Urology Anatomy and Nursing Considerations

Urethra

• Male urethra measures 20-25 cm, while female urethra is about 4 cm.
• Short female urethra and proximity to anal/vaginal areas increase UTI risk.
• Cystoscopies, Transurethral Resection of Prostate (TURP), and Ureteric stents are performed via urethra.

Prostate Gland

• Donut-shaped gland located at the bladder neck, surrounding the urethra.
• Divided into four regions: right lateral, left lateral (intraurethral lobes), and posterior, median (extraurethral lobes).

Male Reproductive Organs

• Paired organs include testes, epididymis, seminal ducts, seminal vesicles, and Cowper’s glands.
• Singular structures consist of penis and scrotum.

Adrenal Glands

• Located retroperitoneally with two main sections: Adrenal Cortex (secretes steroids/hormones) and Adrenal Medulla (secretes adrenaline).
• Blood supply includes similar sources as kidneys plus branches from the inferior phrenic artery.

Perioperative Nursing Considerations

• Urologic procedures may stress patients, requiring careful anatomical positioning.
• Significant use of irrigation fluids necessitates lab/electrolyte monitoring.
• Blood Replacement: Anticipate possible blood transfusions due to extensive vascular tissue dissection.
• Patient positioning varies based on procedure; four common positions include supine, lithotomy, supine with Trendelenburg tilt, and lateral.
• In lithotomy position, ensure stirrups are securely fastened, and avoid excessive hip flexion to prevent nerve injuries.
• Coordinate leg removal post-surgery to facilitate hemodynamic adjustment.

Instrumentation and Counting

• GU surgeries vary between open and minimally invasive.
• Cystoscopy setups use a closed irrigation system, light cord, and different types of scopes with no count required.
• Open surgeries (Nephrectomy, Prostatectomy, Cystectomy, Pyeloplasty) use basic and specialty instruments, with major and minor counts performed to prevent retained instruments.

Equipment

• Use intra-operative fluoroscopy (C-arm) for imaging, ensuring patient protection from radiation.
• Open Prostate Surgery is common in men over 50, involving prostate gland excision.
• Suprapubic approach allows concurrent bladder condition treatment during prostate removal.

Minimally Invasive Radical Prostatectomies

• Robotic Laparoscopic procedure enhances surgeon precision with fewer incisions and shorter recovery.
• Laparoscopic approach includes abdominal insufflation and multiple ports for better visualization.

Bladder Surgery

• Surgeries can be open or transurethral; diagnostic procedures typically use the latter.
• Supra Pubic Cystostomy creates an opening into the bladder for drainage.
• Radical Cystectomy entails removing the bladder and surrounding structures, requiring new urine receptacle creation (Ileal Conduit or Kock Pouch).

Ureteral Surgery

• Common issues demanding surgical intervention include stones, infections, and tumors.
• Ureterostomy/Ureterotomy allows for drainage; Ureterectomy involves complete ureter removal.
• Ureterolithotomy opens the ureter to remove stones.

Kidney Surgery

• Nephrostomy maintains urinary drainage; Pyelolithotomy removes kidney stones.
• Open Nephrectomy is used for various renal conditions, often necessitating rib resection.
• Radical nephrectomy targets cancerous conditions, removing extensive surrounding tissue.

Kidney Transplantation

• Involves transplanting a living or cadaveric donor kidney to restore renal function in end-stage renal disease patients.
• Involves simultaneous preparation in adjacent operating rooms for efficient vessel verification during the donor nephrectomy and recipient surgery.