School for patients
Nephrolithiasis and extracorporeal lithotripsy
Pathology of the prostate
What is anesthesia?
Cysts and sinuses
Hemorrhoids
Hernias
- The average clinical efficiency or performance amounts to 95%, which places it among the highest results reported in the European and American references.
- All lithotripsy patients undergo mandatory blood tests, an ultrasonography and X-ray immediately before the intervention and an X-ray control of the result upon hospital discharge, and all tests are carried out at Doverie Hospital on the day of the intervention.
- The smallest stones suitable for lithotripsy are 4-5мм, and the largest - 3 см.
- There is no restriction re the localization of the stones.
- The average duration of the lithotripsy procedure is 40 minutes.
- In 95% of cases it is performed without anesthesia and no pain is felt or if there is pain it is mild to moderate.
- Pregnancy is the only absolute contraindication for lithotripsy.
- Anticoagulants are a relative contraindication (medications that dilute the blood), a pacemaker and overweight > 130 kg.
- On average in 30% of cases more than one lithotriptic procedure is required with a minimal interval between two procedures of 1 month.
- Lithotripsy can be performed in all age groups.
- Side effects:
- Hematuria (blood in urine) – in 70-80% of cases.
- Kidney pain – in 5 -10% of cases.
- Fever – in 10-15% of cases.
- Complications: none that have required hospital or surgical treatment.
With the rise in longevity a pronounced trend for increasing the incidence of socially significant disease such as:
- Benign prostate hyperplasia
- Prostate cancer
Thus, nearly 50% of the men at 50 have symptoms related to benign prostate hyperplasia. Age is a key risk factor, and it is considered that benign prostate hyperplasia and prostate cancer can manifest themselves in all men provided they lived up to the age of 85-90.
- A conversation in a quiet setting and a quantitative evaluation of the complaints against an international scale for symptom assessment
- Ultrasonographic examination of the prostate, kidneys and urinary bladder
- Measuring residual urine - ultrasonography
- uroflowmetry – evaluating the debit of the urine flow
- palpation (touché) of the prostate
- PSA – assessment – Prostate-Specific Antigen that gives information about the likelihood of prostate cancer even in the absence of complaints and with absolutely normal lab results in other tests
- Prostate biopsy in high PSA values for proving or rejecting prostate cancer
- 32 cases of prostate cancer and nearly 240 cases of benign hyperplasia, of which 90 requiring surgical treatment and 150 suitable for conservative therapy
- Conservative therapeutic methods have been applied to nearly 120 patients, mostly through medication
- State-of-the-art surgical methods:
- Bipolar transurethral resection of the prostate: a prostate resection through the urethra without making an incision. The Urology Sector is the first in Bulgaria that has been equipped and has been working routinely with a bipolar resector of the STORZ – Germany, with 45 operations carried out in a single year. The bipolar resection presents the following advantages to the patient:
- Minimal bleeding – so far no complications related to bleeding or the need of hemotransfusion have been witnessed
- Minimal hospital stay – patient is admitted in the morning, all due tests are carried out, the operation takes place the same day and discharge is on the next day or the day after, i.e. hospital stay amounts to 2-3 days.
- Maximum postoperative comfort and quick recovery related to the diminished need to wash the catheter, which is again due to the fact that bipolar resection combines maximum surgical efficiency with minimal bleeding
- Lack of postoperative infections
- Excellent results in symptom resolution
- Lower percentage of late complications related to strictures of the urethra or the urinary bladder cervix, which conditions often lead to the need of a second operation.
What is anesthesia?
The word anesthesia means ‘loss of sensitivity’. Anesthesia blocks the sensation of pain. It can be carried out in various ways and can be directed at different parts of the human body. Not all types of anesthesia cause ‘unconsciousness’.
The medications that cause anesthesia block the traveling of the signals along the nerve fibres to your brain. When the effect of the medication is over, the normal sensitivity is resolved.
Types of anesthesia
Local anesthesia removes the pain only on a small portion of your body. It is easy to perform, usually via drops, spray, ointment or injection. You remain conscious but without the feeling of pain in the respective site.
Regional anesthesia can be used in operations of larger and deeper body areas. The most common types of regional anesthesia are the spinal and the epidural – used for anesthesizing the lower part of the body. They are applied in Cesarean section, operations of the urinary bladder, knee joint prosthetics, etc. You remain conscious, but you feel no pain.
General anesthesia is a state of controlled unconsciousness. This is important in certain types of operations and can be used as an alternative to regional anesthesia on other occasions. The anesthetics are either injected intravenously or inhaled as gases by the lungs and reach the brain via the blood circulation. They block the nerve impulses traveling from the body to the brain. Controlled unconsciousness is different from unconsciousness due to disease or trauma. It is also different from sleep. When the administration of the anesthetic is over, your consciousness begins to resolve.
Combined anesthesia types: Anesthetic agents and techniques are combined very often. For example, regional anesthesia is combined with general anesthesia assist in the painkilling in the postoperative period. Sedation can be added to regional anesthesia. Sedation is the use of small amounts of anesthetics or similar drugs that cause a ‘sleep-like’ state. This is usually done so that patients submitted to procedures or examinations that can be painful or unpleasant can calm down and relax.
Anesthesiologists are physicians who have a recognized specialty in anesthesiology, reanimation and intensive care. Anesthesiologists look after your good state and safety during the operation. They administer the anesthetic drug and remain with you until the end of the operation. They discuss and plan the strategy for the killing of your pain in the postoperative period.
Preanesthesia consultation:
The anesthesiologist will ask you questions about your overall health status before the operation. These questions will most probably be the following:
- What is your overall health status and condition?;
- Have you suffered from a serious disease before?
- Have you had problems with previous anesthesias?
- Have any of your blood relations had problems with anesthesias?
- Have you experienced chest pain or heartburn?
- Have you ever had difficulty breathing?
- Have you had tinnitus (a noise in your ears)?
- Have you had pains when lying down in a certain body position?
- Have you had any medication, including nutritional or herbal supplements?
- Have you been allergic to anything?
- Do you have dentures or shaking teeth?
- Do you smoke?
- Do you drink alcohol?
After local or regional anesthesia the recovery of the sensitivity of the body takes an hour or a few hours. It is paramount that you keep the bed until the next morning, otherwise headache may occur. To prevent it you need an in-take of 2-3 l of liquids daily.
After general anesthesia, consciousness is regained after the end of the operation. You may feel malaise, nausea, you may wish to vomit or feel pain in the surgical wound. If you have such complaints, you will be given medication that will relieve your symptoms.
Pilonidal sinuses and cysts are a common condition. The name comes from the Latin ‘pilus’ (‘a hair’) and ‘nidus’ (‘a nest’). Pilonidal sinuses and cysts seldom manifest themselves before they become infected. They are usually discovered by accident during a medical examination. One or several apertures are observed in the area of the tailbone (coccyx). Because of the frequent sweating and contamination in the sacrococcygeal region and the entry of bacteria in the sinuses and cysts an acute inflammatory process develops and an infiltrate with abscessus is formed. There is pain, reddening of the skin, and fever up to 38-39 degrees. Sitting down and walking is difficult for the patient.
The treatment of pilonidal sinuses and cysts is surgical.
In the event of acute inflammation an incision of the abscessus is indicated and a drainage should be placed.
The radical operation consists of thorough excision of the primary and secondary fistula pathways and cystic ectasiae, and the operative wound is stitched and drained.
Hemorrhoids
Hemorrhoids are normal venous enlargements connected in a net-like formation called a hemorrhoidal plexus, which is located into the anal canal. The hemorrhoidal disease or clinically manifested hemorrhoids are present when due to various reasons pathological symptoms occur. The inflammation of the anal mucosa and the itching in the anal region are the initial signs of the disease. There are also humidity, sweating and underwear stains because of the incomplete closing of the anal canal. The presence of blood in the feces is another common symptom. The bleeding is of bright red colour, usually very mild and comes as drops of blood after defecation. Pain is the primary symptom, but occurs only in complications. In the event of inflammation there is a swelling and pain in the anal region, and very often immediately after defecation small lumps reminiscent of grapes can be felt.
When the disease is in its 1st and 2nd stage the enlarged venous hemorrhoidal nodules do not protrude outside the anus, and can be felt only during defecation. These stages require conservative treatment with medication, hygienic procedures, baths with cool antiseptic solutions, diet and appropriate exercise.
When the disease is in the 3rd and 4th stage the enlarged venous nodules come out of the anal ring, and while in the 3rd stage they resolve their previous position after defecation, in the final 4th stage of the disease they remain permanently outside the anus. During that latter stage patients are unable to control their sphincters and become incontinent. The only viable solution is the latter two stages is surgical treatment. The radical surgical treatment requires removal of the hemorrhoid nodules with the help of
- a Harmonic scalpel
- the Longo method that uses a special mechanical stitcher HCS and HAL (Hemorrhoid Artery Ligation).
The hernia is the passage of abdominal organs or parts of them (small intestine, large intestine, omentum, stomach) covered in a hernial sac through defects (openings) of the abdominal wall or into other cavities.
Operation is recommended immediately after diagnosing or shortly after that, if preoperative preparation is required.
There are no non-surgical methods for hernia treatment and therefore are not recommended.
The surgical treatment will be carried out under general or spinal anesthesia, for which you will be informed and your consent will be required.
The hernia operation uses an artificial material (a polypropylene plaque) for strengthening of the hernia defect, which reduces to minimum the risk of a relapse.
The herniotomy can be carried out using the endoscopic method with the plaque being placed pre-peritoneally or intraperitoneally in the event of larger abdominal wall defects, and the surgical intervention is done through two small skin incisions.
You will remain in the clinic for at least one day, during which tome you will be required to assist actively in the treatment process.