SUR 104 unit 4

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SUR 104 unit 4
2012-10-18 23:53:10

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  1. what does genitourinary surgery include?
    procedures of the urethra, bladder, ureters, kidneys, and male reproductive system
  2. three common approaches used in GU surgery
    • transurethral surgery
    • open surgery
    • minimally invasive surgery
  3. surgery performed through a flexible or rigid fiberoptic endoscope inserted through the external urethra, providing direct visualization and access to the lower urinary tract
    transurethral surgery
  4. surgery performed through an open incision in the abdomen or flank
    open surgery
  5. closed surgery performed using percutaneous endoscopic techniques (laparotomy)
    minimally invasive surgery
  6. where does retroperitoneal cavity lie?
    posterior to the peritoneal cavity
  7. serous membrane covering the retroperitoneal cavity on the anterior side
  8. primary organs for filtration of blood
  9. where are the kidneys located?
    in the retroperitoneal cavity at the level of the 12th thoracic vertebra
  10. which kidney sits lower than the other?
  11. how are the kidneys supported?
    dense fascia and fatty tissue
  12. 2 main tissue layers that make up the kidney
    • cortex (outer layer)
    • medulla (inner layer)
  13. covered with strong fibrous tissue and contains portions of the microscopic tubules that filter the blood
  14. composed of 8 to 12 large collecting areas (renal pyramids)
  15. notched area on the medial side of each kidney
  16. filtering units in the kidneys
  17. how many nephrons are present in each kidney?
    about 1 million
  18. capillary structure within the kidney that allows nephron to communicate with the vascular system to filter blood
  19. where is the capillary network of each nephron contained?
    Bowman capsule
  20. how much fluid can the glomerulus filter per minute and what is this called?
    • 125 mL
    • glomerular filtration rate
  21. specific regions of the tubule system
    • proximal tubule
    • loop of Henle
    • distal convoluted tubule
  22. what are formed by the precipitation of specific salts?
    renal calculi
  23. decreased or no urinary output
  24. diseases in which kidney stones are seen
    • hyperparathyroidism
    • increased absorption of calcium in the intestine
    • chronic urinary tract infection
    • high protein intake
    • use of some drugs
  25. how are calculi reduced?
    with extra-corporeal shock wave lithotripsy (ESWL)
  26. paired organs that lie on the medial side of the upper kidney
    adrenal glands
  27. what do the adrenal glands secrete?
    corticosteroids and hormones necessary for metabolism
  28. how is blood supplied to each adrenal gland?
    by aorta and branches of renal and inferior phrenic arteries
  29. how long is each ureter?
    about 12 inches long and about 5 mm in diameter
  30. segmental contraction and relaxation of the ureter's muscular layer
  31. 4 tissue layers of the bladder
    • outer serosa
    • muscular layer
    • submucosa
    • inner mucosa
  32. distal portion of the bladder
  33. micturation
  34. what are the sphincter muscles of the bladder neck controlled by?
    autonomic nervous system
  35. urethral opening
  36. mucous-secreting glands located on each side of the urethra just inside the meatus
    Skene's glands
  37. parts of the male urethra
    • prostatic urethra - begins at bladder neck
    • membranous urethra - midportion
    • cavernous urethra - distal end
  38. layered tissue sac that encases the testicles
  39. folds in the skin of the sacrum
  40. male reproductive cells
  41. fibrous membrane enclosing testicles
    tunica vaginalis
  42. smallest units of male ductal system
    seminiferous tubules
  43. primary male sex hormone
  44. convoluted duct that secretes seminal fluid
  45. liquid substance that gives sperm mobility through male reproductive tract
    seminal fluid
  46. joins epididymis with ejaculatory duct
    vas deferens
  47. paired structures that secrete approximately 60% of the semen
    seminal vesicles
  48. surrounds urethra and secretes alkaline fluid that contributes to seminal fluid
    prostate gland
  49. glands that secrete mucus, which contributes to the total volume of the semen
    bulbourethral glands or Cowper's glands
  50. what procedure is performed in patients with chronic end-stage renal disease?
    kidney dialysis
  51. what is kidney dialysis?
    procedure that performs normal kidney function
  52. 2 types of kidney dialysis
    • hemodialysis
    • peritoneal dialysis
  53. dialysis in which blood is shunted into a heparinized machine
  54. 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
  55. major vein and artery are anastomosed by an implanted artificial graft for access to the vascular system during hemodialysis
    arteriovenous fistula (AV shunt)
  56. dialysis in which a Silastic tube is implanted in the suprapubic peritoneal space and dialysis solution is instilled into the catheter
    peritoneal hemodialysis
  57. stones formed by crystalline mineral and salts precipitated from filtrate produced in the kidney
  58. greatest risk factor for cancer of the kidney?
  59. primary cancer of the kidney arises from?
    cortex and renal pelvis
  60. causes of end-stage renal disease
    diabetes, hypertension, sysetmic lupus, nephrotic syndrome and infection
  61. most common tumors in children, arising in kidney
    Wilms' tumor (nephroblastoma)
  62. overproduction of glucocorticoid
    Cushing's syndrome
  63. most common form of urinary tract cancer
    bladder cancer
  64. traumatic injury to the bladder occurs most often when?
    motor vehicle accidents and related to pelvic fracture
  65. loss of sphincter control at the bladder neck
    urinary incontinence
  66. UTI is commonly caused by?
    E. coli contamination of distal urethra or by STD
  67. age-related enlargement of the prostate gland
    benign prostatic hyperplasia (BPH)
  68. congenital anomaly in which one or both testicles fail to descend into scrotum in fetal life
  69. urethra open on top side of the penis or may be exposed along the full length
  70. urethra fails to develop fully, resulting in urethral shortening and displacement of urethral meatus
  71. cancer that originates in the squamous cells of the glans or foreskin
    penile cancer
  72. cancer that arises from the germ cell of the testicle
    testicular cancer
  73. rotation of the testicle related to congenital anomaly or as a result of vigorous activity in young males - medical emergency
    testicular torsion
  74. enlarged, dilated veins in the scrotum
  75. primary function of the urinary system
    filter metabolic waste from the blood
  76. how much urine do the kidneys produce per day?
    about 3.2 pints (1.5 L) per day
  77. main components of urine
    • water (95%)
    • solutes (5%)
  78. ratio of the density of urine compared to water
    specific gravity
  79. primary protein component of the blood
  80. measures rate of creatinine clearance from the blood
    glomerular filtration rate
  81. how is GFR measured?
    as the amount of creatinine filtered per minute
  82. test that assesses the elimination of urea from the liver
    blood urea nitrogen (BUN)
  83. preferred method for imaging tumors of the kidney
    CT scan
  84. what is a noncontrast helical CT used to diagnose?
  85. 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
  86. radiograph of kidney, ureters and bladder
  87. what is KUB used for?
    to outline structures of the urinary system including stones larger than 2 mm
  88. test that provides images of the bladder while it is emptying
    micturating cystourethrogram
  89. radiographic test commonly used in the diagnosis of tumors
  90. radiographic test used to detect metastasis arising from primary tumor of prostate
    nuclear imaging
  91. how is retrograde ureteropyelogram performed?
    • injections made using a catheter inserted into the ureter
    • contrast medium instilled into the catheter and viewed with fluoroscopy
  92. radiographic test used for patients ineligible for CT or other forms of radiographic exposure
  93. ureters require what type of instruments?
    atraumatic clamps such as Babcocks
  94. what types of instruments are used to occlude vessels and for blunt dissection?
    right-angle and Schnitz (tonsil) clamps
  95. what is the direct forward cystoscope used for?
    has a 0-degree angle and is useful for viewing the urethra
  96. what is the right-angle cystoscope for?
    has 30-degree angle and used for viewing the entire bladder and for insertion of ureteral catheters
  97. sizes of Brown-Buerger cystoscope
    ranges from 14 to 26 French
  98. most common Brown-Buerger cystoscope size for adults
    21 French
  99. hollow tube that serves as a passageway for the instruments used during cystoscopy and resection
  100. transurethral, electrosurgical instrument used to remove small fragments of tissue, cutting and coagulating target tissue inside the bladder
  101. most common type of resectoscope
    Iglesias resectoscope
  102. urinary catheter sizes
    ranging from 7 to 26 French
  103. purposes for urinary catheterization
    • short-term urinary drainage
    • continuous urinary drainage
    • hemostasis and evacuation of blood clots or blood
    • continuity of urethra or ureters
  104. used to apply pressure against a tissue or opening
  105. surgery of the distal GU system performed with operative cystourethroscope
  106. when is basic cystoscopy performed?
    at the start of any transurethral procedure for visual assessment
  107. small incision made in the internal urethra to release scar tissue or other stricture
  108. small incision is made in urethral meatus to relieve stricture
  109. most common complications of cystoscopic procedures
    bleeding and edema
  110. most common cause of urinary obstruction
    renal stones (calculi)
  111. specialized instrument that grasps and crushes renal stone
  112. procedure in which the prostate is removed with a resectoscope inserted through urethra
    transurethral resection of prostate (TURP)
  113. nonmalignant enlargement of the prostate gland
    benign prostatic hyperplasia (BPH)
  114. 2 ways in which the prostate can enlarge
    • cells multiply around urethra, causing obstruction
    • cells grow into urethra and bladder outlet area
  115. backward flow of urine
    reflux of urine
  116. in what position is the patient placed for TURP procedure?
    lithotomy position
  117. during TURP, what type of irrigation fluid is used?
    nonelectrolyte solution
  118. after resection, how long does Foley catheter remain?
    12-24 hours
  119. possible postop complications of TURP
    • incontinence
    • impotence
    • infertility
    • passage of semen into the bladder
    • urethral stricture
  120. congenital downward curvature of the penis
  121. principle of hypospadius repair
    reconstruction of urethra using a graft from foreskin or buccal skin
  122. 2 types of penile implants available
    • semirigid implant
    • inflatable reservoir implant
  123. where is cylinder from the penile implant placed during insertion?
    in the corpora cavernosa of the penis
  124. ligation of the veins of the testes to reduce venous backflow of blood into internal spermatic veins, done to improve spermatogenesis
  125. vascular abnormality in which the pampiniform venous plexus of the scrotum is dilated
  126. benign, fluid-filled sac that develops in the anterior testis
  127. surgical removal of one or both testicles
  128. twisting of the testis, resulting in ischemia and necrosis
  129. removing section of vas deferens and sealing the free ends, preventing the movement of sperm through the ejaculatory ducts
  130. surgical anastomosis of vas deferens to restore continuity after vasectomy
  131. insertion of suprapubic catheter into the bladder for drainage through a percutaneous or open approach
    suprapubic cystostotomy
  132. total or partial removal of the bladder, most often to treat bladder cancer
  133. second most common cancer of the GU system
    bladder cancer
  134. for what is cystectomy indicated?
    small, invasive tumors that penetrate the bladder wall
  135. procedure in which a functional bladder is constructed with a loop of bowel that is brought out of the abdominal wall
    ileal conduit
  136. 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)
  137. what is overflow incontinence caused by?
    overactive detrusor muscle with normal urethra
  138. procedure in which bladder neck is held in suspension with biosynthetic strip or fascia graft which is attached to abdominal wall
    pubovaginal sling
  139. removal of a prostatic adenoma through a perineal approach
    perineal prostatectomy
  140. initial tests to diagnose prostate cancer
    PSA and digital rectal examination
  141. why is suprapubic prostatectomy performed?
    treatment of BPH and prostate cancer
  142. removal of tissue or organ without previous fragmentation or dissection
  143. distention of renal pelvis and proximal ureter caused by obstruction in ureter and reflux of kidney filtrate
  144. reconstruction of the ureter at the level of the renal pelvis
  145. procedure of the ureter
  146. reconstruction of the ureter
  147. anastomosis of the ureter with another hollow structure to provide continuity
  148. crossing of one ureter to another to create an anastomosis between the two ureters
  149. reimplantation of the ureter in the bladder
  150. large stones in the kidney or upper ureter are removed percutaneously through nephroscope
    percutaneous nephrolithotomy
  151. what type of irrigation solution is used to flush the operative site during nephroscopy?
    warm isotonic irrigation fluid (0.9% saline)
  152. surgical removal of one kidney
    simple nephrectomy