CHAPTER 20 Genitourinary Surgery - PowerPoint Presentation

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CHAPTER 20

Genitourinary Surgery

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Anatomy

Suprarenal glands

Kidneys

Ureters

Urinary bladder

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Supradrenal Glands

On top of kidneys

Endocrine glands

Cortex

Secretes steroid- type hormones

Control fluid and electrolyte balance

MedullaSecretes epinephrineNorepinephrine

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Kidneys

Differ in location and size

Left is normally larger

Nephron is the functional unit

Renal corpuscle

Renal tubule

Filters bloodExcrete waste

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Ureters

Conduct urine from the kidney to the bladder

Muscular tubes

Small lumen

“S” shaped

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Kidney/Ureter

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Urinary Bladder

Collects urine

Lies in the anterior half of the pelvis

Male

Lies on and is attached to the base of the prostate gland

Female

Lies on the pelvic diaphragm

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Urinary Bladder

Trigone

Ureteral openings

Urethral opening

Base of the bladder

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Bladder Tumors

Present with hematuria

Single growth or multiple present

Benign (papillomas) occur in young adults

Malignant neoplasms usually occur in men over 50

Early removal transurethrally

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Urinary Calculi

Small solid particles

Form in one or both kidneys

Travel through the urinary system

Partial or total obstruction

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Urinary Calculi

Calculi symptoms

Dysuria

Polyuria

Passage of small amounts of urine

Flank pain

Nausea and vomiting

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Male Reproductive System

Penis

Testes

Ductus

Deferens

Seminal vesicles

Ejaculatory ductsProstate gland

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Penis

Superficial structure

Cylindrical masses of cavernous tissue

Two corpora cavernosa

Dorsal

Corpus spongiosum

Midline

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Penis

Glans penis

Prepuce

Foreskin

Covers the glans penis

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Male Urethra

Passes through the prostate gland

Divided into three parts

Prostatic

Membranous

Spongy

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Female Urethra

Only 4 cm long

Passes in front of the lower half of the vagina

Skene’s glands provide lubrication

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Testes

Paired

Lie in the scrotum

Tunica vaginalis covers most of the testis, epididymis, and lower end of spermatic cord

Seminiferous tubules

Epididymis

Maturation site

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Testis

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Ductus Deferens

Arises from the epididymis

Also known as the “vas deferens”

Ascends through the inguinal canal

Delivers semen to the prostatic urethra

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Prostate Gland

Accessory gland

Lobulated gland (50 lobules)

Secrete prostatic fluid

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Pathology

Adrenal Glands

Cushing’s syndrome

Overproduction of cortisol

Addison’s disease

Complication of certain illnesses – TB and AIDS

Renal insufficiency

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Pathology

Adrenal Glands

Pheochromocytoma

Tumor affecting the medulla

Overproduction of adrenaline

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Pathology

Urinary System

Bladder tumors

Urinary calculi

Kidney disorders

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Kidney Disorders

Polycystic Kidney Disease

Occurs when the parenchyma of the kidney is replaced by multiple fluid filled benign cysts

Autosomal dominant

Inherited

Symptomatic between the age of 30 and 40

90% of PKD fall under this category

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Kidney Disorders

Polycystic Kidney Disease

Autosomal recessive

Inherited

Extremely rare

Affects young children

Acquired Develops in patients with long term kidney disease

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Kidney Disorders

Diabetic Nephropathy

Sclerosis

Kimmelstiel-Wilson disease

Diabetic glomerulosclerosis

Caused by uncontrolled diabetes mellitus

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Kidney Disorders

End-Stage Renal Disease (ESRD)

Kidney failure

Kidneys functioning under 10%

Half the population with ESRD is diabetic

Dialysis

Kidney transplant

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Kidney Disorders

Renal Cell Carcinoma

Adenocarcinoma

Most common type of kidney cancer

8,000 deaths per year in the U.S.

Affects men twice as often

Usually appears between 50-60 years oldDirectly linked to cigarette smoking

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Kidney Disorders

Congenital Nephroblastoma

Wilms’ tumor

Malignant

Occurs primarily in children between 3-4 years

Surgical removal is recommended

Followed by radiation and chemotherapy

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Pathology Affecting

the Male Reproductive System

Phimosis

Hypospadias/Epispadias

Benign Prostatic Hypertrophy (BPH)

Cancer

CryptorchidismTesticular Torsion

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Diagnostic Procedures

History and physical

Hematology

Urinalysis

Regular X-ray

KUB (kidney, ureter, bladder)

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Diagnostic Procedures

IVU

Retrograde urogram

MIBG

Biopsy

Endoscopy

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Special Considerations

Transurethral procedures

Specially equipped room

Built-in table

Radiographic equipment

Darkroom

Drainage system

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Special Considerations

General instruments

Kidney instruments

Rib instruments

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Cystoscope

Flexible Cystoscope

Rigid Cystoscope

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Flexible Ureteroscope

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Incisional Options

Inguinal

Access the scrotal contents of an adult or child

Scrotal

Access scrotal contents

Abdominal

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Incisional Options

Gibson

Extraperitoneal abdominal approach

Access the lower ureter

Flank

Lumbar

Adrenalectomy, renal biopsy, removal of low lying kidney

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Common Procedures

Nephrectomy

Adrenalectomy

Renal transplant

ESWL

Cystectomy

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Common Procedures

Marshall-Marchetti-Krantz (MMK)

Circumcision

Orchiopexy

TURP

Prostatectomy

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Nephrectomy

Subtotal removal

Upper or lower pole of the kidney

Total removal

Simple

Small malignancies

Chronic obstructive disordersBenign tumorsTransplant

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Open Cystotomy

Alternate method of catheterizing the bladder for drainage

Percutaneous

Open

Acute urinary retention

Enlarged prostate

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Open Cystotomy

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Stress Incontinence in Women

Restore posterior urethrovesical angle

Elevate base of bladder

MMK procedure

Suprapubic suspension

Stamey procedure

Endoscopic suspensionStamey needle

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MMK

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Stamey Needle Placement