urologic procedures Flashcards
what makes up the upper urinary tract
ureter and kidney
what makes up the lower urinary tract
bladder, prostate, urethra
how does CP nerve injury happen
compression of fibular head on leg brace
how does saphenous nerve injury happen
compression of medial tibial condyle
how does sciatic nerve injury happen
excessive external rotation of legs, excessive extension of the knees
what spinal level is needed for cystoscopy
T9-T10/ T8 for ureters
indications for cysto
retrograde ureteral cauterization, to visualize the ureter and kidney, to place stents, to drain obstructions, to remove renal calculi
TURBT stands for
transurethral resection of the bladder
TURBT indicated for
resection and electrodesication are used to treat superficial bladder tumors
how does the risk of perforation increase when doing a TURBT under regional
the bladder becomes atonic and may become thinner when distended, increasing the risk of perf
how does bladder perf present in the awake patient
shoulder discomfort, nausea, vom, suprapubic fullness, abd spasm and pain
bladder perf consequences
blood loss, hypothermia, bacteremia, spreading high grade malignancy into the peritoneum
bladder perf cv signs
htn and tachycardia are early signs, followed by severe hypotension
bladder perf : cool irrigation causes vaso___, give what to decrease the risk
constriction, give warm fluids
bladder perf causes what clotting abnormality
DIC triggered by release of prostatic thrombogenic substances - esp with cancer of prostate.
what spinal level do you need for TURP
T10
obturator reflex
bladder rupture/ injury secondary to adductor muscle contraction from obturator nerve stimulation from electrocautery
blood loss estimation in TURP
2-5ml of resection time
early signs of TURP
hypertension and tachycardia - think fluid overload
absorbed volume estimate in TURP
10-30ml of resection time
TURP resection time should be limited to
1h
height of TURP solution should be kept no more than ___cm above the OR table in the beginning of the case and no more than ___ above the OR table towards the end
30, 15
sorbitol causes
hyperglycemia and lactic acidosis
mannitol causes
nonmetabolized, osmotic diuresis causing hypervolemia [fluid overload, CHF]
first sign of TURP syndrome may be
change in mental status d/t hyponatremia
turp syndrome circulatory overload symptoms
htn, reflex brady, CHF, pulm edema, dysrhythmias, MI
classic triad TURP syndrome
htn (with increased pulse pressure, bradycardia (reflex), AMS
hypervolemia and hyponatremia is treated with
fluid restriction and diuretics (lasix 10-20mg)
postpone procedure if sodium is
125
open prostate - radical prostatectomy - more hemorrhage occurs with ____ approach
retropubic
methylene blue 1% can cause
hypotension
indigo carmine dye 0.8% has an ____ effect
alpha sympathomimetic , increases BP
pulse ox for dyes
65% (false low)
methyl blue has a ____ effect than indigo
greater
nephrectomy - use lateral-flex table and kidney bar - concerns
vena cava compression and hypotension (d/t decreased venous return)
what conditions are common in pt needing kidney transplant
anemia, hyperK, metabolic acidosis, hypocalc
why would regional be contraindicated in renal transplant patient
preexisting coagulopathy and or immunosuppression
complications of renal transplant
hyperkalemia, delayed renal function, graft failure
temp for kidney preservation
4 degrees C
preservation of kidney with renal perfusion:
72 hours
preservation of kidney with cold storage
48 hours before necrosis jeopardizes graft survival
radical cystectomy is done in what position
supine
what is the main concern with radical cystectomy
fluid shifting - need CVP
radical cystectomy complications
hypothermia, inadequate fluid replacement, need for post op ventilation
what position for orchiopexy
supine or lithotomy
what sensory level block needed for orchiopexy
T9
position for AV fistula/ shunts
supine with arm extended
ESWL - pulse wave is timed to the ___ wave
R
absolute contraindications to ESWL
pregnancy, risk of bleeding
