Poslední úprava: MUDr. Zuzana Kachlířová (02.11.2008)
Úvod, základní principy a rozdělení přístupů, indikace, obecné výhody a nevýhody různých technik (endoskopie, laparoskopie, otevřená operativa), přehled anatomie urogenitální soustavy muže a ženy.
Otevřené urologické operace:
transperitoneální, lumbotomický, interkostální, subkostální přístup k ledvině, možnosti záchovných výkonů vzhledem k anatomii cévního zásobení a kalichopánvičkového systému, polová a mezorenální resekce.
suprapubický přístup k měchýři a prostatě, cystotomie, enukleace prostaty vs. radikální prostatektomie, základy derivace moči po cystektomii
transperineální přístup k uretře a prostatě
radikální orchiektomie, mikrochirurgická varikokelektomie; hydrokéla a různá řešení úpravy obalů, orchiopexe a orchiofixace, transskrotální orchiektomie.
Endourologické operace:
základy a indikace transuretrálního endoskopického ošetření a diagnostiky patologie měchýře a prostaty.
uretroskopie, endopyelotomie, punkční nefrostomie, nefroskopie.
derivace moči.
Laparoskopické a extraperitoneoskopické přístupy, robotika:
varikokela, laparoskopická nefrektomie, resekce ledviny, pyeloplastika, radikální prostatektomie.
robotika v chirurgii a urologii, společné rysy a odlišnosti s laparoskopií, výhody a nevýhody.
Retroperitoneoskopické a extraperitoneoskopické výkony:
retroperitoneální prostor, disekce, nefrektomie, resekce ledviny, adrenalektomie, extraperitoneoskopická radikální prostatektomie, robotické operace
Poslední úprava: MUDr. Zuzana Kachlířová (31.10.2008)
1. Introduction, basic principles and types of approaches, indications, advantages and disadvantages of various techniques in general (endoscopy, laparoscopy, open surgery), the review of anatomy of male and female urogenital tract.
Urological open surgery
2. The abdominal wall, mesogastrium, the layers of abdominal wall, vagina mm. rectorum, the borders of abdomen, xiphisternal, subcostal, bispinal and medioclavicular line, regiones abdominis, cavitas abdominalis, cavitas peritonealis propria (pars supramesocolica et inframesocolica), cavitas peritonealis pelvis,
spatia extraperitonealia (spatium preperitoneale, infraperitoneale a retroperitoneale), clinical classification of supramesocolic space (right and left subphrenic space, r. and left subhepatic space, bursa omentalis, gastrolienal space) and inframesocolic space (right and left and outer paracolic space), subcutaneous vessels of abdomen, inervation (vv. thoracoepigastricae, v. epigastrica superficialis, v. circumflexa ilium superficialis, nn. intercostales and n. subcostalis , n. ilioinguinalis, n. iliohypogastricus), approaches and cutaneous scisions, transperitoneal approach to the right and left kidney, sintopy and blood suply and circulation of kidneys, sintopy of blood vessels and calicopelvic system, accessor and aberant renal blood vessels.
3. Regio lumbalis, dorsal muscles, m. latissimus dorsi, m. obliquus externus et internus, crista iliaca, trigonum lumbale, fascia thoracolumbalis, m. psoas major, m. quadratus lumborum, spatium retroperitoneale, the capsules of kidney (capsula fibrosa, capsula adiposa, fascia renalis, corpus adiposum pararenale), sintopy of ureter and blood vessels, lumbotomic approach to the kidneys + indications, intercostal and subcostal scision. Possibilities of nephron-sparing surgeries in relation to anatomy of blood supply and calicopelvic system, polar and mesorenal resection.
4. Pelvis major et minor, the borders of minor pelvis, pelvic organs, spatium prevesicale, retrovesicale, prerectale and pararectale, endopelvic fascia, parametrium a paracolpium, paraproctium, lig. pubovesicale, puboprostaticum, rectovesicale, lig. vesicouterinum and rectouterinum, visceral a parietal branches of aa. iliacae internae, a. epigastrica inferior, corona mortis Hesselbachi, blood supply of urinary bladder and prostate, dorsal venous complex, diaphragma pelvis, vasa pudenda interna et nervus pudendus, canalis Alcocki, the layers of pelvic diaphragma, capsula prostatae, suprapubic approach to the bladder and prostate, cystotomia, enucleation of prostate vers. radial prostatectomy and the impact for a prostatic cancer screening, the basis of urine derivation after cystectomy. Regio perinealis, regio urogenitalis. Transperineal approach to urethra and prostate. Historical approaches, W. Chesselden a lithotomists.
5. Canalis inguinalis, the borders and the relation to cavitas abdominalis and to the scrotum, anulus inguinalis superficialis et profundus, funiculus spermaticus a ligamentum teres uteri, n. ilioinguinalis, lig. interfoveolare a vasa epigastrica inf., falx inguinalis, fossa inguinalis medialis et lateralis, m. cremaster, fascia speramtica externa et interna, ductus deferens, a. ductus deferentis et plexus deferentialis, a. testicularis et plexus pampiniformis, varicocele, criptorchism, radical orchiectomia + indications, microsurgical varicocelectomy.
6. Scrotum, the layers of scrotum, fascia spermatica externa et interna, m. cremaster, lamina visceralis et parietalis scroti, cavum scroti, hydrocele and various types of tunica testis, arrangement (plasty according Lord, Jaboulay, Bergman, etc.), tunica albuginea, gubernaculum testis, orchiopexy and orchiofixation, spermatocele, transscrotal orchiectomy uni or bilateral + indications.
7. Open surgery : revision lesson.
Endourological surgery
7. Introduction to urogenital tract, endosccopy, upper and lower urinary tract, anatomy revision.
Lower urinary tract approaches
8. Endoscopic approaches to lower urinary tract, anatomy of male urethra, correct technique of cathethrisation and passing endoscope through urethra, possible complications, fosse rout, morphological classification of prostate and Mc Neal´s zonal conception, peripherial and transitory zone of prostate, relation to urethra and sphincter muscle. Trigonum of urinary bladder, basis, corpus a vertex (apex) vesicae, ostia ureterarum, antirefluxe mechanism of ureters. Basics and indiations of transurethral endoscopic treatment, diagnostics and surgeries of the prostatic or bladder pathology, epicystostomia.
Upper urinary tract approaches
9. Anatomy of ureter an physiological straits of ureter, ureter orifices, pyeloureteral junction, antirefluxe mechanism, intramural and juxtavesical ureter, relation of ureter and pyeloureteral junction to blood vessels, ureteroscopy, rigid and flexible uretroscopes and possibilities of use in diagnosis and therapy according to the morphology of upper urinary tract, technical limitations of endoscopes, indications and contraindications of ureterosopic treatment of urolithiasis in the relation to it?s size and location. Endoresection and a laser tretment of upper urinary tract tumors, endoresector. Endopyelotomy and it´s indications and contraindications in relation to blood vessels related to pyeloureteral junction. Temporal upper urinary tract derivation.
10. Percutaneous approaches, scapular and dorsal axilar line, renal capsules, anatomy and morphology of calicopelvic system, calices majores et minores, blood circulation in kidney, Brodel´s avascular line, relations to major vessels and colon and possible complications, bleeding, intestine and plesura injury. Percutaneous nephrostomy, nefroscopy, rigid and flexible nephroscopes, advantages and disadvantages, indications, percutaneous stone extraction including indications, percutaneous treatment of calicopelvic system tumors, urine derivation via orthograde approach .
11. Endoscopy : revision lesson.
Laparoscopic a extraperitoneoscopic approaches, robotic surgery
12. Introduction to laparoscopy in relation to anatomy and location of urogenital organs, cavum peritonei, retroperitoneum, spatium prevesicale, anulus inguinalis profundus, morphology and sintopy. Possibilities of laparoscopic surgeries,advantages and disadvantages, indications and contrandications. Laparoscopic instruments. Laparoscopy, extraperitoneoscopy, retroperitoneoscopy.
13. Use of laparoscopy from urologist´s point of view, capnoperitoneum, varicocele treatment, laparoscopic nephrectomy, renal resection, pyeloplasty, radical prostatectomy. Robotics in surgery and urology, differences and similarities to laparoscopy, advantages and disadvantages.
14. Retroperitoneoscopic a extraperitoneoscopic surgeries, retroperitoneum, dissection, nephrectomy, renal resection, adrenalectomy, extraperitoneoscopic radical prostatectomy. Robotic surgeries.
15. Revision lesson : laparoscopy, extraperitoneoscopy, robotics.
