Urology Flashcards
What is the fascia renalis?
Capsule surrounding each kidney
Where do the renal artery and vein leave the kidney?
Hilum on medial side
How vascular is the kidney?
Uses 1 fifth of blood volume
Where do kidney stones form?
In renal pelvis or uteropelvic junction
What is used in renal stone surgery due to the vascularity of the kidneys?
Hypothermia
What is the most common post op problem?
Oliguria
What incisions are used to gain access to kidney?
Flank - transabdominal incision, possible removal of eleventh or twelfth rib
Lumbar incision - supine and then lateral
Thoracoabdominal - for large upper-pole neoplasms. Tenth and eleventh ribs usually removed, chest cavity opened, collapsing lung
What is a pyelotomy/pyelostomy?
Small incision made and renal pelvis and calyces can be explored.
For pyelostomy a malecot or foley is inserted into pelvis for drainage.
What is involved in a pyeloplasty?
Revision or reconstruction of renal pelvis.allows better flow from kidney to bladder. Temporary nephrostomy usually inserted until healing occurs.
What three types of nephrectomy are there?
Partial - kidney segment and ligation of blood supply
Simple - just kidney
Radical - kidney, capsule, adrenal gland, lymph nodes, perirenal fat.
What are the steps of laparascopic nephrectomy?
Three ports Free kidney Ligate artery fisrt then vein May have accessory vessels Abdominal incision to remove kidney (approx 10 cm long)
Preparation for pt receiving kidney transplant?
Hydration with iv fluid and mannitol
What are some characteristics for an ideal donor in kidney transplant cadaveric donor?
Young
Free of infection and cancer
Normotensive until death
Hospitalized several hours before death.
What does the medulla of the adrenal gland secrete?
Epinephrine
What does the cortex of the adrenal gland secrete?
Steroid and other hormones. Is influenced by pituitary gland
What is the blood supply to the kidney?
Inferior phrenic and renal arteries
Why might an adrenalectomy be preformed?
Hypersecretion of adrenal hormones
Neoplasms (abn tissue growth)
Secondary tx of neoplasms elsewhere that depend on adrenal hormones (breast ca, prostate ca, pheochromocytoma)
Where are the areas of narrowing in the ureters?
Ureteropelvic junction (pelvis of kidney and ureter meet) Crossing of ureter over external iliac vessels Uterovesicle junction
These areas are usually where stones sit
What is a uteroureterostomy?
Segmental resection of diseased portion of ureter with reconstruction
What is a uteroenterostomy?
Diversion of ureter into segment of ileum or sigmoid
How are renal calculi taken care of?
Usually pass on own
Lithotripsy (blasting/fragmenting stone)
Laser (uteroscopy retrieves stone)
Stent (hollow tube between kidney and bladder)
What is uretal reimplantation
Ureters dissected free and transferred to desired site of anastomosis. Can be done laparoscopically. Stent left in place until l healed
What is the name for the triangular area that forms base of bladder?
Trigone
Blood supply to bladder?
Artery- sup, mid, inf vesicle arteries
Venous - drains into internal iliac vein
What is a cystoscopy?
Endoscopic examination of lower urinary tract
What are some indications for a cystoscopy?
Hematuria Urinary retension Uti Cystitis Tumors Fistula Bladder stones Urinary incontinence
What is a cystometrogram?
Measures voiding pressure, muscle tone, nerve supply.
What is a suprapubic cystostomy?
Opening made into urinary bladder through low abdominal incision. Drainage tube inserted.
What is a transurethral resection of bladder tumors?
A resectoscope is passed through the urethra. Bladder lesion and portion of bladder muscle underlying lesion removed.
If there is deep muscle invasion of lesion then a cystectomy is required.
What irrigation solution is used for transurethral resection of bladder tumors? What type catheter is used after?
Sterile water
24 french
What is the Marshall-Marchetti-Krantz surgery?
Correction of stress incontinence cause by abnormal urethrovesicle angle. Brings bladder and urethra into pelvis by suturing paraurethral vaginal tissue to back of symphysis pubis.
Abdominal and vaginal prepping needed
What is the last measure for stress incontinence?
Implantation of prosthetic urethral sphincter. Pressure regulated resevoir. Cuff around urethra.
What is a radical cystectomy?
Total excision of urinary bladder and adjacent structures with pelvic lymph node resection.
Men removal of prostate gland, seminal vesicles, distal ureters.
Women removal of urethra, distal ureters, uterus, cervix, prox third of vagina.
Ileal conduit needed
What is an ileal conduit?
Urine flow diverted to isolated loop of bowel (ileum). Remove segment of ileum.
One end brought out through skin so urine can be collected
Which portion of the urethra is prone to strictures?
Bulbar portion.
What kits are used to remove a urethral caruncle?
Minor or plastic set
What is a urethral meatotomy?
Incisional enlargement of external urethral meatus for stenosis or strictures. Local anesthesia used.
What is urethral dilation and internal urethrotomy?
Gradual dilation and lysis of urethral strictures to relieve lower urinary tract obstruction. Little poles inserted and rotated.
Where are strictures usually found?
At external urinary meatus. Usually congenital.
What is a urethroplasty?
Reconstructive surgery of urethra for strictures, fractures, or narrowing of urethral lumen that is congenital, inflammatory, or traumatic.
May require grafts
Temp urinary diversion may be used
What is phimosis?
Orifice of prepuce is stenosed too narrow to permit retraction
What is belanoposthitis?
Inflamed glans with purulent discharge
What is paraphimosis?
Prepuce cannot be reduced from retracted position
What is the arterial supply to the prostate?
Pudendal
Inferior vesicle
Hemorrhoidal
Elevated levels of what can mean carcinoma?
PSA. Prostate specific antigen
What sx is used to treat benign obstructive disease of prostate?
Transurethral resection of the prostate (TURP)
How is a TURP done?
Resectoscope passed into bladder through urethra. Pieces of prostate resected from around bladder neck. Resectoscope uses cutting loop to coagulate vessels by electric current.
What fluid is used during a TURP?
Nonionizing solution
Glycine 1.5% or sorbitol - mannitol enhances cutting capability.
Post op NS for CBI
What is required preoperatively for prostate surgery?
All require bowel prep and abx therapy
What is simple retropubic prostatectomy?
Enucleation of prostate tissue through incision in anteriorprostatic capsule with extravesicle approach. Good exposure of prostate bed with control of bleeding.
Slight trendelenburg position.
What is a suprapubic prostatectomy?
Removal through tranvesical approach of periurethral tissue obstructing outlet. Carcinoma of prostate. Midline of pfannenstiel incision used. Allows access for bladder conditions. Position slight trendelenburg.
What is a simple perineal prostatectomy?
What are the advantages?
Removal of prostatic adenoma through perineal approach between scrotum and anal sphincter. Advantages are - bladder neck preserved - easier ctrl of bleeding Sequential compression stockings needed.
What is a radical perineal prostatectomy?
Radical approach accompanied by laparoscopic or low abdominal lymph node dissection.
Two positions required, one for lymph node and one for prostatectomy.
What are the types of prostatectomies?
Simple retropubic prostatectomy
Suprapubic prostatectomy
Simple perineal prostatectomy
Radical perineal prostatectomy.
What are the three accessory reproductive glands in the male?
Seminal vesicles
Prostate gland
Bulbourethral gland
What is a hydrocelectomy?
Removal of a hydrocele (abnormal accumulation of fluid within tunica vaginalis of scrotum). Excise tunica vaginalis to remove fluid filled sac.
Result of infection or trauma.
Local anesthetic
What is a vasectomy?
Excision of section of vas deferens. Sometime done before prostatectomy to prevent postop epididymitis.
What is a vasovasostomy?
Surgical reanastomosis of vas deferens using operative microscope.
Used to regain fertility after vasectomy or alleviate chronic testicular pain.
Two approaches for orchidectomy?
Scrotal apporach
Inguinal approach
What is torsion testicle?
Twisted spermatic cord which cuts off testicular blood supply. Try to untwist. If compromised will do orchidectomy.
What is orchidopexy?
Placement and fixation of testicle in normal anatomic position. Do hormone tx for 1 yr prior. Setup is me as for hyrocelectomy.
