This document provides an overview of physiotherapy for urological surgeries and procedures. It discusses common urological diseases, procedures such as nephrectomy, cystectomy, prostatectomy, and their pre-operative and post-operative physiotherapy. Complications of urological surgeries are also outlined. Physiotherapy focuses on breathing exercises, coughing, range of motion exercises, posture correction, and pelvic floor exercises pre-operatively and post-operatively to aid recovery.

1. PHYSIOTHERAPY IN
UROSURGERIES
PRESENTED BY: DR.SHILPA PRAJAPATI (1ST YEAR MPT)

2. Anatomy for Urology

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.

24. • Thank you