Farwaniya Urology — OT Cases

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Farwaniya Urology — OT Cases

Operative Theatre Registry

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Case Info

Date Done ✱

Case Type ✱

Elective

Emergency

OT Consult

Entered by ✱

Patient Info

Patient Name ✱

Civil ID / File Number ✱

Phone Number ✱

Age ✱

Gender ✱

Male

Female

Diagnosis

Category ✱

Stone Details

Location (select all that apply) ✱

Kidney

Ureter

Bladder

Kidney — which calyx/area

Upper calyx

Middle calyx

Lower calyx

Pelvis

Multiple

Ureter — which level

Upper

Mid

Lower

Number of stones

Total burden (mm)

HU value

Sub-type ✱

Specify ✱

Surgery

Procedure ✱

Sub-type ✱

Approach ✱

Supine

Prone

Lithotomy

Flank

Other

Specify procedure ✱

Remarks / Comments

Surgical Team

Consultant in charge ✱

Senior assisting

Surgical team members

Operative Details

Side ✱

Rt

Lt

B/L

N/A

Operative approach ✱

Endo

Open

Lap

Robotic

DJ Stent ✱

Yes

No

Cancer / Histopath ✱

Yes

No

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