Urology Procedures

Question 1

What group of individuals are especially prone to urological procedures?

Answer 1

Para and quadriplegics

Question 2

Cysto is performed to evaluate for:

Answer 2

Hematuria
Pyuria
Calculi
trauma
cancer

Question 3

Upper urinary tract:

Answer 3

Ureters and kidneys

Question 4

Lower urinary tract:

Answer 4

bladder, prostate, urethra

Question 5

Common nerves injured in urologic procedures:

Answer 5

Common peroneal
saphenous
sciatic
obturator
femoral

Question 6

Most urologic procedures are in what position?

Answer 6

Lithotomy

Question 7

Common peroneal injury:

Answer 7

compression of fibular head on leg brace

Question 8

saphenous nerve injury:

Answer 8

compression of medial tibial condyle

Question 9

sciatic nerve injury:

Answer 9

excessive external rotation of legs

excessive extension of the knees

Question 10

Obturator and femoral nerve injury:

Answer 10

excessive flexion of the groin

don’t forget pooling of the blood.

Question 11

Obturator reflex

Answer 11

Bladder rupture/injury secondary to adductor muscle contraction from obtrator 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.

Question 12

Cystocopy

Answer 12

passage of a rigid scope through the urethra

Question 13

cystoscopy for retrograde ureteral catherization:

Answer 13

to visualize ureter and kidney
place stents
drain obstructions
remove renal calculi

Question 14

Transurethral resection of the bladder (TURBT)

Answer 14

endoscopic rescetion and electrodesiccation to treat superficial bladder tumor

Question 15

Bladder perforation

Answer 15

If peritoneal cavity is entered, patient will feel shoulder discomfort, nausea in awake patient.

HTN, Tachycardia, followed by hypotension.

if a high-grade malignancy, risk of seeding into the peritoneum.

blood loss
hypothermia
bacteremia

Question 16

Transurethral resection of the prostate (TURP)

Answer 16

General Anesthesia, spinal anesthesia preferred.

neoplastic or obstructive prostate tissue is removed by electrosurgical resection under direct endoscopic vision.

Distend the bladder with fluid

Question 17

Complications of TURP

Answer 17

-Blood loss

• Venous absorption of irrigation fluid.
  
  • early signs=HTN/Tachy
    - CVP may rise as cardiac decompensation occurs
    - awake patient will complain of nausea, dyspnea, apprehension, disorientation, convulsions, and coma
• General anesthesia: coughing or straining can cause bladder perforation.
• Regional anesthesia: the bladder becomes atonic and may become thinner when distended, increasing risk of perforation.

Question 18

TURP Syndrome

Answer 18

Water intoxication or glycine toxcity
caused by absorbing too much irrigation fluid. dependent on time and pressure of fluids being irrigated with.

apprehension, disorientation, convulsions, coma

Question 19

TURP Syndrome treatment

Answer 19

ask surgeon to control bleeding and finish surgery

send blood sample for NA

Question 20

IF regional anesthesia is chosen for Cystoscopy, what sensory level is needed to cover the bladder/urethra?

What sensory level is needed to cover the ureters?

Answer 20

T9-T10 for bladder and urethra

T8 for ureters

Question 21

Dermatomes: nipple line=

Answer 21

T4

Question 22

Dermatomes: belly button=

Answer 22

T10

Question 23

Why is DIC triggered by bladder perforation?

Answer 23

the release of prostatic thrombogenic substances, especially with cancer of the prostate .

Question 24

What irrigation solutions are used for TURPs?

Answer 24

Glycine (1.5%)

Sorbitol (3.3%)

Mannitol (5%)

Question 25

What is some advantages and disadvantage of using glycine for irrigation?

Answer 25

Advantage: lesser likelihood of TURP syndrome

DA: can cause transient post/op visual impairment.

Question 26

What is some advantages and disadvantage of using Sorbitol for irrigation?

Answer 26

A: less likely to cause TURP syndrome

DA: can cause hyperglycemia and lactic acidosis

Question 27

What is some advantages and disadvantage of using Mannitol for irrigation?

Answer 27

nonmetabolized, osmotic diuresis causing hypervolemia (when absorbed systemically)

Question 28

Treatment of TURP syndrome:

Answer 28

1. ask surgeon to control bleeding and finish up
2. Send serum Sodium level. If sodium level is less than 120mEq/L= serious.
3. Correct hypervolemia with fluid restrictions and diuretics (furosemide 10-20mg).
4. Correct hyponatremai with hypertonic solutions…correct cautiously.
5. Normal saline or LR if Sodium is geater than 125mEq/L.

Question 29

what is a complication of the extreme trendelenberg position?

Answer 29

Increased intraoccular pressure. Can cause permanent visual problems.

Question 30

What are 2 complications of using methylene blue for a radical prostatectomy?

Answer 30

• Can cause hypotension

- can effect the Sat reader, may go as low as 65% for 1-2 minutes despite adequate oxygenation.

Question 31

Indications for nephrectomy:

Answer 31

• Chronic infection
• Trauma
• Cystic or calculus disease
• neoplasm

Question 32

Because a nephrectomy is performed in the lateral or anterior abdominal area. What positioning and pathophysiological effects would be expected?

Answer 32

• Lateral position may cause vena cava compression and hypotension.
• Later-flex table and use kidney bar.

Question 33

Renal transplant:

Answer 33

• optimize serum potassium and correct metabolic acidosis.
• anemia is common
• no succinylcholine, use cisatracurium (hoffman elimination)
• Use normal saline, avoid LR and K+
• regional anesthesia is contraindicated by preexisting coagulopathy and or immunosuppresion
• Adequate hydration is critical: use crystalloid, colloid and blood for revascularization of the kidney.
• methyl prednisone and diuretics to help discourage rejection and encourage diuresis.
• low dose dopamine of oliguric.

Question 34

Complications associated with Renal Transplant:

Answer 34

• Hyperkalemia
• Delayed renal function
• graft failure

Question 35

What is in the preserveration fluid the kidney is stored in?

Answer 35

Glucose, potassium, magnesium, antibiotics, sodium bicarbonate, and heparin (can cause hypersensitivity reaction in recipient.

Question 36

How long can a kidney be preserved?

Answer 36

• 72 hours with renal perfusion

- 48 hours in cold storage before necrosis jeopardizes graft survival.

Question 37

Why is Cisatricurium used for renal patients?

Answer 37

Hoffman Elimination. Does not require kidney function for breakdown.

Question 38

Indications for Radical Cystectomy:

Entire bladder removed

Answer 38

• Invasive bladder tumors
• Pelvic malignancies
• Neurogenic bladder
• Chronic lower urinary tract obstruction
• Post radiation bladder dysfunction
• creation of uretero-ileal anastomosis and ileostomy.

Question 39

Anesthetic considerations for Radical Cystectomy:

Answer 39

• Supine position
• General or combined
• Arterial and CVP (fluid shifts can be extensive-unable to monitor urine-need for CVP)
• diuretics may be needed to stimulate output.
• indigo carmine and methylene blue used at times.

Question 40

Complications of Radical Cystectomy:

Answer 40

• Hypothermia
• inadequate fluid replacement
• need for post op ventilation

Question 41

What dermatome sensory level needs to be achieved for orchidopexy, orchiechotmy, and urogenital plastics?

Answer 41

T9

General, regional, or combined.

Question 42

What kind of anesthesia is used for Extracorporal shock wave lithotripsy?

Answer 42

MAC

Adequate hydration and diuretics to help pass stone fragments.

Question 43

A/V shunts/fistula placement:

Answer 43

• Supine, MAC/LMA

- Coexisting medical problems: Anemia, CAD, DM