Genitourinary Flashcards
Albuminuria
Presence of albumin in urine
Cysitis
Inflammation of the bladder
Glomerulonephritis
Inflammation of the kidneys at the level of the glomerulus (tuft of capillaries that brings blood to the nephron)
A hypotonic solution that enters cells, resulting in swelling and rupture.
Hemolytic solution
Lithotomy
The incision into a duct or organ for the removal of a stome.
Lithotripsy
Crushing of a stone
Nepholithiasis
Condition of kidney stones
Pheochromocytoma
A tumor of the adrenal medulla
Phimosis
Tight foreskin for which a circumcision is performed
Uremia
Accumulation of urine products in the blood due to kidney failure.
Urinary incontience
In ability to control urination
Vesicoureteral reflux
Backflow of urine from the bladder into the ureters; causes recurrent pyelonephritis (inflammation of the kidney pelvis)
Wilms’ tumor
Malignant kidney tumor in children
A flat-plate abdominal x-ray to visualize kidneys,ureters, and bladder is called
KUB
Cystoscopy
Visualization of the urethra, bladder, and ureteral orifices through a lighted telescope (30 and 70 most common)
An x-ray to visualize the bladder with the use of contrast is called
Cystogram
An x-ray to visualize the urethra with the use of contrast media is called
Urethrogram
A test to measure voiding pressure of the bladder is called
Cystometrogram
What are the 7 tests used for detecting prostate cancer?
Serum protstate-specific antigens (PSA), acid phosphatase, bone scans, CT scan, MRI scan, biopsy, and histologic grading of malignancies
An x- ray to visualize the ureters and kidneys following injection of contrast media through a ureteral catheter is called
Retrograde Pyelogram
An x-ray to visualize the ureters and kidneys following intravenous dye injection is called
Intravenous urogram or intravenous pyelogram
Describe the urologic table
Provides an x-ray unit, drainage system, knee supports, hydraulic or electronic controls to adjust the height and tilt, attachments for irrigating solutions, light source, and electrosurgical units
What are the two lasers which are adaptable for most cystoscopes?
Holmium YAG and argon
How high are solution canisters for irrigating hung above the table?
2.5 feet
Name the three common irrigating solutions used for transurethral resections procedures.
1.5% glycine, sorbitol, urogate (uromatic)
What type of irrigating fluid is used for TUR procedures?
Nonelectrolytic and nonhemolytic
What is attached to the endoscope for aspiration of fragments, clots, or resected tissue?
An evacuator
A double bowel shaped glass evacuator used to irrigate debris from the bladder a scope sheath is called
Ellik
A syringe with a wide opening at the hub that can be used with a metal adaptor to permit use with a catheter is called
Toomey
What type of catheter is used for performing a retrograde peelogram, placed to serve as a landmark during radical pelvic procedures or to bypass an obstruction?
Ureteral catheters
What are the three common tips for ureteral catheters?
Whistle, olive, and cone tipped
Self-retaining stents are placed in the ureter to do what? What are the two different ones?
Maintain ureteral patency. J-stents or pigtail stents
What type of catheter is used to function as a stent or drainage tube, or are used in diagnostic procedures?
urethral catheters
What are the two different types of urethral catheters?
Non-retaining (Red Robinson) and indwelling/ retention (Foley)
The size of urethral catheters range from
12 to 30 French.
What is the most commonly used self-retaining catheter?
Foley
What type of suture is used on the urinary tract?
Absorbable usture, such as 2-0 chromic or monocryl
What sutures cause stone formation in the urinary tract?
Silk and some other nonabsorbable
Genitoruinary instruments commonly used are what 5 instruments?
Otis bougies, Otis and van Buren urethral sounds, urethral catheter guide, and Mason-Judd bladder retractor
What are the 11 indications to perform a cystoscopy?
- Hematuria
- Urinary retention
- Recurrent cystitis
- Urinary incontinence
- Urinary tract infection
- Tumor
- Fistulas
- stones
- To obtain biopsy specimen
- Treat lesions
- Follow up examinations of operative or endoscopic procedures.
What are the two common contrast medias used for urinary procedures/
Hypaque or Renografin
Cystotomy
Opening into the bladder to relieve obstruction or as an adjunct to another procedure
A cystotomy is also referred to as what two names?
Cystostomy or vesicostomy
A cystotomy can be performed using what two incisions?
Percutaneously or as a suprapubic incision
Cystectomy
Removal of the urinary bladder for the treatment of a malignancy.
Describe an ileal conduit.
Isolated segment of ileum is removed, continuity of bowel is reestablished, distal end of the segment is sutued to stoma site on the skin of abdomen and ureters anastomosed to the proximal segment, a stoma appliance is worn to collect urine, or the stoma is formed to be continent and catheterized as needed
Describe cutaneous ureterostomy
Distal end of the ureters is brought through the abdominal wall to create an opening to diver urine outside, a stoma appliance is attached.
Bladder neck suspension
For female urinary incontience
What are the two bladder neck suspension procedure called?
marshall-Marchetti-Krantz or (RAZ) or stamey procedure
What type of incision is used during a Marshall-Marchetti-Krantz operation?
Suprapubic extraperitoneal incision.
Marshall-Marchetti-Krantz
The bladder neck is suspended by placement of sutures through the anterior vaginal wall on either side of the urethra and bringing them out through the periosteum on the posterior surface of the pubic symphysis
What type of incision is used for a Stamey procedure?
Short suprapubic incision (right and left of midline) and a vaginal incision.
Stamey or RAZ procedure
A stamey needle with a heavy suture or polyester mesh is used to suspend the bladder neck to the anterior rectus sheath, cystoscopy is performed intraoperatively to guide correct needle passage.
Ureteroneocystostomy
Surgical procedure for reimplantion of ureters into bladder to treat vesicoureteral reflux
Periurethral/ transurethral injection of collagen
Injection of collagen (Contigen) into the urethral mucosa to treat urinary incontinence in both men and women
Urethral dilatation
For strictures following infection and trauma
What are the 4 instruments needed to perform a urethral dilatation?
Balloon dilators, woven filiform and followers, and bougies or metal sounds
Urethrotomy
An otis urethrotome is used to cut into a urethral stricture
Urethroplasty
Re-establishment of the continuity of the urethra following trauma
urethral meatotomy
Incision into the external urethral meatus to enlarge the opening or relieve stenosis or stricture
Circumcision
Excision of the prepuce of the glans penis done for phimosis or balanoposthitis
Balanoposthitis
Inflammation of the glans penis
Hypospadias Repair
Change the urethral meatus from the ventral surface of the penis to its normal position at the tip of the penis.
Chordee
Ventral curvature of the penis caused by fibrous bands exxtending from the hypospadias urethral meatus
Epispadias Repair
Move the urethral meatus form the dorsal surface of the penis to its normal position
Penectomy
Surgical removal of penis for otherwise incurable diseases may be partial or total
Penile implant
Device placed within the penile shaft to treat organic sexual impotence due to diseased such as diabetes mellitus, priapism, or neurolysis during pelvis surgery. Serves as a stent to enable vaginal penetration
What are the two types of penile implants? What is the difference between the two?
Noninflatable, semirigid: inserted in the corpus cavernous
Inflatable prosthesis: reservoir is placed in prevesicle space, inflatable silicone rods in the corpus cavernosus, and a pump in the scrotum
Hydrocelectomy
Removal of the sac of fluid from the tunica vaginalis in the scrotum
Where is the incision made for a Hydroselectomy?
In the scrotum for the adult male but an inguinal incision is used for a congenital hydrocele
vasectomy
Elective sterilization procedure, excision of a sceiton of the vas deferens
Where is the incision for a vasectomy made?
In the scrotum
Vasovasostomy
Microscopic surgery reconnecting the vas deferens for sterilization reveral
Spermatocelectomy
Surgical removal of a spermatocele (intrascrotal cystic mass)
Where is the incision made for a Spermatocelectomy?
In the scrotum
Varicocelectomy
Becasue of venous backflow of blood around the testes, varicose veins develop which interfere with spermatogenesis, usually found on the left side due to anatomy of the spermatic vein, The varicose veins are ligated and excised.
Where is the incision made for a varicocelectomy?
In the upper portion of the scrotum or inguinal canal
Orchidectomy
Surgical removal of testes or testis
Indications for Bilateral orchidectomy
Control metestatic cancer of the prostate gland
Indications for unilateral orchidectomy
Testicular cancer, trauma, or infection
What is the incision for a orchidectomy?
Scrotal incision for benign conditions, and inguinal approach is used for malignant conditions.
Testicular detorsion
Through a scrotal incision, the spermatic cord is untwisted and anchored to prevent future twisting
Orchiopexy
The testis is transplanted to a scrotal pocket and anchored in a normal anatomical position for the treatment of the congenital condition known as cryptorchidism
What incision is used for orchiopexy?
Inguinal incision
Cryptorchidism
Hidden or undescended testicle
What type of approach is used for a needle biopsy when there is suspected prostate cancer?
Transperineal or transrectal
What type of needles are used to perform a prostate biopsy?
tru-cut or Vim-silverman
Transurethral resection of the prostate
By means of a resectoscope passed through the urethra, a cutting loop electrode is used to resect tissue and coagulate bleeders, enlarging the prostatic urethra, which has become contricted from benign prostatic hypertrophy
What type of Foley catheter is used for a TURP?
Size 22fr to 24fr three way Foley catheter with a 30 cc balloon is inserted, inflated, and pulled gently to apply traction to the bladder neck to help control bleeding, the third lumen is used for irrigation.
Transrectal seed implantation
The percutaneous implantation of radioactive seeds into the prostate gland.
Suprapubic prostatectomy
Removal of an enlarged prostate through an incision in the lower abdominal wall through the bladder.
When is the suprapubic prostatectomy performed?A
Used for benign conditions and allows access for correction of bladder problems.
Perineal prostatectomy
The prostate is enucleated through a half-circle incision made in the perineum
What is the position for a perineal prostatectomy?
exaggerated lithotomy position
retropubic prostatecomy
Removal of the prostate gland by an incision behind the pubic symphysis
Radical retropubic prostatectomy
Following limited lymph node dissection with no evidence of spread of cancer, the prostat and periprostatic tissue are widely dissected from the bladder, and the bladder neck is reconstructed.
A radical retropubic prostatectomy carries a higher incidence of what?
Impotence
For open prostate surgery, what position is used?
Supine and Trendelenburg with a bolster under the pelvis
What are the two retractors used for open prostate surgery?
Mason-Judd (supropubic) Dennis Brown (perineal)
What type of incision is made for open prostate procedures?
Pfannenstiel
During open prostate procedures, the recutus abdominus is retracted to expose what?
The space of Retzius anteriorly
Acute renal failure and end-stage renal disease results in
Uremia and hypertension
Hemosidalysis
Use of an artificial kidney machine with a semipermeable membrane (acts as nephrons) through which blood is dialyzed (cleansed of urea and other impurities)
Intermittent or continuous dialysis of the peritoneal cavity through a Tenckhoff silicone catheter placed through a paramedian incision and anchored to subcutaneous tissue and the dialysate is instilled into the peritoneal cavity to draw solutes from the body. This is known as what
Peritoneal dialysis
Renal calculi are also known as
Kidney stones
What are the symptoms of kidney stones?
Pain, obstruction, and infection
When do fistulas form in the genitourinary tract?
When closure is not water tight, done with absorbable suture
When is the lateral position used?
For kidney or adrenal gland procedures
When is the supine position used?
For distal ureters or bladder procedures.
The most common incision when performing surgery on the adrenal glands or kidneys is what
Flank or lumbar
What type of incision provides an excellent approach to the renal pedicle, used for renal neoplasms, with the patient is supine position with kidney bolsters?
Transabdominal transperitoneal
Removal of the adrenal gland is called
Adrenalectomy
A unilateral adrenalectomy is indicated for what? What position is used?
Primary tumor such as pheochromocytoma lateral
A bilateral adrenalectomy is indicated when? What position is used?
Endocrine-dependent tumors such as breast or prostate malignancy
Prone for posterior approach or supine for anterior approach
An opening into the kidney with a tube left in place that exits the skin, used to drain the kidney during healing or as a temporary urinary diversion is called what
Nephrostomy
The surgical revision of narrowing, due to stenosis or anatomic obstructuion, to increase the size of the outlet from the renal pelvis into the ureter is called
pyeloplasty
Crushing of a stone is called
Lithotripsy
What are the three ways to perform a lithotripsy?
Electrohydraulic and Holmium YAG Laser
Laser
Extracorporeal shock wave lithotripsy
What should personnel performing an ESWL wear?
Lead apron
Removal of a stone from the kidney through an open flank incision is called?
Nephrolithotomy
What is a stone which completely fills the renal pelvis called?
Staghorn calculus
The removal of a staghorn calculus from the kidney pelvis through an open incision is called?
Pyelolithotomy
peri-renal fat/ fascia is called?
Gerota’s
Heminephrectomy
Removal of a portion of the kidney
A radical nephrectomy involves removal what
Kidney, perirenal fat, adrenal gland, Gerota’s capsule, near by periaortic lymph nodes
For a kidney transplant, where is the new kidney placed?
Recipient’s iliac fossa
The renal vein of the donor kidney is anastomosed where?
The recipients iliac vein
The donor renal artery is anastomosed where?
The donors iliac artery
Donor organs are transported in what?
Hypothermic pulsatile perfusion machine
Indications for a nephrectomy include what 6 things?
Hydronephrosis, pyelonephritis, renal atrophy, trauma, tumor, renal artery stenosis
During a nephrectomy, what needs to be clamped and divided?
Ureter and kidney pedicle
What are the five complications or hazards with kidney surgery?
- Clamp slipping off the pedicle with resultant hemorrhage
- Injury to aorta or inferior vena cava with hemorrhage
- Damage to spleen Left
- Accidental entry into pleural space and collapse of lung Left
- Damage to duodenum Right
The medulla is composed of 8 to 12 large collecting areas called what?
Renal pyramids
The concave indention on the medial side of the kidney through which all structures must pass is called what?
The hilum
The functional unit of the kidney is referred to as
Nephron
The renal arteries arise from what artery/
Abdominal aorta
The portion of the male urethra which passes through the prostate gland is called
Prostatic portion
The portion of the male urethra that passes through the pelvic floor is referred to as
Membranous portion
The portion of the male urethra which passes along the penis is called
Cavernous portion
The supporting structure of the male reproductive system is the
Spermatic cord
A cluster of capillaries at one end of each nephron is the
Glomerulus
The capillary network of each nephron is contained within a space called the
Bowman capsule
The juxtaglomerular cell in the Bowman capsule releases _________, which is necessary for what
Renin, regulation of blood pressure
The normal glomerular filtration rate is what?
125 ml per minute
The kidney weighs approximately how much
150grams
The blood flows into the capillary network through the…
Efferent arteriole of the glomerulus
As filtrate moves through the tubules, what 3 items does the body need which are absorbed back into the circulatory system?
Electrolytes, nonorganic salts, and water
What are the regions of the renal tubules called?
Proximal tubule, loop of Henle, distal convulated tublue
The adrenal glands lie where?
Medial side of the upper kidney
The adrenal glands secrete what hormones?
Glucocorticoids, mineralcorticoids, and adrenal sex hormones. Epinephrine and norepinephrine
The inner layer of the scrotum is composed of
Fascia and dartos muscle
The testicles are enclosed within a fibrous membrane called
Tunica vaginalis
Where is testosterone produced?
Seminiferous tubules in the testes
What is the function of the epididymis?
It is a convulted duct that secretes seminal fluid (gives sperm motility)
The vas deferens joins what two structures?
The epididymis with the ejaculatory duct.
Where does the vas deferens run?
Through the inguinal canal in the abdominal wall at he level of the internal ring. It lies inside the spermatic cord, continues across the bladder and ureter where it meets the opening of the seminal vesicle and forms the ejaculatory duct.
The seminal vesicles secrete approxminately what percentage of semen?
60
The prostate gland is divided into how many lobes?
Six
What is the function of the prostate gland?
Secretes an alkaline fluid that contributes to seminal fluid.
What is another name for the bulbourethral gland?
Cowper glands
What is the function of the bulbourethral gland?
They lie on each side of the urethra below the prostate to secrete mucus which contributates to the total volume of semen.
The penis is suspended at the pelvic arch by
Fascia
What are the two dorsal columns of the penis, composed of spongy vascular tissue that is necessary for a functional erection?
Corpora cavernosa
The third column, which encloses the urethra is called the
Corpus spongiosum
The distal portion of the corups spongiosum forms the
Glans penis
Albumin is a primary protein component in
Blood
Albumin in the uurine is a sign of
Glomerulus disease
The presence of protein or blood in the urine is an indication of what
Infection
A healthy adult kidney produces how much urine a day?
3.2 pints (1.5L)
What percentage of urine is water and solutes?
95% water and 5% solutes
The ratio of the density of urine compared to water is called
Specific gravity
Normal specific gravity is what?
1.001-1.035
Normal urine pH is
6
Bacterial count over what indicates infection?
5000
A high specific gravity indicates
Dehydration
A normal waste product of metabolism in the muscles that is filtered by the kidneys is
Creatinine.
measurement of blood urea nitrogen is a test that assesses the elimination of urea from what
The liver
BUN is influenced by what?
Age, protein intake, and hydration
A study that provides images of the bladder while it is emptying, using a contrast media instilled into the bladder via a catheter is called
Micturating cystourethogram
What is the common risk when using warm fluid?
Increased hemorrhage.
What is the risk when using cold irrigation solutions?
Bladder spasm or hypothermia
The ballistic lithotripter uses what to apply a jackhammer effect on the stone to which breaks it into small pieces?
Air
A rigid cystourethroscopy includes endoscopic procedures of the _____ and ________.
Urethra and bladder
The ________ is a hollow tube used when operating instrumetns or irrigation is needed.
Sheath
The __________ is a smooth rod with a rounded tip, which is inserted into the heath prior to passing.
Obturator
The optical portion of the cystourethroscope is the
Telescope.
The _____ connects the sheath to the telescope and has one or two working channels for carrying wires, stents, and other instruments.
Bridge.
A commonly used bridge is what
Albarran.
The diagnostic sheath is size ____ to _____ Fr.
15 to 17Fr.
Therapeutic procedures are performed through a sheath that is _____Fr.
28Fr.
There are two types of flexible cystourethroscopes. What is the difference between them.
Digital: fiberoptic capabilities built into the system and does not require a seperate light cable or camera.
Fiberoptic: requires a external light source and camera.
The flexible cystourethroscope is available in sizes ____ to _____Fr.
15 to 18Fr.
The ______ catheter tip is bent and used to traverse the urethra through an enlarged prostate.
Coude
The ______ tip catheter has an elongated opening at the tip for drainage and retrograde pyelogram.
Whistle
A 3-way Foley has a large balloon, either 30ml or 75ml. The large balloon functions as a
Tamponade
A _____ tip catheter has a reinforced tip that resists buckling during insertion.
Council
The _____ tip catheter has a rounded distal tip larger and functions for its ease of use-male catheterization.
Olive
Tissue biopsy is performed with ____ or with a _____.
Cup forceps or a flat wire basket.
Cell biopsy can be taken with a
Cytology brush.
Tumors can be removed by fulguration using the ______ or the _________.
Electrosurgical unit or holminum:YAG laser
A nephroscopy is performed with the patient in what position
Prone
The flexible nephroscope is used mainly for the examination of the
Renal calyces.
A ureteral stent is a slender, hollow tube inserted into the ureter for accesss to ahe ureter itself or the kidney. What is their function?
To relieve obstruction or bypass a stone or tumor to restore continuity in the ureter. It can also be used to support the ureter.
There are two types of stents available. The indwelling types have a curled tip at one or both ends. They include ______ or ______.
Pigtail J or double j
The indwelling stent curls once the guidewire is removed. The curled end is located in the ______ or _________.
Renal pelvis or bladder.
guide wires are moade of _____ or ______.
Steel or nitinol.
The hydrophilic guidewire is extremely slippery and is commonly called a _____.
Glide wire.
The ________ is used to increase the diameter of the ureter. There are two basic types the balloon catheter and the solid synthetic dilator.
Dilating ureteral catheter.
The _____ catheter is used with a follower. It has a slender proximal end.
Filiform.
The male patient is placed in the _______ position ffor flexible cystourethroscopy.
Supine
________ Position is used for female and males undergoing rigid cystourethroscopy.
Lithotomy
What type of prep solution is not used around the genitalia?
Alcohol
What type of cancer has the highest recurrence rate of any other cancer?
Bladder
___________ is the implantation of iodine -125 or palladium into the prostate to treat cancer.
Brachytherapy
enlargement of the prostate in men age 40 and above is often caused by
Benign prostatic adenoma.
Diabetes mellitus, hypertension, glomerulonephritis, polycystic kidney disease, and severe anatomical problems of the urinary tract are common causes of
End stage renal disease
During a circumcision, what type of incision is made/
Dorsal
During a circumcision, what is used to close the incision?
4 chromic stitches
About 30% of penile cancers are related to what?
HPV
If the patient begins to vagal, what position should they be placed in?
Trendelenburg
