical or emergency situation, which reduces the stakes.

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Medical Specialty: Urology
Sample Name: Inguinal Hernia Repair - 4

PREOPERATIVE DIAGNOSIS: , Right inguinal hernia. ,POSTOPERATIVE DIAGNOSIS:,  Right direct inguinal hernia. ,PROCEDURE:,  Right direct inguinal hernia repair with PHS mesh system. ,ANESTHESIA:,  General with endotracheal intubation. ,PROCEDURE IN DETAIL: , The patient was taken to the operating room and placed supine on the operating table.  General anesthesia was administered with endotracheal intubation.  The Right groin and abdomen were prepped and draped in the standard sterile surgical fashion.  An incision was made approximately 1 fingerbreadth above the pubic tubercle and in a skin crease.  Dissection was taken down through the skin and subcutaneous tissue.  Scarpa's fascia was divided, and the external ring was located.  The external oblique was divided from the external ring up towards the anterior superior iliac spine.  The cord structures were then encircled.  Careful inspection of the cord structures did not reveal any indirect sac along the cord structures.  I did, however, feel a direct sac with a direct defect.  I opened the floor of the inguinal canal and dissected out the preperitoneal space at the direct sac and cut out the direct sac.  Once I cleared out the preperitoneal space, I placed a PHS mesh system with a posterior mesh into the preperitoneal space, and I made sure that it laid flat along Cooper's ligament and covered the myopectineal orifice.  I then tucked the extended portion of the anterior mesh underneath the external oblique between the external oblique and the internal oblique, and I then tacked the medial portion of the mesh to the pubic tubercle with a 0 Ethibond suture.  I tacked the superior portion of the mesh to the internal oblique and the inferior portion of the mesh to the shelving edge of the inguinal ligament.  I cut a hole in the mesh in order to incorporate the cord structures and recreated the internal ring, making sure that it was not too tight so that it did not strangulate the cord structures.  I then closed the external oblique with a running 3-0 Vicryl.  I closed the Scarpa's with interrupted 3-0 Vicryl, and I closed the skin with a running Monocril.  Sponge, instrument and needle counts were correct at the end of the case.  The patient tolerated the procedure well and without any complications.
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DESCRIPTION: Right inguinal hernia.    Right direct inguinal hernia repair with PHS mesh system.  The Right groin and abdomen were prepped and draped in the standard sterile surgical fashion.  An incision was made approximately 1 fingerbreadth above the pubic tubercle and in a skin crease.

urology, groin, phs mesh, inguinal hernia repair, direct inguinal hernia, preperitoneal space, external oblique, cord structures, inguinal hernia, inguinal, hernia, external, oblique, mesh,

This scenario involves a surgical procedure to repair a right direct inguinal hernia. Hernia repairs are common surgical interventions in the field of urology and general surgery. While the procedure is routine and generally safe, it does involve general anesthesia and surgical techniques that require precision to avoid complications such as nerve damage, infection, or recurrence of the hernia. The stakes are higher than non-surgical medical situations due to the need for anesthesia and the potential risks associated with surgery, but it's not considered an emergency or life-threatening unless complications arise. Given the described procedure occurred without complications, the stakes are moderate.


Medical Specialty: Urology
Sample Name: Inguinal Hernia Repair - Indirect

PREOPERATIVE DIAGNOSIS: , Left inguinal hernia.,POSTOPERATIVE DIAGNOSIS:, Left indirect inguinal hernia.,PROCEDURE PERFORMED:, Repair of left inguinal hernia indirect.,ANESTHESIA: , Spinal with local.,COMPLICATIONS:,  None.,DISPOSITION,:  The patient tolerated the procedure well, was transferred to recovery in stable condition.,SPECIMEN: , Hernia sac.,BRIEF HISTORY: , The patient is a 60-year-old female that presented to Dr. X's office with complaints of a bulge in the left groin.  The patient states that she noticed there this bulge and pain for approximately six days prior to arrival.  Upon examination in the office, the patient was found to have a left inguinal hernia consistent with tear, which was scheduled as an outpatient surgery.,INTRAOPERATIVE FINDINGS: , The patient was found to have a left indirect inguinal hernia.,PROCEDURE: , After informed consent was obtained, risks and benefits of the procedure were explained to the patient.  The patient was brought to the operating suite.  After spinal anesthesia and sedation given, the patient was prepped and draped in normal sterile fashion.  In the area of the left inguinal region just superior to the left inguinal ligament tract, the skin was anesthetized with 0.25% Marcaine.  Next, a skin incision was made with a #10 blade scalpel.  Using Bovie electrocautery, dissection was carried down to Scarpa's fascia until the external oblique was noted.  Along the side of the external oblique in the direction of the external ring, incision was made on both sides of the external oblique and then grasped with a hemostat.  Next, the hernia and hernia sac was circumferentially grasped and elevated along with the round ligament.  Attention was next made to ligating the hernia sac at its base for removal.  The hernia sac was opened prior grasping with hemostats.  It was a sliding indirect hernia.  The bowel contents were returned to abdomen using a #0 Vicryl stick tie pursestring suture at its base.  The hernia sac was ligated and then cut above with the Metzenbaum scissors returning it to the abdomen.  This was then sutured at the apex of the repair down to the conjoint tendon.  Next, attention was made to completely removing the round ligament hernia sac which was again ligated at its base with an #0 Vicryl suture and removed as specimen.  Attention was next made to reapproximate it at floor with a modified ______ repair.  Using a #2-0 Ethibond suture in simple interrupted fashion, the conjoint tendon was approximated to the ilioinguinal ligament capturing a little bit of the floor of the transversalis fascia.  Once this was done, the external oblique was closed over, reapproximated again with a #2-0 Ethibond suture catching each hump in between each repair from the prior floor repair.  This was done in simple interrupted fashion as well.  Next Scarpa's fascia was reapproximated with #3-0 Vicryl suture.  The skin was closed with running subcuticular #4-0 undyed Vicryl suture.  Steri-Strips and sterile dressings were applied.  The patient tolerated the procedure very well and he was transferred to Recovery in stable condition.  The patient had an abnormal chest x-ray in preop and is going for a CT of the chest in Recovery.
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DESCRIPTION: Repair of left inguinal hernia indirect.  The patient states that she noticed there this bulge and pain for approximately six days prior to arrival.  Upon examination in the office, the patient was found to have a left inguinal hernia consistent with tear, which was scheduled as an outpatient surgery.

urology, bulge, groin, ethibond suture, vicryl suture, external oblique, inguinal hernia, hernia, inguinal, ligament, oblique, vicryl, indirect, sac, suture, repair,

The procedure described is a routine inguinal hernia repair, which is generally considered a common and low-risk operation, especially given the absence of complications and the patient's stable condition post-surgery. Inguinal hernias are common, and the indirect type described typically doesn't involve high emergency risk unless strangulated, which is not indicated here. Moreover, the surgery was scheduled as outpatient, suggesting it wasn't an urgent or high-risk situation and was successfully completed with no complications. The procedure's stakes are further minimized by the fact the patient recovered in stable condition. However, the need for a chest CT due to an abnormal preop x-ray slightly increases the stakes as it suggests a potential undiscovered issue, but this isn't directly related to the hernia surgery itself.


Medical Specialty: Urology
Sample Name: Inguinal Hernia Repair

PREOPERATIVE DIAGNOSES:,  Bilateral inguinal hernia, bilateral hydroceles.,POSTOPERATIVE DIAGNOSES:,  Bilateral inguinal hernia, bilateral hydroceles.,PROCEDURES: , Bilateral inguinal hernia and bilateral hydrocele repair with an ilioinguinal nerve block bilaterally by surgeon 20 mL given.,ANESTHESIA: , General inhalational anesthetic.,ABNORMAL FINDINGS:,  Same as above.,ESTIMATED BLOOD LOSS: , Less than 5 mL.,FLUIDS RECEIVED: , 400 mL of Crystalloid.,DRAINS: , No tubes or drains were used.,COUNT: , Sponge and needle counts were correct x2.,INDICATIONS FOR PROCEDURE:  ,The patient is a 7-year-old boy with the history of fairly sizeable right inguinal hernia and hydrocele, was found to have a second smaller one on evaluation with ultrasound and physical exam.  Plan is for repair of both.,DESCRIPTION OF OPERATION:  ,The patient was taken to the operating room, where surgical consent, operative site and the patient's identification was verified.  Once he was anesthetized, he was then placed in a supine position and sterilely prepped and draped.  A right inguinal incision was then made with 15 blade knife and further extended with electrocautery down to the subcutaneous tissue and electrocautery was also used for hemostasis.  The external oblique fascia was then visualized and incised with 15 blade knife and further extended with curved tenotomy scissors.  Using a curved mosquito clamp, we gently dissected into the inguinal canal until we got the hernia sac and dissected it out of the canal.  The cord structures were then dissected off the sac and then the sac itself was divided in the midline, twisted upon itself and suture ligated up at the peritoneal reflection with 3-0 Vicryl suture.  This was done twice.  The distal end where a large hydrocele noted, was gently milked into the lower aspect of the incision.  The hydrocele sac was then opened and drained and then the testis was delivered into the field.  The sac was then opened completely around the testis.  The appendix testis was cauterized.  We wrapped the sac around the back of the testis and tacked into place using the Lord maneuver using 4-0 Vicryl as a figure-of-eight suture.  Once this was done, the testis was then placed back into the scrotum in the proper orientation.  Ilioinguinal nerve block and wound instillation was then done with 10 mL of 0.25% Marcaine.  A similar procedure was done on the left side, also finding a small hernia, which was divided and ligated with the 3-0 Vicryl as on the right side and distally the hydrocele sac was also wrapped around the back of the testis in a Lord maneuver after opening the sac completely.  Again both testes were placed into the scrotum after the hydroceles were treated and then the external oblique fascia was closed on both sides with a running suture of 3-0 Vicryl ensuring that the ilioinguinal nerve and the cord structures not involved in the closure.  Scarpa fascia was closed with 4-0 chromic suture on each side and the skin was closed with 4-0 Rapide subcuticular closure.  Dermabond tissue adhesive was placed on both incisions.  IV Toradol was given at the end of the procedure and both testes were well descended within the scrotum at the end of the procedure.  The patient tolerated the procedure and was in stable condition upon transfer to the recovery room.
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DESCRIPTION: Bilateral inguinal hernia and bilateral hydrocele repair with an ilioinguinal nerve block bilaterally.

urology, bilateral hydrocele repair, bilateral inguinal hernia, external oblique fascia, ilioinguinal nerve block, bilateral hydroceles, external oblique, oblique fascia, cord structures, hydrocele sac, lord maneuver, nerve block, bilateral inguinal, ilioinguinal nerve, inguinal hernia, hernia, inguinal, hydrocele, bilateral, sac,

The described procedure involves the surgical repair of bilateral inguinal hernias and hydroceles in a 7-year-old child. While the surgery is generally considered routine and has a high success rate, it still involves general anesthesia and surgical intervention, which inherently carry some risks. The low blood loss, absence of abnormal findings during surgery, and smooth recovery indicate that this was a standard, uncomplicated procedure. However, any surgery in a young child can be considered moderately high-stakes due to the potential for complications and the need for precise surgical and anesthetic care.


Medical Specialty: Urology
Sample Name: Inguinal Hernia Repair - 2

PREOPERATIVE DIAGNOSIS:,  Left inguinal hernia.,POSTOPERATIVE DIAGNOSIS:, Left direct and indirect inguinal hernia.,PROCEDURE PERFORMED:, Repair of left inguinal hernia with Prolene mesh.,ANESTHESIA: , IV sedation with local.,COMPLICATIONS:,  None.,DISPOSITION:  ,The patient tolerated the procedure well and was transferred to Recovery in stable condition.,SPECIMEN: , Hernia sac, as well as turbid fluid with gram stain, which came back with no organisms from the hernia sac.,BRIEF HISTORY:  ,This is a 53-year-old male who presented to Dr. Y's office with a bulge in the left groin and was found to have a left inguinal hernia increasing over the past several months.  The patient has a history of multiple abdominal surgeries and opted for an open left inguinal hernial repair with Prolene mesh.,INTRAOPERATIVE FINDINGS: , The patient was found to have a direct as well as an indirect component to the left inguinal hernia with a large sac.  The patient was also found to have some turbid fluid within the hernia sac, which was sent down for gram stain and turned out to be negative with no organisms.,PROCEDURE: , After informed consent, risks and benefits of the procedure were explained to the patient, the patient was brought to the operative suite, prepped and draped in the normal sterile fashion.  The left inguinal ligament was identified from the pubic tubercle to the ASIS.  Two fingerbreadths above the pubic tubercle, a transverse incision was made.  First, the skin was anesthetized with 1% lidocaine and then an incision was made with a #15 blade scalpel, approximately 6 cm in length.  Dissection was then carried down with electro Bovie cautery through Scarpa's fascia maintaining hemostasis.  Once the external oblique was identified, external oblique was incised in the length of its fibers with a #15 blade scalpel.  Metzenbaum scissors were then used to extend the incision in both directions opening up the external oblique down to the external ring.  Next, the external oblique was grasped with Ochsner on both sides.  The cord, cord structures as well as hernia sac were freed up circumferentially and a Penrose drain was placed around it.  Next, the hernia sac was identified and the anteromedial portion of the hernia sac was stripped down, grasped with two hemostats.  A Metzenbaum scissor was then used to open the hernia sac and the hernia sac was explored.  There was some turbid fluid within the hernia sac, which was sent down for cultures.  Gram stain was negative for organisms.  Next, the hernia sac was to be ligated at its base and transected.  A peon was used at the base.  Metzenbaum scissor was used to cut the hernia sac and sending it off as a specimen.  An #0 Vicryl stick suture was used with #0 Vicryl loop suture to suture ligate the hernia sac at its base.,Next, attention was made to placing a Prolene mesh to cover the floor.  The mesh was sutured to the pubic tubercle medially along the ilioinguinal ligament inferiorly and along the conjoint tendon superiorly making a slit for the cord and cord structures.  Attention was made to salvaging the ilioinguinal nerve, which was left above the repair of the mesh and below the external oblique once closed and appeared to be intact.  Attention was next made after suturing the mesh with the #2-0 Polydek suture.  The external oblique was then closed over the roof with a running #0 Vicryl suture, taking care not to strangulate the cord and to recreate the external ring.  After injecting the external oblique and cord structures with Marcaine for anesthetic, the Scarpa's fascia was approximated with interrupted #3-0 Vicryl sutures.  The skin was closed with a running subcuticular #4-0 undyed Vicryl suture.  Steri-Strip with sterile dressings were applied.,The patient tolerated the procedure well and was transferred to Recovery in stable condition.
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DESCRIPTION: Left direct and indirect inguinal hernia.  Repair of left inguinal hernia with Prolene mesh.  The patient was found to have a left inguinal hernia increasing over the past several months.  The patient has a history of multiple abdominal surgeries and opted for an open left inguinal hernial repair with Prolene mesh.

urology, left inguinal hernia, prolene mesh, hernia sac, gram stain, inguinal hernia repair, inguinal hernial repair, metzenbaum scissors, cord structures, inguinal hernia, sac, inguinal, hernia, metzenbaum, prolene, vicryl, cord, suture, oblique, mesh,

The procedure described is a surgical repair of an inguinal hernia, a common and generally routine surgical procedure. While surgeries always carry some degree of risk, this procedure was completed without any complications and the patient was stable postoperatively. The document notes that the patient tolerated the procedure well, further reducing the stakes. Given these considerations, and the fact that it is a common surgical procedure, this situation is assessed as low to moderate-stakes.


Medical Specialty: Urology
Sample Name: Hydrocelectomy - 1

PREOPERATIVE DIAGNOSES:,  Bladder cancer and left hydrocele.,POSTOPERATIVE DIAGNOSES: , Bladder cancer and left hydrocele.,OPERATION:  ,Left hydrocelectomy, cystopyelogram, bladder biopsy, and fulguration for hemostasis.,ANESTHESIA:,  Spinal.,ESTIMATED BLOOD LOSS:  ,Minimal.,FLUIDS:,  Crystalloid.,BRIEF HISTORY:  ,The patient is a 66-year-old male with history of smoking and hematuria, had bladder tumor, which was dissected.  He has received BCG.  The patient is doing well.  The patient was supposed to come to the OR for surveillance biopsy and pyelograms.  The patient had a large left hydrocele, which was increasingly getting worse and was making it very difficult for the patient to sit to void or put clothes on, etc.  Options such as watchful waiting, drainage in the office, and hydrocelectomy were discussed.  Risks of anesthesia, bleeding, infection, pain, MI, DVT, PE, infection in the scrotum, enlargement of the scrotum, recurrence, and pain were discussed.  The patient understood all the options and wanted to proceed with the procedure.,PROCEDURE IN DETAIL: , The patient was brought to the OR.  Anesthesia was applied.  The patient was placed in dorsal lithotomy position.  The patient was prepped and draped in usual sterile fashion.,A transverse scrotal incision was made over the hydrocele sac and the hydrocele fluid was withdrawn.  The sac was turned upside down and sutures were placed.  Careful attention was made to ensure that the cord was open.  The testicle was in normal orientation throughout the entire procedure.  The testicle was placed back into the scrotal sac and was pexed with 4-0 Vicryl to the outside dartos to ensure that there was no risk of torsion.  Orchiopexy was done at 3 different locations.  Hemostasis was obtained using electrocautery.  The sac was closed using 4-0 Vicryl.  The sac was turned upside down so that when it heals, the fluid would not recollect.  The dartos was closed using 2-0 Vicryl and the skin was closed using 4-0 Monocryl and Dermabond was applied.  Incision measured about 2 cm in size.  Subsequently using ACMI cystoscope, a cystoscopy was performed.  The urethra appeared normal.  There was some scarring at the bulbar urethra, but the scope went in through that area very easily into the bladder.  There was a short prostatic fossa.  The bladder appeared normal.  There was some moderate trabeculation throughout the bladder, some inflammatory changes in the bag part, but nothing of much significance.  There were no papillary tumors or stones inside the bladder.  Bilateral pyelograms were obtained using 8-French cone-tip catheter, which appeared normal.  A cold cup biopsy of the bladder was done and was fulgurated for hemostasis.  The patient tolerated the procedure well.  The patient was brought to recovery at the end of the procedure after emptying the bladder.,The patient was given antibiotics and was told to take it easy.  No heavy lifting, pushing, or pulling.  Plan was to follow up in about 2 months.
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DESCRIPTION: Left hydrocelectomy, cystopyelogram, bladder biopsy, and fulguration for hemostasis.

urology, hydrocele, fulguration, bladder biopsy, hydrocelectomy, cystopyelogram, cystopyelogram bladder, bladder cancer, bladder,

This medical scenario involves a hydrocelectomy combined with procedures related to bladder cancer, such as cystopyelogram and biopsy. While surgical procedures inherently carry some risk, these operations are generally considered low to moderate risk, especially since this description indicates the patient tolerated the procedure well with minimal blood loss and straightforward recovery instructions. Additionally, the procedure's success and the detailed communication of both risks and post-operative care contribute to minimizing stakes. However, the underlying condition of bladder cancer adds some complexity and necessity for careful monitoring, slightly increasing the stakes.


Medical Specialty: Urology
Sample Name: Hydrocelectomy

PREOPERATIVE DIAGNOSIS:,  Bilateral hydroceles.,POSTOPERATIVE DIAGNOSIS:,  Bilateral hydroceles.,PROCEDURE: , Bilateral scrotal hydrocelectomies, large for both, and 0.5% Marcaine wound instillation, 30 mL given.,ESTIMATED BLOOD LOSS: , Less than 10 mL.,FLUIDS RECEIVED: , 800 mL.,TUBES AND DRAINS: , A 0.25-inch Penrose drains x4.,INDICATIONS FOR OPERATION:  ,The patient is a 17-year-old boy, who has had fairly large hydroceles noted for some time.  Finally, he has decided to have them get repaired.  Plan is for surgical repair.,DESCRIPTION OF OPERATION:  ,The patient was taken to the operating room where surgical consent, operative site, and patient identification were verified.  Once he was anesthetized, he was then shaved, prepped, and then sterilely prepped and draped.  IV antibiotics were given.  Ancef 1 g given.  A scrotal incision was then made in the right hemiscrotum with a 15-blade knife and further extended with electrocautery.  Electrocautery was used for hemostasis.  Once we got to the hydrocele sac itself, we then opened and delivered the testis, drained clear fluid.  There was moderate amount of scarring on the testis itself from the tunica vaginalis.  It was then wrapped around the back and sutured in place with a running suture of 4-0 chromic in a Lord maneuver.  Once this was done, a drain was placed in the base of the scrotum and then the testis was placed back into the scrotum in the proper orientation.  A similar procedure was performed on the left, which has also had a hydrocele of the cord, which were both addressed and closed with Lord maneuver similarly.  This testis also was normal but had moderate amount of scarring on the tunic vaginalis from this.  A similar drain was placed.  The testes were then placed back into the scrotum in a proper orientation, and the local wound instillation and wound block was then placed using 30 mL of 0.5% Marcaine without epinephrine.  IV Toradol was given at the end of the procedure.  The skin was then sutured with a running interlocking suture of 3-0 Vicryl and the drains were sutured to place with 3-0 Vicryl.  Bacitracin dressing, ABD dressing, and jock strap were placed.  The patient was in stable condition upon transfer to the recovery room.
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DESCRIPTION: Bilateral scrotal hydrocelectomies, large for both, and 0.5% Marcaine wound instillation, 30 mL given.

urology, bilateral scrotal hydrocelectomies, bilateral hydroceles, lord maneuver, hydrocelectomy, hydroceles,

The procedure described is a bilateral scrotal hydrocelectomy, which is a relatively routine surgical intervention in urology to address hydroceles that are causing discomfort or other issues. While the patient is a 17-year-old, which sometimes heightens concern due to age, the surgery is straightforward with an estimated blood loss of less than 10 mL and ends with the patient in stable condition. Such surgeries carry some risk inherent to general anesthesia and operative procedures, but they are considered low-risk and are performed regularly. Given these factors, the overall stakes can be regarded as moderate but not particularly high.


Medical Specialty: Urology
Sample Name: HPV Consult

He has no voiding complaints and no history of sexually transmitted diseases.,PAST MEDICAL HISTORY: , None.,PAST SURGICAL HISTORY: , Back surgery with a fusion of L5-S1.,MEDICATIONS: , He does take occasional Percocet for his back discomfort.,ALLERGIES:,  HE HAS NO ALLERGIES.,SOCIAL HISTORY:,  He is a smoker.  He takes rare alcohol.  His employment is that he does dynamite work and actually putting in the dynamite in large holes for destroying ground to that pipeline can be laid.  He travels to anywhere for his work.  He is married with one son.,FAMILY HISTORY: , Negative for prostate cancer, kidney cancer, bladder cancer, enlarged prostate or kidney disease.,REVIEW OF SYSTEMS:,  Negative for tremors, headaches, dizzy spells, numbness, tingling, feeling hot or cold, tired or sluggishness, abdominal pain, nausea or vomiting, indigestion, heartburn, fevers, chills, weight loss, wheezing, frequent cough, shortness of breath, chest pain, varicose veins, high blood pressure, skin rash, joint pain, ear infections, sore throat, sinus problems, hay fever, blood clotting problems, depressive affect or eye problems.,PHYSICAL EXAMINATION,GENERAL:  The patient is afebrile.  His vital signs are stable.  He is 177 pounds, 5 feet, 8 inches.  Blood pressure 144/66.  He is healthy appearing.  He is alert and oriented x 3.,HEART:  Regular rate and rhythm.,LUNGS:  Clear to auscultation.,ABDOMEN:  Soft and nontender.  His penis is circumcised.  He has a pedunculated cauliflower-like lesion on the dorsum of the penis at approximately 12 o'clock.  It is very obvious and apparent.  He also has a mildly raised brown lesion that the patient states has been there ever since he can remember and has not changed in size or caliber.  His testicles are descended bilaterally.  There are no masses.,ASSESSMENT AND PLAN: , This is likely molluscum contagiosum (genital warts) caused by HPV.  I did state to the patient that this is likely a viral infection that could have had a long incubation period.  It is not clear where this came from but it is most likely sexually transmitted.  He is instructed that he should use protected sex from this point on in order to try and limit the transmission.  Regarding the actual lesion itself, I did mention that we could apply a cream of Condylox, which could take up to a month to work.  I also offered him C02 laser therapy for the genital warts, which is an outpatient procedure.  The patient is very interested in something quick and effective such as a CO2 laser procedure.  I did state that the recurrence rate is significant and somewhere as high as 20% despite enucleating these lesions.  The patient understood this and still wished to proceed.  There is minimal risk otherwise except for those inherent in laser injury and accidental injury.  The patient understood and wished to proceed.
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DESCRIPTION: Likely molluscum contagiosum (genital warts) caused by HPV.  It is not clear where this came from but it is most likely sexually transmitted.

urology, sexually transmitted, molluscum contagiosum, genital warts, hpv,

The situation involves a medical consultation for an urological condition (genital warts) likely caused by HPV. While the presence of genital warts and the decision to proceed with CO2 laser therapy are significant for the patient's health and quality of life, they do not involve immediate life-threatening consequences. Genital warts generally carry social and personal health implications rather than severe medical emergencies. The patient's decision to undergo laser treatment carries some risk, but these are minimal and typical for minor outpatient procedures.


Medical Specialty: Urology
Sample Name: Foreign Object Removal - Urethra

PREOPERATIVE DIAGNOSIS: , Prostate cancer.,POSTOPERATIVE DIAGNOSIS: , Prostate cancer.,OPERATION: , Cystoscopy and removal of foreign objects from the urethra.,BRACHYTHERAPY:,  Iodine 125.,ANESTHESIA: , General endotracheal.  The patient was given Levaquin 500 mg IV preoperatively.,Total seeds were 59.  Activity of 0.439, 30 seeds in the periphery with 10 needles and total of 8 seeds at the anterior of the fold, 4 needles.  Please note that the total needles placed on the top were actually 38 seeds and 22 seeds were returned back.,BRIEF HISTORY: , This is a 72-year-old male who presented to us with elevated PSA and prostate biopsy with Gleason 6 cancer on the right apex.  Options such as watchful waiting, brachytherapy, radical prostatectomy, cryotherapy, and external beam radiation were discussed.  Risk of anesthesia, bleeding, infection, pain, MI, DVT, PE, incontinence, erectile dysfunction, urethral stricture, dysuria, burning pain, hematuria, future procedures, and failure of the procedure were all discussed.  The patient understood all the risks, benefits, and options and wanted to proceed with the procedure.  The patient wanted to wait until he came back from his summer vacations, so a one dose of Zoladex was given.  Prostate size measured about 15 g in the OR and about 22 g about two months ago.  Consent was obtained.,DETAILS OF THE OPERATION:  ,The patient was brought to the OR and anesthesia was applied.  The patient was placed in dorsal lithotomy position.  The patient had a Foley catheter placed sterilely.  The scrotum was taped up using Ioban.  Transrectal ultrasound was done.  The prostate was measured 15 g.  Multiple images were taken.  A volume study was done.  This was given to the physicist, Dr. X was present who is radiation oncologist who helped with implanting of the seeds.  Total of 38 seeds were placed in the patient with 10 peripheral needles and then 4 internal needles.  Total of 30 seeds were placed in the periphery and total of 8 seeds were placed in the inside.  They were done directly under transrectal ultrasound vision.  The seeds were placed directly under ultrasound guidance.  There was a nice distribution of the seeds.  A couple of more seeds were placed on the right side due to the location of the prostate cancer.  Subsequently at the end of the procedure, fluoroscopy was done.  Couple of images were obtained.  Cystoscopy was done at the end of the procedure where a seed was visualized right in the urethra, which was grasped and pulled out using grasper, which was difficult to get the seed off of the spacers, which was actually pulled out.  There were no further seeds visualized in the bladder.  The bladder appeared normal.  At the end of the procedure, a Foley catheter was kept in place of 18 French and the patient was brought to recovery in stable condition.
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DESCRIPTION: Cystoscopy and removal of foreign objects from the urethra.

urology, foreign objects, foley catheter, transrectal ultrasound, prostate cancer, cystoscopy, ultrasound, urethra, endotracheal, prostate

The described medical situation involves a cystoscopy and removal of foreign objects from the urethra, in conjunction with brachytherapy for prostate cancer. This procedure is complex and has several potential complications, such as bleeding, infection, or urethral stricture. The patient has a history of prostate cancer, which further adds to the gravity of the situation. While not an emergency, the medical stakes are high due to the involvement of cancer treatment and the precision required during the procedure to avoid complications. The outcome impacts the patient's cancer treatment and overall health, making it a high-stakes situation.


Medical Specialty: Urology
Sample Name: Flank Pain - Consult - 1

REASON FOR CONSULTATION: , Left flank pain, ureteral stone.,BRIEF HISTORY: , The patient is a 76-year-old female who was referred to us from Dr. X for left flank pain.  The patient was found to have a left ureteral stone measuring about 1.3 cm in size per the patient's history.  The patient has had pain in the abdomen and across the back for the last four to five days.  The patient has some nausea and vomiting.  The patient wants something done for the stone.  The patient denies any hematuria, dysuria, burning or pain.  The patient denies any fevers.,PAST MEDICAL HISTORY: , Negative.,PAST SURGICAL HISTORY:  ,Years ago she had surgery that she does not recall.,MEDICATIONS: , None.,ALLERGIES: , None.,REVIEW OF SYSTEMS: , Denies any seizure disorder, chest pain, denies any shortness of breath, denies any dysuria, burning or pain, denies any nausea or vomiting at this time.  The patient does have a history of nausea and vomiting, but is doing better.,PHYSICAL EXAMINATION:,VITAL SIGNS:  The patient is afebrile.  Vitals are stable.,HEART:  Regular rate and rhythm.,ABDOMEN:  Soft, left-sided flank pain and left lower abdominal pain.,The rest of the exam is benign.,LABORATORY DATA: , White count of 7.8, hemoglobin 13.8, and platelets 234,000.  The patient's creatinine is 0.92.,ASSESSMENT:,1.  Left flank pain.,2.  Left ureteral stone.,3.  Nausea and vomiting.,PLAN: , Plan for laser lithotripsy tomorrow.  Options such as watchful waiting, laser lithotripsy, and shockwave lithotripsy were discussed.  The patient has a pretty enlarged stone.  Failure of the procedure if the stone is significantly impacted into the ureteral wall was discussed.  The patient understood that the success of the surgery may be or may not be 100%, that she may require shockwave lithotripsy if we are unable to get the entire stone out in one sitting.  The patient understood all the risk, benefits of the procedure and wanted to proceed.  Need for stent was also discussed with the patient.  The patient will be scheduled for surgery tomorrow.  Plan for continuation of the antibiotics, obtain urinalysis and culture, and plan for KUB to evaluate for the exact location of the stone prior to surgery tomorrow.
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DESCRIPTION: Left flank pain, ureteral stone.

Left flank pain, ureteral stone.

urology, flank pain, ureteral stone, shockwave lithotripsy, shockwave, nausea, vomiting, lithotripsy, ureteral, stone,

The situation involves a 76-year-old female with a large ureteral stone that is causing significant discomfort, including flank pain, and has likely resulted in nausea and vomiting. Although the patient is stable and vital signs are normal, the stone size (1.3 cm) and symptoms suggest a need for intervention, specifically laser lithotripsy. While not immediately life-threatening, untreated ureteral stones can lead to complications like infections or deteriorating kidney function, or substantial pain. The planned intervention involves surgical procedures that carry typical surgical risks and patient consent was obtained after discussing risks and benefits. These factors suggest that while the situation requires medical intervention and involves some risks, it is not among the most critical or life-threatening scenarios.


Medical Specialty: Urology
Sample Name: Electrofulguration - Bladder Tumor

PREOPERATIVE DIAGNOSIS: , Recurrent bladder tumors.,POSTOPERATIVE DIAGNOSIS:,  Recurrent bladder tumors.,OPERATION: , Cystoscopy, TUR, and electrofulguration of recurrent bladder tumors.,ANESTHESIA:,  General.,INDICATIONS: , A 79-year-old woman with recurrent bladder tumors of the bladder neck.,DESCRIPTION OF PROCEDURE:  ,The patient was brought to the operating room, prepped and draped in lithotomy position under satisfactory general anesthesia.  A #21-French cystourethroscope was inserted into the bladder.  Examination of the bladder showed approximately a 3-cm area of erythema and recurrent papillomatosis just above and lateral to the left ureteral orifice.  No other lesions were noted.  Using a cold punch biopsy forceps, a random biopsy was obtained.  The entire area was electrofulgurated using the Bugbee electrode.  The patient tolerated the procedure well and left the operating room in satisfactory condition.
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DESCRIPTION: Cystoscopy, TUR, and electrofulguration of recurrent bladder tumors.

urology, bladder neck, bladder tumors, cystoscopy, tur, electrofulguration, bladder

This medical procedure involves the diagnosis and treatment of recurrent bladder tumors, which is a serious medical condition. The procedure described, including cystoscopy, TUR, and electrofulguration, indicates that medical professionals are addressing potentially dangerous tumor growth in a patient. However, the patient tolerated the procedure well and left in satisfactory condition, indicating the situation was managed effectively. Nevertheless, the context involves an elderly patient and cancer recurrence, both of which elevate the stakes in terms of medical importance and potential consequences of the treatment. Therefore, while the procedure itself was successful, the context indicates a relatively high-stakes situation due to the nature of the condition being treated.


Medical Specialty: Urology
Sample Name: Erectile Dysfunction - Followup

HISTORY OF PRESENT ILLNESS: , The patient presents today for followup, history of erectile dysfunction, last visit started on Cialis 10 mg.  He indicates that he has noticed some mild improvement of his symptoms, with no side effect.  On this dose, he is having firm erection, able to penetrate, lasting for about 10 or so minutes.  No chest pain, no nitroglycerin usage, no fever, no chills.  No dysuria, gross hematuria, fever, chills.  Daytime frequency every three hours, nocturia times 0, good stream.  He does have a history of elevated PSA and biopsy June of this year was noted for high grade PIN, mid left biopsy, with two specimens being too small to evaluate.  PSA 11.6.  Dr. X's notes are reviewed.,IMPRESSION:  ,1.  Some improvement of erectile dysfunction, on low dose of Cialis, with no side effects.  The patient has multiple risk factors, but denies using any nitroglycerin or any cardiac issues at this time.  We reviewed options of increasing the medication, versus trying other medications, options of penile prosthesis, Caverject injection use as well as working pump is reviewed.,2.  Elevated PSA in a patient with a recent biopsy showing high-grade PIN, as well as two specimens not being large enough to evaluate.  The patient tells me he has met with his primary care physician and after discussion, he is in consideration of repeating a prostate ultrasound and biopsy.  However, he would like to meet with Dr. X to discuss these prior to biopsy.,PLAN: , Following detailed discussion, the patient wishes to proceed with Cialis 20 mg, samples are provided as well as Levitra 10 mg, may increase this to 20 mg and understand administration of each and contraindication as well as potential side effects are reviewed.  The patient not to use them at the same time.  Will call if any other concern.  In the meantime, he is scheduled to meet with Dr. X, with a prior PSA in consideration of a possible repeating prostate ultrasound and biopsy.  He declined scheduling this at this time.  All questions answered.
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DESCRIPTION: Some improvement of erectile dysfunction, on low dose of Cialis, with no side effects.

urology, improvement of erectile dysfunction, erectile dysfunction, erectile, dysfunction, cialis, psa, biopsy,

The situation involves follow-up care for erectile dysfunction, with medication adjustments and monitoring of potential prostate issues due to elevated PSA and a history of high-grade PIN. While there are health considerations, such as the discussion of potentially repeating a prostate biopsy, there is no immediate life-threatening condition. The patient seems to be stable on current medication without side effects, and plans are in place for further evaluations. As such, the stakes are not extremely high, but monitoring and follow-up are important.


Medical Specialty: Urology
Sample Name: Consult - Prostate Cancer

CONSULT FOR PROSTATE CANCER,The patient returned for consultation for his newly diagnosed prostate cancer.  The options including radical prostatectomy with or without nerve sparing were discussed with him with the risks of bleeding, infection, rectal injury, impotence, and incontinence.  These were discussed at length.  Alternative therapies including radiation therapy; either radioactive seed placement, conformal radiation therapy, or the HDR radiation treatments were discussed with the risks of bladder, bowel, and rectal injury and possible impotence were discussed also.  There is a risk of rectal fistula.  Hormonal therapy is usually added to the radiation therapy options and this has the risk of osteoporosis, gynecomastia, hot flashes and impotency.  Potency may not recover after the hormone therapy has been completed.  Cryosurgery was discussed with the risks of urinary retention, stricture formation, incontinence and impotency.  There is a risk of rectal fistula.  He would need to have a suprapubic catheter for about two weeks and may need to learn self-intermittent catheterization if he cannot void adequately.  Prostate surgery to relieve obstruction and retention after radioactive seeds or cryosurgery has a higher risk of urinary incontinence.  Observation therapy was discussed with him in addition.  I answered all questions that were put to me and I think he understands the options that are available.  I spoke with the patient for over 60 minutes concerning these options.
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DESCRIPTION: Consult for prostate cancer

Consult for prostate cancer

urology, prostate cancer, cryosurgery, hdr radiation, prostate surgery, bladder, bleeding, bowel, consultation, impotence, incontinence, infection, prostatectomy, radiation therapy, radical, rectal, rectal fistula, rectal injury, prostate cancer consult, cancer, radiation, prostateNOTE,: Thesetranscribed medical transcription sample reports and examples are provided by various users andare for reference purpose only. MTHelpLine does not certify accuracy and quality of sample reports.These transcribed medical transcription sample reports may include some uncommon or unusual formats;this would be due to the preference of the dictating physician. All names and dates have beenchanged (or removed) to keep confidentiality. Any resemblance of any type of name or date orplace or anything else to real world is purely incidental.,

The situation involves discussing treatment options for prostate cancer, which is a serious medical condition. The stakes are high because incorrect treatment choices could significantly impact the patient's quality of life, including risks of severe side effects and potential progression of cancer. The consultation covers various treatment options, each with its own set of significant risks, highlighting the high importance of this decision-making process.


Medical Specialty: Urology
Sample Name: Cryosurgical Ablation of Prostate

PREOPERATIVE DIAGNOSIS:  ,Carcinoma of the prostate, clinical stage T1C.,POSTOPERATIVE DIAGNOSIS: , Carcinoma of the prostate, clinical stage T1C.,TITLE OF OPERATION: , Cystoscopy, cryosurgical ablation of the prostate.,FINDINGS:  ,After measurement of the prostate, we decided to place 5 rows of needles--row #1 had 3 needles, row #2 at the level of the mid-prostate had 4 needles, row #3 had 2 needles in the right lateral peripheral zone, row #4 was a single needle directly the urethra, and in row #5 were 2 needles placed in the left lateral peripheral zone.  Because of the length of the prostate, a pull-back was performed, pulling row #2 approximately 3 mm and rows #3, #4 and #5 approximately 1 cm back before refreezing.,OPERATION IN DETAIL: , The patient was brought to the operating room and placed in the supine position.  After adequate general endotracheal anesthesia was obtained, the patient was positioned in the dorsal lithotomy position.  Full bowel prep had been obtained prior to the procedure.  After performing flexible cystoscopy, a Foley catheter was placed per urethra into the bladder.  Next, the ultrasound probe was placed into the stabilizer and advanced into the rectum.  An excellent ultrasound image was visualized of the entire prostate, which was re-measured.  Next, the probe template was positioned over the perineum and the template guide brought up on the ultrasound screen in order to guide needle placement.  Then 17-gauge needles were serially placed into the prostate, from an anterior to posterior direction into the prostate.  Ultrasound guidance demonstrated that these needles, numbering approximately 14 to 15 needles, were well placed and spaced throughout the prostate to obtain excellent freezing of the entire gland while sparing the urethra.  Repeat cystoscopy demonstrated a single needle passing through the urethra; and due to the high anterior location of this needle, it was removed.  The CMS urethral warmer was then passed per urethra into the bladder, and flow instituted.  After placing these 17-gauge needles, the prostate was then frozen down to minus 150 degrees for 10 minutes in sequential fashion from anterior to posterior.  The ice ball was monitored and was seen to extend through the capsule of the prostate toward the rectum but not through the rectal wall itself.  Active warming was then performed before refreezing the prostate again and then passively warming it back to room temperature.  The urethral warmer was left on after the needles were removed and the patient brought to the recovery room.  The patient tolerated the procedure well and left the operating room in stable condition.
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DESCRIPTION: Cystoscopy, cryosurgical ablation of the prostate.

urology, carcinoma of the prostate, ablation, cystoscopy, cryosurgical ablation, prostate, ultrasound, cryosurgical, urethra,

The situation described involves a surgical procedure to treat prostate cancer using cryosurgical ablation. While this is a routine medical treatment, it still involves significant risk factors due to the nature of the disease (cancer) and the invasive procedure. The stakes are higher due to potential complications that could arise during or after the surgery, such as damage to surrounding tissues or failure to effectively treat the cancer. Additionally, the use of anesthesia introduces another layer of risk. However, since this is a planned procedure with standard protocols and monitoring, it is not at the highest end of the stakes scale.


Medical Specialty: Urology
Sample Name: Circumcision Followup

REASON FOR VISIT: , Followup circumcision.,HISTORY OF PRESENT ILLNESS: , The patient had his circumcision performed on 09/16/2007 here at Children's Hospital.  The patient had a pretty significant phimosis and his operative course was smooth.  He did have a little bit of bleeding when he woke in recovery room, which required placement of some additional sutures, but after that, his recovery has been complete.  His mom did note that she had to him a couple of days of oral analgesics, but he seems to be back to normal and pain free now.  He is having no difficulty urinating, and his bowel function remains normal.,PHYSICAL EXAMINATION:  ,Today, The patient looks healthy and happy.  We examined his circumcision site.  His Monocryl sutures are still in place.  The healing is excellent, and there is only a mild amount of residual postoperative swelling.  There was one area where he had some recurrent adhesions at the coronal sulcus, and I gently lysed this today and applied antibiotic ointment showing this to mom had to especially lubricate this area until the healing is completed.,IMPRESSION: , Satisfactory course after circumcision for severe phimosis with no perioperative complications.,PLAN:  ,The patient came in followup for his routine care with Dr. X, but should not need any further routine surgical followup unless he develops any type of difficulty with this surgical wound.  If that does occur, we will be happy to see him back at any time.,
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DESCRIPTION: Followup circumcision.  The patient had a pretty significant phimosis and his operative course was smooth.  Satisfactory course after circumcision for severe phimosis with no perioperative complications.

urology, circumcision, adhesions, followup circumcision, sutures, phimosis,

The situation described involves a routine follow-up after a circumcision surgery. The procedure seems to have been straightforward, and the follow-up report indicates no major complications post-surgery. The patient's healing is described as excellent with only mild swelling and some minor issues with adhesions that were addressed. Since there are no current complications and the patient is recovering well, this is a low-stakes medical situation, particularly because it involves a pediatric routine surgical follow-up where expected outcomes were achieved.


Medical Specialty: Urology
Sample Name: Circumcision - 7

PROCEDURE:,  Circumcision.,ANESTHESIA: , EMLA.,FINDINGS: , Normal penis.  The foreskin was normal in appearance and measured 1.6 cm.  There was no bleeding at the circumcision site.,PROCEDURE:,  Patient was placed on the circumcision restraint board.  EMLA had been applied approximately 90 minutes before.  A time-out was completed satisfactorily per protocol.  The area was prepped with Betadine.  The foreskin was grasped with sterile clamps and was dissected away from the corona and the glans penis with blunt dissection.  A Mogen clamp was applied to the cervix.  The excess foreskin was excised with the scalpel.  The clamp was removed.  At this point, the procedure was terminated.  Sterile Vaseline and gauze was applied to the glans penis.  There were no complications.  There was minimal blood loss.
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DESCRIPTION: Normal penis.  The foreskin was normal in appearance and measured 1.6 cm.  There was no bleeding at the circumcision site.

urology, mogen clamp, glans penis, emla, penis, foreskin, circumcision

The procedure described is a routine circumcision, which is generally considered a low-risk surgical procedure. The documentation specifies normal findings and no complications, indicating a typical outcome. Although all medical procedures have some level of risk, the stakes here are relatively low due to the routine nature of the operation and absence of any complications.


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Medical Specialty: Urology
Sample Name: Circumcision - 3

CIRCUMCISION,After informed consent was obtained the baby was placed on the circumcision tray.  He was prepped in a sterile fashion times 3 with Betadine and then draped in a sterile fashion.  Then 0.2 mL of 1% lidocaine was injected at 10 and 2 o'clock.  A ring block was also done using another 0.3 mL of lidocaine.  Glucose water is also used for anesthesia.  After several minutes the curved clamp was attached at 9 o'clock with care being taken to avoid the meatus.  The blunt probe was then introduced again with care taken to avoid the meatus.  After initial adhesions were taken down the straight clamp was introduced to break down further adhesions.  Care was taken to avoid the frenulum.  The clamps where then repositioned at 12 and 6 o'clock.  The Mogen clamp was then applied with a dorsal tilt.  After the clamp was applied for 1 minute the foreskin was trimmed.  After an additional minute the clamp was removed and the final adhesions were taken down.  Patient tolerated the procedure well with minimal bleeding noted.  Patient to remain for 20 minutes after procedure to insure no further bleeding is noted.,Routine care discussed with the family.  Need to clean the area with just water initially and later with soap and water or diaper wipes once healed.
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DESCRIPTION: Circumcision procedure in a baby

Circumcision procedure in a baby

urology, circumcision, 1% lidocaine, betadine, glucose water, adhesions, circumcision tray, diaper wipes, foreskin, frenulum, meatus, straight clamp, sterile fashion, clampNOTE,: Thesetranscribed medical transcription sample reports and examples are provided by various users andare for reference purpose only. MTHelpLine does not certify accuracy and quality of sample reports.These transcribed medical transcription sample reports may include some uncommon or unusual formats;this would be due to the preference of the dictating physician. All names and dates have beenchanged (or removed) to keep confidentiality. Any resemblance of any type of name or date orplace or anything else to real world is purely incidental.

This situation involves a medical procedure on a baby, which inherently carries some risk, especially concerning bleeding or injury during the procedure. However, circumcision is a common and routine procedure, with the description indicating that it was performed carefully and with minimal complications. The post-operative care instructions are standard. Although any procedure on an infant requires careful monitoring, it generally does not represent the highest level of stakes in a medical context unless complications arise.


Medical Specialty: Urology
Sample Name: Cavernosaphenous Shunt - Priapism

PREOPERATIVE DIAGNOSIS:,  Refractory priapism.,POSTOPERATIVE DIAGNOSIS:,  Refractory priapism.,PROCEDURE PERFORMED: , Cavernosaphenous shunt.,ANESTHESIA:,  General.,ESTIMATED BLOOD LOSS:  ,400 cc.,FLUIDS: , IV fluids 1600 crystalloids, one liter packed red blood cells.,INDICATIONS FOR PROCEDURE:  ,This is a 34-year-old African-American male who is known to our service with a history of recurrent priapism.  The patient presented with priapism x48 hours on this visit.  The patient underwent corporal aspiration and Winter's shunt both of which failed and then subsequently underwent _______ procedure.  The patient's priapism did return following this and he was scheduled for cavernosaphenous shunt.,PROCEDURE:,  Informed written consent was obtained.  The patient was taken to the operative suite and administered anesthetic.  The patient was sterilely prepped and draped in the supine fashion.  A #15 French Foley catheter was inserted under sterile conditions.  Incision was made in the left base of the penile shaft on the lateral aspect, approximately 3 cm in length.  Tissue was dissected down to the level of the corpora cavernosum and corpora spongiosum.  The fascia was incised in elliptical fashion for approximately 2 cm.  A #14 gauge Angiocath was inserted into the corpora cavernosum to the glans of the penis and the corpora was irrigated copiously until all of the old clotted blood was removed and fresher irrigation was noted.,Attention was then turned to the left groin and the superficial saphenous vein was harvested.  Due to incisions brought up into the initial incision after gauging enough length, this was then spatulated with Potts scissors for approximately 2 cm.  Vein was irrigated.  One branching vessel was noted to be leaking, this was tied off and repeat injection with heparinized saline showed no additional leaks.  Tunnel was then created from the superior most groin region to the incision in the penile shaft.  Saphenous vein was then passed through this tunnel with the aid of a hemostat.  Anastomosis was performed using #5-0 Prolene suture in a running fashion from proximal to distal.  There were no leaks noted.  There was good flow noted within the saphenous vein graft.  Penis was noted to be in a flaccid state.  All incisions were irrigated copiously and closed in several layers.  Sterile dressings were applied.  The patient was cleaned, transferred to recovery room in stable condition.,PLAN:  ,We will continue with antibiotics for pain control, maintain Foley catheter.  Further recommendations to follow.
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DESCRIPTION: Refractory priapism.  Cavernosaphenous shunt.   The patient presented with priapism x48 hours on this visit.  The patient underwent corporal aspiration and Winter's shunt both of which failed

urology, corporal aspiration, winter's shunt, foley catheter, corpora cavernosum, refractory priapism, saphenous vein, cavernosaphenous shunt, corporal, priapism, aspiration

The situation described involves a surgical procedure to address refractory priapism, which is a prolonged and painful erection that can cause permanent tissue damage if not treated promptly. The condition presented here has been resistant to less invasive treatments, and a cavernosaphenous shunt is being performed. The stakes are high because untreated or inadequately managed priapism can result in serious complications, including erectile dysfunction. Additionally, the surgical procedure itself involves significant risks, including blood loss and infection.


Medical Specialty: Urology
Sample Name: Circumcision - 5

PROCEDURES:,1.  Release of ventral chordee.,2.  Circumcision.,3.  Repair of partial duplication of urethral meatus.,INDICATIONS: , The patient is an 11-month-old baby boy who presented for evaluation of a duplicated urethral meatus as well as ventral chordee and dorsal prepuce hooding.  He is here electively for surgical correction.,DESCRIPTION OF PROCEDURE: , The patient was brought back into operating room 35.  After successful induction of general endotracheal anesthetic, giving the patient, preoperative antibiotics and after completing a preoperative time out, the patient was prepped and draped in the usual sterile fashion.,A holding stitch was placed in the glans penis.  At this point, we probed both urethral meatus.  Using the Crede maneuver, we could see urine clearly coming out of the lower, the more ventral meatus.  At this point, we cannulated this with a 6-French hypospadias catheter.  We attempted to cannulate the dorsal opening, however, we were unsuccessful.  We then attempted to place lacrimal probes and were also unsuccessful indicating this was incomplete duplication.  At this point, we identified the band connecting both the urethral meatus and incised it with tenotomy scissors.  We sutured both meatus together such that there was one meatus at the normal position at the tip of the glans.,At this point, we made a circumcising incision around the penis and degloved the penis in its entirety relieving all chordee.  Once all the chordee had been adequately released, we turned our attention to the circumcision.  Excessive dorsal foreskin was removed from the skin and glans.  Mucosal cuts were reapproximated with interrupted 5-0 chromic suture.  Dermabond was placed over this and bacitracin was placed on this once dry.  This ended the procedure.  ,DRAINS:,  None.,ESTIMATED BLOOD LOSS: , Minimal.,URINE OUTPUT:  ,Unrecorded.,COMPLICATIONS: , None apparent.,DISPOSITION:  ,The patient will now go under the care of Dr. XYZ, Plastic Surgery, for excision of scalp hemangioma.
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DESCRIPTION: Release of ventral chordee, circumcision, and repair of partial duplication of urethral meatus.

urology, release of ventral chordee, repair of partial duplication, partial duplication, ventral chordee, urethral meatus, glans, penis, circumcision, ventral, chordee, urethral, meatus,

The situation involves surgical procedures on an 11-month-old baby boy, including circumcision, release of ventral chordee, and repair of a partial duplication of urethral meatus. While these are common pediatric urological procedures, any surgery on an infant requires precision and care due to the patient's age and vulnerability. The description suggests that the surgery was elective and there were no apparent complications, reducing immediate life-threatening risk. However, the involvement of general anesthesia and the delicate nature of the procedures could impact the child's long-term health if not performed correctly. Hence, this situation has moderate stakes due to the potential consequences of surgical complications and the young age of the patient.


Medical Specialty: Urology
Sample Name: Circumcision - 6

PROCEDURE: , Circumcision.,Signed informed consent was obtained and the procedure explained.,DETAILS OF PROCEDURE: ,The child was placed in a Circumstraint board and restrained in the usual fashion.  The area of the penis and scrotum were prepared with povidone iodine solution.  The area was draped with sterile drapes, and the remainder of the procedure was done with sterile procedure.  A dorsal penile block was done using 2 injections of 0.3 cc each, 1% plain lidocaine.  A dorsal slit was made, and the prepuce was dissected away from the glans penis.  A Gomco clamp was properly placed for 5 minutes.  During this time, the foreskin was sharply excised using a #10 blade.  With removal of the clamp, there was a good cosmetic outcome and no bleeding.  The child appeared to tolerate the procedure well.  Care instructions were given to the parents.
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DESCRIPTION: Circumcision.   A dorsal slit was made, and the prepuce was dissected away from the glans penis.

urology, gomco clamp, dorsal slit, glans penis, slit, circumcision, penisNOTE,: Thesetranscribed medical transcription sample reports and examples are provided by various users andare for reference purpose only. MTHelpLine does not certify accuracy and quality of sample reports.These transcribed medical transcription sample reports may include some uncommon or unusual formats;this would be due to the preference of the dictating physician. All names and dates have beenchanged (or removed) to keep confidentiality. Any resemblance of any type of name or date orplace or anything else to real world is purely incidental.

The described procedure is a routine circumcision for a child, a common surgical procedure performed for various medical, cultural, or religious reasons. The details indicate that it was performed without complications and with proper consent and sterile techniques. In the context of surgery, circumcision is generally considered low to moderate stakes due to its routine nature and low risk of major complications if performed by trained professionals in a controlled environment. However, as with any surgical procedure, there is always a degree of risk involved, such as infection or bleeding, but these risks are generally well-managed and not high-stakes compared to other medical scenarios.


Medical Specialty: Urology
Sample Name: Bladder Laceration Closure

PREOPERATIVE DIAGNOSES: , Bladder laceration.,POSTOPERATIVE DIAGNOSES:,  Bladder laceration.,NAME OF OPERATION: , Closure of bladder laceration.,FINDINGS:,  The patient was undergoing a cesarean section for twins.  During the course of the procedure, a bladder laceration was notices and urology was consulted.  Findings were a laceration on the dome of the bladder.,PROCEDURE: , Initially there as a mucosal layer of suture already placed.  This was done with 3-0 chromic catgut.  The bladder was distended and, while the bladder was distended with physiologic saline, a second layer of 3-0 chromic catgut created a watertight closure.  The second layer included the mucosa an dinner layer of the detrusor muscle.  A third layer of 2-0 Dexon was used.  Each of these were placed in a continuous running-locked suture technique.  There was complete watertight closure of the bladder.  Hemostasis was assured and a Jackson-Pratt drain was brought out through a separate stab wound.  The remaining portion of the operation, both the cesarean section and the wound closure, will be dictated by Dr. Redmond.
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DESCRIPTION: Closure of bladder laceration, during cesarean section.

urology, mucosal layer, closure of bladder laceration, watertight closure, cesarean section, bladder laceration, bladder, cesarean, closure, laceration,

The situation involves a surgical procedure to address a bladder laceration identified during a cesarean section for twins. This is a high-stakes scenario due to the potential risks associated with surgical procedures, the urgency of addressing a laceration to prevent further complications, and the involvement of two ongoing critical procedures—cesarean section and urological repair. Additionally, patient safety is paramount in surgical settings, especially with unexpected findings like a bladder laceration during surgery.


Medical Specialty: Urology
Sample Name: Bladder Instillation

CHIEF COMPLAINT:,  The patient comes for bladder instillation for chronic interstitial cystitis.,SUBJECTIVE:,  The patient is crying today when she arrives in the office saying that she has a lot of discomfort.  These bladder instillations do not seem to be helping her.  She feels anxious and worried.  She does not think she can take any more pain.  She is debating whether or not to go back to Dr. XYZ and ask for the nerve block or some treatment modality to stop the pain because she just cannot function on a daily basis and care for her children unless she gets something done about this, and she fears these bladder instillations because they do not seem to help.  They seem to be intensifying her pain.  She has the extra burden of each time she comes needing to have pain medication one way or another, thus then we would not allow her to drive under the influence of the pain medicine.  So, she has to have somebody come with her and that is kind of troublesome to her.  We discussed this at length.  I did suggest that it was completely appropriate for her to decide.  She will terminate these if they are that uncomfortable and do not seem to be giving her any relief, although I did tell her that occasionally people do have discomfort with them and then after the completion of the instillations, they do better and we have also had some people who have had to terminate the instillations because they were too uncomfortable and they could not stand it and they went on to have some other treatment modality.  She had Hysterectomy in the past.,MEDICATIONS: , Premarin 1.25 mg daily, Elmiron 100 mg t.i.d., Elavil 50 mg at bedtime, OxyContin 10 mg three tablets three times a day, Toprol XL 25 mg daily.,ALLERGIES:,  Compazine and Allegra.,OBJECTIVE:,Vital Signs:  Weight:  140 pounds.  Blood pressure:  132/90.  Pulse:  102.  Respirations:  18.  Age:  27.,PLAN:,  We discussed going for another evaluation by Dr. XYZ and seeking his opinion.  She said that she called him on the phone the other day and told him how miserable she was and he told her that he really thought she needed to complete.  The instillations give that a full trial and then he would be willing to see her back.  As we discussed these options and she was encouraged to think it over and decide what she would like to do for I could not makeup her mind for her.  She said she thought that it was unreasonable to quit now when she only had two or three more treatments to go, but she did indicate that the holiday weekend coming made her fearful and if she was uncomfortable after today’s instillation which she did choose to take then she would choose to cancel Friday’s appointment, also that she would not feel too badly over the holiday weekend.  I thought that was reasonable and agreed that that would work out.,PROCEDURE:,:  She was then given 10 mg of morphine subcutaneously because she did not feel she could tolerate the discomfort in the instillation without pain medicine.  We waited about 20 minutes.  The bladder was then instilled and the urethra was instilled with lidocaine gel which she tolerated and then after a 10-minute wait, the bladder was instilled with DMSO, Kenalog, heparin, and sodium bicarbonate, and the catheter was removed.  The patient retained the solution for one hour, changing position every 15 minutes and then voided to empty the bladder.  She seemed to tolerate it moderately well.  She is to call and let me know what she wishes to do about the Friday scheduled bladder instillation if she tolerated this then she is going to consider trying it.  If not, she will cancel and will start over next week or she will see Dr. Friesen.
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DESCRIPTION: Bladder instillation for chronic interstitial cystitis.

urology, urethra, dmso, bladder, chronic interstitial cystitis, interstitial cystitis, bladder instillation, instillation, instillations,

The situation describes a patient experiencing severe and chronic pain due to interstitial cystitis, which is affecting her daily functioning and mental health. While it is not immediately life-threatening, the ongoing pain and the potential for decreased quality of life present significant stakes. Additionally, the decision-making around continuing or terminating the treatment has implications for her well-being and daily responsibilities, such as caring for her children.


Medical Specialty: Surgery
Sample Name: Youngswick Osteotomy

TITLE OF OPERATION: , Youngswick osteotomy with internal screw fixation of the first right metatarsophalangeal joint of the right foot.,PREOPERATIVE DIAGNOSIS: , Hallux limitus deformity of the right foot.,POSTOPERATIVE DIAGNOSIS: , Hallux limitus deformity of the right foot.,ANESTHESIA:,  Monitored anesthesia care with 15 mL of 1:1 mixture of 0.5% Marcaine and 1% lidocaine plain.,ESTIMATED BLOOD LOSS:,  Less than 10 mL.,HEMOSTASIS:,  Right ankle tourniquet set at 250 mmHg for 35 minutes.,MATERIALS USED: , 3-0 Vicryl, 4-0 Vicryl, and two partially threaded cannulated screws from 3.0 OsteoMed System for internal fixation.,INJECTABLES:  ,Ancef 1 g IV 30 minutes preoperatively.,DESCRIPTION OF THE PROCEDURE: , The patient was brought to the operating room and placed on the operating table in the supine position.  After adequate sedation was achieved by the anesthesia team, the above-mentioned anesthetic mixture was infiltrated directly into the patient's right foot to anesthetize the future surgical site.  The right ankle was then covered with cast padding and an 18-inch ankle tourniquet was placed around the right ankle and set at 250 mmHg.  The right ankle tourniquet was then inflated.  The right foot was prepped, scrubbed, and draped in normal sterile technique.  Attention was then directed on the dorsal aspect of the first right metatarsophalangeal joint where a 6-cm linear incision was placed just parallel and medial to the course of the extensor hallucis longus to the right great toe.  The incision was deepened through the subcutaneous tissues.  All the bleeders were identified, cut, clamped, and cauterized.  The incision was deepened to the level of the capsule and the periosteum of the first right metatarsophalangeal joint.  All the tendinous and neurovascular structures were identified and retracted from the site to be preserved.  Using sharp and dull dissection, all the capsular and periosteal attachments were mobilized from the base of the proximal phalanx of the right great toe and head of the first right metatarsal.  Once the base of the proximal phalanx of the right great toe and the first right metatarsal head were adequately exposed, multiple osteophytes were encountered.  Gouty tophi were encountered both intraarticularly and periarticularly for the first right metatarsophalangeal joint, which were consistent with a medical history that is positive for gout for this patient.,Using sharp and dull dissection, all the ligamentous and soft tissue attachments were mobilized and the right first metatarsophalangeal joint was freed from all adhesions.  Using the sagittal saw, all the osteophytes were removed from the dorsal, medial, and lateral aspect of the first right metatarsal head as well as the dorsal, medial, and lateral aspect of the base of the proximal phalanx of the right great toe.  Although some improvement of the range of motion was encountered after the removal of the osteophytes, some tightness and restriction was still present.  The decision was thus made to perform a Youngswick-type osteotomy on the head of the first right metatarsal.  The osteotomy consistent of two dorsal cuts and a plantar cut in a V-pattern with the apex of the osteotomy distal and the base of the osteotomy proximal.  The two dorsal cuts were longer than the plantar cut in order to accommodate for the future internal fixation.  The wedge of bone that was formed between the two dorsal cuts was resected and passed off to Pathology for further examination.  The head of the first right metatarsal was then impacted on the shaft of the first right metatarsal and provisionally stabilized with two wires from the OsteoMed System.  The wires were inserted from a dorsal distal to plantar proximal direction through the dorsal osteotomy.  The wires were also used as guidewires for the insertion of two 16-mm proximally threaded cannulated screws from the OsteoMed System.  The 2 screws were inserted using AO technique.  Upon insertion of the screws, the two wires were removed.  Fixation of the osteotomy on the table was found to be excellent.  The area was copiously flushed with saline and range of motion was reevaluated and was found to be much improved from the preoperative levels without any significant restriction.  The cartilaginous surfaces on the base of the first right metatarsal and the base of the proximal phalanx were also fenestrated in order to induce some cartilaginous formation.  The capsule and periosteal tissues were then reapproximated with 3-0 Vicryl suture material, 4-0 Vicryl was used to approximate the subcutaneous tissues.  Steri-Strips were used to approximate and reinforce the skin edges.  At this time, the right ankle tourniquet was deflated.  Immediate hyperemia was noted in the entire right lower extremity upon deflation of the cuff.  The patient's surgical site was then covered with Xeroform, copious amounts of fluff and Kling, stockinette, and Ace bandage.  The patient's right foot was placed in a surgical shoe and the patient was then transferred to the recovery room under the care of the anesthesia team with her vital signs stable and neurovascular status at appropriate levels.  The patient was given instructions and education on how to continue caring for her right foot surgery at home.  The patient was also given pain medication instructions on how to control her postoperative pain.  The patient was eventually discharged from Hospital according to nursing protocol and was advised to follow up with Dr. X's office in one week's time for her first postoperative appointment.
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DESCRIPTION: Youngswick osteotomy with internal screw fixation of the first right metatarsophalangeal joint of the right foot.

surgery, hallux limitus deformity, metatarsophalangeal joint, plantar cut, youngswick osteotomy, dorsal cuts, ankle tourniquet, proximal phalanx, anesthesia, tourniquet, youngswick, phalanx, metatarsophalangeal, proximal, metatarsal, dorsal, osteotomy

The described situation involves a surgical procedure, specifically a Youngswick osteotomy, which is not an emergent or life-threatening procedure but still involves surgical intervention and anesthesia. It carries typical surgical risks, such as infection, bleeding, or complications related to anesthesia. While these are generally considered routine risks in surgical practice, they should not be underestimated as they require proper management. The detailed post-operative care and follow-up instructions also underline the necessary vigilance required for a successful outcome. Therefore, while the stakes are not life-threateningly high, they are significant enough to be considered moderately high-stakes due to the surgical nature of the procedure.


Medical Specialty: Surgery
Sample Name: VP Shunt Placement

TITLE OF OPERATION: , Placement of right new ventriculoperitoneal (VP) shunts Strata valve and to removal of right frontal Ommaya reservoir.,INDICATION FOR SURGERY: , The patient is a 2-month-old infant, born premature with intraventricular hemorrhage and Ommaya reservoir recommendation for removal and replacement with a new VP shunt.,PREOP DIAGNOSIS: , Hydrocephalus.,POSTOP DIAGNOSIS: , Hydrocephalus.,PROCEDURE DETAIL: , The patient was brought to the operating room, underwent induction of general endotracheal airway, positioned supine, head turned towards left.  The right side prepped and draped in the usual sterile fashion.  Next, using a 15 blade scalpel, two incisions were made, one in the parietooccipital region and.  The second just lateral to the umbilicus.  Once this was clear, the Bactiseal catheter was then tunneled.  This was connected to a Strata valve.  The Strata valve was programmed to a setting of 1.01 and this was ensured.  The small burr hole was then created.  The area was then coagulated.  Once this was completed, new Bactiseal catheter was then inserted.  It was connected to the Strata valve.  There was good distal flow.  The distal end was then inserted into the peritoneal region via trocar.  Once this was insured, all the wounds were irrigated copiously and closed with 3-0 Vicryl and 4-0 Caprosyn as well as Indermil glue.  The right frontal incision was then opened.  The Ommaya reservoir identified and removed.  The wound was then also closed with an inverted 3-0 Vicryl and 4-0 Caprosyn.  Once all the wounds were completed, dry sterile dressings were applied.  The patient was then transported back to the ICU in stable condition intubated.  Blood loss minimal.  All sponge and needle counts were correct.
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DESCRIPTION: Placement of right new ventriculoperitoneal (VP) shunts Strata valve and to removal of right frontal Ommaya reservoir.

surgery, ommaya reservoir, frontal, strata valve, intraventricular hemorrhage, vp shunt, ventriculoperitoneal, hydrocephalus,

The scenario involves a surgical procedure on a 2-month-old infant to address hydrocephalus by placing a VP shunt and removing an Ommaya reservoir. Given the nature of surgery on a brain condition, especially in an infant, the stakes are inherently high. There is potential risk involved in any surgical procedure, particularly those involving delicate brain-related conditions in premature infants, making it a critical operation.


Medical Specialty: Surgery
Sample Name: Vitrectomy - 1

PREOPERATIVE DIAGNOSIS: , Vitreous hemorrhage and retinal detachment, right eye.,POSTOPERATIVE DIAGNOSIS:,  Vitreous hemorrhage and retinal detachment, right eye.,NAME OF PROCEDURE: , Combined closed vitrectomy with membrane peeling, fluid-air exchange, and endolaser, right eye.,ANESTHESIA: , Local with standby.,PROCEDURE:  ,The patient was brought to the operating room, and an equal mixture of Marcaine 0.5% and lidocaine 2% was injected in a retrobulbar fashion.  As soon as satisfactory anesthesia and akinesia had been achieved, the patient was prepped and draped in the usual manner for sterile ophthalmic surgery.  A wire lid speculum was inserted.  Three modified sclerotomies were selected at 9, 10, and 1 o'clock.  At the 9 o'clock position, the Accurus infusion line was put in place and tied with a preplaced #7-0 Vicryl suture.  The two superior sites at 10 and 1 were opened up where the operating microscope with the optical illuminating system was brought into position, and closed vitrectomy was begun.  Initially formed core vitrectomy was performed and formed anterior vitreous was removed.  After this was completed, attention was placed in the posterior segment.  Several broad areas of vitreoretinal traction were noted over the posterior pole out of the equator where the previously noted retinal tears were noted.  These were carefully lifted and dissected off the edges of the flap tears and trimmed to the ora serrata.  After all the vitreous had been removed and the membranes released, the retina was completely mobilized.  Total fluid-air exchange was carried out with complete settling of the retina.  Endolaser was applied around the margins of the retinal tears, and altogether several 100 applications were placed in the periphery.  Good reaction was achieved.  The eye was inspected with an indirect ophthalmoscope.  The retina was noted to be completely attached.  The instruments were removed from the eye.  The sclerotomy sites were closed with #7-0 Vicryl suture.  The infusion line was removed from the eye and tied with a #7-0 Vicryl suture.  The conjunctivae and Tenon's were closed with #6-0 plain gut suture.  A collagen shield soaked with Tobrex placed over the surface of the globe, and a pressure bandage was put in place.  The patient left the operating room in a good condition.
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DESCRIPTION: Combined closed vitrectomy with membrane peeling, fluid-air exchange, and endolaser, right eye.

surgery, vitreous hemorrhage, retinal detachment, combined closed vitrectomy, vitrectomy, membrane peeling, fluid-air exchange, endolaser, vitrectomy with membrane peeling, membrane, peeling, hemorrhage, detachment, vicryl, eye, retinal,

The situation involves a surgical procedure for a vitreous hemorrhage and retinal detachment, which indicates a serious medical condition that requires precision and expertise to prevent potential vision loss. Retinal detachment, if untreated, can lead to permanent blindness. This makes the stakes fairly high since the outcome could significantly impact the patient's quality of life. However, because it was conducted under a controlled surgical environment, it is not at the highest possible stakes. Therefore, this scenario represents a high-stakes situation in the medical field.


Medical Specialty: Surgery
Sample Name: Ventriculostomy Placement

PROCEDURE: , Placement of left ventriculostomy via twist drill.,PREOPERATIVE DIAGNOSIS:,  Massive intraventricular hemorrhage with hydrocephalus and increased intracranial pressure.,POSTOPERATIVE DIAGNOSIS: , Massive intraventricular hemorrhage with hydrocephalus and increased intracranial pressure.,INDICATIONS FOR PROCEDURE:  ,The patient is a man with a history of massive intracranial hemorrhage and hydrocephalus with intraventricular hemorrhage.  His condition is felt to be critical.  In a desperate attempt to relieve increased intracranial pressure, we have proposed placing a ventriculostomy.  I have discussed this with patient's wife who agrees and asked that we proceed emergently.,After a sterile prep, drape, and shaving of the hair over the left frontal area, this area is infiltrated with local anesthetic.  Subsequently a 1 cm incision was made over Kocher's point.  Hemostasis was obtained.  Then a twist drill was made over this area.  Bones strips were irrigated away.  The dura was perforated with a spinal needle.,A Camino monitor was connected and zeroed.  This was then passed into the left lateral ventricle on the first pass.  Excellent aggressive very bloody CSF under pressure was noted.  This stopped, slowed, and some clots were noted.  This was irrigated and then CSF continued.  Initial opening pressures were 30, but soon arose to 80 or a 100.,The patient tolerated the procedure well.  The wound was stitched shut and the ventricular drain was then connected to a drainage bag.,Platelets and FFP as well as vitamin K have been administered and ordered simultaneously with the placement of this device to help prevent further clotting or bleeding.
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DESCRIPTION: Placement of left ventriculostomy via twist drill.  Massive intraventricular hemorrhage with hydrocephalus and increased intracranial pressure.

surgery, intraventricular hemorrhage, hydrocephalus, intracranial pressure, camino monitor, twist drill, ventriculostomy, hemorrhage, intracranial, pressure, intraventricular

The procedure described is an emergency surgical intervention aimed at relieving life-threatening increased intracranial pressure due to a massive intraventricular hemorrhage with hydrocephalus. The surgery is performed on a patient in critical condition, and the outcome could be the difference between life and death. This makes the situation extremely high-stakes.


Medical Specialty: Surgery
Sample Name: Vasectomy - 4

PROCEDURE: , Elective male sterilization via bilateral vasectomy.,PREOPERATIVE DIAGNOSIS:  ,Fertile male with completed family.,POSTOPERATIVE DIAGNOSIS:,  Fertile male with completed family.,MEDICATIONS:  ,Anesthesia is local with conscious sedation.,COMPLICATIONS: , None.,BLOOD LOSS: , Minimal.,INDICATIONS:  ,This 34-year-old gentleman has come to the office requesting sterilization via bilateral vasectomy.  I discussed the indications and the need for procedure with the patient in detail, and he has given consent to proceed.  He has been given prophylactic antibiotics.,PROCEDURE NOTE: , Once satisfactory sedation have been obtained, the patient was placed in the supine position on the operating table.  Genitalia was shaved and then prepped with Betadine scrub and paint solution and were draped sterilely.  The procedure itself was started by grasping the right vas deferens in the scrotum, and bringing it up to the level of the skin.  The skin was infiltrated with 2% Xylocaine and punctured with a sharp hemostat to identify the vas beneath.  The vas was brought out of the incision carefully.  A 2-inch segment was isolated, and 1-inch segment was removed.  The free ends were cauterized and were tied with 2-0 silk sutures in such a fashion that the ends double back on themselves.  After securing hemostasis with a cautery, the ends were allowed to drop back into the incision, which was also cauterized.,Attention was now turned to the left side.  The vas was grasped and brought up to the level of the skin.  The skin was infiltrated with 2% Xylocaine and punctured with a sharp hemostat to identify the vas beneath.  The vas was brought out of the incision carefully.  A 2-inch segment was isolated, and 1-inch segment was removed.  The free ends were cauterized and tied with 2-0 silk sutures in such a fashion that the ends double back on themselves.  After securing hemostasis with the cautery, the ends were allowed to drop back into the incision, which was also cauterized.,Bacitracin ointment was applied as well as dry sterile dressing.  The patient was awakened and was returned to Recovery in satisfactory condition.
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DESCRIPTION: Fertile male with completed family.  Elective male sterilization via bilateral vasectomy.

surgery, sterilization, vas, fertile male, bilateral vasectomy, vasectomy, cauterized,

The procedure described is an elective vasectomy for sterilization purposes in a 34-year-old male with a completed family. The procedure is common, typically low-risk, and performed under local anesthesia with minimal complications and blood loss expected. Although it is a surgical procedure, it is elective and considered low-stakes compared to emergency or more complex surgeries. The stakes are higher if there were complications or if it were not elective, but given the information, there are none.


Medical Specialty: Surgery
Sample Name: Vasectomy - 3

PREOPERATIVE DIAGNOSIS:,  Desire for sterility.,POSTOPERATIVE DIAGNOSIS:,  Desire for sterility.,OPERATIVE PROCEDURES: , Vasectomy.,DESCRIPTION OF PROCEDURE: , The patient was brought to the suite, where after oral sedation, the scrotum was prepped and draped.  Then, 1% lidocaine was used for anesthesia.  The vas was identified, skin was incised, and no scalpel instruments were used to dissect out the vas.  A segment about 3 cm in length was dissected out.  It was clipped proximally and distally, and then the ends were cauterized after excising the segment.  Minimal bleeding was encountered and the scrotal skin was closed with 3-0 chromic.  The identical procedure was performed on the contralateral side.  He tolerated it well.  He was discharged from the surgical center in good condition with Tylenol with Codeine for pain.  He will use other forms of birth control until he has confirmed azoospermia with two consecutive semen analyses in the month ahead.  Call if there are questions or problems prior to that time.
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DESCRIPTION: Desire for sterility.  Vasectomy.  The vas was identified, skin was incised, and no scalpel instruments were used to dissect out the vas.

surgery, vas, contralateral, desire for sterility, scalpel, sterility, vasectomy

The described situation pertains to a vasectomy procedure, which is a routine surgical operation for male sterilization. While it involves surgery and offers permanent results, it is generally considered a low-risk and relatively straightforward medical procedure with minor potential complications. Therefore, it does not present high-stakes in terms of medical risk. However, due to its life-altering nature, it is significantly impactful at a personal level.