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APA/Foundations 2 > Urologic Procedures - Rupp > Flashcards

Urologic Procedures - Rupp Flashcards

1
Q

5 conditions that can be diagnosed via urologic endoscopy procedures

A
  1. Hematuria
  2. Pyuria
  3. Calculi
  4. Trauma
  5. Cancer
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2
Q

5 nerves commonly injured r/t lithotomy position during urologic procedures

A
  1. Common perineal
  2. Saphenous
  3. Sciatic
  4. Obturator
  5. Femoral
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3
Q

Nerve injured by compression of fibular head on leg brace

A

Common peroneal nerve

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4
Q

Nerve injured by compression of the medial tibial condyle

A

Saphenous nerve

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5
Q

Nerve injured by excessive external rotation of legs or excessive extension of the knees

A

Sciatic Nerve

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6
Q

Nerves injured by flexion of the groin (surgeon leaning on leg)

A
  1. Obturator nerve

2. Femoral nerve

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7
Q

What is the obturator reflex?

A

electrocautery stimulates obturator nerve –> adductor muscle contracts –> bladder ruptures/is injured

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8
Q

What procedure has increased risk of obturator reflex? Why?

A

Resection of lateral wall tumors

Electrosurgical resection of these lesions is more likely to inadvertently stimulate the obturator nerve

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9
Q

Which procedure consists of a rigid scope passed through the urethra?

A

cystoscopy

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10
Q

If regional anesthesia is chosen for cystoscopy, what level of sensory block is required?

A

T9-T10

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11
Q

What spinal level should be blocked for a cystoscopy involving the ureters?

A

T8

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12
Q

4 reasons to perform cystoscopy for retrograde ureteral catheterization

A
  1. To visualize the ureter and kidney
  2. To place stents
  3. To drain obstructions
  4. To remove renal calculi
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13
Q

What is a TURBT?

A

Transurethral Resection of Bladder Tumor

Endoscopic resection and electrodessication used to treat superficial bladder tumors

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14
Q

Why is General anesthesia beneficial for a TURBT?

A

Coughing or straining may cause bladder perforation

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15
Q

What is the risk associated with regional anesthesia for a TURBT?

A

Increased risk of perforation

bladder becomes atonic and may become thinner when distended

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16
Q

S/S bladder perforation in an awake pt (who had regional anesthesia)

A
  1. Shoulder discomfort
  2. N/V
  3. Suprapubic fullness
  4. Abd spasm
  5. Pain
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17
Q

4 Risks associated with bladder perforation

A
  1. If high-grade malignancy present: risk of seeding it into the peritoneum
  2. Blood loss
  3. Hypothermia (cold fluid in peritoneal cavity)
  4. Bacteremia
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18
Q

How do decrease risk of vasoconstriction R/T bladder perforation?

A

Warm the irrigation fluid

Cool irrigation causes vasoconstriction and systemic cooling

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19
Q

What leads to DIC after bladder perforation?

A

release of prostatic thrombogenic substances, especially w prostate CA

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20
Q

Characteristics required for fluid with which the distend the bladder during a TURP

A
  1. Optically clear
  2. Nonconductive
  3. Nonhemolytic
  4. Nontoxic
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21
Q

Advantage to general anesthesia for a TURP

A

coughing must be avoided because it increases the risk of bleeding

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22
Q

Benefits of spinal anesthesia for a TURP

A

Bladder will be atonic with a large capacity therefore:

  • glycine infusion pressure can be low
  • emptying can be less frequent
  • facilitates the resection
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23
Q

Preferred type of anesthesia for a TURP

A

Spinal

b/c of benefits and away pt can supply early detection of complications

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24
Q

How to prevent post-op bladder spasm after TURP

A

allow for homeostasis

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25
Complications of TURP
1. Blood loss | 2. Venous absorption of irrigation fluid
26
How does venous absorption of irrigation fluid occur during a TURP and on what does it depend?
open sinuses provide direct communication to the circulation depends on pressure and time of exposure
27
Early signs of venous absorption during TURP
HTN | Tachycardia
28
During venous absorption during TURP, CVP may rise as ___________ occurs
cardiac decompensation
29
In the event of venous absorption during a TURP, and awake pt may complain of:
1. Dyspnea/SOB | 2. Nausea
30
2 causes of TURP syndrome after venous absorption
Hypoxia and/or hyponatremia
31
Late stages of TURP syndrome/water intoxication/glycine toxicity
1. apprehension 2. disorientation 3. convulsions 4. coma
32
3 irrigating solutions used for TURP
1. Glycine 2. Sorbitol 3. Mannitol
33
Which irrigation solution for TURP can cause transient post-op visual impairment/blindness but carries a decreased likelihood of TURP syndrome?
Glycine
34
Which irrigation solution for TURP can cause hyperglycemia and lactic acidosis but is is less likely to cause TURP syndrome?
Sorbitol
35
Which irrigation solution for TURP is non metabolized and causes osmotic diuresis?
Mannitol
36
Does the osmotic diuresis from Mannitol cause hyper- or hypo-volemia? Why?
Hypervolemia It draws fluid into the vascular spaces
37
How to treat TURP Syndrome
1. Ask surgeon to control bleeding and finish surgery 2. Send a blood sample 3. Fluid restrictions and diuretics (10-20 mg Lasix) to correct hypervolemia and hyponatremia 4. Hypertonic solutions to correct HypoNa 5. Give NS or LR if Na >125 (don't give if Na <125)
38
Below what Na should a TURP be postponed?
125
39
Which approach to open radical prostatectomy carries increased risk for hemorrhage?
Retropubic Approach | supine, flex table, and trendelenberg
40
From where does most of the blood loss during open prostatectomy come from?
Dorsal venous complex
41
Although regional and general anesthesia are both appropriate for open radical prostatectomy, what is a MUST in either case?
Large IV
42
Which position for open radical prostatectomy poses a very high risk for post-op blindness? How can this be prevented?
Perineal approach (extreme lithotomy position) Keep BP up and don't let pt get HoTN
43
Which procedure cares a 50/50 chance that the pt will never have another erection?
Radical Open Prostatectomy
44
What are the effects of Methylene blue dye?
HoTN and sat falsely down to 65% for 1-2 min
45
What are the effects of indigo carmine dye 0.8%?
alpha sympathomimetic effect - increases BP
46
Which dye used for open radical prostatectomies has a greater effect, Methylene blue or indigo?
Methylene blue
47
Indications for nephrectomy
1. Chronic infection 2. Trauma 3. Cystic or calculus dz 4. Neoplasm
48
What may result from the lateral-flex table and kidney bar used for nephrectomy positioning?
vena cava compression and HoTN
49
2 lab values that should be optimized prior to renal transplant
serum K should be normal metabolic acidosis should be corrected
50
common disorder present in renal transplant its
anemia
51
Best NMB to use for renal transplant pts
atracurium (or cisatracurium for any renal pt) definitely not succs
52
contraindications to regional anesthesia for renal transplant
1. preexisting coagulopathy | 2. immunosuppression
53
Adequate hydration is critical in a renal transplant pt. what types of fluid should be used for revascularization of the kidney? What should not be used?
1. Crystalloid (NS) 2. Colloid 3. Blood avoid LR
54
What drugs help discourage rejection and diuresis during renal transplant?
methylprednisone | diuretics
55
What should be used if a renal transplant pt becomes oliguric?
low dose dopamine
56
complications of renal transplant
1. hyper K 2. delayed renal fx 3. graft failure
57
how long can a donor kidney be considered viable if preserved with the POPS (portable organ preservation system)?
72 hrs
58
how long can a donor kidney be considered viable if preserved by cold storage?
48 hrs past that point, necrosis will jeopardize graft survival
59
What monitoring devices should be used during a radical cystectomy?
Arterial line | CVP
60
Why is CVP important during a radical cystectomy?
Fluid shifting can be extensive and UOP cannot be monitored
61
Complications of radical cystectomy
1. hypothermia 2. inadequate fluid replacement 3. need for post-op ventilation
62
If a regional is used for orchidopexy, orchiectomy, or urogenital plastic procedure, up to what sensory level should be blocked?
T9
63
What procedure will likely make a child infertile?
Orchiectomy
64
Common co-existing medical problems in patients receiving AV shunts or fistulas?
Anemia CAD DM
65
procedure that breaks upper urinary tract stones with external shock waves; includes a cushion interface with skin or pt is submersed in a tank of water
ESWL - Extracorporal Shock Wave Lithotripsy
66
What triggers the shock delivered during ESWL?
QRS
67
What is important to help pt pass stone fragments after ESWL?
very adequate hydration and diuretics

APA/Foundations 2 (6 decks)

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