Urology Surgical Procedures Quiz

Introduction

• Genitourinary (GU) surgery is a surgical subspecialty
• Addresses various diseases affecting the male and female GU systems, and male reproductive system
• Urologists are medical professionals specializing in urology
• Diagnose, treat, and manage GU malignancies, renal calculi, and congenital GU defects

Surgical Anatomy

• Kidneys: Essential organs for filtering waste from the blood
• Adrenal glands: Located above the kidneys, producing hormones.
• Ureters: Tubes that carry urine from the kidneys to the bladder.
• Bladder: Stores urine until it's eliminated.
• Urethra: Tube that carries urine out of the body.
• Nephron: Functional filtering unit within the kidney.
• Kidney stones: Precipitation of salts from urine filtrate.

Surgical Anatomy - Kidneys and Kidney Stones

• Nephron: The functional filtering unit of the kidney.
• Kidney stones: Formation of specific salts in the kidneys.
• Common chemical ingredients in kidney stones include Calcium Oxalate Monohydrate, Calcium Oxalate Dihydrate, Uric Acid, and more.

Surgical Anatomy - Adrenal Glands

• Adrenal glands are paired endocrine glands located above the kidneys.

Surgical Anatomy - Ureters

• The ureters are tubes that carry urine from the kidneys to the urinary bladder.

Surgical Anatomy - Urinary Bladder

• Stores urine until elimination.
• Contains rugae, smooth muscles, and openings for the ureters and urethra.

Surgical Anatomy - The Urethra

• Female: Origins at the trigone, ending at the meatus.
• Male: Originates at the trigone, passing through prostatic, membranous, and cavernous portions, and ending at the meatus.

Surgical Anatomy - Male Anatomy

• Scrotum and testicles: External sac holding the testicles.
• Epididymis: Structure containing sperm ducts.
• Vas deferens: Tube carrying sperm to the urethra.
• Seminal vesicles: Produce fluid for semen.
• Prostate gland: Produces fluid for semen.
• Bulbourethral glands: Produce fluid for lubrication.
• Penis: Male copulatory organ highly vascular, flaccid except during sexual stimulation.

Surgical Anatomy - The Testicles

• Epididymis, Vas deferens, Seminal vesicles, Prostate gland, Bulbourethral glands: Components of the male reproductive system.
• The contents are involved in reproduction and the formation of semen.

Surgical Anatomy - Vas Deferens

• Forms part of the seminal fluid path, passing through the bladder and ureter
• Connects to the seminal vesicle, forming the ejaculatory duct

Surgical Anatomy - The Penis

• Highly vascular, flaccid except during sexual stimulation.
• Contains the corpus cavernosum and corpus spongiosum for erection.

Diagnostic Procedures and Tests

• Disorders are diagnosed using various procedures.
• History and physical: Detailed history and specialized examinations such as digital rectal examinations (for men over 40).
• Laboratory Findings: Microscopic examination for urine and blood composition.
• Chemical reagent strips are used for fast general results for some tests.
• Hematology findings: Specific examinations need predetermined requisites.
• Urinalysis: Important diagnostic tool used to diagnose problems affecting the urinary tract.
• Radiologic Findings: Tools like X-rays, ultrasounds, CT scans, and MRIs play in diagnosis of tumors and obstructions of the GU tract.
• Biopsy: Used for the presence of malignancy; tissue samples are obtained to analyze cell types through percutaneous, endoscopic, or open methods.
• Endoscopy: Allows visualizing the structures; tissue and fluid samples may be collected, and additional tests.
• Laparoscopic procedures can also be used for diagnosis and treatment of GU conditions.

Instrumentation, Routine Equipment, and Supplies

• Surgical instrumentation is similar to general surgery with added items for kidney, ureter, and prostate surgery.
• Instrumentation should be added according to procedure types.

Pathology - Cushing's Syndrome

• Signs and symptoms of Cushing syndrome like round face, hump, hirsutism, easy bruising, abdominal weight gain, and stretch marks.

Pathology - Addison's Disease

• Chronic hypoadrenalism results in low cortisol, hypoglycemia, hypercalcemia, high ACTH, pigmentation, low sex hormones, muscle wasting, loss of body hair, amenorrhea.

Pathology - Pheochromocytoma

• Tumor of the adrenal gland causing various physiological changes.

Pathology - Balanoposthitis

• Inflammation of the glans penis and foreskin.

Pathology - Epididymitis

• Inflammation and swelling of the epididymis.

Pathology - Cryptorchidism

• Undescended testicles.

Pathology - Orchitis

• Inflammation of the testes.

Pathology - Phimosis

• Narrowing of the foreskin of the penis.

Pathology - Prostatitis/BPH

• Inflammation of the prostate (prostatitis) and enlarged prostate (BPH).

Pathology - Prostatic Cancer

• Cancerous growth in the prostate gland.

Pathology - Spermatocele

• Cysts in the epididymis.

Pathology - Hydrocele

• Fluid-filled sac around the testicle.

Pathology - Testicular Cancer

• Cancerous growth originating within the testicle.

Pathology - Testicular Torsion

• Twisting of the spermatic cord.

Pathology - Varicocele

• Enlarged varicose veins in the spermatic cord.

Pathology - Erectile Dysfunction

• Inability to achieve or maintain an erection.

Pathology - Glomerulonephritis

• Inflammation of the glomeruli in the kidneys.

Pathology - Hypospadias and Epispadias

• Congenital abnormalities in the urethra's location.

Instrumentation- Rigid/Flexible Cystoscopes and Urethrotome/Resetoscopes

• Specialized instruments to facilitate visualization and treatment of genitourinary structures.

Positioning

• Lithotomy (Cystoscopy): Lying on back with legs raised and separated.
• Supine (Bladder, Prostate): Lying on back.
• Lateral (Kidney, Ureter): Lying on side.
• Prone (Nephroscopy): Lying on stomach.

Incisional Options

• Inguinal, Scrotal, Abdominal and their uses to access scrotal and abdominal structures.
• Gibson, Flank, Lumbar incisions are specialized techniques for specific exposures of the genitourinary structures. The options include limited exposure and direct access for ureter, adrenal gland, kidney surgery

Kidney, Ureter, and Bladder Surgical Procedures

• Procedures like Wilms' tumor excision, nephrectomy, partial/radical nephrectomy, laparoscopic nephrectomy, and kidney transplant are noted.

Kidney, Ureter, and Bladder Surgical Procedures – GU Endoscopy

• Procedures like transurethral, cystoscopy, urogram, biopsy, fulguration, TURP, and TURBIT are described for viewing and treating genitourinary conditions
• Other procedures like ureteral stent insertion and urethral dilation are mentioned.

Kidney, Ureter, and Bladder Surgical Procedures- Specific Procedures

• Procedures like ureteroscopy, pyelolithotomy, Cytoscopy with TURBT, and cystectomy are highlighted.

Procedures for Stress Incontinence Affecting Women

• Procedures restoring the posterior urethrovesical angle and elevating the bladder base, as well as options like anterior colporrhaphy, suprapubic vesicourethral suspension, and suburethral sling.

Prostate Surgery

• Prostatectomy: Surgical removal of all or part of the prostate
• Types of Prostatectomy include transurethral resection (TURP), laparoscopic, suprapubic, and percutaneous procedures including radioactive seed implantation.

Testicular Surgery

• Procedures on testes, including hydrocelectomy, orchiopexy, and simple orchiectomy are noted.

Penile Surgical Procedures

• Surgical procedures (Circumcision, Hypospadias repair, Epispadias repair, and Insertion of inflatable penile prosthesis and Penectomy