GU Exam 2023 with 100% correct questions and and answers

What organs make up the GU system? urethra, bladder, ureters, kidneys What are the three common approaches to GU surgery? Transurethral, Open, MIS Explain the transurethral approach. Surgery performed through a flexible or rigid endoscope inserted through the urethra Explain the open approach. Surgery performed through an open incision of the abdomen (retroperitoneum or flank) Explain the MIS approach. Closed procedure performed using percutaneous (through the skin) technique What is the retroperitoneal made up of? muscle, fascia, fatty tissue Kidneys are the primary organ for what? Filtration of the blood. Where are the kidneys located? retroperitoneal cavity What are the two main tissue layers of the kidney? outer cortex, inner medulla The medulla is composed of what? 8-12 collecting areas called renal pyramids _______ is a notched area on the medial side of each kidney. Hilium What three things emerge from the hilium? Ureter, renal artery, renal vein The ureter opens into the _____ _______ of the kidney, which branches into the ______ ________. renal pelvis, renal calyces What are the filtering units of the kidney? Nephrons. Each kidney has 1 million. How many nephrons are made up in the kidneys? 1 million Which structure does the nephron communicate with? Glomerulus Where are the nephrons located? Bowman's capsule The juxtaglomerular cells in the Bowman's capsule secrete _____. Renin _______ is necessary for the regulation of blood pressure. Renin How much can the glomerulus filter? 125 mL per minute. As filtrate moves through the tubules, what three things are absorbed from filtrate back into the circulatory system? electrolytes, non-organic salts, water What three regions is the tubule system divided? proximal and distal tubule, loop of Henle What is an undesirable effect of most diuretics? excessive loss of potassium What is another name for kidney stones? Calculi How are kidney stones formed? by the precipitation of specific salts from filtrate that becomes supersaturated. What area do stones rarely form? The bladder What symptoms come with stones? undesirable pain, nausea, obstruction, anuria, kidney abscess, sepsis What is anuria? decreased or no urinary output What diseases can kidney stones be present? -hyperparathyroidism, -increased absorption of calcium in the intestines, -chronic UTI, -high protein intake, -drug use How can stones be removed from the body? surgically or through ESWL What are the adrenal glands? paired organs above the kidneys, containing an outer cortex, inner medulla They secrete: glucocorticoids, mineralcorticoids, adrenal sex hormone Important in producing epi, norepi How does urine move along the ureters? Peristalsis What is peristalsis? segmental contraction and relaxation of ureter's muscular layer What are the four tissue layers making up the bladder? outer serosa, muscularis, submucosa, inner mucosa What is macturition? urination What is the name for the urethral opening? The meatus Name the reproductive structures of the male. Scrotum, testicles, epididymus, vas deferens, seminal vesicles, prostate gland, bulbourethral glands, penis UTI is an infection of the lower urinary tract. It is commonly caused by Escherichia coli contamination of the distal urethra. How does that occur? The female urogenital tract is especially vulnerable to infection, because it is very short. Bacteria enter the urethral orfice and proliferate in bladder, causing cystitis. What is dialysis and how does it work? It performs the removal of waste products from the blood for patients with chronic and end-stage renal disease. Performed regularly or for emergency. Two types (hemodialysis, perioneal dialysis) Urethrotomy A small urethral incision. Reduced scarring or releases a stricture. Retrograde pyleography Imaging studies of the renal pelvis. Uses contrast medium instilled via transurethral catheter. Pyeloplasty Reconstruction of a ureter in renal pelvis Meatotomy Small urethral meatus incision. Relives a stricture. ESWL A procedure where ultrasonic sound waves are used to destroy kidney or gall stones Circumcision Removal of prepuce (foreskin) of the penis. Phimosis Condition in which foreksin cannot be retracted from the glans AV shunt Surgical creation of vascular access for pts. undergoing hemodialysis What is a urinalysis? Test performed to detect substances, normal and abnormal, in urine. What is a blood test used for in GU? Detects the presence of absence of specific substances in the blood to reveal kidney function. Glomerular filtration rate (GFR) Measures the rate of creatinine clearance from blood. Blood urea nitrogen Test to assess the elimination of urea from the liver. Tissue biopsy Tissue removed from the GU tract for microscopic testing. CT scan preffered method for imaging tumors of the kidney. Fluroscopy C-arm. IV urography Process involving radiographic studies using contracst media KUB radiograph of the ureters, kidneys, bladder. Micturating Cystourethrogram (MCU) provides images of the bladder as its emptying MRI Provides extremely detailed assessment to diagnose tumors. Nuclear imaging Used in GU studies to detect metastasis arising from a primary tumor of the prostate. Retrograde ureteropyelogram Injections are made using a catheter inserted into the ureter. Ultrasonography Used in the assessment of patients who are ineligible for CT or other forms of radiographic exposure. Explain the purpose of the dartos muscle. In cold environments, the dartos retracts the testicles closer to the body it relaxes when the temperatures get warmer. What are the two types of kidney dialysis? Hemodialysis, Periotneal dialysis Describe hemodialysis. blood is shunted into a hemodialysis machine where it passes through a solution to remove wastes, then returns blood to the body. 3 hours. Describe peritoneal dialysis. a tube is inserted and dialysis solution is instilled. Solution remains in body then removed. Done by the pt. taking 4-6 hrs What are the main components of urine? water 95% and solutes 5% Why is a urinalysis performed? To detect substances normal/abnormal in the urine. What information does a simple urinalysis provide? blood, glucose, WBC, color, odor, density, clarity What is specific gravity? ratio of urine density compared to water. What does a GFR measure? rate of creatinine clearance from the blood. Rigid cystoscopy and ureteroscopy are always performed with the patient in ____________ position. Lithotomy Flexible cystoscopy can utilize _______ and ________ positions. Lithotomy, supine The ureters are extremely delicate and require autramamatic clamps such as... Babcock clamps, right angles, Schnitz (tonsil) clamps What is a sheath? Hollow tube that serves a passageway for the instruments used during cystoscopy and resection. What is an obturator? Placed inside the sheath prior to being placed in the urethra. Straight or deflecting. Resectoscope Used to remove small fragments of tissue endoscope, sheath, obturator, esu loop What are the different uses for urinary catheters? short-term or continuous drainage, bladder irrigation, evacuation of clots, continuity of urethra or ureters What are two common types of urethral catheters? indwelling (Foley), Straight (robinson) What is the most common type of urinary catheter? Foley What are some uses of ureteral catheters? to instill CM into the ureter and kidney (retrograde pyelography) immediate or temp. drainage allowing a stone to pass obtain specimen Where must a grounding pad be placed? Overy a fleshy area such as the thigh or the waist Never over a bony prminence Rigid endoscopy requires what position? Lithotomy Flexible endoscopy requires what position? Supine, but lithotomy can also be used. During cysto procedures, what considerations to the patient must be in place? buttocks must be in line with or just over the table break; legs supported by knee crutches or stirrups; stirrups must have correct padding to prevent pressure to the peroneal nerve Skin prep for cysto procedures require which areas? entire perineum, external genitalia, pubis Which intraop imaging techniques are common during cysto? radiography and fluoroscopy are most common Imaging systems used in GU contain what components? light source and fiberoptic cable, endoscopes, camera control unit video cables, digital output recorder, monitor and equip cart During cysto procedures, why is the bladder distended and how? with fluid, to enhance visualization of internal structures. Whenever ESU is used, which irrigation fluid must be used and why? Nonelectrolytic solutions. these fluids cannot disperse or transmit electricity. Which solutions are most comon in electrosurgery? Sorbitol and glycine Sterile distilled water may be used when? During assessment of the bladder and retrograde pyelography, which do not require electrosurgery. Fluid warmers may contribute to ___________ _____________, because the warm water suppresses to delays the body's natural clotting mechanism. increased hemorrhage What may occur when cold irrigation solutions are used? bladder spasms, hypothermia For cysto, what types of anesthesia are used? local or topical Where is local anesthetic administered for males/females in cysto? Males: instilled into bladder or penis Female: urethral meatus via cotton tip applicator What topical solution is used for cysto procedure anesthestic? Lidocaine gel 1% or 2% Cystoscopy Surgery of the distal GU performed with a cystourethroscope. Used as visual assessment before transurethral Supine Rigid scope, lubricated into urethra Continuous irrigation Urethra and bladder examined Urine specimen obtained Urethral dilation Used to relieve a stricture Dilators lubricated prior to insertion Urethrotomy Sm. incision into internal urethra Releases scar tissue or stricture if dilation fails What are strictures? Caused by scarring from previous trauma, infection, or congenital What causes a urethral stricture? Previous trauma, infection, congenital, or enlarged prostate Meatotomy (meatoplasty) Small incision made into the urethral meatus to relieve a stricture. Common in pediatrics Infection or previous dilation results in scarring, partial obstruction topical anesthesia healing occurs by secondary intention How does healing occur in meatotomy procedures? Secondary intention. Tissue biopsy performed with cup forceps or a flat wire basket. Cell biopsy taken from the bladder with cytology brush ST puts brush in saline to clean cells urinary retention may occur as result of swelling or pain What are the most common complications of cysto procedures? bleeding, edema Management of calculi Removed to relieve pain, restore continuity, remove obstruction, treat infection Causes damage to UT most common cause of UT obstruction Stents may be placed to help stones pass What is bladder calculi? small stones that don't pass and need to be removed using stone grasping forceps What graps and crushes stones? Lithotrite flushed from bladder using ellik evacator bleeders coagulated with bugbee electrode Transurethral resection of the prostate (TURP) Removal of the prostate via resectoscope Prostate enlargement is due to infection, benign/malignant tumor In what two ways does the prostate enlarge? cells multiply around the urethra, causing obstruction cells multiply into the urethra, and spread to bladder What is benign prostatic hyperplasia? Nonmalignant enlargement of the prostate gland. In men over 40. Commonly treated by resection. Obstructive disease may lead to...? reflux, further infection, difficulty voiding What position is the patient placed for a TURP procedure? Lithotomy. What is performed before a TURP procedure as means of visualization? Cystoscopy with 30 degree lense to evaluate the bladder and other structures. What are some possible post-op complications of a TURP procedure? Incontinence, Impotence, Infertility, Retrograde ejaculation, Urethral stricture What is retrograde ejaculation? passage of semen into the bladder instead of the urethra What type of scope is used for a TURP? 30 degree scope Flexible and rigid Ureteroscopy Used to diagnose congenital anomalies, disease, or trauma (ureters or renal pelvis), manages calculi, tissue biopsy flexibility allow scope to be positioned in renal pelvis and adv. into calyces What are some different irrigation solutions in GU? sterile saline for procedures NOT requiring ESU. Sorbitol or glycine for ESU Contrast medium, can be added to irrigation for fluoroscopy Ureteroscope Flexible Inserted with guidewire, which is passed thru the scope and into the ureter and renal pelvis under fluoroscopy accessory inst are threaded thru working channels Rigid scopes Used to dilate the lower ureter allows passage of flexible scope ad catheters or stents TURBT or Bladder tumor removal Removal of bladder tumor resectoscope goes into bladder tumors are removed with loops, ESU, holmium YAG lasers What is a circumcision? Removal of prepuce (foreskin) Improves hygiene, religious cultural Lowers risk of penile cancer related to repeated infection or HPV Coronal ridge identified for incision Foreskin pulled down over glans Dorsal incision Wrapped in petroleum gauze Explain a chordee and its repair. Congenital downward of the penis due to band of CT between the urethral opening and the glans, a short urethera, or combination Brings penis back to normal position. Repair after 6mo Explain hypospadias and its repair. Shortening or incomplete development of the urethra Meatus appears along penile shaft or base of scrotum. Congenital Reconstructed with graft from foreskin or buccal Catheter left in place postop Explain Epispadias. Rare condition Urethral meatus on top side of the penis Associated with exstrophy of the bladder, abdominal protrusion, defects of pelvic and GU Explain a penectomy. Partial or complete amputation of the penis. Treatment of cancer. Surgical goal to preserve voiding and erectile function. Squamous cell carcinoma (rare in uncircumcised) Supine or lithotomy Specimen for frozen section. Tumor covered with glove to prevent seeding. Explain the insertion of a penile implant. Surgically placed to treat impotence caused by disease. Two types: semi-rigid and inflatable reservoir. Impotence caused by neurological, diabetes, vascular disease, psych Describe the three parts of a penile implant. Cylinders are placed in the corpora cavernosa and inflated by the pt. Pump placed in the scrotum Reservoir placed in inguinal area Varicocelectomy Removal of testicular veins. reduces backflow to the internal spermatic veins. improves spermatogenesis. Varacoceles Varicocele Abnormality Veins of spermatic cord are dilated Venous plexus Twisted and dilated Hydrocelectomy removal of a hydrocele (benign fluid sac) developing in anterior testis. drained and removed to prevent rupture/hemorrhage Orchiectomy Surgical removal of one or both testicles. Treats testicular cancer. Prosthestics may be inserted at time of surgery or postop Complications: loss of libido, fatigue, breast tenderness Pts prescribed testosterone postop to prevent symptoms What is torsion? twisting of the testicles, resulting in ischema and necrosis. Vasectomy Removes vas deferens and seals free ends. No more babies. Prevents movement of sperm. Scrotum is incised and vas deferens is located, clamped, removed. Vasovasectomy Reversed vasectomy. Continuity or anastomosis of vas deferns Restores fertility. Complications of postop swelling and hemorrhage Implantation of Prosthetic Testicle Post-orchiectomy Suprapubic approach to prevent postop infections Spermatic cord retracted Placed into scrotal sac Suprapubic cystostomy insertion of a suprapubic catheter percutaneous or open into bladder for drainage passes through skin, sub-q, fascia, muscle -stomy artificial opening Cystectomy removal of the bladder. treats bladder cancer, diagnosed by cystoscopy, cytological brush, bladder washing to collect cells false bladder created at end using part of ileum What are the two most common cancers of the GU system? Bladder, then prostate. Whats the difference between total and simple cystectomy? Total: small tumor penetrating wall Partial: NO lymph node metastasis What is an ileal conduit? False bladder Ileostomy Incision is made over the area for a stoma. Tissue is taken down to the rectus muscle and kelly is placed. Edge of stoma sutured. Wound is irrigated. Suction drain placed in abdomen. Implantable electronic device Treats urinary incontinence. Sends a mild electric current to tell the body to urinate. Can also treat overactive bladder, stress incontinence, urge incontinence, mix of the two Vesicourethral Suspension Marshall-Marchetti-Krantz Suspension of the bladder neck and urethra to pubic symphysis. Only in females From multiple births, prolonged labor, diabetes, neuro, age Can cause hygenic and psych problems What is a pubovaginal sling? Biosynthetic strip of fascia graft to hold the bladder neck. attached to the abdominal wall abdomen, cysto, drills, anchoring sys. rectus/abdominal/fascia graft What is brachytherapy? Implantation of radon seed and crysurgery. Treats prostate cancer. Performed lap, robotic, opem. cystoscopic