CST 103:Chapter 26: Genitourinary Surgery

Arteriovenous fistula (or AV shunt)

Surgically created vascular access for patients undergoing hemodialysis.

Calculi

Stones caused by the precipitation of minerals, such as calcium, and other substances from the urine or kidney filtrate.

Epispadias

A rare congenital abnormality in which the opening of the urethra is on the dorsum of the penis. This anomaly does not usually occur in isolation but is part of a more complex set of defects of the urogenital system.

Extracorporeal shock wave lithotripsy (ESWL):

A procedure in which ultrasonic sound waves are used to pulverize kidney or gallbladder stones.

Foley Catheter

A retention catheter with an expandable balloon at the distal end.

Glomerular filtration rate (GFR):

An indication of kidney function in which serum creatinine (normally filtered by the kidney) is measured.

Indwelling catheter

A urethral or ureteral catheter that is left in place.

Intravasation

The absorption of irrigation fluids into the vascular system, which causes fluid overload and can result in cardiac arrest.

Meatotomy

A procedure in which a small incision is made in the urethral meatus to relieve a stricture. A topical anesthetic is used.

Nonelectrolytic

Nonconductive; nonelectrolytic solutions must be used for bladder distention or continuous irrigation whenever the electrosurgical unit (ESU) is used.

Percutaneous

A term for a procedure that is performed "through the skin." For example, in percutaneous nephroscopy, the nephroscope is inserted into the kidney through a skin incision.

Reflux

Flow of a body fluid in the direction opposite its normal path. Urinary reflux is backward flow of urine into the ureter or kidney.

Resectoscope

A cutting instrument used to remove and coagulate tissue piece by piece. It is used in conjunction with endoscopic procedures to remove tumors or other tissue, such as the prostate or endometrium.

Retrograde pyelography

Imaging studies of the renal pelvis in which a contrast medium is instilled through a transurethral catheter. Retrograde refers to flow, which is opposite the normal direction.

Specific gravity

The ratio of the density of a fluid compared to water. The specific gravity of urine is an important diagnostic tool.

Staghorn stone

A large, jagged kidney stone that forms in the renal pelvis.

Stent

A supportive catheter that is placed in a duct or tube to allow fluids to pass through while the duct heals.

Straight catheter

A urinary catheter used for one-time drainage of the bladder. It may be called a "red Robinson" or simply a "Robinson" catheter.

Suprapubic catheter

A bladder catheter inserted through the skin in the suprapubic area of the abdomen.

Tamponade

An instrument or other device that puts pressure on tissue, usually to stop bleeding.

Torsion

Twisting of an organ or a structure on itself. Torsion may cause local ischemia and necrosis.

Transurethral

Surgical access through the urethral orifice. The term also may describe an instrument that enters the bladder through the urethral meatus.

Labeling urinary catheters
1. Conical-tip catheter.
2. Robinson catheter.
3. Whistle-tip urethral catheter.
4. Coud� olive-tip catheter.
5. Malecot catheter
6. Malecot catheter. (2)
7. Pezzer catheter.
8. Foley retention catheter.
9. Three-way irrigation

Labeling components of male reproductive system.
1. Urinary bladder
2. Vas deferens
3. Urethra
4. Penis
5. Glans penis
6. Prepuce (foreskin)
7. Seminal vesicle
8. Ejaculatory Duct
9. Prostate gland
10. Bulbourethral gland
11. Anus
12. Epididymis
13. Teste

List and define the reproductive structures of the male.

The scrotum is a layered tissue sac that encases the testicles.
The epididymis is a convoluted duct that secretes seminal fluid, the liquid substance that gives sperm mobility through the male reproductive tract.
The vas deferens joins the epididymis with

UTI is an infection of the lower urinary tract and is commonly caused by Escherichia coli contamination of the distal urethra. How does that occur?

Infection of the lower urinary tract. It is commonly caused by E. coli contamination of the distal urethra or by a sexually transmitted disease. Chronic UTIs may result in scarring of the urethra that requires surgery.
The female urogenital tract is espec

What is dialysis and how does it work?

The kidneys normally remove waste products from the blood. Without this function, the body becomes quickly weakened by toxins produced during normal metabolism. Kidney dialysis is a procedure that performs this function in patients with chronic and end-st

A small incision made in the urethra to reduce scarring or relieve a stricture.

Urethrotomy

Imaging studies of the renal pelvis that use a contrast medium instilled through a transurethral catheter.

Retrograde pyelography

Reconstruction of the ureter in the renal pelvis

Pyeloplasty

A small incision made in the urethral meatus to relieve a stricture

Meatotomy

Urination

Micturition

A procedure in which ultrasonic sound waves are used to pulverize kidney or gallbladder stones

Extracorporeal shock wave lithotripsy (ESWL)

The removal of tissue or an organ without prior fragmentation or dissection

Enucleation

Removal of all or part of the prepuce (foreskin) of the penis

Circumcision

Inflammation of the glans penis

Balanitis

Condition in which the foreskin cannot be retracted from the glans.

Phimosis

Surgical creation of vascular access for patients undergoing hemodialysis

A-V shunt

Is performed to detect specific substances, both normal and abnormal, in urine.

Urinalysis

The presence or absence of specific substances in the blood reveals kidney function

Blood test

Measures the rate of creatinine clearance from the blood

GFR glomerular filtration rate

Is a test that assesses the elimination of urea from the liver

Blood urea nitrogen

Tissue removed from the genitourinary (GU) tract for microscopic pathological testing.

Tissue biopsy

Is preferred method for imaging tumors of the kidney.

Computed tomography (CT)

C-arm.

Fluoroscopy

This process involves radiograph studies using a contrast media.

IV urography

This is a radiograph of the kidney, ureters, and bladder.

KUB

This study provides images of the bladder while it is emptying.

MCU Micturating cystourethrogram

Provides an extremely detailed assessment and is commonly used in the diagnosis of tumors.

Magnetic resonance imaging (MRI):

This is used in GU studies to detect metastasis arising from a primary tumor of the prostate.

Nuclear imaging

Injections are made using a catheter inserted into the ureter.

Retrograde ureteropyelography:

This is used in the assessment of patients who are ineligible for CT or other forms of radiographic exposure.

Ultrasonography:

Case Study
You are about to scrub for a Cystoscopy when the operating room supervisor delivers a a surgical tech student to you and asks you to serve as her preceptor for the case. Your student has never seen a Cystoscopy before, and you decide to describ

The patient is placed in the supine position on the urology table. Low lithotomy stirrups or knee crutches are used to abduct and externally rotate the patient's legs. 2 The patient is prepped and draped for a perineal procedure. 3 A topical anesthetic or

During cystoscopic procedures, the bladder is distended with fluid to enhance visualization of the internal structures. Describe the following solutions, which are commonly used in cystoscopic procedures, and explain when they might be used.

A. Sorbitol
B. Glycine
C. Sterile distiller water
D. Water

Labeling (part 2) answers/components of male reproductive system

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Explain the purpose of continuous irrigation during transurethral surgery.

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Explain how a urethral catheter is used as a tamponade.

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What is a French (Fr) size? What is the most common catheter size for an adult?

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Explain why testicular torsion is an emergency.

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The lateral position is used for many procedures of the genitourinary tract. List at least five critical safety considerations for this position. Include specific anatomical locations and risk factors.

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What surgical approaches are used to enter the retroperitoneal cavity?

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What specific psychological considerations are important for the male patient undergoing surgery of the external genitalia?

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Many patients undergoing transurethral surgery are older. List four methods you would use to communicate with these patients.

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Testicular cancer is the most common cancer among young men. How would you approach a 26-year-old patient undergoing surgery for testicular cancer? Be specific. Define the patient's emotional needs at the time of surgery as part of your response.

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TURP

Surgical Goal
In transurethral resection of the prostate (TURP), the prostate is removed with a resectoscope inserted through the urethra.
Pathology
Enlargement of the prostate generally is related to infection, a benign tumor, or malignancy.
Benign prost

TURP diagram

TURB

Note: Transurethral resection of a bladder tumor is performed in the same manner as TURP.

Prostatectomy

Prostatectomy traditionally has been performed by cystoscopic resection or open surgery using various perineal and suprapubic techniques.
Modern prostatectomy is performed laparoscopically, robotically, or through an open approach (perineal or suprapubic)

Suprapubic prostatectomy

SUPRAPUBIC PROSTATECTOMY
Surgical Goal In a suprapubic prostatectomy, the prostate is removed through a suprapubic incision.
Pathology
Prostatectomy is performed to treat benign prostatic hypertrophy and for cancer of the prostate.
If the patient has been

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ROBOTIC-ASSISTED PROSTATECTOMY
Robotic-assisted laparoscopic prostatectomy follows the surgical techniques used in the routine laparoscopic procedure, with some technical differences.
The robotic arms are used to guide the instruments, and the monitor vie

Ileal conduit

ILEAL CONDUIT
Surgical Goal
In an ileal conduit procedure, a functional bladder is constructed with a loop of bowel that is brought out of the abdominal wall.
A stoma is created for urine drainage.
This procedure has been widely successful for urinary div

Ileal conduit diagram

Ileal conduit techniques

1. The bowel is mobilized to free a section of ileum.
2 The ileum is transected, and the proximal ileal segment and mesentery are closed.
3 The distal and proximal sections of the ileum are anastomosed.
4 The ureters are implanted into the ileal pouch.
5

GU TEST

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