Urologic Procedures Flashcards
What anatomical parts are considered upper urinary tract?
Ureter and Kidney
What anatomical parts are considered lower urinary tract?
Bladder, prostate, urethra
What common nerve injuries occur during urological procedures?
- Common peroneal
- Saphenous
- Sciatic
- Obturator
- Femoral
What positioning method/device causes common peroneal nerve injury?
Compression of fibular head on leg brace
What nerve would be damage by compression of medial tibial condyle?
Saphenous nerve
What two positioning methods/techniques would cause sciatic nerve injury?
- Excessive external rotation of legs
2. Excessive extension of the knees.
What nerves could be injured by excessive flexion of the groin?
Obturator and femoral nerves
What happens to BP at end of lithotomy positioned case and patient is moved supine?
Hypotension
Which nerve can be inadvertently stimulated during electrocautery?
Obturator nerve
What procedure is associated with more likely inadvertent stimulation of the obturator nerve?
Resection of lateral wall tumors
What complication can be caused by obturator nerve stimulation?
Bladder rupture/injury
What dermatome level needs sensory block for cystoscopy?
T9-10, T8 for ureters
What 4 things would retrograde ureteral catherterization via cystoscopy be performed for?
- To visualize the ureter and kidney
- To place stents
- To drain obstructions
- To remove renal calculi
What is a TURBT?
Transurethreal resection of bladder tumor
What complications can regional anesthesia create for TURBT?
The bladder becomes atonic and may become thinner when distended, increasing the risk of perforation
What are signs and symptoms of bladder perforation?
- Shoulder discomfort
- N/V
- Blood loss
- Hypothermia
- Bacteremia
- Risk of seeding malignant cells into peritoneum.
What are intraop/postop risks of bladder perforation?
- Suprapubic fullness, abd spasm, and pain
- HTN and tachycardia are early, followed by severe hypotension
- Blood loss
- Hypothermia
- Bacteremia
- Risk of seeding malignant cells into peritoneum.
What is a TURP?
Transurethral resection of the prostate
How is a TURP performed?
Application of high frequency current to a wire loop.
What type of anesthesia should be done for TURP?
GA and/or Spinal
What are the benefits to doing a spinal for TURP?
- Bladder will be atonic w/ large capacity.
- Postoperative bladder spasm is prevented allowing for hemostasis
- Awake patients may supple early detection of complications.
What are the two biggest complications of TURP?
- Blood loss
2. Venous absorption of irrigation fluid.
What can venous absorption lead to in TURPs?
TURP Syndrom=Water intoxication=Glycine toxicity
What are signs of venous absorption during TURP?
- Early signs= HTN and tachy
- CVP may rise
- Awake pt= c/o dyspnea or nausea
- Leads to hypoxia and/or hyponatremia
- Ultimately leads to apprehension, disorientation, convulsions, and coma
What three solutions are typically used at irrigating solutions during TURP?
- Glycine 1.5%
- Soribitol 3.3%
- Mannitol 5%
Which irrigation solution is most likely to cause TURP syndrome?
Mannitol
Which irrigation solution can cause hyperglycemia and lactic acidosis?
Sorbitol
Which irrigation solution can cause Transient post-op visual impairment (blindness)?
Glycine
Which irrigation solution can cause osmotic diuresis?
Mannitol
Does mannitol lead to hypovolemia or hypervolemia first?
Hypervolemia
What perop lab is VITAL to obtain prior to TURP?
Sodium
What is the cutoff for serum Na+ prior to TURP?
<125mEg/l
What is the treatment for TURP syndrome with hypervolemia and hyponatremia?
Fluid restriction and diuretics (lasix 10-20mg)
What are the first two steps immediately after diagnosing TURP syndrome intra-operatively?
1st. Ask surgeon to control bleeding and finish surgery
2nd. Send blood sample to check serum Na+
Which prostatectomy approach has more hemorrhage risk?
Retropubic approach
Which prostatectomy approaches utilize the supine/trendelenburg position?
Suprapubic and retropubic
Which prostatectomy approach utilizes the extreme lithotomy position?
Perineal approach
What post-operative complication is of significance with radical prostatectomy?
Impotence
What is the frequency of impotence following radical prostatectomy?
50%
What two things can be caused by methylene blue administration during radical prostate?
- Hypotension
2. SaO2 drop to 65-85%
What affect does indigo carmine dye have on BP?
Increase in BP
What side effect may the use of the kidney bar have during nephrectomy ?
Hypotension and vena cava compression
What NMBA should be used on renal transplant recipients?
Preferably cisatracurium. Rocuronium has bad renal clearance and succinylcholine may increase serum K+
T/F: Regional anesthesia is an excellent choice for renal transplant recipients?
False; regional is contraindicated by preexisting coagulopathy and/or immunosuppresision.
What type of fluid should be used during a renal transplant case?
NS; avoid LR and K+ containing fluids
What medications should be used for oliguria with renal transplant recipients?
Dopamine and adequate hydration
Why might a CVP be specifically helpful for radical cystectomies?
Because unable to monitor urine output
What are three big complications of radical cystectomies?
- Hypothermia
- Inadequate fluid replacement
- Need for post-op ventilation
What are typically coexisting medical problems for patients have A/V fistula placed?
- Anemia
- CAD
- Diabetes
- HTN
- Severely out of whack labs
What two things intra-op and post-op are vital to helping pass stone fragments following ESWL?
Adequate hydration and diuretics
