Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

APA Funds 2 > Urologic Procedures > Flashcards

Urologic Procedures Flashcards

1
Q

What are some of the concerns for laparascopic renal surgery?

A

Potential for extravasation of insufflated carbon dioxide to
retroperitoneal space and thorax
• Potential for postoperative airway compromise secondary to
subcutaneous emphysema and pharyngeal obstruction
• Increased incidence of acidosis due to absorption of carbon
dioxide
• Higher incidence of intraoperative oliguria potentially due to
perirenal pressure from pneumoperitoneum
• Potentially longer duration than open procedure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Know the dermatomes.

A

Nipple: T4

Lower end of scapula: T7

Belly: T10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the consideration for CYSTOSCOPY
for passage of a rigid scope through the urethra ?

A

Minor procedure may be done with 2% lidocaine jelly

Urethral stimulation, dilation and distention of bladder can be painful requiring general or regional anesthesia

If regional anesthesia is chosen a T9-T10 sensory level is required/ T8 for ureters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What type of scope is used in percutaneous nephrolithotomy?

A

Stones are removed via a rigid operating scope inserted in the
lower calyx of the kidney under fluoroscopy. Once located, calculi
are pulverized by using laser, electrohydraulic, or ultrasound probes placed directly on the stones.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are some of the complication of TURP?

A

Fluid overload

Water intoxication or Hypo-osmolality

Hyponatremia

Hemolysis

Coagulopathy/bleeding

bladder performation

infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are some complications of lithotripsy?

A

hemorrhagic lesions on the kidneys,secondary to vascular damage.

Perforation of the abdominal organs or vasculature.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the potential complication of the surgical position in nephrectomy?

A

Lateral-flex table and use kidney bar:

◦May cause vena cava compression and hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the different surgical methods for prostatectomy?

A

A retropubic prostatectomy describes a procedure that accesses the prostate by going through the lower abdomen and behind the pubic bone.

A suprapubic prostatectomy describes a procedure cuts through the lower abdomen and through the bladder to access the prostate.

A perineal prostatectomy is done by making an incision between the rectum and scrotum on the underside of the abdomen.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are some indications for cystoscopy for retrograde ureteral catheterization?

A

To visualize the ureter and kidney

To place stents

To drain obstructions

To remove renal calculi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What does TURP stand for?

A

transuretheral resection of the prostate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the management of bladder perforation?

A

• Stop surgery and achieve hemostasis.
• Treat hypotension with IV crystalloids, vasopressors, and
inotropes.
• Obtain a hematocrit. Start blood transfusion.
• Perform a cystourethrogram to locate the perforation.
• For most perforations, suprapubic cystotomy, an indwelling
Foley catheter, and (occasionally) ureteral stents are sufficient.
In some instances, immediate exploratory laparotomy may be
necessary to control bleeding and repair the perforation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the side effects of indigo carmine?

A

hypertension (d/t alpha receptor stimulating effect) and bradycardia

decreased oxygen saturation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Kidney transplant recipients may require surgery for nontransplant-related procedures. What are some of the surgical management goals?

A

Management involves maintenance of
adequate volume status, avoiding nephrotoxic medicines such as
nonsteroidal antiinflammatory drugs (NSAIDs) or contrast dyes,
and proper dosing of immunosuppressive drugs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is TURP syndrome?

A

It is a procedure-induced combination
of water intoxication, fluid overload, and hyponatremia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the S/S of bladder perforation during TURP?

A

shoulder discomfort, nausea, and vomiting

Blood loss, Hypothermia, bacteremia

suprapubic fullness, abdominal spasm and pain

hypertension, tachycardia, then hypotension

DIC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the surgical positions for prostatectomy?

A

Suprapubic and retropubic approach: supine, flex table and trendelenburg

Perineal approach: extreme lithotomy position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which prostatectomy approach has the greatest risk of hemorrhage?

A

Retropubic approach

Blood loss occurs during control of dorsal venous complex.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Define cold ischemia time.

A

Cold ischemia is the clamping of blood vessels with kidney cooling.

Ends: Perfusion of harvested organ with cold preservation solution; storage at 4°C

or

Perfusion by recipient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the preop goal of the renal transplant recipient?

A

K+ < 5.5 mEq/L

Coag studies and acid-base status normal

Serum creatinine < 10 mg/dL

BUN < 60 mg/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Define warm ischemia time.

A

Warm ischemia is the clamping of blood vessels without cooling the kidney in renal transplant.

Begins: Clamping of donor vessels or initial placement in
recipient

Ends: Vascular anastomosis in recipient or interrupted with
perfusion of cold preservation solution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the clinical manifestations of TURP syndrome?

A

Fluid overload: Hypertension, bradycardia, arrhythmia,
angina, pulmonary edema and hypoxemia

Water intoxication: Confusion and restlessness; twitching or
seizures, lethargy or coma, dilated,
sluggish pupils, papilledema, low-voltage
EEG, hemolysis
Hyponatremia: CNS changes as above, reduced inotropy,
widened QRS complex, low-voltage ECG,
T-wave inversion on ECG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are some of the indications for urologic procedures?

A

Performed to visualize and evaluate the upper and lower urinary tracts. To diagnose and treat such conditions as:

◦Hematuria

◦Pyuria

◦Calculi

◦Trauma

◦Cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What type of fluid should be given during transplantation?

A

0.9% NaCl

Avoid LR or any other K+ containing solution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What preparations must be taken by the recipient in the renal transplantation?

A

Must not be acutely ill.

Acute alterations in fluid and electrolyte balance should be corrected with dialysis carried out 24hours before transplantation. Postdialysis laboratory values should be checked.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What muscle relaxant should be used during renal transplantation?

A

Cisatracurium, owing to its Hoffman Elimination.

Succinylcholine can be used if K+ level is normal.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What type of anesthesia is preferred in renal transplantation?

A

General anesthesia. Regional can cause hypotension associated with sympathetic blockade, the length of the procedure, and heparinization of the kidney.

Due to the prolonged surgery, large amounts of sedation may be needed to supplement regional techniques

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

If TURP syndrome is detected intraoperatively, what should be the next course of action?

A

Control bleeding.

Comeplete surgery.

Diuretic.

Hypertonic solution.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the complications associated with ESWL?

A
  • Hypothermia, hyperthermia
  • Cardiac arrhythmias
  • Skin bruising hematomas
  • Petechiae, soft tissue
  • Renal hematoma
  • Lung injury
  • Flank pain
  • Hypertension, hypotension
  • Nausea, vomiting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the indications for orchiopexy, orchiectomy and urogenital plastic procedures

A

Performed to treat congenital malformation

Neoplasm

Impotence

Torsion of testicle

Supine or lithotomy

General or regional

T9 sensory needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the borderline sodium level for the development of severe reactions in hyponatremia?

A

120 mEq/L

32
Q

What sensory level should be blocked in spinal anesthesia for TURP?

A

T10 sensory level

33
Q

What is the consideration in providing steroids to impede organ rejection?

A

Infection from immunosuppression

34
Q

What is the indication for percutaneous nephrolithotomy?

A

When lithotripsy fails to resolve the stone or to remove kidney stones 20 mm or greater

35
Q

What are the indications for radical cystectomy?

A

Patient with invasive bladder tumors

Pelvic malignancies

Neurogenic bladder

Chronic lower urinary tract obstruction

Post radiation bladder dysfunction

Creation of a uretero-ileal anastomosis and ileostomy

36
Q

What is the indication for extracorporeal shock-wave
lithotripsy (ESWL)?

A

ESWL is used for stones less than 10 to 20
mm in the proximal or midureter.

37
Q

Why does TURP syndrome occur?

A

Venous absorption of irrigation fluid

Open sinuses provide direct communication to the circulation. The amount of solution absorbed into the systemic circulation depending on the amount of pressure and time of exposure

38
Q

What is the surgical position for nephrectomy and how is the incision made?

A

Lateral-flex table and use kidney bar

Performed by lateral retroperitoneal or anterior abdominal incision

39
Q

Why is spinal anesthesia preferred in TURP?

A

Early signs and symptoms of TURP syndrome, hypervolemia, and bladder perforation are more easily detected in a responsive patient.

The bladder will be atonic with a large capacity, thus glycine infusion pressure can be low, emptying less frequent, facilitating resection

Postoperative bladder spasm is prevented allowing for hemostasis

40
Q

Briefly describe how the kidney is attached to the recipient in renal transplant.

A

The donor kidney is placed extraperitoneally in the recipient’s iliac fossa. The renal artery is anastomosed to the internal iliac artery, the renal vein to either the external or the common iliac vein, and the ureter to the bladder.

41
Q

What is extracorporeal shock-wavelithotripsy (ESWL) and how is it delivered?

A

ESWL breaks upper urinary tract stones with external shock waves-cushion interface with skin or patient submersed in a tank of water.

The shock is delivered in synchronous with R wave on the ECG to prevent dysrhythmia.

Atropine or glycopyrrolate may be given to increase the heart rate and thus the shock-wave rate.

Adequate hydration and diuretics to help pass stone fragments.

42
Q

How is the donor’s kidney stored?

A

In a cold storage solution at 4 Celcius

Continuous perfusion of the kidney causing a pulsatile flow of cold preservation pumped at 40-60 mm Hg

Solution is glucose, potassium, magnesium, antibiotics, sodium bicarb, and heparin (can trigger hypersensitivy reaction in recipient)

43
Q

What drug is preferred to facilitate urinary output in renal transplantation?

A

Mannitol

44
Q

What is a complication of renal transplant and its signs/symptoms?

A

Graft rejection.

Oliguria, hyperkalemia, hypernatremia, hyperphosphatemia, fever.

45
Q

List the disadvantages of each irrigation solution in TURP.

A

Glycine: retinal toxic effect, encephalopathy (from ammonia conversion)

Mannitol: pulmonary edema, hyponatremia d/t hypervolemia

Sorbitol: hyperglycemia, lactic acidosis, hypokalemia

46
Q

What are some indications for nephrectomy?

A

◦Chronic infection

◦Trauma

◦Cystic or calculus disease

◦Neoplasm

47
Q

Is transfusion warranted if the transplant recipient is anemic?

A

In chronically anemic patients, blood transfusion is not needed if oxygen delivery is adequate.

If blood transfusion is required, it should be done with dialysis to avoid volume overload.

48
Q

What is the concern for hyponatremia?

A

Central pontine mylenolysis, also referred to as osmotic demyelination syndrome (ODS).

Symptoms usually occur ~1 week after the osmotic stress and may include seizures, palsy, dysarthria, paralysis, mental changes, and coma.

49
Q

What is the anesthetic goal in the management of the donor in renal transplant?

A

Adequate amounts of balanced salt solution and colloid bolus to ensure brisk diuresis

Maintenance of a Pao2 over 100 mmHg; normocapnia; hematocrit
30% or greater; and systolic blood pressure 100 mmHg or greater

50
Q

When is regional block contraindicated in renal transplant.

A

When there is preexisting coagulopathy and or immunosuppression

51
Q

What type of anesthesia does percutaneous nephrolithotomy require?

A

General anesthesia and post op hospitalization

52
Q

What are some contraindications to lithotripsy?

A

active urinarytract infection

uncorrected bleeding disorder or coagulopathy

distal obstruction

pregnancy.

53
Q

What is the indication for ureterorenoscopy (URS).

A

To remove stones in the distal ureters, of all sizes.

54
Q

Why is the use of 0.9% NaCl or LR discouraged in TURP?

A

Normal saline or Lactated Ringer’s solution is highly ionized and promotes dispersion of high current from the resectoscope.

55
Q

What is the consideration for a patient with pacemaker undergoing TURP?

A

The device must be converted to a fixed rate

56
Q

What opioids can be used during renal transplantation?

A

Fentanyl, sufentanil, alfentanil

(Not remifentanil)

57
Q

What is the treatment plan for hyponatremia in TURP?

A

Hypertonic saline (3% to 5% sodium chloride) at a rate no greater than 100 mL/hr.

Sodium correction should not exceed 0.5 mEq/L per hour or 8 mEq/day.

Severe symptoms may require initial doses of 1-2 mEq/L per hour.

Target level for correction is 120 mEq/L.

58
Q

What are some preoperative preparations for lithotripsy?

A

Discontinuation of aspirin-containing medications, anticoagulants, platelet inhibitors, and nonsteroidal antiinflammatory agents for 7 to 10 days before the procedure

59
Q

What is the position for cystoscopy and what are some potential nerve damages?

A

lithotomy position

◦Common peroneal: Compression of fibular head on leg brace

◦Saphenous: Compression of medial tibial condyle

◦Sciatic: Excessive external rotation of legs or excessive extension of the knees

◦Obturator and femoral: Excessive flexion of the groin

60
Q

What are some complications of cystectomy?

A

Hypothermia

Inadequate fluid replacement

peritonitis

Need for post op ventilation

61
Q

What are the two most common causes of ESRD?

A

Diabetes and HTN

62
Q

What is an obturator reflex?

A

Bladder rupture/injury secondary to adductor muscle contraction from obturator nerve stimulation from electrocautery. This risk is increased when resecting lateral wall tumors, as electrosurgical resection of these lesions is more likely to inadvertently stimulate the obturator nerve.

63
Q

Describe Transurethral resection of the bladder (TURBT) and its anesthesia management.

A

TURBT endoscopic resection and electrodesiccation are used to treat superficial bladder tumors

General anesthesia-no coughing or straining can cause bladder perforation

Regional anesthesia-the bladder becomes atonic and may become thinner when distended, increasing the risk of perforation

64
Q

What are the irrigating solutions for TURP?

A

Per powerpoint slide:

Glycine (1.5%), Sorbitol (3.3%), Mannitol (5%)

Per Nagelhout:

Cytal (sorbitol 2.7% and mannitol 0.54%), glycine 1.2% or 1.5%, or physiologic saline.

65
Q

What are some of the side effects/complications of methylene blue dye?

A

hypertension, headache, confusion, N/V, discoloration of urine, anemia, serotonin syndrome, hypoxia

66
Q

What three interrelated variables affect surgical
outcomes of renal transplant?

A

management of the donor

preservation of the harvested organ

perioperative care of the transplant recipient

67
Q

What is the surgical position in renal transplant?

A

Supine with a roll under the hip

68
Q

What diagnostic dyes are used to identify ureters?

A

Methylene blue

Indigo carmine

69
Q

What is the consideration in cystectomy?

A

Fluid shifting can be extensive-unable to monitor urine

Need for CVP and arterial line monitoring

Diuretics may be needed to stimulate output

Indigo carmine and Methylene Blue used at times

70
Q

Name two ways to protect the AV fistula in renal transplantation?

A

Do not insert an IV on the same side.

No blood pressure cuff on the same side.

71
Q

What is the surgical position in percutaneous nephrolithotomy?

A

prone or supine

72
Q

What are the preventive measures for TURP syndrome?

A

* avoid the Trendelenburg position as it promotes fluid absorption

*limit resection time to less than 1 hour

* keep the prostate capsule intact until the end of the resection

* place irrigating fluids less than 60 cm above the prostate gland

* measure electrolytes during and after the procedureas indicated;

* use a regional technique with light sedation so mental changes can be identified

73
Q

What are the early signs of venous absorption of the irrigation fluid during TURP?

A

hypertension and tachycardia

CVP may rise as cardiac decompensation occurs

Awake patient may complain of dyspnea or nausea

74
Q

Cardiac complications from hyponatremia begin to manifest at what sodium level?

A

115 mEq/L

75
Q

What is the indication of TURP and how does it work?

A

Neoplastic or obstructive prostate tissue is removed by electrosurgical resection under direct endoscopic vision

This is performed by application of a high-frequency current to a wire loop. Hemostasis is achieved by sealing the vessels with the coagulation current.

An optically clear, nonconductive, nonhemolytic, nontoxic solution is required to distend the bladder

76
Q

How long can the donor’s kidney be preserved?

A

With renal perfusion 72hours

Cold storage 48 hours before necrosis jeopardizes graft survival

APA Funds 2 (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions