Urological Impressions episode 3 - Revenge of the Testes

Hi everybody and welcome to the third installment of the urological impressions series, a bit of a late post due to the fact that it was independence day weekend. For this post I'll be even more brief than I was for the previous ones considering that in the urological department you tend to see a lot of repeat surgical procedures every week. So let's blast off with my surgical highlights and we will continue on from there.

For the week of June 28th, my mentor Dr. Scherr performed a right partial nephrectomy (kidneys), robotic radical cystectomy with an ileal conduit pouch (bladder), a left radical orchiectomy (testes), and a radical cystectomy with a neobladder (bladder). The most interesting ones were the first cystectomy with the pouch and the radical orchiectomy because it was the first time I have seen those exact procedures being done. The cystectomy was done with the daVinci robot and was a relatively standard procedure except for a problems concerning foggy lens (apparently it was due to a bad cable cord), but the most interesting aspect was the ileal pouch creation. So assuming that you read my previous posts, the ileal pouch procedure is very similar to the neobladder procedure except that the urethra is not reconnected and the pouch ends in a stoma on the abdomen. The stoma is kept closed naturally by the abdominal wall pressure and generally won't leak, however the patient in the future would have to stick a catheter into his stoma every 2-3 hours to empty it. From what I have seen so far, this type of ileal conduit by far seems the most favorable due to the simplicity and concealability (is this a word?) of the end product; I find this much more preferable over a neobladder or the ileal conduit with a bag.

Now time for the main dish of this blog - the left radical orchiectomy which means 'complete removal of the left testes'. The patient was a man in his 40's I believe, who had left orchitis (inflammation of testes) with an abscess inside that needed to be removed. It was the first time I have ever seen such a surgery and I was more than a little nervous when going in to see the prep. My friend was also tagging along to watch the surgery and was absolutely terrified but we stayed nonetheless. The surgery itself was very straightforward, an incision was made through the scrotum pass the tunica vaginalis, and the tunica albuginea to the testes which was then popped out of the scrotum. The doctors proceeded to tie off the spermadic cord and then simply cut off the testis. The scrotum was then closed up and Dr. Scherr proceeded to dissect the testes to show me where the abscess was; turns out it was fairly large actually. One hilarious quote the doctors left me with was "You cannot screw up the scrotum", which meant that no matter how bad or well you close up the scrotum it still looks great once it heals.

For the rest of the week I saw more patients with my mentor, which while interesting did not showcase anything particularly interesting medically and so I will spare you the tedium of the patients' medical histories. As for my research project, I am happy to say that progress was made whereby my mentor, PI from Ithaca (Prof. Putnam) and I held a conference call concerning the artificial bladder project proposed by Dr. Scherr. My goal for the next few days will be to develop or find the best in vitro model for testing stone formation of calcium oxalate on different biomaterials. Calcium Oxalate is a molecule found in urine that can precipitate out of solution and form stones in the bladder.

So that's it for the week and I will continue on with episode 4 of urological impressions next time...