Category Consent

Informed Consent For Surgical Operation / Procedure Procedure: Open/Laproscopic Orchidopexy ± Orchidectomy 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following…

Informed Consent For Surgical Operation / Procedure Procedure: Urethral Dilatation Consent 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s):…

Informed Consent For Surgical Operation / Procedure Procedure: Direct Vision Internal Urethrotomy (VIU / DVIU) 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance…

Informed Consent For Surgical Operation / Procedure Procedure: Penile Skin Island Flap (Orandi / McAninch Technique) 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for…

Informed Consent For Surgical Operation / Procedure Procedure: Stage 2 Urethroplasty 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s):…

Informed Consent For Surgical Operation / Procedure Procedure: Open/Laproscopic Orchidopexy ± Orchidectomy 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following…

Informed Consent For Surgical Operation / Procedure Procedure: Urethroplasty Using Martius/Labial Flap 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following…

Informed Consent For Surgical Operation / Procedure Procedure: End to End Anastomotic Urethroplasty for PFUI 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance…

Informed Consent For Surgical Operation / Procedure Procedure: Open/Laproscopic Orchidopexy ± Orchidectomy 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following…

Informed Consent For Surgical Operation / Procedure Procedure: Donor Nephrectomy 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s): Procedure:…

Informed Consent For Surgical Operation / Procedure Procedure: Graft Nephrectomy 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s): Procedure:…

Informed Consent For Surgical Operation / Procedure Procedure: Robotic Kidney Transplantation 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s):…

Informed Consent For Surgical Operation / Procedure Procedure: Open Recipient Kidney Transplantation 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following…

Informed Consent For Surgical Operation / Procedure Procedure: Left Radio-Cephalic AV Fistula Creation 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the…

Informed Consent For Surgical Operation / Procedure Procedure: Open/Laproscopic Orchidopexy ± Orchidectomy 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following…

Informed Consent For Surgical Operation / Procedure Procedure: Cystoscopy and Endoscopic Posterior Urethral Valve Ablation/Valve Incision 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for…

Informed Consent For Surgical Operation / Procedure Procedure: Open/Laproscopic/Robotic Ureteric Reimplantation ± Tailoring ± DJ Stent 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for…

Informed Consent For Surgical Operation / Procedure Procedure: Laproscopic / Open Pyeloplasty ± DJ Stent ± Nephrostomy 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent…

Informed Consent For Surgical Operation / Procedure Procedure: Hypospadias Repair ± Chordee Correction / Staged Repair 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for…

Informed Consent For Surgical Operation / Procedure Procedure: Endoscopic/Percutaneous Cystolithotripsy/Open Cystolithotomy 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s):…

Informed Consent For Surgical Operation / Procedure Procedure: Open/Laproscopic Orchidopexy ± Orchidectomy 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following…

Informed Consent For Surgical Operation / Procedure Procedure: Robot Assisted Video Endoscopic Inguinal Lymph Node Dissection 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for…

Informed Consent For Surgical Operation / Procedure Procedure: Robotic Partial Nephrectomy 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s):…

Informed Consent For Surgical Operation / Procedure Procedure: Robot Assisted Radical Prostatectomy + Extended Pelvic Lymph Node Dissection 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete…

Informed Consent For Surgical Operation / Procedure Procedure: Robot-assisted/Open Radical Cystectomy + Ileal Conduit + Bilateral Standard Pelvic Lymph Node Dissection 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and…

Informed Consent For Surgical Operation / Procedure Procedure: Radical Orchidectomy 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s): Procedure:…

Informed Consent For Surgical Operation / Procedure Procedure: Partial/Total Penectomy 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s): Procedure:…

Informed Consent For Surgical Operation / Procedure Procedure: Laproscopic Vesicovaginal Fistula Repair 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following…

Informed Consent For Surgical Operation / Procedure Procedure: Laproscopic Ureterolithotomy 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s): Procedure:…

Informed Consent For Surgical Operation / Procedure Procedure: Laproscopic Ureteric Reimplantation 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s):…

Informed Consent For Surgical Operation / Procedure Procedure: Laproscopic Urachal Cyst Excision 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following…

Informed Consent For Surgical Operation / Procedure Procedure: Laproscopic Simple Nephrectomy 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s):…

Informed Consent For Surgical Operation / Procedure Procedure: Laproscopic Renal Cyst Deroofing 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following…

Informed Consent For Surgical Operation / Procedure Procedure: Laproscopic Radical Nephrectomy 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s):…

Informed Consent For Surgical Operation / Procedure Procedure: Laproscopic Pyeloplasty 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s): Procedure:…

Informed Consent For Surgical Operation / Procedure Procedure: Laproscopic Pyelolithotomy 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s): Procedure:…

Informed Consent For Surgical Operation / Procedure Procedure: Laproscopic Partial Nephrectomy 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s):…

Informed Consent For Surgical Operation / Procedure Procedure: Laproscopic Orchipexy 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s): Procedure:…

Informed Consent For Surgical Operation / Procedure Procedure: Laproscopic Distal Ureterectomy with Reimplantation 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the…

Informed Consent For Surgical Operation / Procedure Procedure: Laproscopic Bladder Diverticulectomy 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s):…

Informed Consent For Surgical Operation / Procedure Procedure: Laparoscopic Adrenalectomy 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s): Procedure:…

Informed Consent For Surgical Operation / Procedure Procedure: Vesicovaginal Fistula Repair 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s):…

Informed Consent For Surgical Operation / Procedure Procedure: Percutaneous Tibial Nerve Stimulation (PTNS) 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the…

Informed Consent For Surgical Operation / Procedure Procedure: Urinary Diversion 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s): Procedure:…

Informed Consent For Surgical Operation / Procedure Procedure: Sacral Neuromodulation 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s): Procedure:…

Informed Consent For Surgical Operation / Procedure Procedure: Ureterovaginal Fistula Repair 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s):…

Informed Consent For Surgical Operation / Procedure Procedure: Urethrovaginal Fistula Repair ± Martius Flap ± Urethral Reconstruction 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent…

Informed Consent For Surgical Operation / Procedure Procedure: Urethral Diverticulectomy ± Urethral Reconstruction ± Martius Flap 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for…

Informed Consent For Surgical Operation / Procedure Procedure: Urodynamic Study (UDS) ± Video Urodynamics 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of…

Informed Consent For Surgical Operation / Procedure Procedure: Urethral Dilatation 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s): Procedure:…

Informed Consent For Surgical Operation / Procedure Procedure: Autologous Pubovaginal Sling 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s):…

Informed Consent For Surgical Operation / Procedure Procedure: Mid Urethral Sling (TVT/TOT/Single-Incision Sling) 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the…

Informed Consent For Surgical Operation / Procedure Procedure: Buccal Mucosal Graft Urethroplasty 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following…

Informed Consent For Surgical Operation / Procedure Procedure: Burch Colposuspension 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s): Procedure:…

Informed Consent For Surgical Operation / Procedure Procedure: Endoscopic Urethral Bulking Agent Injection 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the…

Informed Consent For Surgical Operation / Procedure Procedure: Intravesical Botulinum Toxin Injection 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following…

Informed Consent For Surgical Operation / Procedure Procedure: Bladder Autoaugmentation (Detrusor Myectomy/Detrusorectomy) 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following…

Informed Consent For Surgical Operation / Procedure Procedure: Artificial Urinary Sphincter (AUS) Implantation Female 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of…

Informed Consent For Surgical Operation / Procedure Procedure: Augmentation Cystoplasty (Bladder Augmentation) 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following…

Informed Consent For Surgical Operation / Procedure Procedure: Bladder Neck Closure With Mitrofanoff (Appendivesicostomy) 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of…

Informed Consent For Surgical Operation / Procedure Procedure: Visual Internal Urethrotomy 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s):…

Informed Consent For Surgical Operation / Procedure Procedure: Ureteroscopic Lithotripsy 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s): Procedure:…

Informed Consent For Surgical Operation / Procedure Procedure: Prostati Urethral Lift 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s):…

Informed Consent For Surgical Operation / Procedure Procedure: Trans-Uretheral Resection of Bladder Tumor 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the…

Informed Consent For Surgical Operation / Procedure Procedure: RIRS With Laser Lithotripsy 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following…

Informed Consent For Surgical Operation / Procedure Procedure: REZUM Water Vapor Therapy 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following…

Informed Consent For Surgical Operation / Procedure Procedure: Percutaneous Nephrolithotomy 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s): Procedure:…

Informed Consent For Surgical Operation / Procedure Procedure: Double-J (DJ) Ureteric Stenting 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following…

Informed Consent For Surgical Operation / Procedure Procedure: Cystoscopy (Rigid/Flexible) 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s): Procedure:…

Informed Consent For Surgical Operation / Procedure Procedure: Laser Enucleation of the Prostate (HoLEP / ThuLEP / ThuFLEP) 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete…

Informed Consent For Surgical Operation / Procedure Procedure: Cystoscopic Clot Evacuation 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s):…

Informed Consent For Surgical Operation / Procedure Procedure: Bladder Neck Incision 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s):…

Informed Consent For Surgical Operation / Procedure Procedure: Surgical Management of Ischemic Priapism 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the…

Informed Consent For Surgical Operation / Procedure Procedure: Microvaricocelectomy 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s): Procedure: _______________________________Diagnosis:…

Informed Consent For Surgical Operation / Procedure Procedure: Shah Penile Prosthesis 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s):…

Informed Consent For Surgical Operation / Procedure Procedure: Malleable / Semi-Rigid Penile Prosthesis 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the…

Informed Consent For Surgical Operation / Procedure Procedure: Inflatable Penile Prosthesis (IPP) 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following…

Informed Consent For Surgical Operation / Procedure Procedure: Plaque Incision and Grafting for Peyronie’s Disease 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance…

Informed Consent For Surgical Operation / Procedure Procedure: Plication Procedure for Peyronie’s Disease 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the…

Informed Consent For Surgical Operation / Procedure Procedure: Vasoepididymal Anastomosis (VEA) 1. Patient Details I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s):…

Informed Consent For Surgical Operation / Procedure Procedure: Microsurgical Testicular Sperm Extraction 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following…

Informed Consent For Surgical Operation / Procedure Procedure: Testicular Sperm Aspiration 1. Patient Details I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s):…

Informed Consent For Surgical Operation / Procedure Procedure: Frenuloplasty 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s): Procedure: _______________________________Diagnosis:…

Informed Consent For Surgical Operation / Procedure Procedure: Circumcision 1. Patient Identification I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s): Procedure: _______________________________Diagnosis:…