smoh/medical-transcriptions huggingface dataset:
D&C & Hysteroscopy  ( Surgery)
Description:  Enlarged fibroid uterus, hypermenorrhea, and secondary anemia.  Dilatation and curettage and hysteroscopy.

PREOPERATIVE DIAGNOSES:,1.  Enlarged fibroid uterus.,2.  Hypermenorrhea.,POSTOPERATIVE DIAGNOSES:,1.  Enlarged fibroid uterus.,2.  Hypermenorrhea.,3.  Secondary anemia.,PROCEDURE PERFORMED:,1.  Dilatation and curettage.,2.  Hysteroscopy.,GROSS FINDINGS: , Uterus was anteverted, greatly enlarged, irregular and firm.  The cervix is patulous and nulliparous without lesions.  Adnexal examination was negative for masses.,PROCEDURE:  ,The patient was taken to the operating room where she was properly prepped and draped in sterile manner under general anesthesia.  After bimanual examination, the cervix was exposed with a weighted vaginal speculum and the anterior lip of the cervix grasped with a vulsellum tenaculum.  The uterus was sounded to a depth of 11 cm.  The endocervical canal was then progressively dilated with Hanks and Hegar dilators to a #10 Hegar.  The ACMI hysteroscope was then introduced into the uterine cavity using sterile saline solution as a distending media and with attached video camera.  The endometrial cavity was distended with fluids and the cavity visualized.  Multiple irregular areas of fibroid degeneration were noted throughout the cavity.  The coronal areas were visualized bilaterally with corresponding tubal ostia.  A moderate amount of proliferative appearing endometrium was noted.  There were no direct intraluminal lesions seen.  The patient tolerated the procedure well.  Several pictures were taken of the endometrial cavity and the hysteroscope removed from the cavity.,A large sharp curet was then used to obtain a moderate amount of tissue, which was the sent to pathologist for analysis.  The instrument was removed from the vaginal vault.  The patient was sent to recovery area in satisfactory postoperative condition.
Cystourethroscopy & TURP - 1  ( Surgery)
Description:  Cystourethroscopy and tTransurethral resection of prostate (TURP).  Urinary retention and benign prostate hypertrophy.  This is a 62-year-old male with a history of urinary retention and progressive obstructive voiding symptoms and enlarged prostate 60 g on ultrasound, office cystoscopy confirmed this.

PREOPERATIVE DIAGNOSES:,1.  Urinary retention.,2.  Benign prostate hypertrophy.,POSTOPERATIVE DIAGNOSES:,1.  Urinary retention.,2.  Benign prostate hypertrophy.,PROCEDURES PERFORMED:,1.  Cystourethroscopy.,2.  Transurethral resection of prostate (TURP).,ANESTHESIA:,  Spinal.,RESECTION TIME:,  Less than one hour.,INDICATION FOR PROCEDURE:  ,This is a 62-year-old male with a history of urinary retention and progressive obstructive voiding symptoms and enlarged prostate 60 g on ultrasound, office cystoscopy confirmed this.,PROCEDURE:  PROCEDURE: , Informed written consent was obtained.  The patient was taken to the operative suite, administered spinal anesthetic and placed in dorsal lithotomy position.  She was sterilely prepped and draped in normal fashion.  A #27-French resectoscope was inserted utilizing the visual obturator blanching the bladder.  The bladder was visualized in all quadrants, no bladder tumors or stones were noted.  Ureteral orifices were visualized and did appear to be near the enlarged median lobe.  Prostate showed trilobar prostatic enlargement.  There were some cellules and tuberculations noted.  The visual obturator was removed.  The resectoscope was then inserted utilizing the #26 French resectoscope loop.  Resection was performed initiating at the bladder neck and at the median lobe.,This was taken down to the circular capsular fibers.  Attention was then turned to the left lateral lobe and this was resected from 12 o'clock to 3 o'clock down to the capsular fibers maintaining hemostasis along the way and taking care not to resect beyond the level of the verumontanum.  Ureteral orifices were kept out of harm's way throughout the case.  Resection was then performed from the 3 o'clock position to the 6 o'clock position in similar fashion.  Attention was then turned to the right lateral lobe and this was resected again in a similar fashion maintaining hemostasis along the way.  The resectoscope was then moved to the level of the proximal external sphincter and trimming of the apex was performed.  Open prostatic fossa was noted.  All chips were evacuated via Ellik evacuator and #24 French three-way Foley catheter was inserted and irrigated.  Clear return was noted.  The patient was then hooked up to better irrigation.  The patient was cleaned, reversed for anesthetic, and transferred to recovery room in stable condition.,PLAN:  ,We will admit with antibiotics, pain control, and bladder irrigation possible void trial in the morning.
D&C & Laparoscopy  ( Surgery)
Description:  Enlarged fibroid uterus, infertility, pelvic pain, and probable bilateral tubal occlusion.  Dilatation and curettage and laparoscopy and injection of indigo carmine dye.

PREOPERATIVE DIAGNOSES:,1.  Hypermenorrhea.,2.  Pelvic pain.,3.  Infertility.,POSTOPERATIVE DIAGNOSES:,1.  Enlarged fibroid uterus.,2.  Infertility.,3.  Pelvic pain.,4.  Probable bilateral tubal occlusion.,PROCEDURE PERFORMED:,1.  Dilatation and curettage.,2.  Laparoscopy.,3.  Injection of indigo carmine dye.,GROSS FINDINGS: , The uterus was anteverted, firm, enlarged, irregular, and mobile.  The cervix is nulliparous without lesions.  Adnexal examination was negative for masses.,PROCEDURE:  ,The patient was placed in the lithotomy position, properly prepared and draped in sterile manner.  After bimanual examination, the cervix was exposed with a weighted vaginal speculum and the anterior lip of the cervix was grasped with vulsellum tenaculum.  Uterus sounded to a depth of 10.5 cm.  Endocervical canal was progressively dilated with Hanks dilators to #20-French.  A medium-sized sharp curet was used to obtain a moderated amount of tissue upon curettage, which was taken from all uterine quadrants and sent to the pathologist for analysis.  A ________ syringe was then introduced into the uterine cavity to a depth of 9 cm and the balloon insufflated with 10 cc of air.  A 20 cc syringe filled with dilute indigo carmine dye was attached to the end of the ________ syringe to use to inject at the time of laparoscopy.,A small subumbilical incision was then made with insertion of the step dilating sheath with a Veress needle into the peritoneal cavity.  The peritoneal cavity was insufflated with 3 liters of carbondioxide and a 12 mm trocar inserted.  The laparoscope was then inserted through the trocar with visualization of the pelvic contents.  In steep Trendelenburg position, the uterus was visualized and aided by use of a Bierman needle to displace bowel from visualized areas.  The fallopian tubes appeared normal bilaterally with good visualization of a normal appearing fimbria.  The ovaries also appeared normal bilaterally.  The uterus was greatly enlarged and distorted with large fibroids in multiple areas and especially on the right coronal area.  An attempt was made to inject the indigo carmine dye and in fact a three syringes of 20 cc were injected without any visualization of intraperitoneal dye still.  Both fallopian tubes apparently were blocked.  The upper abdomen was visually explored and found to be normal as was the bowel and area of the right ileum.  The patient tolerated the procedure well.  Instruments were removed from the vaginal vault and the abdomen.  Trocar was removed and the carbondioxide allowed to escape and the subumbilical wound repaired with two #4-0 undyed Vicryl sutures.  Sterile dressing was applied to the wound and the patient was sent to the recovery area in satisfactory postoperative condition.
Cystourethroscopy & TURP  ( Surgery)
Description:  Benign prostatic hypertrophy and urinary retention.  Cystourethroscopy and transurethral resection of prostate (TURP).

PREOPERATIVE DIAGNOSES:,1.  Benign prostatic hypertrophy.,2.  Urinary retention.,POSTOPERATIVE DIAGNOSES:,1.  Benign prostatic hypertrophy.,2.  Urinary retention.,PROCEDURE PERFORMED:,1.  Cystourethroscopy.,2.  Transurethral resection of prostate (TURP).,ANESTHESIA:  ,Spinal.,DRAIN: , A #24 French three-way Foley catheter.,SPECIMENS: , Prostatic resection chips.,ESTIMATED BLOOD LOSS:  ,150 cc.,DISPOSITION:  ,The patient was transferred to the PACU in stable condition.,INDICATIONS AND FINDINGS:  ,This is an 84-year-old male with history of BPH and subsequent urinary retention with failure of trial of void, scheduled for elective TURP procedure.,FINDINGS: , At the time of surgery, cystourethroscopy revealed trilobar enlargement of the prostate with prostatic varices of the median lobe.  Cystoscopy showed a few cellules of the bladder with no obvious bladder tumors noted.,DESCRIPTION OF PROCEDURE: , After informed consent was obtained, the patient was moved to operating room and spinal anesthesia was induced by the Department of Anesthesia.  The patient was prepped and draped in the normal sterile fashion and a #21 French cystoscope inserted into urethra and into the bladder.  Cystoscopy performed with the above findings.  Cystoscope was removed.  A #27 French resectoscope with a #26 cutting loop was inserted into the bladder.  Verumontanum was identified as a landmark and systematic transurethral resection of the prostate tissue was undertaken in an circumferential fashion with good resection of tissue completed.  ________ irrigator was used to evacuate the bladder of prostatic chips.  Resectoscope was then inserted and any residual chips were removed in piecemeal fashion with a resectoscope loop.  Any obvious bleeding from the prostatic fossa was controlled with electrocautery.  Resectoscope was removed.  A #24 French three-way Foley catheter inserted into the urethra and into the bladder.  Bladder was irrigated and connected to three-way irrigation.  The patient was cleaned and sent to recovery in stable condition to be admitted overnight for continuous bladder irrigation and postop monitoring.
Cystourethroscopy & Urethral Dilation  ( Surgery)
Description:  Cystourethroscopy, urethral dilation, and bladder biopsy and fulguration.  Urinary hesitancy and weak stream, urethral narrowing, mild posterior wall erythema.

PREOPERATIVE DIAGNOSIS:  ,Urinary hesitancy and weak stream.,POSTOPERATIVE DIAGNOSES:,1.  Urinary hesitancy and weak stream.,2.  Urethral narrowing.,3.  Mild posterior wall erythema.,PROCEDURE PERFORMED:,1.  Cystourethroscopy.,2.  Urethral dilation.,3.  Bladder biopsy and fulguration.,ANESTHESIA:  ,General.,SPECIMEN:  ,Urine culture sensitivity and cytology and bladder biopsy x1.,DISPOSITION: , To PACU in stable condition.,INDICATIONS AND FINDINGS:  ,This is a 76-year-old female with history of weak stream and history of intermittent catheterization secondary to hypotonic bladder in the past, last cystoscopy approximately two years ago.,FINDINGS AT TIME OF SURGERY:,  Cystourethroscopy revealed some mild narrowing of the urethra, which was easily dilated to #23 French.  A midureteral polyp was noted.  Cystoscopy revealed multiple cellules and mild trabeculation of the bladder.  Posterior wall revealed some mild erythema with some distorted architecture of the bladder mucosa.  No obvious raised bladder tumor was noted.  No foreign bodies were noted.  The ureteral orifices were noted on the trigone just proximal to the bladder neck.,DESCRIPTION OF PROCEDURE: , After informed consent was obtained, the patient was moved to the operating room, general anesthesia was induced by the Department of Anesthesia.  The patient was prepped and draped in normal sterile fashion and urethral sounds used to dilate the urethra to accommodate #23 French cystoscope.  Cystoscopy was performed in its entirety with the above findings.  The small area of erythema on the posterior wall was biopsied using a flexible biopsy forceps and Bovie cautery was used to cauterize and fulgurate this area.  The bladder was drained, cystoscope was removed, scope was reinserted and bladder was again reexamined.  No evidence of active bleeding noted.  The bladder was drained, cystoscope was removed, and the patient was cleaned and sent to recovery room in stable condition to followup with Dr. X in two weeks.  She is given prescription for Levaquin and Pyridium and given discharge instructions.
Cystourethroscopy & Retrograde Pyelogram  ( Surgery)
Description:  Cystourethroscopy, bilateral retrograde pyelogram, and transurethral resection of bladder tumor of 1.5 cm in size.  Recurrent bladder tumor and history of bladder carcinoma.

PREOPERATIVE DIAGNOSES:,1.  Recurrent bladder tumor.,2.  History of bladder carcinoma.,POSTOPERATIVE DIAGNOSIS:,
Cystoscopy & Visual Urethrotomy  ( Surgery)
Description:  Cystoscopy & Visual urethrotomy procedure

CYSTOSCOPY & VISUAL URETHROTOMY,OPERATIVE NOTE:,  The patient was placed in the dorsal lithotomy position and prepped and draped in the usual manner under satisfactory general anesthesia.  A Storz urethrotome sheath was inserted into the urethra under direct vision.  Visualization revealed a stricture in the bulbous urethra.  This was intubated with a 0.038 Teflon-coated guidewire, and using the straight cold urethrotomy knife, it was incised to 12:00 to allow free passage of the scope into the bladder.  Visualization revealed no other lesions in the bulbous or membranous urethra.  Prostatic urethra was normal for age.  No foreign bodies, tumors or stones were seen within the bladder.  Over the guidewire, a #16-French Foley catheter with a hole cut in the tip with a Cook cutter was threaded over the guidewire and inserted into the bladder and inflated with 10 mL of sterile water.,He was sent to the recovery room in stable condition.
Cysto Stent Removal  ( Surgery)
Description:  Right lower pole renal stone and possibly infected stent.  Cysto stent removal.

PREOPERATIVE DIAGNOSIS: , Right lower pole renal stone and possibly infected stent.,POSTOPERATIVE DIAGNOSIS: , Right lower pole renal stone and possibly infected stent.,OPERATION:,  Cysto stent removal.,ANESTHESIA:,  Local MAC.,ESTIMATED BLOOD LOSS: , Minimal.,FLUIDS: , Crystalloid.,MEDICATIONS: , The patient was on vancomycin and Levaquin was given x1 dose.  The patient was on vancomycin for the last 5 days.,BRIEF HISTORY:  ,The patient is a 53-year-old female who presented with Enterococcus urosepsis.  CT scan showed a lower pole stone with a stent in place.  The stent was placed about 2 months ago, but when patient came in with a possibly UPJ stone with fevers of unknown etiology.  The patient had a stent placed at that time due to the fevers, thinking that this was an urospetic stone.  There was some pus that came out.  The patient was cultured; actually it was negative at that time.  The patient subsequently was found to have lower extremity DVT and then was started on Coumadin.  The patient cannot be taken off Coumadin for the next 6 months due to the significant swelling and high risk for PE.  The repeat films were taken which showed the stone had migrated into the pole.,The stent was intact.  The patient subsequently developed recurrent UTIs and Enterococcus in the urine with fevers.  The patient was admitted for IV antibiotics since the patient could not really tolerate penicillin due to allergy and due to patient being on Coumadin, Cipro, and Levaquin where treatment was little bit more complicated.  Due to drug interaction, the patient was admitted for IV antibiotic treatment.  The thinking was that either the stone or the stent is infected, since the stone is pretty small in size, the stent is very likely possibility that it could have been infected and now it needs to be removed.  Since the stone is not obstructing, there is no reason to replace the stent at this time.  We are unable to do the ureteroscopy or the shock-wave lithotripsy when the patient is fully anticoagulated.  So, the best option at this time is to probably wait and perform the ureteroscopic laser lithotripsy when the patient is allowed to off her Coumadin, which would be probably about 4 months down the road.,Plan is to get rid of the stent and improve patient's urinary symptoms and to get rid of the infection and we will worry about the stone at later point.,DETAILS OF THE OR: , Consent had been obtained from the patient.  Risks, benefits, and options were discussed.  Risk of anesthesia, bleeding, infection, pain, MI, DVT, and PE were discussed.  The patient understood all the risks and benefits of removing the stent and wanted to proceed.  The patient was brought to the OR.  The patient was placed in dorsal lithotomy position.  The patient was given some IV pain meds.  The patient had received vancomycin and Levaquin preop.  Cystoscopy was performed using graspers.  The stent was removed without difficulty.  Plan was for repeat cultures and continuation of the IV antibiotics.
Cysto & Double-J Stent Insersion  ( Surgery)
Description:  Residual stone status post right percutaneous nephrolithotomy, attempted second-look nephrolithotomy, cysto with insertion of 6-French variable length double-J stent.

PREOPERATIVE DIAGNOSIS:,  Residual stone, status post right percutaneous nephrolithotomy.,POSTOPERATIVE DIAGNOSES: , Residual stone status post right percutaneous nephrolithotomy, attempted second-look nephrolithotomy, cysto with insertion of 6-French variable length double-J stent.,ANESTHESIA:,  General via endotracheal tube.,BLOOD LOSS:,  Minimal.,DRAINS: , 16-French Foley, 6-French variable length double-J stent.,INTRAOPERATIVE COMPLICATIONS: , Unable to re-access the collecting system.,DESCRIPTION OF PROCEDURE:  ,The patient was brought to the operating room and laid supine.  General anesthesia was accomplished.  A 16-French Foley was placed using aseptic technique.  The patient was then placed on the operating table prone.  His right flank was prepped and draped in a sterile fashion.  At this point, contrast was injected through his existing nephrostomy tube and there was no continuity with the collecting system and it was removed.  The 5-French Pollack catheter was used to pass a 0.38 super-stiff Amplatz wire.  The wire would not go down the ureter.  Multiple attempts were made using Pollack catheters and Cobra catheters and attempts were made to dilate the track, both with rigid dilator and the balloon dilator and access could not be obtained.  After multiple attempts, access was lost.  At this point, the tubes were left out of the kidney and sterile dressings were applied.  The patient was then placed on another operating table supine.  His genitalia were prepped and draped after removing his Foley catheter.  Flexible cystoscopy was performed and the right orifice identified, which was edematous and erythematous.  The wire was passed up to kidney and a 5-French Pollack catheter was then passed over to after the removing the scope.  The wire was removed.  Contrast injection with good placement in the collecting system.  The wire was replaced.  The Pollack catheter removed and 6-French variable length double-J stent was inserted using fluoroscopic guidance.  The wire was removed leaving the double-J stent in good position.  _______ 16-French Foley was reinserted and connected to close drains.,Procedure was terminated at this point and had been well tolerated.  The patient was awakened and taken to recovery room in satisfactory condition having tolerated the procedure well.
Cystolithalopaxy  ( Surgery)
Description:  Holmium laser cystolithalopaxy.  A diabetic male in urinary retention with apparent neurogenic bladder and intermittent self-catheterization, recent urinary tract infections.  The cystoscopy showed a large bladder calculus, short but obstructing prostate.

PREOPERATIVE DIAGNOSES:,1.  Prostatism.,2.  Bladder calculus.,OPERATION:,  Holmium laser cystolithalopaxy.,POSTOPERATIVE DIAGNOSES:,1.  Prostatism.,2.  Bladder calculus.,ANESTHESIA:  ,General.,INDICATIONS:,  This is a 62-year-old male diabetic and urinary retention with apparent neurogenic bladder and intermittent self-catheterization, recent urinary tract infections.  The cystoscopy showed a large bladder calculus, short but obstructing prostate.  He comes in now for transurethral resection of his prostate and holmium laser cystolithotripsy.,He is a diabetic with obesity.,LABORATORY DATA:  ,Includes urinalysis showing white cells too much to count, 3-5 red cells, occasional bacteria.  He had a serum creatinine of 1.2, sodium 138, potassium 4.6, glucose 190, calcium 9.1.  Hematocrit 40.5, hemoglobin 13.8, white count 7,900.,PROCEDURE: , The patient was satisfactorily given general anesthesia.  Prepped and draped in the dorsal lithotomy position.  A 27-French Olympus rectoscope was passed via the urethra into the bladder.  The bladder, prostate, and urethra were inspected.  He had an obstructing prostate.  He had marked catheter reaction in his bladder.  He had a lot of villous changes, impossible to tell from frank tumor.  He had a huge bladder calculus.  It was white and round.,I used the holmium laser with the largest fiber through the continuous flow resectoscope and sheath, and broke up the stone, breaking up approximately 40 grams of stone.  There was still stone left at the end of the procedure.  Most of the chips that could be irrigated out of the bladder were irrigated out using Ellik.,Then the scope was removed and a 24-French 3-way Foley catheter was passed via the urethra into the bladder.,The plan is to probably discharge the patient in the morning and then we will get a KUB.  We will probably bring him back for a second stage cystolithotripsy, and ultimately do a TURP.  We broke up the stone for over an hour, and my judgment continuing with litholapaxy transurethrally over an hour begins to markedly increase the risk to the patient.
Cystoscopy & Bladder Biopsy  ( Surgery)
Description:  Cystoscopy and Bladder biopsy with fulguration.   History of bladder tumor with abnormal cytology and areas of erythema.

PREOPERATIVE DIAGNOSIS:,  History of bladder tumor with abnormal cytology and areas of erythema.,POSTOPERATIVE DIAGNOSIS: , History of bladder tumor with abnormal cytology and areas of erythema.,PROCEDURE PERFORMED:,1.  Cystoscopy.,2.  Bladder biopsy with fulguration.,ANESTHESIA: , IV sedation with local.,SPECIMEN: , Urine cytology and right lateral wall biopsies.,PROCEDURE:,  After the consent was obtained, the patient was brought to the operating room and given IV sedation.  He was then placed in dorsal lithotomy position and prepped and draped in standard fashion.  A #21 French cystoscope was then used to visualized the entire urethra and bladder.  There was noted to be a narrowing of the proximal urethra, however, the scope was able to pass through.  The patient was noted to have a previously resected prostate.  On visualization of the bladder, the patient did have areas of erythema on the right as well as the left lateral walls, more significant on the right side.  The patient did have increased vascularity throughout the bladder.  The ________ two biopsies of the right lateral wall and those were sent for pathology.  The Bovie cautery was then used to cauterize the entire area of the biopsy as well as surrounding erythema.  Bovie was also utilized to cauterize the areas of erythema on the left lateral wall.  No further bleeding was identified.  The bladder was drained and the cystoscope was removed.  The patient tolerated the procedure well and was transferred to the recovery room.,He will have his defibrillator restarted and will followup with Dr. X in approximately two weeks for the result.  He will be discharged home with antibiotics as well as pain medications.  He is to restart his Coumadin not before Sunday.