Urologic Procedures

Question 1

What is considered the upper urinary tract?

Answer 1

Ureter

Kidney

Question 2

What is considered the lower urinary tract?

Answer 2

Bladder
Prostate
Urethra

Question 3

Urologic procedures are usually performed in the ________ position.

Answer 3

Lithotomy

Question 4

Common nerve injury when there is compression of the fibular head on the leg brace:

Answer 4

Common Peroneal nerve

Question 5

Common nerve injury when there is compression of the medial tibial condyle:

Answer 5

Saphenous Nerve (not lateral)

Question 6

Common nerve injury when there is excessive external rotation of the legs and/or excessive extension of the knees:

Answer 6

Sciatic Nerve

Question 7

Common nerve injury when there is excessive flexion of the groin:

Answer 7

Obturator and Femoral Nerve

Don’t forget pooling of blood) (500ccs in each leg

Question 8

The _________ reflex can cause bladder rupture/injury during electrocautery.

Answer 8

Obturator Reflex

> risk when resecting lateral wall tumors) (inadvertent stimulation of the obturator nerve

Question 9

If regional anesthesia is used for cystoscopy, what sensory level is appropriate?

Answer 9

T9-T10 (T8 for ureters)

Question 10

Dermatome Man

Slides 16-17

Answer 10

SLIDES 16-17

Question 11

What can cause a bladder perforation during TURBT?

Answer 11

Coughing or straining

Question 12

What problem can arise with a bladder perforation?

Answer 12

N/V
Shoulder discomfort
> risk of seeding into peritoneum if malignancy present.
Blood Loss
Hypothermia
Bacteremia
HTN and Tachycardia (early sign) followed by hypotension
DIC

Question 13

What must be avoided during a TURP to avoid the risk of bleeding?

Answer 13

Coughing

Question 14

What type of anesthesia is preferred for a TURP procedure?

Answer 14

Spinal anesthesia

Question 15

Complications of TURP

Answer 15

Blood loss

Venous absorption of irrigation fluid.

Question 16

What are early signs of venous absorption?

Answer 16

HTN
Tachycardia

(CVP may rise as cardiac decompensation occurs)
Awake opt may complain of dyspnea or nausea

Question 17

Hypoxia and/or hyponatremia causes what?

Answer 17

TURP SYNDROME
Water intoxication
Or GLYCINE TOXICITY

Question 18

3 irrigation solutions:

Answer 18

Glycine 1.5%
Sorbitol 3.3%
Mannitol 5%

Question 19

Pro and Con of Glycine:

Answer 19

Pro: < risk of TURP syndrome
Con: post-op blindness

Question 20

Pro and Con of Sorbitol:

Answer 20

Pro: < risk of TURP syndrome
Con: > BSG and lactic acidosis

Question 21

Pro and Con of Mannitol:

Answer 21

Pro: nonmetabolized?
Con: osmotic diuresis causes HYPERvolemia (lung and heart congestion) fluid pulled out of cells into vascular system

Question 22

TURP Syndrome ask surgeon to do what?

Answer 22

Control bleeding and finish surgery

Question 23

Do what with TURP syndrome?

Answer 23

Send blood sample, in serious shit if if Na less than 120 mEq/L

Give hypertonic solutions

Question 24

What common finding with TURP syndrome?

Answer 24

Hypervolemia and hyponatremia (correct with fluid restriction and diuretics (furosemide 10-20 mg)

Postpone is Na < 125

Question 25

What is a must with open prostate (radical prostatectomy)

Answer 25

Large IV (A MUST MUST!)

50% risk for impotence

Question 26

Radical prostatectomy has an > risk for bleeding the the ______ approach.

Answer 26

Retropubic approach

Question 27

Methylene blue 1% can cause ____________. What happens to SaO2?

Answer 27

HYPOTENSION

SaO2 down to 65% for 1-2 minutes.

Methylene blue has a greater effect than indigo.

Question 28

Indigo carmine dye 0.8% has ___________ effect which __ BP

Answer 28

Alpha sympathomimetic, >

Question 29

Indications for nephrectomy:

Answer 29

Chronic infection
Trauma
Cystic or calculus disease
Neoplasm

Question 30

Nephrectomy using the lateral-flex table and use of kidney bar can…

Answer 30

Cause vena cava compression and hypotension

Question 31

Optimize and correct what with renal transplants:

Answer 31

Optimize serum K levels and metabolic acidosis

Question 32

What is common with renal transplant patients?

Answer 32

Anemia

Question 33

Dont use ______ with renal transplant pts, use _________ with general anesthesia.

Answer 33

No anectine, use atracurium.

Question 34

What type of IV solution to use with renal transplant patients.

Answer 34

NSS

Avoid LR and K+

Question 35

What helps to discourage rejection and diuresis with renal transplant patients?

Answer 35

Methyl prednisone and diuretics

Low dose dopamine if oliguric

Question 36

Complications of renal transplant surgery:

Answer 36

> K
Delayed renal function
Graft failure

Question 37

How to preserve kidney?

Answer 37

Cold storage (4 degrees C)
Cold pulsatile flow at 40-60 mm Hg

Question 38

what is POPS?

Answer 38

Portable Organ Preservation System (> time frame)

Used to be 24 hours
Now 72 hours with perfusion

Cold storage 48 hours

Question 39

Anesthetic considerations with radical cystectomy:

Answer 39

Supine position
Large IV
A-line and CVP (fluid shifting)
Diuretics to stimulate Urine output
Indigo carmine and Meth Blue used

Question 40

Complication of radical cystectomy (bladder removal)

Answer 40

Hypothermia
Inadequate fluid replacement
Need for post op ventilation

Question 41

Orchidopexy, Orchiectomy

Answer 41

T9 sensory needed

Removal of testicles

Question 42

Extracorporal Shock Wave Lithotripsy (ESWL)

Answer 42

External shock waves to break up stones

Lithotomy for stent placement

Lasix in room to flush out stones

No R on T ‘bang bang’. —>SVT