Genitourinary Surgery PDF

CHAPTER 20 Genitourinary Surgery © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. ...

CHAPTER 20 Genitourinary Surgery © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Introduction Genitourinary (GU) surgery – Surgical subspecialty Addresses a wide spectrum of diseases involving the male and female GU systems and the male reproductive system Urologists – Medical professionals: specialize in urology Diagnose, treat, and manage diseases ranging from GU malignancies and renal calculi to congenital GU defects © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Surgical Anatomy Kidney Adrenal glands Ureters Bladder Urethra © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Surgical Anatomy The Kidneys © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Surgical Anatomy Kidneys and Kidney Stones Nephron – Functional filtering unit of the kidney Kidney stones – Precipitation of specific salts from the – filtrate and the urine © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Surgical Anatomy Adrenal Glands © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Surgical Anatomy Ureters © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Surgical Anatomy Urinary Bladder © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Surgical Anatomy The Urethra Female – Originating at the trigone – Ending at the meatus Male – Originating at the trigone – Prostatic urethra – Membranous urethra – Cavernous urethra – Ending at the meatus © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Surgical Anatomy Male Anatomy Scrotum and testicles Epididymis Vas deferens Seminal vesicles Prostate gland Bulbourethral glands Penis © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Surgical Anatomy Scrotum Lies at base of penis Protects the testicles © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Surgical Anatomy The Testicles © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Surgical Anatomy Vas Deferens Forms a portion of the path that the seminal fluid travels Continues across bladder and ureter – Meets opening of seminal vesicle and forms ejaculatory duct © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Surgical Anatomy The Penis Male copulatory organ Highly vascular – Flaccid except during sexual stimulation © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Diagnostic Procedures and Disorders of the GUTests tract – Diagnosed through many standard procedures History and physical – Detailed history – Digital rectal examination for men over 40 Laboratory Findings Microscopic examination – Accurate method for determining blood and urine composition © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Diagnostic Procedures and Tests Laboratory findings – Chemical reagent strips – Available for fast general results for some tests Urinalysis Blood test Hematology findings Glomerular filtration rate Blood urea nitrogen (BUN) – Specific hematologic Tissue biopsy Imaging studies examinations will require a patient to comply with certain prerequisites – Refer to Table 20-1 – Common chemistry findings: refer to Table 20-2 © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Diagnostic Procedures and Urinalysis Tests – Most important laboratory examination Urinalysis Blood test used in diagnosing Glomerular filtration rate Blood urea nitrogen (BUN) problems affecting the Tissue biopsy Imaging studies urinary tract – Simple voided specimen is commonly used – Clean-catch or catheterized specimen if infection is suspected Composition of urine (refer to Table 20-3) – Visual and microscopic © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Diagnostic Procedures and Tests Radiologic Findings – Regular X-rays, ultrasound, CT scan, and MRI Important tools in diagnosing tumors and obstructions of the GU tract – KUB: kidney, ureters, and bladder X-ray: AP (anteroposterior) – IVU Enhancement of the KUB Involves injection of a © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, contrast medium duplicated, or posted to a publicly accessible website, in whole or in part.  Diagnostic Procedures and Tests Biopsy – Only accurate way to determine the presence of malignancy and the exact cell type Tissue samples are obtained using percutaneous, endoscopic, and open methods © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Diagnostic Procedures and Endoscopy Tests – Allows for visualization of the affected structures Tissue and fluid samples may be collected at the same time, and/or additional tests Laparoscopic procedures may also be performed to diagnose and treat conditions of the GU system © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Instrumentation, Routine Equipment, and Supplies Instrumentation – Similar to those for general surgery with the exception of specialty items needed for kidney, ureter, and prostate surgery – ST should add instrumentation according to the type of procedure and the patient’s individual © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Pathology Cushing’s Syndrome © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Pathology Addison’s Disease © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Pathology Pheochromocytoma © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Pathology Balanoposthitis © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Pathology Epididymitis © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Pathology Cryptorchidism © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Pathology Orchitis © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Pathology Phimosis © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Pathology Protatitis/BPH © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Pathology Prostatic Cancer © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Pathology Spermatocele © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Pathology Hydrocele © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Pathology Testicular Cancer © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Pathology Testicular Torsion © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Pathology Varicocele © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Pathology Erectile Dysfunction © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Pathology Glomerulonephritis © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Pathology Hypospadias Epispadias © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Instrumentation Rigid/Flexible Cystoscopes Ellik Evacuator Urethrotome/Resectoscope © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Positioning Lithotomy – Cystoscopy Supine – Bladder, prostate Lateral – Kidney and ureters Prone – Nephroscopy © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Incisional Options Inguinal incision – Often used to access the scrotal contents of an adult or child – Refer to Chapter 14 Scrotal incisions – Performed to access the scrotal contents Abdominal incisions – Refer to Chapters 14 and 15 © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Incisional Options Gibson incision – Extraperitoneal abdominal approach – Designed for access to the lower portion of the ureter – Refer to Figure 20-7 and text for description Flank incision – Provides direct access to the adrenal gland, kidney, and proximal ureter – May be subcostal, transcostal, or © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Incisional Options Lumbar incision – Provides limited exposure – Used for adrenalectomy, renal biopsy, or removal of a small low-lying kidney – May be done with the patient in lateral or prone position © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Kidney, Ureter, and Bladder Surgical Procedures Several procedures are used: – Wilms’ tumor excision (20-1) – Nephrectomy (Figures 20-10, 20-11) Partial or radical Open simple nephrectomy (20-2, Figure 20-12) Laparoscopic simple nephrectomy (20-3, Figure 20-13) – Kidney transplant (20-4) © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, Wilm’s Tumor duplicated, or posted to a publicly accessible website, in whole or in part.  Kidney, Ureter, and Bladder Surgical – GU endoscopy Procedures Transurethral Cystoscopy – Viewing and diagnosing Urogram, biopsy, fulguration, TURP, TURBIT, ureteral stents, calculi removal, urethral dilation Cystoscopy Video: https://www.youtube.com/watch?v=TPLnrejeL3U TURP Video: https://www.youtube.com/watch?v=72aHgYupkeo © 2018 Cengage Learning. All Rights Ureteral Stent: https://www.youtube.com/watch?v=byrXGUAlZYc Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Kidney, Ureter, and Bladder Surgical Procedures Ureteroscopy (male ) (20-5) Pyelolithotomy (20-6) Cytoscopy with Overview of TURBT (20-7) Cystectomy – Partial or segmental – Radical cystectomy with ileal conduit— male patient surgical anatomy and pathology (20-8) Ureteroscopy Video: https://www.youtube.com/watch?v=6rFViQjZr0c Open Pyelolithotomy Video: https://www.youtube.com/watch?v=NLPiGg5u4Us TURBT Video: https://www.youtube.com/watch?v=PFLLfWOUX-8 Cystectomy: https://www.youtube.com/watch?v=8Oxm1fIUP_0 © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Procedures for Stress Incontinence Affecting Objectives Women – Restore the posterior urethrovesical angle and elevate the bladder base May have been distorted during childbirth or as the natural result of aging Mild stress incontinence – May be reduced following an anterior colporrhaphy Significant incontinent episodes – May be eliminated with suprapubic vesicourethral suspension (Marshall-Marchetti-Krantz [MMK] procedure) 20- 9 Suburethral sling (pubovaginal sling) – May be recommended to women who have been unsuccessfully treated via surgical elevation and stabilization techniques – Stress Urinary Incontinence Video: https://www.youtube.com/watch?v=YhZ65opUXo8 © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Prostate Surgery Prostatectomy – Surgical removal of all or part of the prostate – May be accomplished transurethrally (for BPH) or may require an open procedure (cancer) Procedures – Transurethral resection of the prostate (TURP) (20-10) – Laparoscopic prostatectomy with robot (20-11) – Suprapubic prostatectomy (20-12) – Percutaneous implantation of radioactive seeds in the prostate gland (20-13) – Prostatectomy Video: https://www.youtube.com/watch?v=2XKnkB7p_l8&has_verified=1 © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Testicular Surgery Large percentage of testicular surgical procedures are performed on pediatric patients – Adult males may undergo procedures as an adjunct Procedures – Hydrocelectomy (20-14) – Orchiopexy (20-15) – Simple orchiectomy (20-16) – Hydrocele Video: https://www.youtube.com/watch?v=HlRHTnbM12c&has_verified=1 – Orchiopexy Video: https://www.youtube.com/watch?v=X1a0FmXt8qU&has_verified=1 – Orchiectomy Video: https://www.youtube.com/watch?v=cXUm87SkDDY&has_verified=1 © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Penile Surgical Procedures Performed to treat congenital defects, disorders, and cancer Procedures – Circumcision (20-17) – Hypospadias repair (20-18) – Epispadias repair (20-19) – Insertion of Inflatable penile prosthesis (20-20) – Penectomy (20-21) Infant Circumcision Video: https://www.youtube.com/watch?v=UHmtYTEkMbU&has_verified=1 Hypospadias Repair Video: https://www.youtube.com/watch?v=me0xRlbMmA4&has_verified=1 Penile Prosthesis Video: https://www.youtube.com/watch?v=z7WwTMTgCws © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.  Questions © 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.