Case Study 14-1: Herniorrhaphy and Vasectomy
E.D., a 48-year-old married dock worker with three children, developed inguinal bulging and pain on exertion when he lifted heavy objects. An occupational health service advised a surgical referral. The surgeon diagnosed E.D. with bilateral direct inguinal hernias and suggested that he not delay surgery, although he was not at high risk for a strangulated hernia. E.D. asked the surgeon if he could also be sterilized at the same time. He was scheduled for bilateral inguinal herniorrhaphy and elective vasectomy.
During the herniorrhaphy procedure an oblique incision was made in each groin. The incision continued through the muscle layers by either resecting or splitting the muscle fibers. The spermatic vessels and vas deferens were identified, separated, and gently retracted. The spermatic cord was examined for an indirect hernia. Repair began with suturing the defect in the rectus abdominis muscles, transverse fascia, cremaster muscle, external oblique aponeurosis, and Scarpa fascia with heavy-gauge synthetic nonabsorbable suture material.
The vasectomy began with the identification of the vas deferens through the scrotal skin. An incision was made, and the vas was gently dissected and retracted through the opening. Each vas was clamped with a small hemostat, and a 1-cm length was resected. Both cut ends were coagulated with electrosurgery and tied independently with a fine-gauge absorbable suture material. The testicles were examined, and the scrotal incision was closed with an absorbable suture material.
Case Study 14-2: Benign Prostatic Hyperplasia with TURP
C.S., a 62-year-old businessman, saw a urologist with complaints of decreased force of urine stream and ejaculation, hesitancy, and sensation of incomplete bladder emptying. He claimed he had taken prostate-health herbal supplements without any real benefit for 2 years before making the appointment. He denied dysuria, hematuria, or flank pain. He has no history of UTI, epididymitis, prostatitis, renal disease, or renal calculi. Rectal examination revealed a 50-g prostate with slight firmness in the right prostatic lobe. Bladder ultrasound showed no intravesical lesions or prostate protrusion into the bladder base. C.S. was diagnosed with benign prostatic hyperplasia with bladder neck obstruction and was scheduled for a TURP.
Case Study 14-3: Circumcision
S.G., a 12-year-old Jewish Russian immigrant, was preparing for his bar mitzvah. He had not been circumcised on the eighth day after his birth, as is Jewish tradition, because he had been unable to practice his religion within the former soviet system. On recommendation of his rabbi, his family brought him to a urologist for referral and surgery. On examination, the phallus and meatus were normal and without lesions. S.G. had no signs of discharge, phimosis, or balanitis. Surgery for an adult circumcision was scheduled along with the attendance of a mohel, a Jewish ritual circumciser.
S.G. was positioned in the supine position after administration of general anesthesia. His penis and scrotum were prepped with an antimicrobial solution and draped in sterile sheets. The surgeon and mohel scrubbed in and donned sterile gowns and gloves. The mohel chanted several prayers in Hebrew before and after making the first small cut below the foreskin, enough to draw blood. The urologist completed the resection of the redundant foreskin and approximated the circumferential incisions with fine-gauge absorbable suture material. After the incision was dressed with petrolatum gauze, and S.G. recovered enough to be returned to his room, the mohel met with him and his family to continue the sacred rite with prayer and ceremonial wine.
Case Studies, continued
CASE STUDY QUESTIONS
Multiple choice: Select the best answer and write the letter of your choice to the left of each number.
_ 1. The term for male sterilization surgery is:
a. herniorrhaphy b. circumcision c. vagotomy d. vasectomy e. vasovasotomy
_ 2. An oblique surgical incision follows what direction?
a. slanted or angled b. superior to inferior c. lateral d. circumferential e. elliptical
_ 3. When the ends of the vas were coagulated with electrosurgery, they were:
a. probed b. dilated c. sealed d. sutured e. clamped
_ 4. A urologist is a physician who treats health and disease conditions of the:
_ 5. A person with painful, blood-tinged, scanty urination would be described with:
a. hematocrit, dyspnea, oliguria b. dystonia, hematuria, oliguria c. dysuria, hematuria, oliguria d. oliguria, hematogenesis, dystonia e. dyspnea, hematuria, polyuria
_ 6. Another name for the foreskin is the:
a. prepuce b. phimosis c. phallus d. glans e. balan
Case Studies, continued
_ 7. The circumferential incisions followed a direction:
a. inferior to the scrotum b. suprapubic and transverse c. around the penis d. lateral to the prostate e. medial to the inguinal canal
Write a term from the case studies with each of the following meanings:
8. surgical repair of a weak abdominal muscle in the groin area on both sides
9. entrapment of a loop of bowel in a hernia _
10. inflammation of the prostate gland _
11. within the urinary bladder _
12. inflammation of the glans penis _
13. narrowing of the distal opening of the foreskin _
Abbreviations. Define the following abbreviations:
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