Urological Procedures - Quiz 2 Flashcards
What is the patient position for urological procedures?
Lithotomy
Risk for Common Peroneal, Saphenous, Sciatic, Obturator, and Femoral nerve injury
How does the Lithotomy cause Common Peroneal nerve injury?
Leg brace compresses Fibular Head
How is the Saphenous nerve injured in Lithotomy?
Compression of Medial Tibial Condyle
Excessive external rotation of legs & extension of knees in the Lithotomy position causes damage to which nerve?
Sciatic Nerve
In Lithotomy position, how is the Obturator and Femoral nerve injured?
Excessive Groin Flexion
Elevated legs can cause blood pooling
How could the Obturator Reflex potentially be harmful during Urological Procedures?
Accidental electrosurgical stimulation of Obturator nerve can cause adductor muscle contraction leading to Bladder Rupture.
Especially during Lateral Wall Tumor Resection
What is needed in Cystoscopy for a passing rigid scope?
Urethral stimulation, dilation, & bladder distension
Regional or General for pain
Regional @ T9-T10 (T8 for Ureters)
2% Lidocaine Jelly
When is Cystoscopy for Retrograde Ureteral Cath indicated?
Visualization of Upper Urinary Tract
Stent Placement
Drain Obstructions
Calculi Removal
What procedure is done to treat Superficial Bladder Tumors?
Transurethral Resection of the Bladder (TURBT)
What should be avoided during a TURBT?
Coughing/Straining - bladder perf
How does Regional Anesthesia affect the bladder?
Atonicity & thinning of bladder = more perf risk
What can happen due to a Bladder Perf?
Shoulder Pain
N/V
Spreading of Malignancy to Peritoneum
Blood Loss
Hypothermia
Bacteremia
Possible convert to Open Procedure
What should you suspect if a patient complains of Suprapubic Fullness, Abdominal spasms, and pain?
Bladder Perforation
What are the early signs of a Bladder perf?
HTN & Tachycardia, then, severe Hypotension
With a Bladder Perf, what can be triggered by release of Prostatic Thrombogenic Substances, especially w/ Prostate Cancer?
DIC
What does a TURP procedure entail?
Endoscopic electrosurgical resection of obstructive prostate tissue or tumor using a high frequency wire loop.
How is the bladder distended for a TURP procedure?
Distend bladder w/ nonconductive, nonhemolytic, nontoxic solution
How is homeostasis achieved during a TURP?
Coagulation current seals vessels
Why is Spinal Anesthesia preferred over General Anesthesia for a TURP?
Avoids Cough & Bleed
Atonic Bladder w/ Large Capacity
Less Post-Op Bladder Spasms
Awake patients can voice complications
What are the main complications of a TURP?
Blood Loss
Venous Absorption of Irrigation Fluid
TURP Syndrome
What are the signs and symptoms of Venous Absorption of Irrigation fluid?
Early: HTN & Tachycardia
↑CVP
Dyspnea
Nausea
Hypoxia
Hyponatremia
What is TURP Syndrome?
Water Intoxication Or Glycine Toxicity
Apprehension
Disorientation
Convulsions
Coma
What are the Irrigation Solutions used for TURPs?
Glycine (1.5%)
Sorbitol (3.3%)
Mannitol (5%)
What are the Disadvantages of using the TURP Irrigation Fluids?
- Glycine = Post-Op Vision Problems
- Sorbitol = Hyperglycemia & Lactic Acidosis
- Mannitol = Osmotic Diruesis & Hypervolemia
How should TURP Syndrome be managed?
Tell MD to control Bleeding & Finish
Draw Sodium Level
Fluid Restriction
Lasix
Hypertonic Solutions
50% of Radical Prostatectomy cases result in what?
Impotence
What are the positions used for a Radical Prostatectomy?
Supine, Trendelenburge, Flex Table for Supra/Retropubic approach
&
Extreme Lithotomy for Perineal approach
(Hemmorrhage Risk)
During which period of a Radical Prostatectomy would you be most concern for Blood Loss?
During Control of Dorsal Venous Complex
During a Radical Prostatectomy, what can be used to Identify Ureters?
- Methylene Blue 1% - Hypotension
- Indigo Carmine 0.8% - Pressor Effect
- Both can cause a lower O2 Sat Reading to 65% for 2 min, but more so for Methylene
When is a Nephrectomy indicated?
Chronic Infections
Trauma
Cystic/Calculus Disease
Neoplasms
What is invovled in a Nephrectomy?
Lateral-Flex Table
Kidney Bar
Lateral Retroperitoneal Incision
Anterior Abdominal Incision
What is a concern when using a Kidney Bar during a Nephrectomy?
Vena Cava Compression & Hypotension
How should the patient be positioned for a Renal Transplant?
Supine w/ Role under hip
Which NMBs should not be used for Renal Transplants?
Sux & Atracurium
How is a Renal Transplant done?
Kidney connected to External Illac Arteries or Prior Nephrectomy
&
Ureteral Anastomosis
_________ Anesthesia is contraindicated in the presence of Coagulopathy or Immunosuppression for Renal Transplants
Regional Anesthesia is contraindicated in the presence of Coagulopathy or Immunosuppression for Renal Transplants
Which fluids should not be used for hydration during Renal Transplants?
LR & Fluids containing Potassium
Which drugs can help w/ Renal Transplant rejection & Diuresis?
Methylprednisone & Diuretics
If the patient is oliguric once the new kidney is transplanted, what can be given?
Low dose dopamine
What are Renal Transplant complications?
Graft Failure
Hyperkalemia
Delayed Renal Fxn
What can be used to preserve the Kidney for transplant and how long would the kidney last?
POPS - Portable Organ Preservation System
72 hrs w/ renal perfusion @ 40-60 mmHg
48 hrs w/ cold storage @ 4° C
When is a Radical Cystectomy indicated?
Invasive Bladder Tumors
Pelvic Cancer
Neurogenic Bladder
Chronic Lower Urinary Tract Obstruction
Post Radiation Bladder Problems
What is the end result of a Radical Cystectomy?
Uretero-Ileal Anastomosis & Ileostomy
What are the Anesthetic Considerations for a Radical Cystectomy?
Supine Position
A-Line
CVP
Diuretics
Dyes
What are the Complications of a Radical Cystectomy?
Hypothermia
Inadequate Fluids
Post-Op Ventilation
When are Orchidopexy or Orchiectomy Indicated?
Congenital Malformations
Neoplasms
Impotence
Testicle Torsion
What kind of anesthesia is needed for an Orchidopexy or Orchiectomy?
General or Regional
T9 Sensory Block
Supine/Lithotomy Position
How does Extracorporal Shock Wave Lithotripsy (ESWL) work?
- Shocks upper urinary tract stones while patient is in water
- Triggered by QRS on R-WAVE
- Lithotomy, then Supine
- Fluids & Diuretics to flush stone fragments
