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PHYSIOTHERAPY IN
 UROSURGERIES
 PRESENTED BY: DR.SHILPA PRAJAPATI (1ST YEAR MPT)
Anatomy for Urology
COMMON DISEASES

•   Nephritis
•   Renal stone
•   Renal tumors
•   Polycystic kidney

•   Uteric stone
•   Duplex ureter
•   Rupture bladder
•   Prostate cancer
•   Neurological bladder
UROLOGY PROCEDURES

• Kidney Transplant        • Bladder Augmentation

• Nephrectomy              • Transurethral Bladder
                             Resection
• Cystectomy and
 utero-colic anastomosis   • Artificial Sphincter Insertion

• Ureterostomy             • Needle Bladder Neck
                             Suspension

                           • Prostatectomy
NEPHRECTOMY
• One kidney may be             • Incision used- oblique
  removed provided that the       lumbar incision
  other is healthy.             • Latissimus dorsi and
• Reasons for removal are         external oblique mainly cuts
  tumor, infection, pyonephro     and traverses, internal
  sis, tuberculosis, multiple     oblique and lumbar fascia
  calculi or hydronephrosis.      also cuts.
• Problems that may occur
  with long-term decreased
  kidney function include:
   – High blood pressure
     (hypertension)
   – Chronic kidney disease
CYSTOSTOMY AND URETERO-COLIC
          ANASTOMOSIS
• Reasons are malignant       • Incision used- pfannentiel
  disease of                    incision.
  bladder.                    • requires partial or
• After removal of the          compete transaction of
  bladder the ureters are       the rectus abdominis
  transplanted into the         muscle.
  sigmoid colon.
• The terminal part of the
  ureter is in an oblique
  tunnel in the bowel wall.
URETEROSTOMY
• creation of a new outlet
  for a ureter.
• Indications : removal of
  the bladder, congenital
  defect or absence of
  portions of the urinary
  tract, and neurogenic
  bladder
TRANSURETHRAL BLADDER
             RESECTION
• This is used both to
  diagnose bladder
  cancer and to remove
  cancerous tissue from
  the bladder.
• Complication :
  – Urinary tract or bladder
    infection
  – bladder cancer can come
    back after this surgery
  – Difficulty passing urine
BLADDER AUGMENTATION
• Known as augmentation             • During a bladder
  cystoplasty                         augmentation procedure, an
• Is reconstructive surgery to        incision is made in the
  increase the reservoir capacity     abdomen to expose the
  of the bladder.                     intestines and bladder
• Bladder augmentation is used      • complications : cardiovascular,
  to treat irreversible forms of      thrombo-embolic (blood clot),
  incontinence and to protect         gastrointestinal, and
  the upper urinary tract (kidney     respiratory complications
  function) from reflexia (urine
  back up to the kidneys).
• some patients recover
  spontaneous voiding function.
PROSTATECTOMY
• After the age of fifty, it is   • Incision used- midline
  common for the prostate           incision.
  gland become enlarged.          • requires partial or compete
• 42% in men 45 to 49 years         transaction of the rectus
  of age and 18% in men 50          abdominis muscle.
  to 54 years of age.             • this condition, by
• The main symptom is               suprapubic operation
  difficult micturition with        involving the bladder, or by
  frequency due to pressure         rectopubic operations, in
  on the urethra.                   which the prostate is
• Retention of the urine may        enucleated from its capsule.
  occur, necessitating urgent     • Complications: phlebo-
  operation.                        thrombosis
ARTIFICIAL SPHINCTER INSERTION
• The implantation of an    • Men have incontinence
  artificial valve in the     rates that are much
  genitourinary tract, as     lower than
  "gatekeeper" control.       women, with a range of
• Severe incontinence         1.5–5%, compared to
  due to lack of muscle       women with rates of
  contraction by the          50%.
  urethral sphincter pelvic
  fracture; urethral
  reconstruction; prostate
  surgeries
NEEDLE BLADDER NECK SUSPENSION
• Known as needle suspension,         • passage of a needle from the
  or paravaginal surgery                suprapubic area to the vagina
• This is performed to support          with multiple sutures through
  the hypermobile, or moveable          looping
  urethra using sutures to attach
  it to tissues covering the pelvic
  floor.
• According to a recent report, a
  study of the effects of needle
  suspension found only a 67%
  cure, with delayed failures of
  sutures in a very high
  percentage (33-80%) of cases
PRE-OPERATIVE PHYSIOTHERAPY
• Postural drainage: If there are lung secretion should be
  cleared, postural drainage should be use several times
  a day.
   – The sputum should be measured carefully and the surgeon
     informed when the amount is minimal, as the patient will
     ready for operation.
• Breathing exercises
• Coughing: which can bring up mucus
• Arm exercises: the prayer position is best, the palm
  being held, flat together, finger pointing upwards, then
  straightened until the upper arm are against the ear.
PRE-OPERATIVE PHYSIOTHERAPY
• Leg exercises: toe and ankle movements are taught in full
  range, also static contraction of quadriceps and glutei. All
  these movement should be done rhythmically and
  repeated at frequent intervals, e.g. for five minute in every
  hour.
   – Also be shown how to flex hip and knee, keeping heel on the
     floor, so that the minimum of lifting strain is put on the
     abdominal muscle.
• Posture correction: the patient should be taught to sit
  equally on both buttocks, arms hanging to sides, lie equally
  outside hips, shoulder should be in level.
• Static abdominals: 10 repetitions, 5sec hold each
• Pelvic floor exercises:
POST-OPERATIVE PHYSIOTHERAPY
• Immediately after surgery, watch blood pressure,
  electrolytes and fluid balance. These body
  functions are controlled in part by the kidneys.
  most likely have a urinary catheter (tube to drain
  urine) in bladder for a short time during recovery.
  discomfort and numbness (caused by severed
  nerves) near the incision area.
• Encourage for plenty of fluid intake.
• Strenuous activity and heavy lifting should be
  avoided for 6 weeks.
POST-OPERATIVE PHYSIOTHERAPY
• Bed cradler: should be used to release tight or heavy bed
  cloths and facilitate leg movement.
• Breathing: dressings are kept to minimum to avoid
  restriction, Elastoplast being use to secure dressing.
   – It is frequently easier to get maximum thoracic excursion and air
     interchange by lateral costal breathing.
   – Emphasis will be usually be placed on those part of the lungs
     needing specific attention.
   – Bilateral breathing exercise are best:
   – With a right side incision, because of the right arm will be
     painful to move, the right basal expansion must be encouraged.
   – Left side basal expansion may also be limited by patient have
     had a long term operation and patient may lying on that side to
     relieve pressure on right.
POST-OPERATIVE PHYSIOTHERAPY
                                   by B. SHOTTON
   –   The best way to be sure that lung tissue is expanding satisfactory is
       by X-ray,
   –   More simply findings : breath sounds are normal, percussion to
       detect collapse of lung tissue.
   –   Another method is to ask the patient to hold his breath, he will find
       difficult if there is some collapse.
   –   The pulse is taken at frequent intervals.
   –   Frequently, rapid rise in pulse rate could indicate early collapse of
       lung, it can be detected before rise patient’s temperature.

• Coughing : this can be aided by firm pressure over the wound
  by the therapist or by patient him self.
   – Relaxant drugs are now in frequent use because, normal muscle
     tone dose note always reappear until several days after
     operation, so it is difficult for the patient to produce a strong cough.
POST-OPERATIVE PHYSIOTHERAPY
                       by B. SHOTTON

• Leg exercise : test for Homan’s sign
   – Foot exercise and static quadriceps and glutei are safe
     in upper abdominal operations.
   – In lower abdominal operations, start exercise when
     surgeon allow for movements, start with hip and knee
     flexion and heel on the floor, Progressed by lifting the
     heel, then straight leg raising.
   – Early ambulation being allow 1 or 2 days after
     operation.
   – Prolong sitting in chair should be avoided, this
     position causes pressure on the veins of the leg.
POST-OPERATIVE PHYSIOTHERAPY
                        by B. SHOTTON

• Posture :
   – back needs firm support,
   – Best taught for flatten the lumbar hollow, at the same time
     drawing his pubic symphysis and his sternum closer
     together.
   – Trunk movement usually be started on the forth
     day, before that they were use trunk movement for bed
     mobility and toilet purposes.
• WARD CLASSSES
   – Once out of bed and ambulant, exercise can be continued
     in small groups.
   – Except in specific cases, physiotherapy should no longer be
     needed after the 10th day.
COMPLICATIONS
IMMEDIATE COMPLICATIONS
• Postoperative shock
• Respiratory complication
• Acute dilatation of stomach
DELAYED COMPLICATIONS:
• Thrombo-embolic (blood clot),
• Unhealed wound and incisional hernia
• Retention of urine
• Uremia
• paralytic ileus
• Post operative cough
• Infection and septicemia
• Postural deformities
SURGERY ON THE BLADDER
To increase bladder capacity:
   Augmentation
    Continent diversion
To increase outlet resistance:
  Injection therapy
  External compressive procedures
  Artificial urinary sphincter
 To decrease outlet resistance:
  Sphincterotomy
  Urinary diversion
References
• Physical and medical rehabilitation, 3rd
  edition, by RANDALL BRADDOM.
• Physiotherapy in general surgery, by B.
  Shotton.
• Thank you

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Pt in urosurgery

  • 1. PHYSIOTHERAPY IN UROSURGERIES PRESENTED BY: DR.SHILPA PRAJAPATI (1ST YEAR MPT)
  • 3. COMMON DISEASES • Nephritis • Renal stone • Renal tumors • Polycystic kidney • Uteric stone • Duplex ureter • Rupture bladder • Prostate cancer • Neurological bladder
  • 4. UROLOGY PROCEDURES • Kidney Transplant • Bladder Augmentation • Nephrectomy • Transurethral Bladder Resection • Cystectomy and utero-colic anastomosis • Artificial Sphincter Insertion • Ureterostomy • Needle Bladder Neck Suspension • Prostatectomy
  • 5. NEPHRECTOMY • One kidney may be • Incision used- oblique removed provided that the lumbar incision other is healthy. • Latissimus dorsi and • Reasons for removal are external oblique mainly cuts tumor, infection, pyonephro and traverses, internal sis, tuberculosis, multiple oblique and lumbar fascia calculi or hydronephrosis. also cuts. • Problems that may occur with long-term decreased kidney function include: – High blood pressure (hypertension) – Chronic kidney disease
  • 6. CYSTOSTOMY AND URETERO-COLIC ANASTOMOSIS • Reasons are malignant • Incision used- pfannentiel disease of incision. bladder. • requires partial or • After removal of the compete transaction of bladder the ureters are the rectus abdominis transplanted into the muscle. sigmoid colon. • The terminal part of the ureter is in an oblique tunnel in the bowel wall.
  • 7. URETEROSTOMY • creation of a new outlet for a ureter. • Indications : removal of the bladder, congenital defect or absence of portions of the urinary tract, and neurogenic bladder
  • 8. TRANSURETHRAL BLADDER RESECTION • This is used both to diagnose bladder cancer and to remove cancerous tissue from the bladder. • Complication : – Urinary tract or bladder infection – bladder cancer can come back after this surgery – Difficulty passing urine
  • 9. BLADDER AUGMENTATION • Known as augmentation • During a bladder cystoplasty augmentation procedure, an • Is reconstructive surgery to incision is made in the increase the reservoir capacity abdomen to expose the of the bladder. intestines and bladder • Bladder augmentation is used • complications : cardiovascular, to treat irreversible forms of thrombo-embolic (blood clot), incontinence and to protect gastrointestinal, and the upper urinary tract (kidney respiratory complications function) from reflexia (urine back up to the kidneys). • some patients recover spontaneous voiding function.
  • 10. PROSTATECTOMY • After the age of fifty, it is • Incision used- midline common for the prostate incision. gland become enlarged. • requires partial or compete • 42% in men 45 to 49 years transaction of the rectus of age and 18% in men 50 abdominis muscle. to 54 years of age. • this condition, by • The main symptom is suprapubic operation difficult micturition with involving the bladder, or by frequency due to pressure rectopubic operations, in on the urethra. which the prostate is • Retention of the urine may enucleated from its capsule. occur, necessitating urgent • Complications: phlebo- operation. thrombosis
  • 11. ARTIFICIAL SPHINCTER INSERTION • The implantation of an • Men have incontinence artificial valve in the rates that are much genitourinary tract, as lower than "gatekeeper" control. women, with a range of • Severe incontinence 1.5–5%, compared to due to lack of muscle women with rates of contraction by the 50%. urethral sphincter pelvic fracture; urethral reconstruction; prostate surgeries
  • 12. NEEDLE BLADDER NECK SUSPENSION • Known as needle suspension, • passage of a needle from the or paravaginal surgery suprapubic area to the vagina • This is performed to support with multiple sutures through the hypermobile, or moveable looping urethra using sutures to attach it to tissues covering the pelvic floor. • According to a recent report, a study of the effects of needle suspension found only a 67% cure, with delayed failures of sutures in a very high percentage (33-80%) of cases
  • 13. PRE-OPERATIVE PHYSIOTHERAPY • Postural drainage: If there are lung secretion should be cleared, postural drainage should be use several times a day. – The sputum should be measured carefully and the surgeon informed when the amount is minimal, as the patient will ready for operation. • Breathing exercises • Coughing: which can bring up mucus • Arm exercises: the prayer position is best, the palm being held, flat together, finger pointing upwards, then straightened until the upper arm are against the ear.
  • 14. PRE-OPERATIVE PHYSIOTHERAPY • Leg exercises: toe and ankle movements are taught in full range, also static contraction of quadriceps and glutei. All these movement should be done rhythmically and repeated at frequent intervals, e.g. for five minute in every hour. – Also be shown how to flex hip and knee, keeping heel on the floor, so that the minimum of lifting strain is put on the abdominal muscle. • Posture correction: the patient should be taught to sit equally on both buttocks, arms hanging to sides, lie equally outside hips, shoulder should be in level. • Static abdominals: 10 repetitions, 5sec hold each • Pelvic floor exercises:
  • 15. POST-OPERATIVE PHYSIOTHERAPY • Immediately after surgery, watch blood pressure, electrolytes and fluid balance. These body functions are controlled in part by the kidneys. most likely have a urinary catheter (tube to drain urine) in bladder for a short time during recovery. discomfort and numbness (caused by severed nerves) near the incision area. • Encourage for plenty of fluid intake. • Strenuous activity and heavy lifting should be avoided for 6 weeks.
  • 16. POST-OPERATIVE PHYSIOTHERAPY • Bed cradler: should be used to release tight or heavy bed cloths and facilitate leg movement. • Breathing: dressings are kept to minimum to avoid restriction, Elastoplast being use to secure dressing. – It is frequently easier to get maximum thoracic excursion and air interchange by lateral costal breathing. – Emphasis will be usually be placed on those part of the lungs needing specific attention. – Bilateral breathing exercise are best: – With a right side incision, because of the right arm will be painful to move, the right basal expansion must be encouraged. – Left side basal expansion may also be limited by patient have had a long term operation and patient may lying on that side to relieve pressure on right.
  • 17. POST-OPERATIVE PHYSIOTHERAPY by B. SHOTTON – The best way to be sure that lung tissue is expanding satisfactory is by X-ray, – More simply findings : breath sounds are normal, percussion to detect collapse of lung tissue. – Another method is to ask the patient to hold his breath, he will find difficult if there is some collapse. – The pulse is taken at frequent intervals. – Frequently, rapid rise in pulse rate could indicate early collapse of lung, it can be detected before rise patient’s temperature. • Coughing : this can be aided by firm pressure over the wound by the therapist or by patient him self. – Relaxant drugs are now in frequent use because, normal muscle tone dose note always reappear until several days after operation, so it is difficult for the patient to produce a strong cough.
  • 18. POST-OPERATIVE PHYSIOTHERAPY by B. SHOTTON • Leg exercise : test for Homan’s sign – Foot exercise and static quadriceps and glutei are safe in upper abdominal operations. – In lower abdominal operations, start exercise when surgeon allow for movements, start with hip and knee flexion and heel on the floor, Progressed by lifting the heel, then straight leg raising. – Early ambulation being allow 1 or 2 days after operation. – Prolong sitting in chair should be avoided, this position causes pressure on the veins of the leg.
  • 19. POST-OPERATIVE PHYSIOTHERAPY by B. SHOTTON • Posture : – back needs firm support, – Best taught for flatten the lumbar hollow, at the same time drawing his pubic symphysis and his sternum closer together. – Trunk movement usually be started on the forth day, before that they were use trunk movement for bed mobility and toilet purposes. • WARD CLASSSES – Once out of bed and ambulant, exercise can be continued in small groups. – Except in specific cases, physiotherapy should no longer be needed after the 10th day.
  • 20. COMPLICATIONS IMMEDIATE COMPLICATIONS • Postoperative shock • Respiratory complication • Acute dilatation of stomach
  • 21. DELAYED COMPLICATIONS: • Thrombo-embolic (blood clot), • Unhealed wound and incisional hernia • Retention of urine • Uremia • paralytic ileus • Post operative cough • Infection and septicemia • Postural deformities
  • 22. SURGERY ON THE BLADDER To increase bladder capacity: Augmentation Continent diversion To increase outlet resistance: Injection therapy External compressive procedures Artificial urinary sphincter  To decrease outlet resistance: Sphincterotomy Urinary diversion
  • 23. References • Physical and medical rehabilitation, 3rd edition, by RANDALL BRADDOM. • Physiotherapy in general surgery, by B. Shotton.