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92 terms

Genitourinary Surgery

STUDY
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<4 ng/mL
Normal PSA
Sit on the superior and medial portion of the kidneys
Suprarenal glands (adrenal)
Endocrine glands with a cortex and medulla
Suprarenal glands
Concave glands
Suprarenal glands
Highly vascular and receive multiple arteries
Inferior phrenic artery, abdominal aorta, and renal artery
Celiac plexus, and the greater thoracic splanchnic nerve
Nerve supply of the suprarenal glands
Left kidney
Normally larger
Right kidney
Slightly lower than the left
Two types of nephrons
Juxtamedullary and cortical nephrons
Extends deep into the medulla of the kidney
Juxtamedullary nephron
Renal corpuscle and the renal tubule
Nephron's two basic units
Consist of a network of capillaries
Renal corpuscles
Lie in the cortex of the kidney
Glomerulus and Bowman's capsule
The parietal layer
Outer layer of the Bowman's capsule
Visceral layer
Inner layer of Bowman's capsule
Second component of the nephron
Renal tubules
Kidneys are bounded
Psoas muscles on the medial side, transverse abdominal muscles on the lateral, and the quadratus lumborum muscles posteriorly.
A membranous sheet
Renal fascia
Great increase in surface area
Proximal convoluted tubule
Increased reabsorption and secretion
Proximal convoluted tubule
Plays a significant role in urine concentration
Loop of Henle and Distal convoluted tubule
Restricts movement of blood, cells, and large molecules
Glomerular capillary endothelium
Allows passage of molecules smaller than plasma proteins
Glomerular basement membrane
Final barrier before slit pore and lumen
Bowman's capsule, visceral layer
High concentration of glomeruli, looks granular in apperance
Outer zone, the cortex
Consiste of straight tubules and connecting ducts, has a striated appearance
Inner zone, the medulla
The initial portions of the system of extrarenal ducts
Minor calyces
Drains the superior, middle, and inferior portions of the kidney into a common renal pelvis
Major calyces
Conducts urine from the renal pelvis to the bladder
Ureter
Supplies branches that are classified as visceral, parietal, or terminal
Abdominal aorta
Situated lower and greater in length
Right renal artery
Renal vein that is longer
Left
Rise on both the anterior and posterior sides of the kidney sinus
Renal veins
The effect on urine production is second to
Changes in blood supply
Bladder is prevented from reflux
Muscular contraction upon the ureter
In the male, the bladder lies on and is attached to
Base of the prostate gland
In the female, the bladder lies on
Pelvic diaphragm
Testes, ductus deferens, seminal vesicles, ejaculatory ducts,and the penis
Male genital organs
Prostate and bulbourethral glands
Male accessory structures
20 cm in length
Male urethra
Prostatic, membranous, and spongy
Parts of the urethra
4 cm in length
Female urethra
Covers most of the testis, epididymis, and lower end of the spermatic cord
Tunica vaginalis
A thick external covering of connective tissue on the testes
Tunica albuginea
Comes from the duct of the epididymis and is 45 cm long
Ductus vas deferens
Ascends through the inguinal canal as the center portion of the spermatic cord
Ductus vas deferens
Contained within the prostate gland
Ejaculatory ducts
A seminal tract accessory gland that lies under the bladder
Prostate gland
Covered with endopelvic fascia
Prostate gland
Can be benign or malignant, usually present with hematuria
Bladder tumors
Tumors that occur only in young adults
Benign tumors or papillomas
Used to locate bladder tumors
Intravenous urogram (IVU)
Bladder tumor diagnosis
Cystoscopically
Bladder tumors removed
Transurethrally
Come from the epithelial lining of the bladder and affect individuals over 50, mostly men
Malignant neoplasms
Symptoms - painful urination, frequent urination, passage of small amounts of urine, flank pain - mild to severe, nausea and vomiting, UTI, Hematuria
Urinary Calculi
Affect fluid and electrolyte balance, blood volume, and the ability to filter out waste products
Kidney disorders
CAPD
Continuous ambulatory peritoneal dialysis
Dialysis done by gravity
CAPD
Most common type of peritoneal dialysis
CAPD
CCPD
Continous cyclic peritoneal dialysis
Dialysis done at home while patient sleeps
CCPD
IPD
Intermittent peritoneal dialysis
Recommended treatment for renal cell carcinoma that has not spread
Radical nephrectomy
Five year survival rate around 75%
Renal cell carcinoma
Performed suprapubically or retropubically and accompanied by pelvic lymph node dissection
Radical prostatectomy
Radiation and/or hormone therapy may be the sole treatment
Prostate cancer
Cadavers, living relatives, or unrelated living donors
Organs for kidney transplant
Spleen and lymph nodes are removed to
Aid in tissue typing and cross-matching the donor with the recipient
Kidneys are flushed
Collins solution (a preservative)
Perferred kidney for donation from a living donor
Left kidney (renal vein is longer)
80% kidney transplant success rate
Unrelated donor
90% kidney transplant success rate
Related donor
Best kidney transplant success rate
Identical twin
Kidney to be transplanted
Graft
Graft placed in an adult
Right pelvis through a Gibson incision
Suture for the arterial anastomosis of a kidney transplant
6-0 polypropylene
Graft placed in a child
Midline incision, kidney placed in the mid-retroperitoneum posterior to the right colon
Provides an internal view of the genitourinary tract
Transurethral endoscopy
Urinary tract endoscopy is referred to as
Cystoscopy
The main purpose of urinary tract endoscopy
Diagnosis
Suspension of the fascial attachments of the bladder to the rectus fascia with sutures
Stamey procedure
Abnormal dilation of the spermatic veins
Varicoceles
Condition usually occurs on the left side
Varicoceles
A congenital condition in the male where the urethra ends on the ventral side of the glans penis, anywhere along the penile shaft, on the corona, or on the perineum
Hypospadias
Vasovasostomy
Reversal of a vasectomy
Procedure done to correct obstructions of the vas deferens due to congenital anomalies, inflammation, or trauma
Vasovasostomy
Performed to treat adenomas that are too large for endoscopic, or to remove malignancy
Suprapubic prostatectomy
Provides better visualization of the prostatic fossa, allowing for better hemostatic control
Retrobubic prostatectomy
To identify ureters
Indigo carmine
Rarely used for prostate
Perineal prostatectomy
Exaggerated lithotomy position with extreme Trendelenburg position to do procedure
Perineal prostatectomy