SUR 104 unit 4
Card Set Information
SUR 104 unit 4
what does genitourinary surgery include?
procedures of the urethra, bladder, ureters, kidneys, and male reproductive system
three common approaches used in GU surgery
minimally invasive surgery
surgery performed through a flexible or rigid fiberoptic endoscope inserted through the external urethra, providing direct visualization and access to the lower urinary tract
surgery performed through an open incision in the abdomen or flank
closed surgery performed using percutaneous endoscopic techniques (laparotomy)
minimally invasive surgery
where does retroperitoneal cavity lie?
posterior to the peritoneal cavity
serous membrane covering the retroperitoneal cavity on the anterior side
primary organs for filtration of blood
where are the kidneys located?
in the retroperitoneal cavity at the level of the 12th thoracic vertebra
which kidney sits lower than the other?
how are the kidneys supported?
dense fascia and fatty tissue
2 main tissue layers that make up the kidney
cortex (outer layer)
medulla (inner layer)
covered with strong fibrous tissue and contains portions of the microscopic tubules that filter the blood
composed of 8 to 12 large collecting areas (renal pyramids)
notched area on the medial side of each kidney
filtering units in the kidneys
how many nephrons are present in each kidney?
about 1 million
capillary structure within the kidney that allows nephron to communicate with the vascular system to filter blood
where is the capillary network of each nephron contained?
how much fluid can the glomerulus filter per minute and what is this called?
glomerular filtration rate
specific regions of the tubule system
loop of Henle
distal convoluted tubule
what are formed by the precipitation of specific salts?
decreased or no urinary output
diseases in which kidney stones are seen
increased absorption of calcium in the intestine
chronic urinary tract infection
high protein intake
use of some drugs
how are calculi reduced?
with extra-corporeal shock wave lithotripsy (ESWL)
paired organs that lie on the medial side of the upper kidney
what do the adrenal glands secrete?
corticosteroids and hormones necessary for metabolism
how is blood supplied to each adrenal gland?
by aorta and branches of renal and inferior phrenic arteries
how long is each ureter?
about 12 inches long and about 5 mm in diameter
segmental contraction and relaxation of the ureter's muscular layer
4 tissue layers of the bladder
distal portion of the bladder
what are the sphincter muscles of the bladder neck controlled by?
autonomic nervous system
mucous-secreting glands located on each side of the urethra just inside the meatus
parts of the male urethra
prostatic urethra - begins at bladder neck
membranous urethra - midportion
cavernous urethra - distal end
layered tissue sac that encases the testicles
folds in the skin of the sacrum
male reproductive cells
fibrous membrane enclosing testicles
smallest units of male ductal system
primary male sex hormone
convoluted duct that secretes seminal fluid
liquid substance that gives sperm mobility through male reproductive tract
joins epididymis with ejaculatory duct
paired structures that secrete approximately 60% of the semen
surrounds urethra and secretes alkaline fluid that contributes to seminal fluid
glands that secrete mucus, which contributes to the total volume of the semen
bulbourethral glands or Cowper's glands
what procedure is performed in patients with chronic end-stage renal disease?
what is kidney dialysis?
procedure that performs normal kidney function
2 types of kidney dialysis
dialysis in which blood is shunted into a heparinized machine
how long does hemodialysis normally last and how many times is it performed?
it lasts about 3 hours and performed 3 or 4 times a week
major vein and artery are anastomosed by an implanted artificial graft for access to the vascular system during hemodialysis
arteriovenous fistula (AV shunt)
dialysis in which a Silastic tube is implanted in the suprapubic peritoneal space and dialysis solution is instilled into the catheter
stones formed by crystalline mineral and salts precipitated from filtrate produced in the kidney
greatest risk factor for cancer of the kidney?
primary cancer of the kidney arises from?
cortex and renal pelvis
causes of end-stage renal disease
diabetes, hypertension, sysetmic lupus, nephrotic syndrome and infection
most common tumors in children, arising in kidney
Wilms' tumor (nephroblastoma)
overproduction of glucocorticoid
most common form of urinary tract cancer
traumatic injury to the bladder occurs most often when?
motor vehicle accidents and related to pelvic fracture
loss of sphincter control at the bladder neck
UTI is commonly caused by?
E. coli contamination of distal urethra or by STD
age-related enlargement of the prostate gland
benign prostatic hyperplasia (BPH)
congenital anomaly in which one or both testicles fail to descend into scrotum in fetal life
urethra open on top side of the penis or may be exposed along the full length
urethra fails to develop fully, resulting in urethral shortening and displacement of urethral meatus
cancer that originates in the squamous cells of the glans or foreskin
cancer that arises from the germ cell of the testicle
rotation of the testicle related to congenital anomaly or as a result of vigorous activity in young males - medical emergency
enlarged, dilated veins in the scrotum
primary function of the urinary system
filter metabolic waste from the blood
how much urine do the kidneys produce per day?
about 3.2 pints (1.5 L) per day
main components of urine
ratio of the density of urine compared to water
primary protein component of the blood
measures rate of creatinine clearance from the blood
glomerular filtration rate
how is GFR measured?
as the amount of creatinine filtered per minute
test that assesses the elimination of urea from the liver
blood urea nitrogen (BUN)
preferred method for imaging tumors of the kidney
what is a noncontrast helical CT used to diagnose?
what is IV urography used for?
contrast medium is injected IV to obtain serial radiographs of the renal pelvis and calyces
rate of emptying and size of ureters are also measured
radiograph of kidney, ureters and bladder
what is KUB used for?
to outline structures of the urinary system including stones larger than 2 mm
test that provides images of the bladder while it is emptying
radiographic test commonly used in the diagnosis of tumors
radiographic test used to detect metastasis arising from primary tumor of prostate
how is retrograde ureteropyelogram performed?
injections made using a catheter inserted into the ureter
contrast medium instilled into the catheter and viewed with fluoroscopy
radiographic test used for patients ineligible for CT or other forms of radiographic exposure
ureters require what type of instruments?
atraumatic clamps such as Babcocks
what types of instruments are used to occlude vessels and for blunt dissection?
right-angle and Schnitz (tonsil) clamps
what is the direct forward cystoscope used for?
has a 0-degree angle and is useful for viewing the urethra
what is the right-angle cystoscope for?
has 30-degree angle and used for viewing the entire bladder and for insertion of ureteral catheters
sizes of Brown-Buerger cystoscope
ranges from 14 to 26 French
most common Brown-Buerger cystoscope size for adults
hollow tube that serves as a passageway for the instruments used during cystoscopy and resection
transurethral, electrosurgical instrument used to remove small fragments of tissue, cutting and coagulating target tissue inside the bladder
most common type of resectoscope
urinary catheter sizes
ranging from 7 to 26 French
purposes for urinary catheterization
short-term urinary drainage
continuous urinary drainage
hemostasis and evacuation of blood clots or blood
continuity of urethra or ureters
used to apply pressure against a tissue or opening
surgery of the distal GU system performed with operative cystourethroscope
when is basic cystoscopy performed?
at the start of any transurethral procedure for visual assessment
small incision made in the internal urethra to release scar tissue or other stricture
small incision is made in urethral meatus to relieve stricture
most common complications of cystoscopic procedures
bleeding and edema
most common cause of urinary obstruction
renal stones (calculi)
specialized instrument that grasps and crushes renal stone
procedure in which the prostate is removed with a resectoscope inserted through urethra
transurethral resection of prostate (TURP)
nonmalignant enlargement of the prostate gland
benign prostatic hyperplasia (BPH)
2 ways in which the prostate can enlarge
cells multiply around urethra, causing obstruction
cells grow into urethra and bladder outlet area
backward flow of urine
reflux of urine
in what position is the patient placed for TURP procedure?
during TURP, what type of irrigation fluid is used?
after resection, how long does Foley catheter remain?
possible postop complications of TURP
passage of semen into the bladder
congenital downward curvature of the penis
principle of hypospadius repair
reconstruction of urethra using a graft from foreskin or buccal skin
2 types of penile implants available
inflatable reservoir implant
where is cylinder from the penile implant placed during insertion?
in the corpora cavernosa of the penis
ligation of the veins of the testes to reduce venous backflow of blood into internal spermatic veins, done to improve spermatogenesis
vascular abnormality in which the pampiniform venous plexus of the scrotum is dilated
benign, fluid-filled sac that develops in the anterior testis
surgical removal of one or both testicles
twisting of the testis, resulting in ischemia and necrosis
removing section of vas deferens and sealing the free ends, preventing the movement of sperm through the ejaculatory ducts
surgical anastomosis of vas deferens to restore continuity after vasectomy
insertion of suprapubic catheter into the bladder for drainage through a percutaneous or open approach
total or partial removal of the bladder, most often to treat bladder cancer
second most common cancer of the GU system
for what is cystectomy indicated?
small, invasive tumors that penetrate the bladder wall
procedure in which a functional bladder is constructed with a loop of bowel that is brought out of the abdominal wall
suspension of the bladder neck and urethra to the cartilage of the pubic symphysis to treat urinary stress incontinence in the female
vesicourethral suspension (Marshall-Marchetti-Krantz procedure)
what is overflow incontinence caused by?
overactive detrusor muscle with normal urethra
procedure in which bladder neck is held in suspension with biosynthetic strip or fascia graft which is attached to abdominal wall
removal of a prostatic adenoma through a perineal approach
initial tests to diagnose prostate cancer
PSA and digital rectal examination
why is suprapubic prostatectomy performed?
treatment of BPH and prostate cancer
removal of tissue or organ without previous fragmentation or dissection
distention of renal pelvis and proximal ureter caused by obstruction in ureter and reflux of kidney filtrate
reconstruction of the ureter at the level of the renal pelvis
procedure of the ureter
reconstruction of the ureter
anastomosis of the ureter with another hollow structure to provide continuity
crossing of one ureter to another to create an anastomosis between the two ureters
reimplantation of the ureter in the bladder
large stones in the kidney or upper ureter are removed percutaneously through nephroscope
what type of irrigation solution is used to flush the operative site during nephroscopy?
warm isotonic irrigation fluid (0.9% saline)
surgical removal of one kidney