Urology lecture

Question 1

What population will you see

Answer 1

elderly or pediatric
quadreplegic

Question 2

what is the upper urinary tract vs lower

Answer 2

upper- ureter and kidney
lower- bladder, prostate, urthetra

Question 3

common nerve injuries

Answer 3

common peroneal
saphneous
sciatic
obturator
femoral

Question 4

How is common peroneal injured

Answer 4

compression of fibular head on leg brace

Question 5

how to damage saphneous nerve

Answer 5

compression of medial tibial condyle

Question 6

how to damage sciatic nerve

Answer 6

excessive eternal rotation of legs
excessive extension of knees

Question 7

how to damage obturator and femoral

Answer 7

excessive flexion of groin

Question 8

Obturator reflex

Answer 8

bladder rupture secondary to adductor muscle from obturator stimulation from electrocautery

Question 9

cystoscopy

Answer 9

rigid scope thru urethra
2% lido jelly
can be painful and require ga / regional
if regional- t9 t10 , or t8 for ureters

Question 10

why would we do cystoscopy

Answer 10

visualize ureter and kidney
place stents
drain obstructions
remove renal calculi

Question 11

TURB

Answer 11

LMA
treat superficial bladder tumor
ga to prevent coughing and bladder perforation
RA can atony and become thinner and risk perforation

Question 12

bladder perf

Answer 12

awake- fullness, ab spasm, pain, nausea, vomiting
tachy, htn, followed by hotn
Cold irrigdation will cause hypothermia and vasoconstriction
DIC triggered by release of prostatic substances

Question 13

TURP

Answer 13

prostate tissue removed with electrocautery
ga to precent risk of bleeding from bucking
spinal preferred

Question 14

complciaitons of turp

Answer 14

blood loss
benous absorption of irrigation fluid into sinuses

Question 15

turp syndrome

Answer 15

hypoxia and hyponatremia
early signs htn and tachy
AKA water intoxication or glycine toxicity- absorption of irrigation fluid
Apex says htn, reflex Brady, chance in LOC.

Question 16

what are the irrigation solutions for turp

Answer 16

glycine 1.5%- less likely of turp syndrome- visual impairement
sorbitol 3.3% less likely, causes hyperglycemia and lactic acidosis
mannitol 5%- osmotic diuresis causing hypervolemia (before hypovolemia)

Question 17

treatment of turp syndrome

Answer 17

ask surgeon to control bleeding and finish surgery
blood sample to check na
fluid restriction and diuretics lasix 20mg
for hyponatremia- give hypertonic solutions
postpone case if sodum is under 125 - although not in real life

Question 18

open prostate radical prostatectomy

Answer 18

Large iv is a must
methylene blue can cause hotn can drop spo2 to 65 for 2 minutes
indigo carmine has alpha 1 effects
50% chance of impotence

Question 19

nephrectomy indications

Answer 19

nephrectomy chornic infection, trauma, calculus disease, neoplasm

Question 20

nephrectomy side effects

Answer 20

vena cava compression hotn
GA possibly with regional

Question 21

why is nimbex used for renal patients

Answer 21

hoffman elimnation not renal

Question 22

renal transplant

Answer 22

ns avoid lr and k
anemia is common

Question 23

renal transplant complications

Answer 23

hyperkalemia
delayed renal function
graft failure

Question 25

POPS

Answer 25

portable organ preservation system
4c is the goal to preserve organ
continuous perfusion to organ of 40-60mmhg of glucoise, potassium , mag, abx, hco3, heparin
preserved to 72h (48h before)

Question 26

radical cystectomy

Answer 26

invasive bladder tumors
supine
geta
large iv duh
indigo carmine and meth blue may be used

Question 27

radical cystectomy complications

Answer 27

hypothermia (losing warm pee?)
inadequate fluid replacement (losing fluids from bladder?)
need post op ventilation

Question 28

orchidoplexy, orchiectomy

Answer 28

treat congenital malformation
taking out a testical
torsion of testicle
supine litho

Question 29

av shunt and fistula

Answer 29

supine arm extended
anemia, cad, dm

Question 30

eswl

Answer 30

extracorporal shcock wave lithotripsy
breaks upper urinary stones
stent placement
MAC
hydration and diuretics
submersion in a tank of water??