Urology Procedures Flashcards
What group of individuals are especially prone to urological procedures?
Para and quadriplegics
Cysto is performed to evaluate for:
Hematuria Pyuria Calculi trauma cancer
Upper urinary tract:
Ureters and kidneys
Lower urinary tract:
bladder, prostate, urethra
Common nerves injured in urologic procedures:
Common peroneal saphenous sciatic obturator femoral
Most urologic procedures are in what position?
Lithotomy
Common peroneal injury:
compression of fibular head on leg brace
saphenous nerve injury:
compression of medial tibial condyle
sciatic nerve injury:
excessive external rotation of legs
excessive extension of the knees
Obturator and femoral nerve injury:
excessive flexion of the groin
don’t forget pooling of the blood.
Obturator reflex
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.
Cystocopy
passage of a rigid scope through the urethra
cystoscopy for retrograde ureteral catherization:
to visualize ureter and kidney
place stents
drain obstructions
remove renal calculi
Transurethral resection of the bladder (TURBT)
endoscopic rescetion and electrodesiccation to treat superficial bladder tumor
Bladder perforation
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
Transurethral resection of the prostate (TURP)
General Anesthesia, spinal anesthesia preferred.
neoplastic or obstructive prostate tissue is removed by electrosurgical resection under direct endoscopic vision.
Distend the bladder with fluid
Complications of TURP
-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
- early signs=HTN/Tachy
- 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.