Genitourinary surgery on 9/23 Flashcards
What areas of the body does the genitourinary surgery cover?
urinary organs
male reproductive organs
adrenal glands
Where are the adrenal glands located?
on top of each kidney
What do the adrenal glands do?
secrete steroids and hormones necessary for body function
What 4 hormones come from the adrenal glands
cortisol
aldosterone
adrenaline
androgen/ estrogen
Where are the kidneys found?
retroperitoneal
What do the kidneys do?
filtrate blood
waste removal
body fluid levels
electrolyte levels (sodium and potassium)
What are the 3 surrounding layers of the kidney?
renal fascia-outer anchor
perirenal fat- protection
Gerota’s capsule- between adrenal gland and kidney
What are 8 structures of the kidney?
cortex
medulla/ pyramids
calyx/calyces
renal pelvis
hilum
renal artery
renal vein
ureters
What does the cortex of the kidney do? Describe its location.
body of kidney
outer area surrounding other structures
What does the medulla of the kidney do? Describe its location?
renal pyramid- inside the cortex
What does the calx/ calyces of the kidney do? Describe its location.
collection of urine
cup like structures at point of medullas
What does the renal pelvis do? Describe its location.
collects urine from the calx
all renal calyces come together
What does the hilum do? Describe its location.
concave indentation
where renal vein and artery, and ureter exit the kidney
What are 3 parts of the nephron?
glomerulus
Bowmans capsule
loop of henle
What is a nephron?
microscopic filtration system
What is the glomerulus?
capillary bed
waste products and H2O filtered from the blood
What is Bowmans capsule?
tissue enclosing the glomerulus
beginning of urine production
What is the loop of Henle?
recovery of H2O and nutrients based on needs
drains urine out
What are the ureters? How many are there?
emerge from renal pelvis
go directly to urinary bladder
carries urine
2 for each kidney
What are the 5 steps for the blood flow and urinary production?
Renal artery: inflow of blood
Nephrons: filtration
Calyces: collection of urine
renal pelvis: calyces merge
Ureter- urine to bladder
What is the urinary bladder?
reservoir for urine
Where do the ureters attach to the bladder?
the trigone muscles
Where is the detrusor muscle located?
smooth muscle coating inside of the bladder
What does the urethra do?
convey (carry) urine
ejaculation in male
How long is the urethra?
male- 20cm (7-8 in)
female- 3-4 cm (1.5 in)
What are the 2 columns of tissue in the penis called? How many of each are there?
Corpora cavernosa (2)
dorsal/ erectile tissue
Corpus spongiosum (1)
ventral/ urethra & erectile tissue
What membrane lines the scrotum?
tunica vaginalis
What is the Dartos layer of the scrotum? What is its purpose?
muscular layer
expansion and contraction
What do the testes produce?
sperm
testosterone
What is the epididymis?
long coiled up structure (~ 22ft)
stores sperm and maturation
What is the spermatic cord?
flow to and from testes
(cremaster muscle)
What is the prostate gland?
surrounds urethra
about 50 lobules
secretes alkaline fluid for sperm mobility
(neutralizes urine)
What is a PSA lab test?
prostate specific antigen
detects elevated levels
Normal PSA is <4ng/ml
What would a urinalysis test detect?
urine composition
sugar, protein, blood, microbes
UTI’s
What would a BUN test detect?
blood urea nitrogen
urea in blood
high urea indicative of renal issue
inflammation may be cancer
What would a blood creatine test detect?
waste product of muscle
rises with kidney failure
What are 6 diagnostic assessments for GU surgeries?
cystoscopy
cystogram
urethrogram
KUB
Intravenous urogram
retrograde pyelogram
What is a cystoscopy?
endoscopic exam of lower urinary tract
-urethra, bladder, and ureteral orifices
What is a cystogram?
xray of bladder
contrast medium through the urethral catheter
What is a urethrogram?
xray or urethra
medium into the urethra
What is a KUB assessment?
kidney, ureter, bladder
abdominal xray
no contrast used
What is an IVU?
intravenous urogram
xray of ureter, renal pelvis, and bladder
radiopaque die by IV
filtered by the kidney
What is a retrograde pyelogram?
xray of kidney ureters, and bladder
radiopaque die via ureteral catheterization
What are 6 incisional approaches for GU procedures?
inguinal
scrotal
abdominal
Gibson
Thoracoabdominal
Lumbar
If approaching through an inguinal incision what procedure is being done? What position is the patient in?
inguinal canal for an orchiectomy
supine
If approaching through a scrotal incision what procedure is being done? What position is the patient in?
scrotal contents
supine
If approaching through an abdominal incision what procedure is being done? What position is the patient in?
low line incision
prostatectomy or cystectomy
supine, split leg, or low lithotomy
If approaching through a Gibson incision what procedure is being done? What position is the patient in?
lower ureters
kidney implantation
supine
If approaching through a thoracoabdominal incision what procedure is being done? What position is the patient in?
open kidney resections
or subcostal
lateral position
If approaching through a lumbar incision what procedure is being done? What position is the patient in?
lateral or prone position
What are the 3 basic surgical approaches for the GU system?
transurethral
laparoscopic
open (less common)
What kind of surgical approach is a cystoscopy/ ureteroscopy?
Transurethral
What structures can be seen in a cystoscopy/ ureteroscopy? What can be removed?
Bladder, ureters, and urethra
Remove urinary tract stones
What structures can be seen in a cystoscopy? What can be removed?
Bladder, ureters, and urethra
Remove urinary tract stones
What position is a patient in for cystoscopy/ ureteroscopy?
Lithotomy on a cysto table
How is a patient prepped for a cysto procedure? Is this a clean or sterile procedure?
Betadine
Scrub person does prep
Begin at meats work outward
Clean case NOT sterile
If a cystoscopy uses anesthesia, what are the steps?
Anesthesia jelly instilled in urethra
Penile clamp used to hold jelly in place
In a cystoscopy how is the bladder distended?
Sorbitol/ mannitol &1.5% glycine
Never saline can conduct electricity and cause burns
What kind of contrast media is used in cystoscopies?
Omnipaque
Visipaque
Emigration
Isovue
Can be harmful to kidneys- dilute
What are the parts of a cystoscope?
Sheath- hollow tube
Obturator-blunt metal in sheath
Bridge- allows instrument insertion
Telescope- 30 or 70 degree
What is a resecto scope?
Scope with cautery element
Resects bladder, urethral and prostrate tissue
When using a resectoscope, how are the loose tissues removed?
Collect in bladder
Removed with Ellik evacuator (looks like a bong)
or toomey syringe (large 60cc)
What is a TURP procedure?
Transurethral resection of the prostate
Remove some prostate gland with resectoscope
What does a TURP procedure treat?
Trouble urinating
Commonly from benign prostatic hypertrophy
Sometimes to tx cancer (not cure)
After a TURP procedure what is done to the bladder?
Bladder continuously irrigated with a 3 way foley
30cc retention balloon to aid in hemostasis
What is a complication of a TURP procedure?
Post TURP syndrome- systemic absorption of irrigating fluid
Be alert for Jerking of legs
Can lead to seizures, coma, cardio respiratory problems
What is a TURBT procedure?
Same as TURP but tissue is respected from the bladder
Malignant or benign masses
Use H2O to irrigate
Why would a laser be used in a cystoscopy?
For stone obliteration and tissue resection
What 2 cysto procedures and what laser is used for each?
Lithotripsy- holmium yag laser
Prostate resection- green light (neodymium YAG)
What 2 cysto procedures and what laser is used for each?
Lithotripsy- holmium yag laser
Prostate resection- green light (neodymium YAG)
What 2 cysto procedures and what laser is used for each?
Lithotripsy- holmium yag laser
Prostate resection- green light (neodymium YAG)
What structures are seen in a ureteroscopy?
Ureters
Passed through urethra and bladder
Rigid or flexible
What is a ureterolithotomy procedure?
Removal of ureteral stones
Via ureteroscopy
What instrument is used to collect stones in a ureterolithotomy procedure?
Basket stone forceps
How are ureter stones sent to pathology?
Dry
What is a ureteral stent?
Placed after stone removal
Keeps ureters patent during healing
What are urethral catheters used for?
Shirt or long term drainage
Bladder irrigation
Patent of urethra
Hemostasis after surgery
What are 2 types of urethral catheters?
Robinson (red rubber) used for quick bladder drainage
Coude has a bent tip to pass through urethral passages
What is the urethral catheter guide?
Rigid insert for difficult catheter insertion
What is a suprapubic/ percutaneous catheter?
Placed percutaneously above the arch into bladder
Or directly into renal pelvis
When would a suprapubic/ percutaneous catheter be used? What incision is used?
Long term placement
Urethral or ureteral damage
Terminal illness/ impairment
Seldingers technique
What are 2 types of suprapubic catheters?
Malecot
Pezzer (yellow rubber
What is hypospadias?
Anomaly where urethral opening not at normal position
Where does hypospadias occur on a male and female?
Male- ventral side of penis accompanied by chordee (curve of penis)
Female- urethra opens into vagina
What is epispadias?
Males- opening on dorsal side of penis
Females- opening above clitoris
What procedure fixes hypospadias and epispadias?
Urethroplasty- reconstruct and reposition of urethra
What is phimosis?
Occurs on uncircilumcised males
Prepuce does not retract from glans
What is paraphimosis?
Can’t unretract a retracted prepuce
Possible necrosis
Cover prepuce after foley insertion
What is a circumcision?
Excision of foreskin
At birth for religious or prophylaxis
What is a penile implant?
Tx for sexual impotence
(Diabetes, vascular disorders, nerve damage, trauma)
Rigid or inflatable prosthesis in corpus cavernosa
What is a hydrocelectomy?
Tx of hydrogels- fluid in membrane of testicle (Tunica vaginalis)
Incision into scrotum to drain fluid and remove part of tunica vaginalis
What is a spermatocelectomy?
Removal of mass on epididymis
Usually caused by tubular system
What is a varicocele?
Enlargement of veins of spermatic cord
What is vericocelectomy procedure?
Ligation and partial excision of veins of scrotum
What is a vasectomy procedure?
Excision of section of vas deferens
Male sterilization
What is a vasovasostomy?
Reversal of vasectomy
Anastomosis of vas deferens
What is cryptorchidism? what 2 incisions are done?
testicle fails to descend during development
link to testicular cancer
inguinal incision to push into place
scrotal incision to suture into place
What is a testicular torsion?
testicles rotate/ twist
inhibits blood supply to testes
surgical emergency- necroses possible
What is orchiopexy?
suturing of testicle to floor of the scrotum
What is an orchiectomy procedure? Why would it need to be done?
removal of testes
cancer, trauma, necrosis
What types of orchiectomy procedures are there?
simple and radical
What is a simple orchiectomy? what incision is used?
removal of testes and epididymis
scrotal incision
What is a radical orchiectomy? What incision is used?
removal of testes, epididymis, and spermatic cord
inguinal incision
What is a radical prostatectomy?
complete removal of prostate gland
After a radical prostatectomy what needs to be resected? anastomosed?
resect retroperitoneal lymph node
anastomosis of bladder neck to remaining urethra
What is a potential disadvantage of a radical prostatectomy?
nerve damage leading to impotence
What is brachytherapy? What instruments are used?
radiation therapy for small localized prostate cancer
percutaneous radioactive seeds implanted with a guide
What is an interstim implant? Where is it implanted?
“pacemaker” for sacral nerves
helps with urinary retention, overactive bladder, and incontinence
near sacral nerves/ iliac crest
What is a cystectomy?
removal of the bladder
What are the different types of cystectomies?
partial and total
What is a partial cystectomy?
removal of diseased portion of the bladder
What is a total cystectomy? What must be done after this procsdure?
removal of entire bladder
must create a urinary conduit
What is a ureteroileostomy? What are the main steps?
creation of new bladder using a piece of the ileum
ureters anastomosed to ileum
urostomy created with ileum
What is a pyelolithotomy? What incision will be used?
remove of staghorn stones through renal pelvis of the kidney
lumbar incision
What is Extracorporeal shockwave lithotripsy?
ESWL
shockwaves break up stones so can pass
What is an adrenalectomy?
partial or total excision of adrenal glands
Why is an adrenalectomy performed?
hyperfunction of gland
tumors
tumors elsewhere affected by adrenal hormones
What is a nephrectomy?
surgery to remove all or part of a kidney
What are the different types of nephrectomies?
Heminephrectomy
simple nephrectomy
radical nephrectomy
What is a heminephrectomy?
partial excision of kidney due to small tumor
clamp renal vessels to limit bleeding
NO more than 30 minutes
What is a simple nephrectomy? What needs to be ligated?
removal of whole kidney
renal vein, renal artery, and ureter ligated
What is a radical nephrectomy? Why do this procedure?
removal of kidney, adrenal gland, perirenal fat, Gerota’s capsule, and involved periaortic lymph nodes
advanced cancer
What is Wilm’s tumor? What is required to be done?
childhood malignant tumor in 3-8 yo
nephrectomy and chemo/ radiation
What is a renal transplantation?
end stage renal failure or polycystic disease
matching blood types
living or deceased donor
What are the surgeries involved in gender confirmation for male to female?
penectomy
orchiectomy
labiaplasty
vaginoplasty
What are the surgeries involved in gender confirmation for female to male?
phalloplasty
testicular implants
vaginectomy
hysterectomy/ salpingectomy
