Urology Procedures Overview

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Questions and Answers

What is the purpose of using sterile water in surgical interventions?

It is used with resectoscopes for high blood absorption.

It is used with lasers for stone removal.

It is used for observing interventions.

It is suitable for monopolar cautery where little absorption is anticipated. (correct)

Which surgical intervention is most commonly performed using a rigid cystoscope?

TURP (correct)

Ureteroscopy

Pyelostomy

Prostatectomy

What is a key feature of the flexible cystoscope?

It is exclusively for open surgeries.

It can only be used with laser lithotripsy.

It can only be used in male patients.

It promotes visualization of obstructive symptoms. (correct)

What precaution is essential when using lasers in surgical settings?

Having wet towels and a basin of water available for fire safety. Signup and view all the answers

In which scenario is a non-electrolytic medium preferred?

When using monopolar cautery where high absorption into the bloodstream is anticipated. Signup and view all the answers

What solution is used for preserving the kidney during transplantation?

University of Wisconsin solution Signup and view all the answers

What is the primary objective of orchidopexy?

To reposition the testicle into the scrotal sac Signup and view all the answers

In a kidney transplant, which artery connects the donor renal artery to the recipient?

Internal iliac artery Signup and view all the answers

What is a major risk associated with testicular torsion?

Loss of the testicle due to compromised blood supply Signup and view all the answers

What suture material is commonly used for the anastomosis in kidney transplants?

Prolene or Surgipro Signup and view all the answers

What is the primary function of the kidneys?

Remove urea and liquid waste from blood Signup and view all the answers

Which artery supplies blood directly to the kidneys?

Renal artery Signup and view all the answers

How does urine travel from the kidneys to the bladder?

Via peristalsis in the ureters Signup and view all the answers

What is a primary function of the adrenal glands?

Secrete hormones such as epinephrine Signup and view all the answers

What distinguishes the male urethra from the female urethra?

Length and function Signup and view all the answers

What is the anatomical position of the prostate gland?

At the base of the bladder neck, surrounding the urethra Signup and view all the answers

Which arteries supply blood to the bladder?

Superior and inferior vesical arteries Signup and view all the answers

What type of instrumentation is typically required for kidney surgery?

Basic laparotomy set Signup and view all the answers

What is the main purpose of a retrograde pyelogram?

To visualize blocks in kidneys or ureters Signup and view all the answers

Which procedure involves the use of a ureteroscope to remove stones?

Ureteroscopy Signup and view all the answers

In which scenario would lithotripsy be most likely performed?

For large stones in the kidney Signup and view all the answers

What is a key characteristic of laser lithotripsy?

It is a noninvasive procedure Signup and view all the answers

Which statement regarding Transurethral Resection of the Prostate (TURP) is correct?

It aims to relieve symptoms of an enlarged prostate Signup and view all the answers

What is one of the procedural considerations when using a resectoscope?

Application of the cutting loop electrode Signup and view all the answers

What potential complication should be monitored for during irrigation when using a resectoscope?

Irrigation fluid overload Signup and view all the answers

What is the purpose of using a non-electrolytic ionic medium with monopolar cautery during TURP procedures?

To prevent electrolysis and ensure safety Signup and view all the answers

What is one of the main goals of the Transurethral Ureteropyeloscopy (TUR)?

To excise tumour of the bladder wall Signup and view all the answers

Which symptom is commonly associated with bladder tumours?

Hematuria Signup and view all the answers

What method is used to control intraoperative bleeding during the Simple Retropubic Prostatectomy?

Electrocautery Signup and view all the answers

In Nerve Sparing Radical Retropubic Prostatectomy, what is the surgeon attempting to preserve?

Pelvic blood vessels and nerves Signup and view all the answers

Which type of prostatectomy involves an incision through the bladder?

Suprapubic Prostatectomy Signup and view all the answers

What is used for irrigation in a case requiring Continuous Bladder Irrigation (CBI)?

Normal saline Signup and view all the answers

What is the purpose of the pathology assessment performed after resection of a bladder tumour?

To identify the stage of the cancer Signup and view all the answers

Which suture type is used for vesicourethral anastomosis in Radical Prostatectomy?

3-0 Polysorb sutures Signup and view all the answers

Study Notes

Retrograde Pyelogram

Performed concurrently with cystoscopy to identify kidney or ureteral blockages.
Contrast dye is injected through ureters via catheter for X-ray visualization.
Stents may be placed to maintain urinary tract patency.

Ureteroscopy/Urethroscopy

Endoscopic procedures designed to remove stones from the urethra, ureter, or kidney.
Ureteroscope advances through the urethra, bladder, and into the ureter to locate stones.
Small stones can be snared; larger stones are treated with Lithotripsy to fragment them.

Pyelolithotomy

An open surgical technique to extract stones from the renal pelvis.
May utilize Randal stone forceps for stone removal.
Can also be performed laparoscopically with lithotripsy.

Laser Lithotripsy

A noninvasive approach for treating larger kidney stones using laser technology.
X-ray guidance assists in targeting stones.
Various lasers (Ho:YAG, Er:YAG, Nd:YAG) break stones into smaller fragments for easier excretion.
Continuous irrigation is maintained using normal saline.

Transurethral Resection of the Prostate (TURP)

Surgical intervention involving the removal of prostate tissue to alleviate symptoms of benign prostatic hyperplasia (BPH).
Procedure involves using a resectoscope to cauterize and remove obstructive tissue.
Irrigation fluid carries resected tissue to the bladder, which is later flushed out through a catheter.

Anatomy: Kidneys

Positioned retroperitoneally; they filter blood, removing waste products.
Blood supply derived from the renal artery, branches of the aorta.
The right kidney is smaller and situated lower due to liver placement.

Anatomy: Adrenal Glands

Located atop the kidneys; they act as endocrine glands.
Medulla secretes adrenaline; the cortex produces hormones influenced by the pituitary gland.

Anatomy: Ureters

Tubes extending from renal pelvis to bladder, approximately 25-30 cm long and 4-5 mm in diameter.
Function to propel urine via peristalsis.

Anatomy: Bladder

Extraperitoneal in location, serves as a urine reservoir.
Supplied with blood from the superior and inferior vesical arteries; drains into the internal iliac vein.

Anatomy: Urethra

Male urethra measures 20-25 cm while female urethra is only 4 cm long.

Anatomy: Prostate Gland

Surrounds the urethra and is located at the bladder neck.
Divided into four glandular regions; vascular supply from the pudendal and inferior vesical arteries.

Surgical Instrumentation

Basic laparotomy, prostate, bladder, and kidney-specific instruments are utilized.
Includes short and long instruments as well as retractors like the Bookwalter.

Anesthesia and Positioning

General or local anesthesia may be employed depending on procedure type.
Positioning varies (e.g., supine, lithotomy) according to the surgical approach.

Anesthesia Precautions

Monitor for signs of fluid overload and electrolyte imbalances especially during procedures involving irrigation.

Irrigation Fluids

Normal saline is used for interventions like cystoscopy; sterile water for monopolar cautery.
Non-electrolytic solutions (e.g., Sorbitol, Glycine) should be used to minimize blood absorption risks.

Surgical Interventions: Closed vs. Open GU Surgery

Closed: Cystoscopy, ureteroscopy, laser lithotripsy.
Open: Prostatectomy, cystectomy, pyelolithotomy, and nephrectomy.

Orchidopexy

Surgical procedure aimed at repositioning an undescended testicle into the scrotum, mainly in pediatric patients.

Testicular Torsion

An emergency condition characterized by twisted spermatic cord leading to compromised blood supply.
Requires immediate surgical intervention to prevent testicular loss.

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Description

This quiz covers essential urological procedures, including retrograde pyelogram, ureteroscopy, and the placement of ureteral stents. Understand the techniques employed for diagnosing and treating blockages in the urinary system, as well as the equipment used during these endoscopic interventions.