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Surginal Procedures > Gynecology and Genitourinary Surgery > Flashcards

Gynecology and Genitourinary Surgery Flashcards

1
Q

List the 6 main structures of the female reproductive system.

A 
Vulva
Vagina
Cervix
Uterus
Tubes
Ovaries
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2
Q

List the 4 supporting ligaments of the uterus:

A

Round, broad, cardinal, uterosacral ligaments

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3
Q

List the 3 parts of cervix:

A

Internal os; external os; endocervical canal

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4
Q

List 4 parts of the uterus:

A

Fundus, cornua, body (corpus), cervix

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5
Q

List the three layers of the uterine body

A

Endometrium, myometrium, perimetrium

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6
Q

Adnexa

A

new term meaning accessory structures: Tubes and Ovaries

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7
Q 
Physiology of the:
Vulva
Vagina
Cervix
Uterus
Tubes
Ovaries
A

Vulva–Facilitate sexual intercourse
Vagina –Intercourse; menstrual discharge, and delivery of infant
Cervix–Holds developing fetus inside uterus
Uterus–Support developing embryo/fetus
Tubes–Fertilization, peristalsis of zygote (fertilized ovum) to uterus
Ovaries–Store, mature, and release ovum “egg”

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8
Q 
menstrual;
Dyspareunia
PID 
(CIS)
Dysplasia
Intraepithelial
Neoplasia
Pruritus
A 
Pertaining to to the menses or menstruation
Difficult or painful sexual intercourse
Pelvic inflammatory disease
Carcinoma in situ 
Condition; ill, bad, or poor; growth
Pertaining to; within; epithelium
Condition; new; growth
Severe itching
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9
Q

Ectopic pregnancy

A

A fertilized egg attached outside the uterus

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10
Q

Define D&C

A

Dilation of the cervix and curettage of the uterus

Gradual expansion of the cervical opening to provide access to the uterus to remove a tissue sample

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11
Q

Anatomy/Physiology of D&C

A 
Vagina
Cervix
Internal os
External os
Endocervical canal
Uterus
Endometrium (inner layer)
Physiology: Reproduction; conception and growth of infant
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12
Q

Pathophysiology/Indication for D&C

A 
diagnostic for:
DUB: dysfunctional uterine bleeding
     Dysmenorrhea, amenorrhea
     Menorrhagia, hypermenorrhea
     Metrorrhagia
Assessment of infertility
treatment for: 
Miscarriage (D&E)
Uterine polyps (called a polypectomy)
Post partum bleeding (D&C)
Retained placenta (D&E)
Abnormal uterine bleeding (ablation)
Uterine cancer (place radium implants)
Retrieval of “lost” IUD
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13
Q

Procedure Steps D&C

A

Retract vagina (Auvard and Heaney or Sims)
Grasp cervix (Schroeder tenaculum)
Sound uterus (Sims uterine sound)
Take endocervical specimen (Kervorkian curette and telfa)
Dilate cervix (Hegars or Hanks)
FYI: May check for polyps (Randall stone forceps)
Curette uterine cavity (Sims curettes and telfa)
FYI: May clean out with Bozeman/raytex or stick sponge
Dress with OB pad

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14
Q

Define Conization of the Cervix

A

Removal of a cone-shaped piece of cervical tissue for diagnosis

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15
Q

Anatomy/Physiology of Conization of the Cervix

A 
Vagina
Cervix
Internal os
External os
endocervical canal
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16
Q

Pathophysiology/Indication for Conization of the Cervix:

A 
Cervical dysplasia (severe) AKA: Carcinoma in situ (CIN grade 3)
     Changes in cervical epithelium 
Cone biopsy checks to see if the changes have infiltrated to the cervix
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17
Q

Procedure Steps Conization of the Cervix

A

Place retractors (Auvard and Heaneys)
Grasp cervix with tenaculum (mark area with staining agent)
Excise cone (ESU, knife, laser, etc.)
Hemostasis (ESU), pack PRN, dress (NuGauze packing, peri pad)

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18
Q

Define Cervical Cerclage (Shirodkar)

A

Placement of a ligature at the internal os of the cervix

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19
Q

Anatomy and physiology of Cervical Cerclage (Shirodkar)

A

Vagina
Cervix
Internal os

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20
Q

Pathophysiology/Indication for Cervical Cerclage (Shirodkar)

A

Post-conceptional incompetent cervix

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21
Q

Procedure steps Cervical Cerclage (Shirodkar)

A 
Retract, grasp cervix
Incise anterior mucosa, retract bladderIncise posterior mucosa, place Allises
Place and tie ligature 
     5 mm Mersilene tape on huge needle
Close mucosa
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22
Q

Define Hysteroscopy/endometrial ablation

A

hysteroscopy-Visual exam, uterine cavity

Endometrial ablation-destruction of the inner layer of the uterus

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23
Q

Anatomy/physiology Hysteroscopy/endometrial ablation

A 
Vagina
Cervix
Internal os
External os
Endocervical canal
Uterus
Endometrium (inner layer)
Physiology: Reproduction; conception and growth of infant
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24
Q

Pathology/Indication Hysteroscopy/endometrial ablation

A

DUB
Hysteroscopy also used to Diagnose cause of infertility and Treatment for “lost” IUDs; intrauterine adhesions; intrauterine polyps

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25
Q

Procedure steps Hysteroscopy/endometrial ablation

A

Retract, grasp cervix, sound uterus, dilate cervix
Insert hysteroscope
Distend uterine cavity, EUA
Suction curettage of uterine cavity
Insert balloon, apply heat to destroy endometrium
(FYI: usually done without hysteroscopy)
Remove instruments; clean patient, dress

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26
Q

Define diagnostic laparoscopy (GYN)

A

Visual exam of the abdominal cavity

With particular attention to the organs of the female reproductive system

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27
Q

Anatomy/physiology diagnostic laparoscopy

A 
Vagina
Cervix
Internal os; External os; Endocervical canal
Uterus
Uterine tubes
Ovaries
Bladder
Ureters
Physiology: Reproduction; conception/growth of infant
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28
Q

Pathology/indication diagnostic laparoscopy

A

diagnostic for:Unexplained gynecologic pain
Assessment of infertility
PID-Pelvic inflammatory disease
Evaluation of masses
such as ovarian cysts, ovarian mass, or fibroids

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29
Q

Procedure steps diagnostic laparoscopy

A

Place vaginal speculum, grasp cervix
Apply uterine manipulator (change outer gloves)
Lift abdominal wall (may use 2 towel clips)
Make incision (umbilicus, 12 blade)
Insert Veress needle; verify placement in peritoneal cavity; insufflate abdomen with CO2; (remove Veress needle)
Insert 10/12mm trocar, laparoscope and camera
Suprapubic incision; place 5mm port and insert accessory instruments (such as probe)
EUA, treat PRN
Could be tubal dye studies; remove ovarian cyst; do tubal ligation; laser endometriosis and other options
I/H/desufflate/C/D
Remove uterine manipulator

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30
Q

Define Oophorectomy (laparoscopic)

A

Excision of ovary through MIS technique

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31
Q

Anatomy/physiology Oophorectomy (laparoscopic)

A 
Vagina
Cervix
Internal os; External os; Endocervical canal
Uterus
Uterine tubes
Ovaries
Bladder
Physiology: Reproduction; conception/growth of infant
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32
Q

Pathology/indication Oophorectomy (laparoscopic)

A

Ovarian cyst
Others, not common:
Strangulated ovary
Infection, adhesion, endometriosis (endometrioma)

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33
Q

Define Salpingectomy (laparoscopic)

A

Excision of uterine tube through MIS technique

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34
Q

Anatomy/physiology Salpingectomy (laparoscopic)

A 
Vagina
Cervix
Internal os; External os; Endocervical canal
Uterus
Uterine tubes
Ovaries
Bladder
Physiology of tubeObtain ovum, peristalsis of ovum,  fertilization location and peristalsis of fertilized ovum to uterus
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35
Q

Pathology/indication Salpingectomy (laparoscopic)

A

Chronic salpingitis (PID)

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36
Q

Define Tubal pregnancy (laparoscopic)

A

AKA. ectopic pregnancy

Excision of a fertilized ovum that is seated outside the uterus, usually seated in the uterine tube; through MIS

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37
Q

Anatomy/physiology Tubal pregnancy (laparoscopic)

A 
Vagina
Cervix
Internal os; External os; Endocervical canal
Uterus
Uterine tubes
Ovaries
Bladder
Physiology: Reproduction; conception/growth of infant
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38
Q

Pathology/indication Tubal pregnancy (laparoscopic)

A

a fertilized ovum that is seated outside the uterus

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39
Q

Define Tubal sterilization (lap) (tubal ligation)

A

Occlusion/interruption of the uterine tubes through MIS technique

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40
Q

Anatomy/physiology Tubal sterilization (lap)

A 
Vagina
Cervix
Internal os; External os; Endocervical canal
Uterus
Uterine tubes
Ovaries
Bladder
Physiology: Reproduction; conception/growth of infant
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41
Q

Indication Tubal sterilization (lap)

A

Patient desire to be sterilized (i.e., to be made unable to conceive another child)

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42
Q

Define Abdominal Hysterectomy

A

Excision of the entire uterus through an open incision

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43
Q

Anatomy/physiology Abdominal Hysterectomy

A 
Uterus, tubes, ovaries
Cervix, vagina
Ligaments: round, broad, cardinal, uterosacral
Bladder, ureters
Physiology: reproduction
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44
Q

Pathology/indication Abdominal Hysterectomy

A 
PID (causing chronic pelvic pain)
Endometriosis (causing chronic pelvic pain)
Large fibroids
DUB (dysfunctional uterine bleeding)
Uterine or cervical cancer
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45
Q

Define Tuboplasty

A

Surgical repair of uterine tubes with use of a microscope

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46
Q

Anatomy/physiology Tuboplasty

A 
Uterus, tubes, ovaries
Cervix, vagina
Ligaments: round, broad, cardinal, uterosacral
Bladder, ureters
Physiology: reproduction
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47
Q

Pathology/indication Tuboplasty

A

Tubal blockage d/t PID (pathology; PID may be more common than adhesions from previous surgery)
Patient changed mind about fertility post tubal ligation (indication)

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48
Q

Define Myomectomy

A

Excision of uterine fibroids (AKA: myomas)

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49
Q

Anatomy/physiology Myomectomy

A 
Uterus, tubes, ovaries
Cervix, vagina
Ligaments: round, broad, cardinal, uterosacral
Bladder, ureters
Physiology: reproduction
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50
Q

Pathology/indication Myomectomy

A

Uterine fibroids affecting fertility;

AKA: fibromyoma; uterine leiomyoma

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51
Q

Define Vaginal Hysterectomy

A

Excision of uterus through an incision in the vaginal wall

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52
Q

Anatomy/physiology Vaginal Hysterectomy

A 
Uterus, tubes, ovaries
Cervix, vagina
Ligaments: round, broad, cardinal, uterosacral
Bladder, ureters
perineum
Physiology: reproduction
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53
Q

Pathology/indication Vaginal Hysterectomy

A

Uterine prolapse
Symptomatic uterine leiomyomas
Endometriosis

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54
Q

Define A&P repair (colporrhaphy)

A

Anterior and Posterior repair
Reconstruction of the anterior and posterior aspects of the vaginal vault
suturing of the vagina walls

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55
Q

Anatomy/physiology A&P repair (colporrhaphy)

A

vagina, bladder, and/or rectum

56
Q

Pathology/indication A&P repair (colporrhaphy)

A

Cystocele (anterior) herniation of the bladder into vagina
Rectocele (posterior) herniation of the rectum into vagina
Enterocele herniation of the intestine into

57
Q

Define Robot laparoscopic hysterectomy

A

Excision of uterus through the vagina, with MIS techniques for dissection from pelvic cavity

58
Q

Anatomy/physiology Robot laparoscopic hysterectomy

A

Vagina
Cervix
Internal os; External os; Endocervical canal
Uterus
Ligaments: round, broad, cardinal, uterosacral
Uterine tubes
Ovaries
Bladder
Ureters
Physiology: Reproduction; conception/growth of infant

59
Q

Pathophysiology/indication Robot laparoscopic hysterectomy

A

Absence of genital prolapse
(ligaments too tight to pull uterus into vagina easily)
Presence of intra-abdominal scarring
Such as post c-section (bladder adhesions) or PID scars
Large fibroids or adnexal massesCancer; endometrial or cervical

60
Q

Procedure steps Robot laparoscopic hysterectomy

A

Insert a vaginal manipulator into the cervix and a vaginal balloon occluder into the vagina
Establish laparoscopic access
laparoscopic access
Dock the robots and position the instruments in the robotic arms and through the ports
Manipulate the uterus as the surgeon directed
Transect the round ligament using bipolar cautery
Identify the ureters
Hydrodissect broad ligament; free bladder from uterus
Transect the uterosacral and cardinal ligaments and blood vessels
Open vaginal vault (FYI: colpotomy; will lose pneumoperitoneum)
Move to vaginal approach, transect remaining attachments (including vessels), remove uterus; close vault
Restore pneumoperitoneum to
Irrigate surgical site with normal saline
Achieve hemostasis
Close incision and apply dressings (Dermabond, Steri-strips, Obi/peri pad)

61
Q

Define Cesarean section

A

Delivery of a fetus (or fetuses) through abdominal and uterine incisions

62
Q

Anatomy/physiology Cesarean section

A 
Uterus
Tubes & ovaries
Bladder
Cervix
Uterine vessels (huge)
Placenta; umbilical cord
Physiology: reproduction
63
Q

Pathology/indication Cesarean section

A

Elective
Malpresentation (malposition)
Fetus is not in correct position for delivery
Cephalopelvic disproportion (CPD)
fetus’ head is too big to pass through mother’s pelvic outlet
multiple fetuses (quadruplets; quintuplets; etc.)
Placenta previa
A portion of the placenta is seated over the cervix
Toxemia
pre-eclampsia – hypertension, edema, proteinuria
Eclampsia – all signs listed above plus seizures
Active Herpes or presence of genital warts
Some patients with diabetes
Some previous C-sections
Urgent
Dystocia; AKA failure to progress
Cervical dystocia: fails to soften to dilate and efface
Uterine dysfunction: won’t contract effectually even with oxytocin
Emergent
Fetal distress
Diagnosed by fetal heart rate/tone and blood chemistry (pH)
Abruptio placenta (AKA: placental abruption)
Placenta detaches before delivery; varying degrees from minor detachment to major detachment
Prolapsed cord
Umbilical cord drops out ahead of baby

64
Q

Procedure steps Cesarean section

A

Using a #10 blade on a #3 knife handle a Pfannenstiel incision is made
Achieve hemostasis PRN using ESU
The incision is carried deeper with ESU and tissue forceps
Fascia is identified and incised
Goalet or Army-Navy retractors is used to retract the abdominal wall
Superior edge of fascia is grasped (Kochers x 2), fascia is bluntly dissected from underlying rectus muscle
ESU used on perforating vessels, transect septum, repeat on inferior edge of fascia
Rectus abdominis muscles are separated at midline by blunt dissection
Peritoneum is identified, grasped (hemostat x 2), and lifted
Incise peritoneum and extend with Metzenbaum scissors
Place self-retaining retractor for abdominal wall
After open peritoneum:
Separate bladder flap and retract it inferiorly
Palpate the uterus to determine the fetal placement and position
Incise uterus with knife, extend with bandage scissors
The obstetrician places their hand into the uterus and manipulates the fetus
Remove retractors, deliver baby’s head
Clamp and cut cord the umbilical cord using Metzenbaum scissors or Lister bandage scissors, pass baby off to neonatal team
Clamp uterine walls (Ring forceps or Penningtons)
Deliver placenta, inspected it, and removed from the back table
Close uterus in layers using absorbable sutures
FYI: First closing count
Suture to reattach bladder flap
Irrigate the surgical site
Achieve hemostasis
Close the abdominal wall, followed by the skin
Stiches or skin staplers may be used to lose the skin
Dressings (ABD pad, 4x4 gauze or long tegaderm) and perineal pad is applied.

65
Q

Define cystoscopy

A

Visual exam of the urinary bladder

66
Q

Anatomy/physiology cystoscopy

A 
Urethra
Bladder
Bladder trigone
Ureters
Ureteral orifices (openings)
Physiology
     Storage and emptying of urine
67
Q

Pathophysiology/indication cystoscopy

A

Diagnostic exam for:
Recurrent UTI; hematuria
Urinary retention
Cystitis, tumors, fistulae, stones, incontinence

68
Q

Define Ureteroscopy

A

Visual exam of ureter/s and renal pelvis

69
Q

Anatomy/physiology Ureteroscopy

A 
Urethra
Bladder
Bladder trigone
Ureters
Ureteral orifices (openings)
Renal pelvis
Physiology
     Transport of urine to bladder
70
Q

Pathophysiology/indication Ureteroscopy

A

Ureteral obstruction due to calculi or strictures

71
Q

Define ESWL

A

Extracorporeal shock wave lithotripsy

To crush stone using shockwaves outside the body

72
Q

Anatomy/physiology ESWL

A 
Urethra
Bladder
Bladder trigone
Ureters
Ureteral orifices (openings)
Physiology
     Transport of urine to bladder
73
Q

Pathophysiology/indication ESWL

A

Urinary calculus/calculi; kidney or ureteral

74
Q

Define Cystectomy w/ileal conduit

A

Excision of bladder with diversion of urine into an isolated segment of bowel

75
Q

Anatomy/physiology Cystectomy w/ileal conduit

A

Bladder, ureters, urethra
Ileum and mesentery
Physiology: evacuation of urine

76
Q

Pathophysiology/indication Cystectomy w/ileal conduit

A

Bladder cancer

77
Q

Procedure steps Cystectomy w/ileal conduit

A

I/H/D/R per Pfannenstiel incision; EUA
Isolate bladder from attachments and excise bladder
Identify, mobilize and transect ureters; (create mesenteric tunnel)
Resect segment of ileum keeping mesenteric blood supply intact
Re-anastomose original ileum; close mesentery
Sew ureters into the isolated segment of ileum
Bring ileal pouch to abdominal wall and create small ostomy
Place ureteral catheters as stents; I/H/drain/C/D

78
Q

Define Urethral-Vesical angle repair (Suburethral Sling)

A

Placement of a supportive device to correct improper urethrovesical (UV) angle

79
Q

Anatomy/physiology Urethral-Vesical angle repair

A 
Bladder
Urethra
Bladder neck
Vagina
Physiology: controlled release of urine from bladder
80
Q

Pathophysiology/indication Urethral-Vesical angle repair

A

Female urinary incontinence d/t urethral hypermobility

Diagnostic tests: H&P; voiding cystometrogram

81
Q

Define Nephrectomy

A

Excision of kidney

82
Q

Anatomy/physiology Nephrectomy

A 
Kidney; Gerota’s capsule/fascia
Renal pelvis; ureter
Renal artery and vein (renal pedicle)
Vena cava and aorta
Physiology of kidney: formation and excretion of urine
83
Q

Pathology/Indication Nephrectomy

A

Renal cancer

84
Q

Procedure steps Nephrectomy

A

Mark the incision site with a skin marker
Using #15 blade on a #3 knife handle a flank incision is made
Achieve hemostasis using ESU
The incision is carried deeper through the fat, latissimus dorsi, external oblique, and internal oblique muscles
Retract the skin, subcutaneous layers, and rib
Incise the transverses abdomens fascia
Expose the Gerota’s capsule by dissecting paranephric fat
Isolate, clamp, cut, ligate ureter
Isolate, clamp, triply ligate, cut renal artery then renal vein
heavy silk ties - #1 or #2
Remove the kidney
Close the incision by layer
Gerota’s capsule
External oblique muscle
Skin
Place a drain
Apply dressings (4x4 gauze, Long tegaderm, ABD pad, and Surgical tape)

85
Q

Define Kidney transplant

A

Placement of a living-related or cadaveric donor kidney into the recipient’s iliac fossa

86
Q

Anatomy/physiology Kidney transplant

A

Donor kidney and pedicle, recipient’s iliac artery and vein, bladder, ureter
Physiology of kidney: formation and excretion of urine

87
Q

Pathophysiology/indication Kidney transplant

A

End-stage renal disease (pathology)

To restore renal function (indication)

88
Q

Define Adrenalectomy (endoscopic)

A

Excision of one or both adrenal glands via MIS approach

89
Q

Anatomy/physiology Adrenalectomy (endoscopic)

A

Adrenal gland, upper pole of kidney

Physiology: his is an endocrine gland, so the function is secretion of adrenal hormones

90
Q

Pathophysiology/indication Adrenalectomy (endoscopic)

A

Hypersecretion
Neoplasms
Pheochromocytoma

91
Q

Definition TURP

TUR/BT:

A

Transurethral resection of the prostate

Transurethral resection of bladder tumors

92
Q

Anatomy/physiology TURP/ and bladder tumor

A 
Prostate gland
Penis
Urethra
Bladder neck
Bladder
Physiology: Secretion of seminal fluid
93
Q

Pathophysiology/indication TURP/ and bladder tumor

A 
TURP:
     Benign prostatic hypertrophy (BPH)
          (Hyperplasia)
TURBT:
     Bladder tumors
94
Q

Define Prostate seeding

A

Percutaneous implantation of radioactive seeds in prostate gland
brachytherapy

95
Q

Anatomy/physiology Prostate seeding

A

rectum, scrotum, and prostate

Physiology: secretion of seminal fluid

96
Q

Pathophysiology/indication Prostate seeding

A

Stage A or B prostate cancer

97
Q

Define Laparoscopic prostatectomy/robotic

A

Removal of the prostate gland through MIS approach with robotic assistance

98
Q

Anatomy/physiology Laparoscopic prostatectomy/robotic

A

Prostate gland and capsule
Seminal vesicles, rectum
Penis, urethra, bladder neck, bladder
Physiology: Secretion of seminal fluid

99
Q

Pathophysiology/indication Laparoscopic prostatectomy/robotic

A

Prostate cancer

100
Q

Procedure steps Laparoscopic prostatectomy/robotic

A

A 24 Fr Foley catheter is inserted into the patient
Establish laparoscopic access • Dock the robots and position the instruments in the robotic arms and through the ports
Replace the 30 degree camera with a 0 degree
Grasp and pull the bowel superiorly
Identify the rectum
Incise the peritoneum
Identify and divide the vas deferens and seminal vesicles and dissect gland
Preserve the neurovascular bundle
Replace the 0 degree camera with a 30 degree
Incise the transverse peritoneum
Divide the umbilical ligament
Incise bladder neck, transect urethra distal to prostate
A surgical entrapment bad is inserted through the sheath and the prostate is placed inside
The specimen is remove
Perform urethrovesical anastomosis and test it
The sheaths are removed and each incision site is checked for hemostasis
Desufflate
A new Foley is inserted
Each port site is closed and dressing is applied (derma bond, steri-trips).

101
Q

Define Orchiectomy (scrotal)

A

Excision of one or both testes through a scrotal incision

102
Q

Anatomy/physiology Orchiectomy (scrotal)

A

Scrotum
Tunica vaginalis
Testes
Epididymis
Spermatic cord: Vas deferens, Testicular vessels, Cremaster muscle
Physiology: Reproduction; production of sperm and endocrine function to produce testosterone

103
Q

Pathophysiology/indication Orchiectomy (scrotal)

A

Unilateral: Testicular cancer
trauma, infection (both quite rare)
Bilateral: Testosterone sensitive metastatic prostate cancer
castration-resistant prostate cancer (CRPC) emerging

104
Q

Define Hydrocelectomy

A

Excision of the tunica vaginalis to remove a fluid-filled sac surrounding the testis

105
Q

Anatomy/physiology Hydrocelectomy

A

Scrotum, tunica vaginalis, testes, epididymis

Physiology: Reproduction; production of sperm and endocrine function to produce testosterone

106
Q

Pathophysiology/indication Hydrocelectomy

A

A fluid-filled sac surrounding the testis called a hydrocele

107
Q

Define Orchiopexy

A

Fixation or suspension of testis

108
Q

Anatomy/physiology Orchiopexy

A

Scrotum, tunica vaginalis, testes, epididymis

Physiology: Reproduction; production of sperm and endocrine function to produce testosterone

109
Q

Pathophysiology/indication Orchiopexy

A

Cryptorchidism (undescended testis/testes)

110
Q

Define Penectomy

A

Excision of the penis (all or part)

111
Q

Anatomy/physiology Penectomy

A

Penis, urethra, corpora, ligaments and dorsal vessels, perineum, scrotum
Physiology: reproduction and urination

112
Q

Pathophysiology/indicationPenectomy

A

Penile cancer

113
Q

Define Circumcision

A

Excision of the foreskin of the glans penis

114
Q

Anatomy/physiology Circumcision

A

urethra, Penis and foreskin

scrotum

115
Q

Pathophysiology/indication Circumcision

A

Phimosis (foreskin can’t be retracted)
Balanoposthitis (inflammation with discharge)
Paraphimosis (foreskin can’t be reduced back)
Patient request

116
Q

Define Penile prosthesis insertion

A

Placement of a device to enable sexual penetration

117
Q

Anatomy/physiology Penile prosthesis insertion

A

Penis, urethra, corpora, ligaments and dorsal vessels, perineum, scrotum
Physiology: reproduction and urination

118
Q

Pathophysiology/indication Penile prosthesis insertion

A

Organic sexual impotence d/t physiologic cause such as:
Nerve damage post-prostatectomy
Priapism, Peyronie’s disease, trauma
HTN/blood pressure medication; Diabetes; and more

119
Q

Ectopic pregnancy

A

A pregnancy in which the fertilized egg implants outside the uterus.

120
Q

Pfannenstiel steps

A

Incision made with 10 blade on #3 handle, hemostasis, deepen with ESU and tissue forceps
Fascia is identified, incised, and incision extended
Small retractor placed in lateral corners to view
Superior edge of fascia is grasped (Kochers x 2), fascia is bluntly dissected from underlying rectus muscle
ESU used on perforating vessels, transect septum, repeat on inferior edge of fascia
Rectus abdominis muscles are separated at midline by blunt dissection
Peritoneum is identified, grasped (hemostat x 2), and lifted
Incise peritoneum and extend with Metzenbaum scissors
(FYI: caution don’t damage bladder inferiorly)
Place self-retaining retractor for abdominal wall

121
Q

TAH BSO

A

Total abdominal hysterectomy with bilateral salpingooophorectomy

122
Q

RSO

A

right salpingooophorectomy

123
Q

LSO

A

eft salpingooophorectomy

124
Q

LAVH

A

laparoscopic-assisted vaginal hysterectomy

125
Q

VBAC

A

Vaginal birth after cesarean

126
Q

Anatomy and Physiology of GU

A

Kidneys: filter waste from the body by excretion of urine
Adrenal glands: part of the endocrine system
Ureters: Peristalsis to carry urine to bladder
Urinary bladder: Reservoir for urine
bladder trigone:
Ureteral orifices (openings) and the urethral orifice
Urethra: Exit of urine from body

127
Q

list 5 anatomic features of the kidney

A

Perirenal fat – serves to protect kidneys
Fascia renalis (Gerota’s capsule)– keeps kidneys in position
Hilum – concave area where vessels enter/exit
Renal artery and vein – blood supply to kidneys
Together with nerves + lymph vessels are called the pedicle
Renal pelvis and calyces – funnel for urine

128
Q

UPJ

UVJ

A
  • ureteropelvic junction

- ureterovesical junction

129
Q

Male Reproductive System Anatomy/physiology

A

Prostate gland: Production of alkaline fluid for sperm viability
Testes: Produce sperm and secrete hormones (reproductive & endocrine)
Epididymis (head, body, tail): Seminal fluid secretion
Vas deferens: Sperm transport to seminal vesicle
Penis: Urination and reproduction

130
Q

Three vascular bodies of the penis

A 
corpora cavernosum (2)
Spongiosum
131
Q 
UA 
UTI
PSA 
BUN 
KUB 
IVU 
RU
A 
Urinalysis
urinary tract infection
prostate specific antigen
blood urea nitrogen
 x-ray of kidneys, ureters, bladder
 intravenous urogram
retrograde urogram
132
Q

Sterile water is used for?
Saline is used for?
TURP use either

A 
Cystoscopy and RU
     Sterile water is hypotonic
Basic ureteroscopy
     Saline is isotonic, but is electrolytic
3% Sorbitol or 1.5% Glycine
133
Q

Incisions used in GU: state purpose for each

A

Inguinal
Orchiopexy; radical orchiectomy
Scrotal
Vasectomy; testicular biopsy; simple orchiectomy; orchiopexy
Pfannenstiel (provided):
Open procedures on the bladder such as cystectomy
Gibson
Placement of donor kidney (still extraperitoneal)
Flank
Access to adrenal glands, kidney, and proximal ureter
FYI: can be subcostal, transcostal, or intercostal depending upon location of kidney (high-lying or low-lying); note that the left kidney is positioned higher than the right kidney because liver is on the right side
Lumbar
Adrenalectomy; renal biopsy; small low-lying kidney for nephrectomy

134
Q

Ostomy

A

to create an opening

135
Q

Pyelo

A

renal pelvis

136
Q

Otomy

A

cutting into

Surginal Procedures (14 decks)

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