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APA - 2 > Urologic Procedures > Flashcards

Urologic Procedures Flashcards

1
Q

Endoscopy is performed to visualize and evaluate the upper and lower urinary tracts. To diagnose and treat such conditions as (5)

A 
Hematuria
Pyuria
Calculi
Trauma
Cancer
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2
Q

Upper urinary tract

A

Ureter and Kidney

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3
Q

Lower urinary tract

A

Bladder, prostate, urethra

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4
Q

What nerve injuries are common when doing urologic procedures?

A 
Common peroneal
Saphenous
Sciatic
Obturator
Femoral
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5
Q

What position are urologic procedures usually performed in?

A

Lithotomy

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6
Q

How does the common peroneal nerve get injured?

A

compression of fibular head on leg brace

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7
Q

How does the saphenous nerve get injured?

A

Compression of medial tibial condyle

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8
Q

How does the sciatic nerve get injured?

A

Excessive external rotation of legs

Excessive extension of the knees

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9
Q

How does the obturator and femoral nerve get injured?

A

excessive flexion of the groin

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10
Q

What happens to circulating blood when in lithotomy position?

A

Blood pools in the trunk - when legs put down BP drops even further

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11
Q

What is the 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.

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12
Q

Definition of cystoscopy

A

passage of a rigid scope through the urethra

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13
Q

Cystoscopy is a minor procedure and may be done with

A

2% lidocaine

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14
Q

Urethral stimulation, dilation and distention of bladder can be painful requiring general or regional anesthesia. If regional anesthesia is chosen a ______ sensory level is required/ ____ for ureters

A

T9-T10

T8 ureters

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15
Q

When doing a spinal, where is the sensory and motor levels?

A

Sensory 2 levels higher

Motor 2 levels lower

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16
Q

What are the cardiac accelerators

A

T1-T4

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17
Q

Cystoscopy for retrograde ureteral catheterization

A

To visualize the ureter and kidney
To place stents
To drain obstructions
To remove renal calculi

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18
Q

What is a TURBT

A

Transurethral resection of the bladder

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19
Q

What is a TURBT used to treat

A

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

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20
Q

What type of anesthesia would you use for a TURBT?

A

General anesthesia-no coughing or straining can cause bladder perforation

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21
Q

Why shouldn’t you use regional anesthesia for a TURBT?

A

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

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22
Q

If a bladder ruptured and entered the peritoneal cavity, what would you see?

A

shoulder discomfort, nausea, and vomiting may occur in the awake patient

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23
Q

If there was a high grade malignancy and the bladder ruptured - what could happen?

A

risk of seeding it into the peritoneum

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24
Q

What are some other risks from a bladder rupture?

A

Blood loss
Hypothermia (cold fluid into peritoneum)
bacteremia

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25
Q

If there is a bladder perforation on an awake patient, what will that tell you

A

suprapubic fullness, abdominal spasm and pain

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26
Q

What are the early and late signs of bladder rupture

A

Htn and tachycardia are early signs followed by severe hypotension

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27
Q

What does the cool irrigation cause?

A

Cool irrigation causes vasoconstriction-systemic cooling—warm fluids will decrease this risk

28
Q

How is DIC triggered with bladder rupture?

A

triggered by release of prostatic thrombogenic substances-especially with cancer of prostate

29
Q

What is TURP

A

Transurethral resection of the prostate

30
Q

How is a TURP performed

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.

31
Q

What type of solution is required to extend the bladder for a TURP

A

An optically clear, nonconductive, nonhemolytic, nontoxic solution

32
Q

What type of anesthetic is used for a TURP

A

General anesthesia-coughing must be avoided increase the risk of bleeding
Spinal anesthesia is preferred r/t benefits provided

33
Q

Benefits of a spinal for TURP

A

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

Awake patients may supply early detection of complications

34
Q

Complications of TURP

A

Blood loss
Venous absorption of irrigation fluid-open sinuses provide direct communication to the circulation-depending on pressure time of exposure

35
Q

Venous absorption: early signs

A

hypertension and tachycardia

36
Q

Venous absorption: CVP may rise as

A

cardiac decomposition occurs

37
Q

Venous absorption: awake patients make complain of

A

dyspnea or nausea

38
Q

Hypoxia and /or hyponatremia causes what??????????

A

TURP syndrome

39
Q

What is TURP syndrome

A

WATER INTOXICATION—OR GLYCINE TOXICITY

Apprehension(spinal), disorientation (spinal), convulsions, and coma (spinal)

40
Q

What are the 3 types of irrigation solutions?

A

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

41
Q

Disadvantage of glycine

A

can cause transient post-op visual impairment (blindness)

less likelihood of TURP syndrome

42
Q

Disadvantage of sorbitol

A

can cause Hyperglycemia and lactic acidosis

43
Q

Disadvantage of mannitol

A

nonmetabolized, osmotic diuresis causing hypervolemia

44
Q

What to do for TURP syndrome

A

Ask surgeon to control bleeding and finish surgery
Send blood sample-if decrease in serum SODIUM less than 120 mEq/l- serious
Hypervolemia and hyponatremia correct with fluid restrictions and diuretics ( furosemide 10-20 mg)
Hyponatremia give hypertonic solutions correct cautiously
Normal saline or ringer’s lactate—postpone if sodium <=125 mEq/l

45
Q

Why are Open prostate- radical prostatectomy emotional?

A

50% chance of impotence

46
Q

2 positions for open prostate - radical prostatectomy

A

Suprapubic (retropubic) approach, supine, flex table, and trendlenburg - (MORE HEMORRHAGE)

Perineal approach, extreme lithotomy position

47
Q

When does the blood loss occur?

A

during control of dorsal venous complex

48
Q

T/F: Large IV is a must

A

TRUE!!!

49
Q

Diagnostic dyes used to identify ureters
What happens with each dye?

Methylene blue 1%
Indigo carmine dye 0.8%

A

Methylene blue 1% - CAN CAUSE HYPOTENSION

Indigo carmine dye 0.8% has an alpha sympathomimetic effect increase BP

50
Q

What happens to SaO2 with the dye

A

SaO2 down to 85%

Sao2 down to 65% for 1-2 minutes
Methylene blue greater effect than indigo

51
Q

Indications for a nephrectomy

A

Chronic infection
Trauma
Cystic or calculus disease
Neoplasm

52
Q

What position and table do you use for a nephrectomy?

A

Performed by lateral retroperitoneal or anterior abdominal incision

Lateral-flex table and use KIDNEY BAR
May cause vena cava compression and hypotension
General or combined general regional

53
Q

What type of anesthetic is contraindicated in renal transplant and why?

A

Regional contraindicated by preexisting coagulopathy and or immunosuppression

54
Q

What fluids do you use for a renal transplant?

A

normal saline— avoid LR and K+

Adequate hydration is critical use crystalloid, colloid and blood for revascularization of the kidney

55
Q

What does Methyl prednisone and diuretics do for transplant patients?

A

to help discourage rejection and diuresis

56
Q

If still oliguric, what could you give?

A

Low dose dopamine

57
Q

Complications of renal transplant

A

Hyperkalemia
Delayed renal function
Graft failure

58
Q

Indications for a 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 &amp; ileostomy
59
Q

Anesthetic considerations for radical cystectomy

A

Done in supine position
General or combined anesthesia
Arterial and CVP
Large IV (duh)
Fluid shifting can be extensive-unable to monitor urine –need for CVP
Diuretics may be needed to stimulate output
Indigo carmine & Methylene Blue used at times

60
Q

Complications of radical cystectomy

A

Hypothermia
Inadequate fluid replacement
Need for post op ventilation

61
Q

Highlights for orchidopexy, 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

usually a child and making them sterile

62
Q

Highlights for A/V fistulas

A 
Access for dialysis
Patient lies supine with arm extended
General, regional and local infiltration all acceptable
Co-existing medical problems
Anemia
CAD
Diabetes
63
Q

Why is BP very labile with pts getting AV fistulas?

A

because they are chronic HTN - clamped down so with anesthetic = hypotension

64
Q

For ESWL - when is the shock delivered?

A

on the QRS
worried about R on T
“5,000 hits”

65
Q

If you see radical, what should you think?

A

large bore IV

APA - 2 (2 decks)

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