smoh/medical-transcriptions huggingface dataset:
Inguinal Hernia Repair - 5  ( Urology)
Description:  Direct right inguinal hernia.  Marlex repair of right inguinal hernia.

PREOPERATIVE DIAGNOSIS: , Right inguinal hernia.,POSTOPERATIVE DIAGNOSIS: , Direct right inguinal hernia.,TITLE OF PROCEDURE: , Marlex repair of right inguinal hernia.,ANESTHESIA:,  Spinal.,PROCEDURE IN DETAIL:,  The patient was taken to the operative suite, placed on the table in the supine position, and given a spinal anesthetic.  The right inguinal region was shaved and prepped and draped in a routine sterile fashion.  The patient received 1 gm of Ancef IV push.,Transverse incision was made in the intraabdominal crease and carried through skin and subcutaneous tissue.  The external oblique fascia was exposed and incised down to and through the external inguinal ring.  The spermatic cord and hernia sac were dissected bluntly off the undersurface of the external oblique fascia exposing the attenuated floor of the inguinal canal.  The cord was surrounded with a Penrose drain.  The hernia sac was separated from the cord structures.  The floor of the inguinal canal, which consisted of attenuated transversalis fascia, was imbricated upon itself with a running locked suture of 2-0 Prolene.  Marlex patch 1 x 4 in dimension was trimmed to an appropriate shape with a defect to accommodate the cord.  It was placed around the cord and sutured to itself with 2-0 Prolene.  The patch was then sutured medially to the pubic tubercle, inferiorly to Cooper's ligament and inguinal ligaments, and superiorly to conjoined tendon using 2-0 Prolene.  The area was irrigated with saline solution, and 0.5% Marcaine with epinephrine was injected to provide prolonged postoperative pain relief.  The cord was returned to its position.  External oblique fascia was closed with a running 2-0 PDS, subcu with 2-0 Vicryl, and skin with running subdermal 4-0 Vicryl and Steri-Strips.  Sponge and needle counts were correct.  Sterile dressing was applied.
Inguinal Hernia Repair - 4  ( Urology)
Description:  Right inguinal hernia.    Right direct inguinal hernia repair with PHS mesh system.  The Right groin and abdomen were prepped and draped in the standard sterile surgical fashion.  An incision was made approximately 1 fingerbreadth above the pubic tubercle and in a skin crease. 

PREOPERATIVE DIAGNOSIS: , Right inguinal hernia. ,POSTOPERATIVE DIAGNOSIS:,  Right direct inguinal hernia. ,PROCEDURE:,  Right direct inguinal hernia repair with PHS mesh system. ,ANESTHESIA:,  General with endotracheal intubation. ,PROCEDURE IN DETAIL: , The patient was taken to the operating room and placed supine on the operating table.  General anesthesia was administered with endotracheal intubation.  The Right groin and abdomen were prepped and draped in the standard sterile surgical fashion.  An incision was made approximately 1 fingerbreadth above the pubic tubercle and in a skin crease.  Dissection was taken down through the skin and subcutaneous tissue.  Scarpa's fascia was divided, and the external ring was located.  The external oblique was divided from the external ring up towards the anterior superior iliac spine.  The cord structures were then encircled.  Careful inspection of the cord structures did not reveal any indirect sac along the cord structures.  I did, however, feel a direct sac with a direct defect.  I opened the floor of the inguinal canal and dissected out the preperitoneal space at the direct sac and cut out the direct sac.  Once I cleared out the preperitoneal space, I placed a PHS mesh system with a posterior mesh into the preperitoneal space, and I made sure that it laid flat along Cooper's ligament and covered the myopectineal orifice.  I then tucked the extended portion of the anterior mesh underneath the external oblique between the external oblique and the internal oblique, and I then tacked the medial portion of the mesh to the pubic tubercle with a 0 Ethibond suture.  I tacked the superior portion of the mesh to the internal oblique and the inferior portion of the mesh to the shelving edge of the inguinal ligament.  I cut a hole in the mesh in order to incorporate the cord structures and recreated the internal ring, making sure that it was not too tight so that it did not strangulate the cord structures.  I then closed the external oblique with a running 3-0 Vicryl.  I closed the Scarpa's with interrupted 3-0 Vicryl, and I closed the skin with a running Monocril.  Sponge, instrument and needle counts were correct at the end of the case.  The patient tolerated the procedure well and without any complications.
Inguinal Hernia Repair - 1  ( Urology)
Description:  A 9-year-old boy with a history of intermittent swelling of the right inguinal area consistent with a right inguinal hernia, taken to the operating room for inguinal hernia repair.

PREOPERATIVE DIAGNOSIS:,  Right inguinal hernia.,POSTOPERATIVE DIAGNOSIS:,  Right inguinal hernia.,PROCEDURE:,  Right inguinal hernia repair.,INDICATIONS FOR PROCEDURE: , This patient is a 9-year-old boy with a history of intermittent swelling of the right inguinal area consistent with a right inguinal hernia.  The patient is being taken to the operating room for inguinal hernia repair.,DESCRIPTION OF PROCEDURE: , The patient was taken to the operating room, placed supine, put under general endotracheal anesthesia.  The patient's inguinal and scrotal area were prepped and draped in the usual sterile fashion.  An incision was made in the right inguinal skin crease.  The incision was taken down to the level of the aponeurosis of the external oblique, which was incised up to the level of the external ring.  The hernia sac was verified and dissected at the level of the internal ring and a high ligation performed.  The distal remnant was taken to its end and excised.  The testicle and cord structures were placed back in their native positions.  The aponeurosis of the external oblique was reapproximated with 3-0 Vicryl as well as the Scarpa's, the skin closed with 5-0 Monocryl and dressed with Steri-Strips.  The patient was extubated in the operating room and taken back to the recovery room.  The patient tolerated the procedure well.
Inguinal Hernia & Hydrocele Repair  ( Urology)
Description:  Left communicating hydrocele.  Left inguinal hernia and hydrocele repair.  The patient is a 5-year-old young man with fluid collection in the tunica vaginalis and peritesticular space on the left side consistent with a communicating hydrocele. 


PREOPERATIVE DIAGNOSIS:  ,Left communicating hydrocele.,POSTOPERATIVE DIAGNOSIS: , Left communicating hydrocele.,ANESTHESIA: , General.,PROCEDURE:  ,Left inguinal hernia and hydrocele repair.,INDICATIONS: , The patient is a 5-year-old young man with fluid collection in the tunica vaginalis and peritesticular space on the left side consistent with a communicating hydrocele.  The fluid size tends to fluctuate with time but has been relatively persistent for the past year.  I met with the patient's mom and also spoke with his father by phone in the past couple of months and explained the diagnosis of patent processus vaginalis for communicating hydrocele and talked to them about the surgical treatment and options.  All their questions have been answered and the patient is fit for operation today.,OPERATIVE FINDINGS:  ,The patient had a very thin patent processus vaginalis leading to a rather sizeable hydrocele sac in the left hemiscrotum.  We probably drained around 10 to 15 mL of fluid from the hydrocele sac.  The processus vaginalis was clearly seen back to the peritoneal reflection where a high ligation was successfully performed.  There were no other abnormalities noted in the inguinal scrotal region.,DESCRIPTION OF OPERATION: , The patient came to the operating room and had an uneventful induction of inhalation anesthetic.  A peripheral IV was placed, and we conducted a surgical time-out to reiterate all of The patient's important identifying information and to confirm that we were indeed going to perform a left inguinal hernia and hydrocele repair.  After preparation and draping was done with chlorhexidine based prep solution, a local infiltration block as well as an ilioinguinal and iliohypogastric nerve block was performed with 0.25% Marcaine with dilute epinephrine.  A curvilinear incision was made low in the left inguinal area along one of prominent skin folds.  Soft tissue dissection was carried down through Scarpa's layer to the external oblique fascia, which was then opened to expose the underlying spermatic cord structures.  The processus vaginalis was dissected free from the spermatic cord structures, and the distal hydrocele sac was widely opened and drained of its fluid contents.  The processus vaginalis was cleared back to peritoneal reflection at the deep inguinal ring and a high ligation was performed there using both the transfixing and a mass ligature of 3-0 Vicryl.  After the excess hydrocele and processus vaginalis tissue was excised, the spermatic cord structures were replaced and the external oblique and Scarpa's layers were closed with interrupted 3-0 Vicryl sutures.  Subcuticular 5-0 Monocryl and Steri-Strips were used for the final skin closure.  The patient tolerated the operation well.  He was awakened and taken to the recovery room in good condition.  Blood loss was minimal.  No specimen was submitted.,
I&D - Penoscrotal Abscess  ( Urology)
Description:  Incision and drainage of the penoscrotal abscess, packing, penile biopsy, cystoscopy, and urethral dilation.

PREOPERATIVE DIAGNOSIS: , Penoscrotal abscess.,POSTOPERATIVE DIAGNOSIS:,  Penoscrotal abscess.,OPERATION: , Incision and drainage of the penoscrotal abscess, packing, penile biopsy, cystoscopy, and urethral dilation.,BRIEF HISTORY: , The patient is a 75-year-old male presented with penoscrotal abscess.  Options such as watchful waiting, drainage, and antibiotics were discussed.  Risks of anesthesia, bleeding, infection, pain, MI, DVT, PE, completely the infection turning into necrotizing fascitis, Fournier's gangrene were discussed.  The patient already had significant phimotic changes and disfigurement of the penis.  For further debridement the patient was told that his penis is not going to be viable, he may need a total or partial penectomy now or in the future.  Risks of decreased penile sensation, pain, Foley, other unexpected issues were discussed.  The patient understood all the complications and wanted to proceed with the procedure.,DETAIL OF THE OPERATION:  ,The patient was brought to the OR.  The patient was placed in dorsal lithotomy position.  The patient was prepped and draped in the usual fashion.  Pictures were taken prior to starting the procedure for documentation.  The patient had an open sore on the right side of the penis measuring about 1 cm in size with pouring pus out using blunt dissection.  The penile area was opened up distally to allow the pus to come out.  The dissection around the proximal scrotum was done to make sure there are no other pus pockets.  The corporal body was intact, but the distal part of the corpora was completely eroded and had a fungating mass, which was biopsied and sent for permanent pathology analysis.,Urethra was identified at the distal tip, which was dilated and using 23-French cystoscope cystoscopy was done, which showed some urethral narrowing in the distal part of the urethra.  The rest of the bladder appeared normal.  The prostatic urethra was slightly enlarged.  There are no stones or tumors inside the bladder.  There were moderate trabeculations inside the bladder.  Otherwise, the bladder and the urethra appeared normal.  There was a significantly fungating mass involving the distal part of the urethra almost possibility to have including the fungating wart or fungating squamous cell carcinoma.  Again biopsies were sent for pathology analysis.  Prior to urine irrigation anaerobic aerobic cultures were sent, irrigation with over 2 L of fluid was performed.  After irrigation, packing was done with Kerlix.  The patient was brought to recovery in a stable condition.  Please note that 18-French Foley was kept in place.  Electrocautery was used at the end of the procedure to obtain hemostasis as much as possible, but there was fungating mass with slight bleeding packing was done and tight scrotal Kling was applied.  The patient was brought to Recovery in a stable condition after applying 0.5% Marcaine about 20 mL were injected around for local anesthesia.
Hydrocelectomy.  ( Urology)
Description:  Left hydrocelectomy.   This is a 67-year-old male with pain, left scrotum.  He has had an elevated PSA and also has erectile dysfunction.  He comes in now for a left hydrocelectomy.  Physical exam confirmed obvious hydrocele, left scrotum.

PREOPERATIVE DIAGNOSIS: , Left hydrocele.,OPERATION: , Left hydrocelectomy.,POSTOPERATIVE DIAGNOSIS: , Left hydrocele.,ANESTHESIA: , General,INDICATIONS AND STUDIES: , This is a 67-year-old male with pain, left scrotum.  He has had an elevated PSA and also has erectile dysfunction.  He comes in now for a left hydrocelectomy.  Physical exam confirmed obvious hydrocele, left scrotum, approximately 8 cm.  Laboratory data included a hematocrit of 43.5, hemoglobin of 15.0, and white count 4700.  Creatinine 1.3, sodium 141, and potassium 4.0.  Calcium 8.6.  Chest x-ray was unremarkable.  EKG was normal.,PROCEDURE: , The patient was satisfactorily given general anesthesia, prepped and draped in supine position, and left scrotal incision was made, carried down to the tunica vaginalis forming the hydrocele.  This was dissected free from the scrotal wall back to the base of the testicle and then excised back to the spermatic cord.  In the fashion, the hydrocele was excised and fluid drained.,Cord was infiltrated with 5 mL of 0.25% Marcaine.  The edges of the tunica vaginalis adjacent to the spermatic cord were oversewn with interrupted 3-0 Vicryl sutures for hemostasis.  The left testicle was replaced into the left scrotal compartment and affixed to the overlying Dartos fascia with a 3-0 Vicryl suture through the edge of the tunica vaginalis and the overlying Dartos fascia.,The left scrotal incision was closed, first closing the Dartos fascia with interrupted 3-0 Vicryl sutures.  Skin was closed with an interrupted running 4-0 chromic suture.  A sterile dressing was applied.  The patient was sent to the recovery room in good condition, upon awakening from general anesthesia.  Plan is to discharge the patient and see him back in the office in a week or 2 in followup.  Further plans will depend upon how he does.
Hydrocelectomy - 1  ( Urology)
Description:  Left hydrocelectomy, cystopyelogram, bladder biopsy, and fulguration for hemostasis.

PREOPERATIVE DIAGNOSES:,  Bladder cancer and left hydrocele.,POSTOPERATIVE DIAGNOSES: , Bladder cancer and left hydrocele.,OPERATION:  ,Left hydrocelectomy, cystopyelogram, bladder biopsy, and fulguration for hemostasis.,ANESTHESIA:,  Spinal.,ESTIMATED BLOOD LOSS:  ,Minimal.,FLUIDS:,  Crystalloid.,BRIEF HISTORY:  ,The patient is a 66-year-old male with history of smoking and hematuria, had bladder tumor, which was dissected.  He has received BCG.  The patient is doing well.  The patient was supposed to come to the OR for surveillance biopsy and pyelograms.  The patient had a large left hydrocele, which was increasingly getting worse and was making it very difficult for the patient to sit to void or put clothes on, etc.  Options such as watchful waiting, drainage in the office, and hydrocelectomy were discussed.  Risks of anesthesia, bleeding, infection, pain, MI, DVT, PE, infection in the scrotum, enlargement of the scrotum, recurrence, and pain were discussed.  The patient understood all the options and wanted to proceed with the procedure.,PROCEDURE IN DETAIL: , 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 usual sterile fashion.,A transverse scrotal incision was made over the hydrocele sac and the hydrocele fluid was withdrawn.  The sac was turned upside down and sutures were placed.  Careful attention was made to ensure that the cord was open.  The testicle was in normal orientation throughout the entire procedure.  The testicle was placed back into the scrotal sac and was pexed with 4-0 Vicryl to the outside dartos to ensure that there was no risk of torsion.  Orchiopexy was done at 3 different locations.  Hemostasis was obtained using electrocautery.  The sac was closed using 4-0 Vicryl.  The sac was turned upside down so that when it heals, the fluid would not recollect.  The dartos was closed using 2-0 Vicryl and the skin was closed using 4-0 Monocryl and Dermabond was applied.  Incision measured about 2 cm in size.  Subsequently using ACMI cystoscope, a cystoscopy was performed.  The urethra appeared normal.  There was some scarring at the bulbar urethra, but the scope went in through that area very easily into the bladder.  There was a short prostatic fossa.  The bladder appeared normal.  There was some moderate trabeculation throughout the bladder, some inflammatory changes in the bag part, but nothing of much significance.  There were no papillary tumors or stones inside the bladder.  Bilateral pyelograms were obtained using 8-French cone-tip catheter, which appeared normal.  A cold cup biopsy of the bladder was done and was fulgurated for hemostasis.  The patient tolerated the procedure well.  The patient was brought to recovery at the end of the procedure after emptying the bladder.,The patient was given antibiotics and was told to take it easy.  No heavy lifting, pushing, or pulling.  Plan was to follow up in about 2 months.
Hydrocelectomy  ( Urology)
Description:  Bilateral scrotal hydrocelectomies, large for both, and 0.5% Marcaine wound instillation, 30 mL given.

PREOPERATIVE DIAGNOSIS:,  Bilateral hydroceles.,POSTOPERATIVE DIAGNOSIS:,  Bilateral hydroceles.,PROCEDURE: , Bilateral scrotal hydrocelectomies, large for both, and 0.5% Marcaine wound instillation, 30 mL given.,ESTIMATED BLOOD LOSS: , Less than 10 mL.,FLUIDS RECEIVED: , 800 mL.,TUBES AND DRAINS: , A 0.25-inch Penrose drains x4.,INDICATIONS FOR OPERATION:  ,The patient is a 17-year-old boy, who has had fairly large hydroceles noted for some time.  Finally, he has decided to have them get repaired.  Plan is for surgical repair.,DESCRIPTION OF OPERATION:  ,The patient was taken to the operating room where surgical consent, operative site, and patient identification were verified.  Once he was anesthetized, he was then shaved, prepped, and then sterilely prepped and draped.  IV antibiotics were given.  Ancef 1 g given.  A scrotal incision was then made in the right hemiscrotum with a 15-blade knife and further extended with electrocautery.  Electrocautery was used for hemostasis.  Once we got to the hydrocele sac itself, we then opened and delivered the testis, drained clear fluid.  There was moderate amount of scarring on the testis itself from the tunica vaginalis.  It was then wrapped around the back and sutured in place with a running suture of 4-0 chromic in a Lord maneuver.  Once this was done, a drain was placed in the base of the scrotum and then the testis was placed back into the scrotum in the proper orientation.  A similar procedure was performed on the left, which has also had a hydrocele of the cord, which were both addressed and closed with Lord maneuver similarly.  This testis also was normal but had moderate amount of scarring on the tunic vaginalis from this.  A similar drain was placed.  The testes were then placed back into the scrotum in a proper orientation, and the local wound instillation and wound block was then placed using 30 mL of 0.5% Marcaine without epinephrine.  IV Toradol was given at the end of the procedure.  The skin was then sutured with a running interlocking suture of 3-0 Vicryl and the drains were sutured to place with 3-0 Vicryl.  Bacitracin dressing, ABD dressing, and jock strap were placed.  The patient was in stable condition upon transfer to the recovery room.
Hydrocele Repair  ( Urology)
Description:  Inguinal hernia hydrocele repair.
Hematuria - ER Visit  ( Urology)
Description:  Presents to the ER with hematuria that began while sleeping last night.   He denies any pain, nausea, vomiting or diarrhea.

HISTORY OF PRESENT ILLNESS:,  The patient is an 85-year-old gentleman who follows as an outpatient with Dr. A.  He is known to us from his last admission.  At that time, he was admitted with a difficulty voiding and constipation.  His urine cultures ended up being negative.  He was seen by Dr. B and discharged home on Levaquin for five days.,He presents to the ER today with hematuria that began while he was sleeping last night.  He denies any pain, nausea, vomiting or diarrhea.  In the ER, a Foley catheter was placed and was irrigated with saline.  White count was 7.6, H and H are 10.8 and 38.7, and BUN and creatinine are of 27 and 1.9.  Urine culture is pending.  Chest x-ray is pending.  His UA did show lots of red cells.  The patient currently is comfortable.  CBI is running.  His urine is clear.,PAST MEDICAL HISTORY:,1.  Hypertension.,2.  High cholesterol.,3.  Bladder cancer.,4.  Bilateral total knee replacements.,5.  Cataracts.,6.  Enlarged prostate.,ALLERGIES:,  SULFA.,MEDICATIONS AT HOME:,1.  Atenolol.,2.  Cardura.,3.  Zegerid.,4.  Flomax.,5.  Levaquin.,6.  Proscar.,7.  Vicodin.,8.  Morphine.,9.  Phenergan.,10.  Ativan.,11.  Zocor.,12.  Prinivil.,13.  Hydrochlorothiazide.,14.  Folic acid.,15.  Digoxin.,16.  Vitamin B12.,17.  Multivitamin.,SOCIAL HISTORY: , The patient lives at home with his daughter.  He does not smoke, occasionally drinks alcohol.  He is independent with his activities of daily living.,REVIEW OF SYSTEMS:,  Not additionally rewarding.,PHYSICAL EXAMINATION:,GENERAL:  An awake and alert 85-year-old gentleman who is afebrile.,VITAL SIGNS:  BP of 162/60 and pulse oximetry of 98% on room air.,HEENT:  Pink conjunctivae.  Anicteric sclerae.  Oral mucosa is moist.,NECK:  Supple.,CHEST:  Clear to auscultation.,HEART:  Regular S1 and S2.,ABDOMEN:  Soft and nontender to palpation.,EXTREMITIES:  Without edema.,He has a Foley catheter in place.  His urine is clear.,LABORATORY DATA:,  Reviewed.,IMPRESSION:,1.  Hematuria.