smoh/medical-transcriptions huggingface dataset:
TURBT - 1  ( Urology)
Description:  Transurethral resection of the bladder tumor (TURBT), large.

PREOPERATIVE DIAGNOSIS:  ,Bladder cancer.,POSTOPERATIVE DIAGNOSIS: , Bladder cancer.,OPERATION:  ,Transurethral resection of the bladder tumor (TURBT), large.,ANESTHESIA:,  General endotracheal.,ESTIMATED BLOOD LOSS: , Minimal.,FLUIDS: , Crystalloid.,BRIEF HISTORY: , The patient is an 82-year-old male who presented to the hospital with renal insufficiency, syncopal episodes.  The patient was stabilized from cardiac standpoint on a renal ultrasound.  The patient was found to have a bladder mass.  The patient does have a history of bladder cancer.  Options were watchful waiting, resection of the bladder tumor were discussed.  Risk of anesthesia, bleeding, infection, pain, MI, DVT, PE were discussed.  The patient understood all the risks, benefits, and options and wanted to proceed with the procedure.,DETAILS OF THE OR:  ,The patient was brought to the OR, anesthesia was applied.  The patient was placed in dorsal lithotomy position.  The patient was prepped and draped in the usual sterile fashion.  A 23-French scope was inserted inside the urethra into the bladder.  The entire bladder was visualized, which appeared to have a large tumor, lateral to the right ureteral opening.,There was a significant papillary superficial fluffiness around the left ________.  There was a periureteral diverticulum, lateral to the left ureteral opening.  There were moderate trabeculations throughout the bladder.  There were no stones.  Using a French cone tip catheter, bilateral pyelograms were obtained, which appeared normal.  Subsequently, using 24-French cutting loop resectoscope a resection of the bladder tumor was performed all the way up to the base.  Deep biopsies were sent separately.  Coagulation was performed around the periphery and at the base of the tumor.  All the tumors were removed and sent for path analysis.  There was an excellent hemostasis.  The rest of the bladder appeared normal.  There was no further evidence of tumor.  At the end of the procedure, a 22 three-way catheter was placed, and the patient was brought to the recovery in a stable condition.
TURBT  ( Urology)
Description:  Cystoscopy, transurethral resection of medium bladder tumor (4.0 cm in diameter), and direct bladder biopsy.

PREOPERATIVE DIAGNOSIS:  ,Clinical stage Ta Nx Mx transitional cell carcinoma of the urinary bladder.,POSTOPERATIVE DIAGNOSIS: , Clinical stage Ta Nx Mx transitional cell carcinoma of the urinary bladder.,TITLE OF OPERATION: , Cystoscopy, transurethral resection of medium bladder tumor (4.0 cm in diameter), and direct bladder biopsy.,ANESTHESIA: , General laryngeal mask.,INDICATIONS: , This patient is a 59-year-old white male, who had an initial occurrence of a transitional cell carcinoma 5 years back.  He was found to have a new tumor last fall, and cystoscopy in November showed Ta papillary-appearing lesion inside the bladder neck anteriorly.  The patient had coronary artery disease and required revascularization, which occurred at the end of December prior to the tumor resection.  He is fully recovered and cleared by Cardiology and taken to the operating room at this time for TURBT.,FINDINGS: , Cystoscopy of the anterior and posterior urethra was within normal limits.  From 12 o'clock to 4 o'clock inside the bladder neck, there was a papillary tumor with some associated blood clot.  This was completely resected.  There was an abnormal dysplastic area in the left lateral wall that was biopsied, and the remainder of the bladder mucosa appeared normal.  The ureteral orifices were in the orthotopic location.  Prostate was 15 g and benign on rectal examination, and there was no induration of the bladder.,PROCEDURE IN DETAIL: , The patient was brought to the cystoscopy suite, and after adequate general laryngeal mask anesthesia obtained, placed in the dorsal lithotomy position and his perineum and genitalia were sterilely prepped and draped in usual fashion.  He had been given oral ciprofloxacin for prophylaxis.  Rectal bimanual examination was performed with the findings described.  Cystourethroscopy was performed with a #23-French ACMI panendoscope and 70-degree lens with the findings described.  A barbotage urine was obtained for cytology.  The cystoscope was removed and a #24-French continuous flow resectoscope sheath was introduced over visual obturator and cold cup biopsy forceps introduced.  Several biopsies were taken from the tumor and sent to the tumor bank.  I then introduced the Iglesias resectoscope element and resected all the exophytic tumor and the lamina propria.  Because of the Ta appearance, I did not intentionally dissect deeper into the muscle.  Complete hemostasis was obtained.  All the chips were removed with an Ellik evacuator.  Using the cold cup biopsy forceps, biopsy was taken from the dysplastic area in the left bladder and hemostasis achieved.  The irrigant was clear.  At the conclusion of the procedure, the resectoscope was removed and a #24-French Foley catheter was placed for efflux of clear irrigant.  The patient was then returned to the supine position, awakened, extubated, and taken on a stretcher to the recovery room in satisfactory condition.
Testicular Ultrasound  ( Urology)
Description:  Left testicular swelling for one day.  Testicular Ultrasound.  Hypervascularity of the left epididymis compatible with left epididymitis.  Bilateral hydroceles.

TESTICULAR ULTRASOUND,REASON FOR EXAM:  ,Left testicular swelling for one day.,FINDINGS:  ,The left testicle is normal in size and attenuation, it measures 3.2 x 1.7 x 2.3 cm.  The right epididymis measures up to 9 mm.  There is a hydrocele on the right side.  Normal flow is seen within the testicle and epididymis on the right.,The left testicle is normal in size and attenuation, it measures 3.9 x 2.1 x 2.6 cm.  The left testicle shows normal blood flow.  The left epididymis measures up to 9 mm and shows a markedly increased vascular flow.  There is mild scrotal wall thickening.  A hydrocele is seen on the left side.,IMPRESSION:,1.  Hypervascularity of the left epididymis compatible with left epididymitis.,2.  Bilateral hydroceles.
Spermatocelectomy  ( Urology)
Description:  Spermatocelectomy and orchidopexy

PREOPERATIVE DIAGNOSIS:,  Right spermatocele.,POSTOPERATIVE DIAGNOSIS:  ,Right spermatocele.,OPERATIONS PERFORMED:,1.  Right spermatocelectomy.,2.  Right orchidopexy.,ANESTHESIA: , Local MAC.,ESTIMATED BLOOD LOSS:,  Minimal.,FLUIDS: , Crystalloid.,BRIEF HISTORY OF THE PATIENT:  ,The patient is a 77-year-old male who comes to the office with a large right spermatocele.  The patient says it does bother him on and off, has occasional pain and discomfort with it, has difficulty with putting clothes on etc. and wanted to remove.  Options such as watchful waiting, removal of the spermatocele or needle drainage were discussed.  Risk of anesthesia, bleeding, infection, pain, MI, DVT, PE, risk of infection, scrotal pain, and testicular pain were discussed.  The patient was told that his scrotum may enlarge in the postoperative period for about a month and it will settle down.  The patient was told about the risk of recurrence of spermatocele.  The patient understood all the risks, benefits, and options and wanted to proceed with removal.,DETAILS OF THE PROCEDURE:  ,The patient was brought to the OR.  Anesthesia was applied.  The patient's scrotal area was shaved, prepped, and draped in the usual sterile fashion.  A midline scrotal incision was made measuring about 2 cm in size.  The incision was carried through the dartos through the scrotal sac and the spermatocele was identified.  All the layers of the spermatocele were removed.  Clear layer was visualized, was taken all the way up to the base, the base was tied.  Entire spermatocele sac was removed.  After removing the entire spermatocele sac, hemostasis was obtained.  The testicle was not in normal orientation.  The testis and epididymis was removed, which is a small appendage on the superior aspect of the testicle.  The testicle was placed in a normal orientation.  Careful attention was drawn not to twist the cord.  Orchidopexy was done to allow the testes to stay stable in the postoperative period using 4-0 Vicryl and was tied at 3 different locations.  Absorbable sutures were used, so that the patient does not feel the sutures in the postoperative period.  The dartos was closed using 2-0 Vicryl in running locking fashion.  There was excellent hemostasis.  The skin was closed using 4-0 Monocryl.  Dermabond was applied.  The patient tolerated the procedure well.  The patient was brought to the recovery room in stable condition.
Sling (SPARC Suburethral)  ( Urology)
Description:  SPARC suburethral sling due to stress urinary incontinence.

PREOPERATIVE DX: , Stress urinary incontinence.,POSTOPERATIVE DX: , Stress urinary incontinence.,OPERATIVE PROCEDURE: , SPARC suburethral sling.,ANESTHESIA: , General.,FINDINGS & INDICATIONS: , Outpatient evaluation was consistent with urethral hypermobility, stress urinary incontinence.  Intraoperatively, the bladder appeared normal with the exception of some minor trabeculations.  The ureteral orifices were normal bilaterally.,DESCRIPTION OF OPERATIVE PROCEDURE:,  This patient was brought to the operating room, a general anesthetic was administered.  She was placed in dorsal lithotomy position.  Her vulva, vagina, and perineum were prepped with Betadine scrubbed in solution.  She was draped in usual sterile fashion.  A Sims retractor was placed into the vagina and Foley catheter was inserted into the bladder.  Two Allis clamps were placed over the mid urethra.  This area was injected with 0.50% lidocaine containing 1:200,000 epinephrine solution.  Two areas suprapubically on either side of midline were injected with the same anesthetic solution.  The stab wound incisions were made in these locations and a sagittal incision was made over the mid urethra.  Metzenbaum scissors were used to dissect bilaterally to the level of the ischial pubic ramus.  The SPARC needles were then placed through the suprapubic incisions and then directed through the vaginal incision bilaterally.  The Foley catheter was removed.  A cystoscopy was performed using a 70-degree cystoscope.  There was noted to be no violation of the bladder.  The SPARC mesh was then snapped onto the needles, which were withdrawn through the stab wound incisions.  The mesh was snugged up against a Mayo scissor held under the mid urethra.  The overlying plastic sheaths were removed.  The mesh was cut below the surface of the skin.  The skin was closed with 4-0 Plain suture.  The vaginal vault was closed with a running 2-0 Vicryl stitch.  The blood loss was minimal.  The patient was awoken and she was brought to recovery in stable condition.
Scrotal Exploration  ( Urology)
Description:  Left scrotal exploration with detorsion.  Already, de-torsed bilateral testes fixation and bilateral appendix testes cautery.

PREOPERATIVE DIAGNOSIS: , Left testicular torsion, possibly detorsion.,POSTOPERATIVE DIAGNOSIS: , Left testicular torsion, possibly detorsion.,PROCEDURE: , Left scrotal exploration with detorsion.  Already, de-torsed bilateral testes fixation and bilateral appendix testes cautery.,ANESTHETIC:,  A 0.25% Marcaine local wound insufflation per surgeon, 15 mL of Toradol.,FINDINGS:,  Congestion in the left testis and cord with a bell-clapper deformity on the right small appendix testes bilaterally.  No testis necrosis.,ESTIMATED BLOOD LOSS:,  5 mL.,FLUIDS RECEIVED: , 300 mL of crystalloid.,TUBES AND DRAINS:,  None.,SPECIMENS: , No tissues sent to pathology.,COUNTS:,  Sponges and needle counts were correct x2.,INDICATIONS OF OPERATION: , The patient is a 4-year-old boy with abrupt onset of left testicular pain.  He has had a history of similar onset.  Apparently, he had no full on one ultrasound and full on a second ultrasound, but because of possible torsion, detorsion, or incomplete detorsion, I recommended an exploration.,DESCRIPTION OF OPERATION:,  The patient was taken to the operating room, where surgical consent, operative site, and patient identification was verified.  Once he was anesthetized, he was placed in supine position and sterilely prepped and draped.  Superior scrotal incisions were then made with 15-blade knife and further extended up to the subcutaneous tissue and dartos fascia with electrocautery.  Electrocautery was used for hemostasis.  The subdartos pouch was created with curved tenotomy scissors.  The tunica vaginalis was then delivered, incised, and testis was delivered.  The testis itself with a bell-clapper deformity.  There was no actual torsion at the present time, there was some modest congestion and, however, the vasculature was markedly congested down the cord.  The penis fascia was cauterized and subdartos pouch was created.  The upper aspect of fascia was then closed with pursestring suture of 4-0 chromic.  The testis was then placed into the scrotum in a proper orientation.  No tacking sutures within the testis itself were used.  The tunica vaginalis; however, was wrapped perfectly behind the back of the testis.  A similar procedure was performed on the right side.  Again, an appendix testis was cauterized.  No torsion was seen.  He also had a bell-clapper deformity and similar dartos pouch was created and the testis was placed in the scrotum in the proper orientation and the upper aspect closed with #4-0 chromic suture.  The local anesthetic was then used for both as cord block, as well as a local wound insufflation bilaterally with 0.25% Marcaine.  The scrotal wall was then closed with subcuticular closure of #4-0 chromic.  Dermabond tissue adhesive was then used.  The patient tolerated the procedure well.  He was given IV Toradol and was taken to the recovery room in stable condition.
Pubic Cellulitis  ( Urology)
Description:  A 16-month-old with history of penile swelling for 4 days, had circumcision 1 week ago.

DIAGNOSIS: , Pubic cellulitis.,HISTORY OF PRESENT ILLNESS:,  A 16-month-old with history of penile swelling for 4 days.  The patient was transferred for higher level of care.  This 16-month-old had circumcision 1 week ago and this is the third circumcision this patient underwent.  Apparently, the patient developed adhesions and the patient had surgery for 2 more occasions for removal of the adhesions.  This time, the patient developed fevers 3 days after the surgery with edema and erythema around the circumcision and it has spread to the pubic area.  The patient became febrile with 102 to 103 fever, treated with Tylenol with Codeine and topical antibiotics.  The patient was transferred to Children's Hospital for higher level of care.,REVIEW OF SYSTEMS: , ,ENT:  Denies any runny nose.  ,EYES:  No apparent discharge.  ,FEEDING:  Good feeding.  ,CARDIOVASCULAR:  There is no cyanosis or edema.  ,RESPIRATORY:  Denies any cough or wheezing.  ,GI:  Positive for constipation, no bowel movements for 2 days.  ,GU:  Positive dysuria for the last 2 days and penile discharge for the last 2 days with foul smelling.  ,NEUROLOGIC:  Denies any lethargy or seizure.  ,MUSCULOSKELETAL:  No pain or swelling.  ,SKIN:  Erythema and edema in the pubic area for the last 3 days.  All the rest of systems are negative except as noted above.,At the emergency room, the patient had a second dose of clindamycin.  The transfer labs are as follows:  15.7 for WBC, H&H 12.0 and 36.  One blood culture.  We will follow the results.  He is status post Rocephin and Cleocin.,PAST MEDICAL HISTORY: , Denied.  ,PAST SURGICAL HISTORY:,  The patient underwent 3 circumcisions since birth, the last 2 had been for possible removal of adhesions.,IMMUNIZATIONS: , He is behind with his immunizations.  He is due for his 16-month-old immunizations.,ACTIVITY: , NKDA.,BIRTH HISTORY: , Born to a 21-year-old, first baby, born NSVD, 8 pounds 10 ounces, no complications.,DEVELOPMENTAL:,  He is walking and speaking about 15 words.,FAMILY HISTORY: , Noncontributory.,MEDICATIONS: , Tylenol with Codeine q.6h.,SOCIAL HISTORY: , He lives with both parents and both of them smoke.  There are no pets.,SICK CONTACTS: , Mom has some upper respiratory infection.,DIET: , Regular diet.,PHYSICAL EXAMINATION: , ,VITAL SIGNS:  Temperature max at ER is 102, heart rate 153.,GENERAL:  This patient is alert, arousable, big boy.,HEENT:  Head:  Normocephalic, atraumatic.  Pupils are equal, round, and reactive to light.  Mucous membranes are moist.,NECK:  Supple.,CHEST:  Clear to auscultation bilaterally.  Good air exchange.,ABDOMEN:  Soft, nontender, nondistended.,EXTREMITIES:  Full range of movement.  No deformities.
Prostate Adenocarcinoma - H&P  ( Urology)
Description:  Adenocarcinoma of the prostate, Erectile dysfunction - History & Physical

HISTORY OF PRESENT ILLNESS: , The patient is a 62-year old male with a Gleason score 8 adenocarcinoma of the prostate involving the left and right lobes.  He has a PSA of 3.1, with a prostate gland size of 41 grams.  This was initially found on rectal examination with a nodule on the right side of the prostate, showing enlargement relative to the left.  He has undergone evaluation with a bone scan that showed a right parietal lesion uptake and was seen by Dr. XXX and ultimately underwent an open biopsy that was not malignant.  Prior to this, he has also had a ProstaScint scan that was negative for any metastatic disease.  Again, he is being admitted to undergo a radical prostatectomy, the risks, benefits, and alternatives of which have been discussed, including that of bleeding, and a blood transfusion.,PAST MEDICAL HISTORY: , Coronary stenting.  History of high blood pressure, as well.  He has erectile dysfunction and has been treated with Viagra.,MEDICATIONS: , Lisinopril, Aspirin, Zocor, and Prilosec.,ALLERGIES:,  Penicillin.,SOCIAL HISTORY:,  He is not a smoker.  He does drink six beers a day.,REVIEW OF SYSTEMS: , Remarkable for his high blood pressure and drug allergies, but otherwise unremarkable, except for some obstructive urinary symptoms, with an AUA score of 19.,PHYSICAL EXAMINATION:,HEENT:  Examination unremarkable.,Breasts:  Examination deferred.,Chest:  Clear to auscultation.,Cardiac:  Regular rate and rhythm.,Abdomen:  Soft and nontender.  He has no hernias.,Genitourinary:  There is a normal-appearing phallus, prominence of the right side of prostate.,Extremities:  Examination unremarkable.,Neurologic:  Examination nonfocal.,IMPRESSION:,1.  Adenocarcinoma of the prostate.,2.  Erectile dysfunction.,PLAN:  ,The patient will undergo a bilateral pelvic lymphadenectomy and radical retropubic prostatectomy.  The risks, benefits, and alternatives of this have been discussed.  He understands and asks that I proceed ahead.  We also discussed bleeding and blood transfusions, and the risks, benefits and alternatives thereof.
Prostate Brachytherapy  ( Urology)
Description:  Prostate Brachytherapy - Prostate I-125 Implantation

PROSTATE BRACHYTHERAPY - PROSTATE I-125 IMPLANTATION,This patient will be treated to the prostate with ultrasound-guided I-125 seed implantation.  The original consultation and treatment planning will be separately performed.  At the time of the implantation, special coordination will be required.  Stepping ultrasound will be performed and utilized in the pre-planning process.  Some discrepancies are frequently identified, based on the positioning, edema, and/or change in the tumor since the pre-planning process.  Re-assessment is required at the time of surgery, evaluating the pre-plan and comparing to the stepping ultrasound.  Modifications will be made in real time to add or subtract needles and seeds as required.  This may be integrated with the loading of the seeds performed by the brachytherapist, as well as coordinated with the urologist, dosimetrist or physicist.,The brachytherapy must be customized to fit the individual's tumor and prostate.  Attention is given both preoperatively and intraoperatively to avoid overdosage of rectum and bladder.
Retrograde Pyelogram & Cystourethroscopy  ( Urology)
Description:  Cystourethroscopy, right retrograde pyelogram, and right double-J stent placement 22 x 4.5 mm.  Right ureteropelvic junction calculus.

PREOPERATIVE DIAGNOSIS: , Right ureteral calculus.,POSTOPERATIVE DIAGNOSIS: , Right ureteropelvic junction calculus.,PROCEDURE PERFORMED:,1.  Cystourethroscopy.,2.  Right retrograde pyelogram.,3.  Right double-J stent placement 22 x 4.5 mm.,FIRST SECOND ANESTHESIA: , General.,SPECIMEN:,  Urine for culture and sensitivity.,DRAINS: , 22 x 4.5 mm right double-J ureteral stent.,PROCEDURE: , After consent was obtained, the patient was brought to operating room and placed in the supine position.  She was given general anesthesia and then placed in the dorsal lithotomy position.  A #21 French cystoscope was then passed through the urethra into the bladder.  There was noted to be some tightness of the urethra on passage.  On visualization of the bladder, there were no stones or any other debris within the bladder.  There were no abnormalities seen.  No masses, diverticuli, or other abnormal findings.  Attention was then turned to the right ureteral orifice and attempts to pass to a cone tip catheter, however, the ureteral orifice was noted to be also tight and we were unable to pass the cone tip catheter.  The cone tip catheter was removed and a glidewire was then passed without difficulty up into the renal pelvis.  An open-end ureteral catheter was then passed ________ into the distal right ureter.  Retrograde pyelogram was then performed.,There was noted to be an UPJ calculus with no noted hydronephrosis.  The wire was then passed back through the ureteral catheter.  The catheter was removed and a 22 x 4.5 mm double-J ureteral stent was then passed over the glidewire under fluoroscopic and cystoscopic guidance.  The stent was clear within the kidney as well as within the bladder.  The bladder was drained and the cystoscope was removed.  The patient tolerated the procedure well.  She will be discharged home.  She is to follow up with Dr. X for ESWL procedure.  She will be given prescription for Darvocet and will be asked to have a KUB x-ray done prior to her followup and to bring them with her to her appointment.