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GU Surgery
Surg Tech GU
| Question | Answer |
|---|---|
| most important lab exam used in dx problems affecting urinary tract | urinalysis (UA) |
| KUB | kidneys, ureters, bladder |
| KUB has an ____ radiographic view | anteroposterior |
| IVU | intravenous urogram; previously called intravenous pyelogram - enhancement of KUB that involves injection of contrast medium into pt's vein |
| Rigid endo instrumentation: sheath | outfitted with stopcocks affixed to either side to allow for inflow and outflow of irrigation |
| Rigid endo instrumentation: obturator | blunt tip that fits inside sheath to facilitate introduction of sheath into urethra without causing damage |
| Rigid endo instrumentation: bridge | to accommodate added length of telescope; may have additional parts for introducing caths, probes, electrodes, and forceps |
| Rigid endo instrumentation: deflecting mechanism | movable deflector that extends to end of sheath aids in placing accessories such as caths or probes into ureters |
| Rigid endo instrumentation: telescopic lens | primary viewing component; start with 0 degrees straight lens first and then a 120 degree lens for retrograde viewing |
| Resectoscope | sheaths differ from cystoscope with insulation to allow for use of ESU |
| How much and what kind of irrigation fluid is used for cystoscope? | 3-6L; 3% sorbital or 1.5% glycine |
| Position for cystoscopy | low lithotomy |
| Ellik evacuator or Toomey syringe | forcefully removes tumor segments and blood clots from bladder |
| The mesh-bottom fluid drain pain attached at the end of the table is used for... | to "catch" tissue specimens or stones; aka "strainer" |
| Different types of caths | Pezzer, Robinson, Coude, whistle tipped, multi-eyed |
| Inguinal incision | used to access scrotal contents - cryptorchidism and radial orchiectomy |
| Scrotal incision | used to access scrotal contents - vasectomy, testicular biopsy, simple orchiectomy, orchipexy |
| Gibson incision | extraperitoneal abdominal approach designed for access to lower portion or ureter but sometimes used for implantation of donor kidney |
| Flank incision | direct access is provided to adrenal gland, kidney, and proximal ureter - peritoneal cavity is not entered |
| Subcostal flank incision | used when kidney is low lying or if mid to upper ureter in intended target |
| Muscles transected in flank incision (with ESU) | latissimus dorsi (on back), external oblique, and internal oblique |
| Transcostal flank incision | used to expose entire kidney, especially if it's high in retroperitoneal space and involves resection of rib - incision is made directly over rib selected for removal (usually 11th or 12th) |
| Lumbar incision | provides limited exposure by making an incision below the 12th rib lateral to sacrospinalis muscles and extends pas tip of rib; used for adrenalectomy, renal biopsy, or removal of a small low-lying kidney |
| Another name for adrenal glands | suprarenal glands |
| Cortex of adrenal gland secretes | steroid-type hormones essential to control of fluid and electrolyte balance |
| Medulla of adrenal gland secretes | two catecholamines: epi and norepi |
| Another name for Wilms tumor | congenital nephroblastoma |
| Wilms tumor eventually... | replaces most of involved kidney, causing hemorrhage and eventual necrosis |
| Peak occurrence of Wilms tumor | ages 3 - 8 |
| Position for Wilms tumor excision | supine with small roll positioned under affected side to slightly elevate tumor |
| Nephrectomy | total or subtotal removal of kidney |
| Partial nephrectomy | obtain a specimen for biopsy, remove small cancers, remove calculi that have caused damage to surrounding parenchymal tissue, or to treat traumatic injury |
| Incision used for nephrectomy | Gibson's |
| Radical nephrectomy | removal of kidney, adrenal gland, perirenal fat, upper ureter, and Gerota's fascia |
| Incision and position used for radical nephrectomy | abdominal incision (transperitoneal) in supine |
| Why is 3% sorbital or 1.5% glycine used for ESU endoscopy? | it's nonelectrolytic and nonhemolytic |
| The (left/right) kidney is larger than the other | left |
| The (left/right) kidney is slightly lower than the other | right |
| Where does the pancreas lie in relation to the left kidney? | across the hilum |
| Functional unit of kidney | nephron |
| How many nephrons are there? | 1 million |
| Nephrons are subdivided into 2 types: | juxtamedullary and cortical |
| 2 basic units of nephron | renal corpuscle and renal tuble |
| Blood supply to kidney | renal arteries follow a transverse course from abdominal aorta to hilum of kidney |
| Where is juxtamedullary nephron located? | extends deep into medulla |
| Where is the cortical located? | in cortex |
| Why is a simple nephrectomy performed? | small malignancies, chronic obstructive disorders, benign tumors, or removal of a kidney for transplant |
| Drain superior, middle, and inferior portions of kidney into renal pelvis | Major calyces |
| Location of renal pelvis | in hilum of kidney and continues to ureter |
| Glomerulus | network of capillaries in renal corpuscles |
| Position for simple nephrectomy | lateral with affected side up |
| Incision for simple nephrectomy | subcostal flank approx. 2 cm below 12th rib |
| 2 ways to preserve donor kidney | Collin's solution or sterile ice slush in Lahey intestinal bag |
| During a simple nephrectomy, is the renal artery or renal vein clamped first? | Renal artery |
| 3 muscles cut through during simple nephrectomy | external oblique, latissimus dorsi, external oblique |
| Morcellator | cuts pieces of kidney to remove with suction during lap simple nephrectomy |
| What is used to place a ureteral cath during a lap simple nephrectomy? | cystoscope (short) then ureteroscope (long) |
| PKD | polycystic kidney disease; cysts form in tubular portions of nephrons and enlarge substintially |
| 3 types of PKD | autosomal dominant, autosomal recessive, acquired |
| Autosomal dominant PKD | inherited form, usually develops between ages 30 - 40 |
| Autosomal recessive PKD | inherited form, affects young children (extremely rare) |
| Acquired PKD | develops in pts with long-term kidney disorders |
| How does uncontrolled DM affect urinary system? | causes sclerosis to glomerular apparatus of kidney making filtering blood more difficult |
| Results of progressive PKD | chronic renal failure and ESRD within 2 - 6 yrs |
| 2 tx for ESRD | dialysis and transplant |
| ESRD | end stage renal disease; >10% normal capacity |
| Why is Collins solution NOT used as perfusion solution for a living donor kidney? | residual perfusion solution could inc serum K in recipient |
| Before the surgeon clamps and divides renal vessels, what meds will anesthesia give and why? | heparin and mannitol to promote diuresis and prevent clotting in arteries and veins |
| What meds are given to pt after kidney removal and why? | protamine sulfate to reverse heparinization and furosemide and mannitol to promote urinary output |
| What is done with the harvested kidney? | it's placed in a basin on back table containing sterile ice slush and flushed with electrolyte solution |
| What is the electrolyte solution a mixture of? | Ringer's lactate with procaine and heparin |
| What instrument is used to extend a venotomy in a kidney recipient transplant? | 45 degree Potts scissors |
| Why are stockinettes used to hold the donor kidney? | aids in keeping friable kidney tissue from being injured during handling by OR team |
| What type of suture is used to anastomose donor renal vein and recipient's internal iliac vein? | double-armed polypropylene (Prolene) |
| Before the surgeon places the final stitch in each anastomosis, what should the ST remind them to do? | irrigate the vessels with heparin sodium using a 10-mL syringe or cath |
| What is placed to maintain patency or ureter after kidney transplant? | 5 Fr ureteral stent - inserted through ureteroneocystostomy up to renal pelvis and exteriorized through urethra |
| Ureteroneocystostomy | procedure of connecting a donor ureter to a recipient bladder |
| Urinary tract endoscopy is commonly referred to as | cystoscopy |
| TURP | transurethral resection of the prostate |
| TURBT | transurethral resection of a bladder tumor |
| Main role of ST during cystoscopy | do NOT run out of irrigation to avoid bubbles |
| CBI | cont. bladder irrigation - used postop on TURP or TURBT procedures to slowly flush bladder and aid in hemostasis by avoiding blood clots |
| Type of cath used in CBI | 3-way foley |
| Position for ureteroscopy | low lithotomy |
| Order of scope use for ureteroscopy | cystoscope (short) and ureteroscope (long) |
| Will fluoroscopy be used for a ureteroscopy? | yes |
| If a stone is too large for basket stone forceps, what is used to break up the stone into smaller pieces? | holmium laser |
| What kind of stent is inserted after ureteroscope and why? | JJ stent "pigtail stent" - ureteroscope causes swelling of ureter which will obstruct urine flow to bladder and cause reflux into kidney |
| Pyelolithotomy | excision of a calculus from renal pelvis - stone is lodged in hilum |
| Position for pyelolithotomy | lateral if stone is in renal pelvis or upper part of ureter, supine if stone is located in distal ureter |
| Muscle responsible for emptying bladder and closing bladder orifice | detrusor |
| Where is bladder located in males? | lies on and is attached to base of prostate gland |
| Where is bladder located in females? | lies on pelvic diaphragm |
| Position for TURBT | low lithotomy - knees and legs are well padded and protected from pressure, especially in popliteal region |
| Irrigation solution for TURBT | NONhemolitic and NONelectrolytic and isotonic - glycine, sorbitol, water |
| Difference in setups between TURP and TURBT cystoscopy | in TURP, a resectoscope (including sheath and obturator and working element) and cutting loops (ESU) is added |
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fyrevalkyrie
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