Common Urological procedures Flashcards
What is a cytoscopy?
What kind of surgeries are done under cystoscopy?
- Most commonly performed urologic procedure
- Passing a rigid scope through the urethra into the bladder
- indicated for:
- hematuria
- recurrent urinary infections
- urinary obstruction
- other surgeries performed under cysto include:
- bladder biopsies
- extraction of renal stones
- placement of renal stent
What are endoscopy procedures?
- visualized the ureter, kidney, bladder, prostate, and ureter
- Dx and Tx for renal calculi, hematuria, trauma, cancer
What is the anesthetic technique for cystoscopy?
- usually GA
- procedure is short (15-20 minutes)
- most pts apprehensive
- LMA
- regional
- spinal preferred (faster onset)
- no need to wait for spinal to set to move to lithotomy position
- 2% lidocaine jelly can be used on scope
- regional or GA for discomfort caused by bladder distension
What level regional do you need for cystoscopy?
spinal dose:
lumbar epidural dose
- T8-T10
- Spinal
- 0.75% bupivacaine 10-12 mg if >1hr
- 0.75% bupivacaine 7.5 mg if <1 hr
- Lumbar epidural
- 1.5-2% lidocaine with epi 15-25 ml
- supplement with 5-10 ml bolus as needed
- **dont need to know doses for this exam
What is the issue with regional anesthesia for a cystoscopy?
- does not abolish the obturator reflex, which may be stimulated when the electrocautery gets touches the nerve which is close tothe bladder wall
- causes external rotation and adduction of thigh
- Obturator reflex can be blocked only by muscle paralysis
What is the TURP procedure done for?
how?
- to alleviate urinary obstruction from BPH
- most common GU surgery for men >60
- Done with resectoscope inserted into the urethra/bladder which allows for capability of both cutting and coagulation of tissue and vessels
What are the different types of TURPS?
- M-Turp (monopolar)- traditional, uses electric current
- cannot have ions in fluid
- pt becomes hyponatremic
- B-turp (bipolar)- keeps current contained to unit
- can use NS for fluid
- pt can still become ofluid overloaded
- L-Turp (laser)- lithotripsy
- can use NS
What are problems that can be caused by the absorption of fluid from the irrigation during a TURP?
- pulm edema
- hyponatremia
- cardiac and retinal toxic effects
- increased blood volume
- hyperglycemia
- turp syndrom- neurologic changes from hyponatremia
- hypothermia- warm fluids
Anesthetic technique
position
pre-op meds
abx
ebl
- Lithotomy with slight trendelenburg
- pre-op sedation as needed for anxiety
- Abx per surgeion, usually Gentamycin 80 mg IV slowly
- EBL about 500 mls
- EBL is 2-4 ml/min of resection time
- consider type and cross
Should you do general or spinal for a TURP?
- No difference in outcomes between GA and spinal
- Spinal is technique of choice for an M-turp so you can monitor their neuro status
- also allows for recognition of bladder perforation
- reduces opst-op venous thrombosis
- reduces intra-op blood loss
- General- difficult to notice turp syndrome
What is TURP syndrom?
- Caused by absorption of the irrigation solutions
- can lead to hyponatremia
- some solutions have glycine in them, which is an inhibitor neurotransmitter
- Presents as HA, confusion, cyanosis, dyspnea, arrhythmias, hypotension, bradycardia, sz
How can TURP syndrome be prevented?
- Hang irrigating solution no higher than 60 cm above surgical table
- amt of irrigating fluid absorbed is proportional to surgical time
- approx 20 ml/min of resection time
How is TURP treated?
- early recognition
- fluid resitriction
- loop diuretic
- hypertonic solution if hyponatremia present
- 100 ml 3% Saline over 1-2 hrs
- Ideally pts Na is >120
- treat sz with midaz, propofol, or phenytoin
- if glycine used, try magnesium
- intubate if necessary
What is ESWL?
What is 1st generation vs 3rd generation
- extracorporal shock wave lithotripsy
- disintigrates calculi in kidneys or upper 2/3 of ureters
- shock waves focused on the calculi
- 1st generation- high energy units; pt was submerged in H2O
- 2nd and 3rd generation- low energy; no water bath
- use a small water-filling coupling device instead and tightly focused sound beam
ESWL
How is the procedure related to the pts HR?
- Shock waves are synchronized to 20 ms after R wave
- during ventricular refractory period
- bradycardia can prolong the procedures
- pts with pacemaker or AICD are at risk of developing arrhythmias