Surgeries

Dr. Jörg performs following surgeries and procedures for adults:

 

Hernia repair (with and without mesh)

Hydrocelectomy ("water" around the testicle)

Spermatocelectomy

Epididymectomy

Vasectomy

Varicocelectomy (antegrade Embolisation)

Orchiectomy and radical Orchiectomy (for cancer of testicle)

Meatotomy/ Meatoplasty for stricture (narrowing) of distal urethra

Frenulotomy/ Frenuloplasty (short band on penis)

Circumcision

Re-circumcision (for cosmetic reasons)

Cystoscopy (endoscopic examination of urinary bladder)

Urethrotomy under vision (for stricture of urethra)

Endoscopic insertion of ureter stents (DJ) for stones, narrowing of ureter, PUJ obstruction etc.

URS (endoscopic examination of ureter and kidney) with lithotripsy and removal of stones

RIRS (endoscopic inrarenal surgery)

TUR-BT (endoscopic surgery for bladder cancer)

Biopsy of prostate (ultrasound guided)

Uroflow

Urodynamic

Urethrography

and others

 

More questions? Don't hesitat to send an email to Dr Jörg.

 

 

Cystoscopy

Diagnostic cystoscopy is an endoscopic examination to check urinary bladder, prostate and urethra (tube that carries urine from the bladder to the outside of the body). Nowadays mostly flexible instruments are used. Procedure is usually done in local anesthesia. Typical findings are stones (movie), tumors or obstructions caused by prostate or urethra.

 

 

 

 

 

 

Lithotripsy

Lithotripsy is a procedure to break up stones in the bladder, ureter or kidney. The movie shows a pneumatic lithotritor. It is called Lithoclast and works like a small jackhammer.

 

 

 

 

 

 

 

 

 

 

 

Ureteroscopy

Ureteroscopy is an examination of the upper urinary tract, usually performed with an endoscope that is passed through the urethra, bladder, and then directly into the ureter (tubes made of smooth muscle fibers that propel urine from the kidneys to the urinary bladder). The procedure is useful in the diagnosis and the treatment of disorders such as stones or tumors in the ureter or kidney. The movie shows extraction of stone by forceps.

 

 

 

 

 

TransUrethral Resection of Bladder Tumor (TUR-BT) is an endoscopic procedure to remove tumors from urinary bladder. It is performed by visualizing the tumor through the urethra and removing tissue by electrocautery. The movie shows an medium size cancer of bladder which is finally total removed.

 

 

 

 

 

 

 

 

 

 

Varicocelectomy

 

Technique of embolisation of varicocele.

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The spermatic cord along with the scrotal skin is grasped between the index finger and thumb, and a 1–2 cm long incision is made in the taut scrotum 1.5-2 cm below the external inguinal ring. The subcutaneous tissue is incised until the external spermatic fascia becomes visible.

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After having mobilized the spermatic cord a small clamp is drawn underneath the spermatic cord and a vessel loop is pulled through it, constantly making sure to include the spermatic duct.

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The external spermatic fascia and the cremasteric fascia is incised, and the pampiniform plexus is exposed to the surface.

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A dilated and straight plexus vein is selected from among those merging into the spermatic vein. The vein is dissected and distally ligated.

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After incision, a 24 G thin-walled cannula is introduced in an antegrade fashion towards the internal spermatic vein and, with injection of a few millilitres of physiological saline, is advanced and secured with a single ligature. Then 3–5 mL of a non-ionic contrast medium is injected to trace the internal spermatic vein by fluoroscopy. After having ensured that the contrast medium is draining through the spermatic vein, the sclerosing agent is injected in an antegrade direction using an air-block technique (1 mL of air, followed by 3 mL of the sclerosing agent), during which the patient is instructed to perform the Valsalva manoeuvre. Only one injection is administered.

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The cannula is removed and the vein is ligated proximally. The opened spermatic cord fascia is closed with a suture and the spermatic cord is repositioned after removing the rubber band. Finally, the skin is closed and the wound is dressed after 5 min of manual compression for haemostasis.

POSTOPERATIVE CARE

After 4 h of assessment the patient is sent home; we ask him to keep calm for the rest of the day, and we recommend daily wound-cleaning. He should avoid sports for 1 week. Constant bed rest is unnecessary. Persistence of the varicocele should be assessed after ≥ 3 months, and sperm analysed ≥ 6 months after the operation.

COMPLICATIONS

The complication rate was determined after procedure included scrotal haematoma (2.2%), sterile epididymitis (0.3%), testicular atrophy (0.6%) and subsequent development of a partial abdominal wall necrosis (0.3%). [Tauber R, Johnsen N. Die antegrade skrotale Verödung zur Behandlung der Testisvarikozele. Urologe [a] 1993; 32: 3206; Tauber R, Johnsen N. Antegrade scrotal sclerotherapy for the treatment of varicocele: technique and late results. J Urol 1994; 151: 38690]