function of urinary system
filter blood
create and excrete urine
organs of male GU system
testes
vas/ductus deferens
seminal vesicles
ejaculatory ducts
penis
6 paired male reproductive organs
testes
epididymides
seminal vesicles
ejaculatory ducts
bulbourethral glands
vas deferens (seminal ducts)
describe the kidneys
remove waste/filter blood
BP
hematopoiesis
vitamin D
regulate fluid balance
pH
location of kidneys
retroperitoneal space
either side of T12-L3
right lower than left
blood supply to kidneys
renal artery
renal parenchyma
nephron-Gerota’s capsule
external cortex, inner medulla
perirenal fat pad and fascia renalis
fatty areolar tissue
position and protect kidneys
hilum of kidney
medial side
concave where renal artery and vein enter, ureter, and lymphatics
renal pedicle
lymphatics of the kidney
renal pelvis
funnel structure posterior to vascular pedicle
divides into calyces
adrenal gland
retroperitoneal on top of the kidneys
hormones
adrenal regions
medulla: epinephrine, norepinephrine
cortex: steroids, hormones, cortisol, aldosterone, androgens
ureters
penal pelvis to bladder
25-30cm 4-5mm diameter
retroperitoneal
ureteral action to propel urine
peristalsis
3 areas of calculi in ureters
UPJ: ureteropelvic junction
UVJ: ureterovesical junction
ureteral point crossing over external iliac vessels
urinary bladder
hollow muscular
anterior pelvic cavity
capacity of bladder
600-800mL
trigone of bladder
triangle forms base
orifices of ureters in the neck
blood supply of bladder
superior, middle, inferior vesical arteries
urethra
internal urethral orifice to outside
male urethra
20-25cm
female urethra
3-5cm
6-8mm in diameter
why are females prone to UTI
less distance to travel
verumontanum
elevation in prostatic urethra where seminal ducts enter
prostate gland
donut shaped at base of bladder neck
prostate and urethra
surrounds urethra
lobes in prostate
4-5
weight of healthy prostate
20-30g
true prostatic capsule
separates prostate and seminal vesicles from rectum
surgical capsule
outer ring of normal tissue surrounding hyperplastic inner tissue
TURP
blood supply to prostate
pudendal, hemorrhoidal, inferior vesical arteries (from internal iliac arteries)
prostatic venous plexus –> vesical plexus –> internal iliac veins
BPH
increased size of prostate
who is affected by BPH
men over 50
two most common methods of diagnosing BPH
rectal exam
prostate specific antigen blood test
BPH vs. prostate cancer
BPH: limited to prostate
cancer: malignant spread to skeletal system/lungs
penis
shaft: corpus spongiosum houses urethra
corpora cavernosa: 2 lateral
root with crura
vascular bodies for erection
corpus spongiosum urethrae
2 corpora cavernosa
prepuce (foreskin)
mucous membrane covering glans
scrotum
sac protecting testes
epididymides located within
tunica vaginalis
smoothing glistening membrane sac covering testes
testes
paired ovoid in scrotum
4-5cm long
3cm wide
2cm thick
testosterone, endocrine glands
epididymides
long convoluted duct –> vas deferens
final maturation and storage of sperm
vasa deferentia
paired continuations of epididymides –> ejaculatory ducts via peristalsis
spermatic cord
suspends testes in scrotum
vas deferens, vessels, cremaster muscle, nerves, lymphatics
ejaculatory ducts
paired tubes formed by union of seminal vesicles and vas deferens
sperm to urethra
seminal vesicles
paired at base/fundus of bladder and prostate
nourish sperm
bulbourethral glands
mucous secretions into urethra on either side of membranous and bulbar urethra
intravenous pyelogram/urogram
enhancement of KUB
contrast into a vein into kidney
retrograde pyelogram/urogram
contrast into ureters with a cystoscope
KUB
anterior to posterior x-ray for size, shape, position, stones
PSA blood test
prostate specific antigen
digital rectal exam
finger up rectum to check prostate size
topical anesthetic for cystoscopy
viscous lidocaine jelly
topical anesthetic for male
into urethra after prep and drape with urojet
topical anesthetic for female
cotton applicator into urethral meatus
why use sterile irrigation for cystoscopy
distend, visualize
irrigating fluid for simple surgical cysto
sterile water
distilled water
CHECK
irrigating fluid for TURP
3% sorbitol
1.5% glycine
special irrigating fluid in TURP
isotonic and nonelectrolytic to allow electrical transmission
4 components of a urologic endoscope
sheath
obturator
telescope
light source
3 types of urologic endoscopes
Brown-Buerger cystoscope
McCarthy Panendoscope
Wrappler Cystourethroscope
resectoscope
electrical current to excise tissue from bladder, urethra, prostate
4 types of resectoscope
Iglesias
Nesbit
Baumrucker
Stern-McCarthy
Bugbee electrode
in Brown-Buerger or Wrappler to fulgurate bladder tumors, control bleeding, ureteral meatotomy
evacuator
attach to endoscope to irrigate the bladder and aspirate stone fragments
2 types of evacuator
Ellik: double bowl glass w/ trap
Toomey: syringe with wide opening
suprapubic bladder drainage
drain bladder from incision in suprapubic region
uremia, nurogenic bladder, urinary retention
4 self-retaining catheters for suprapublic bladder drainage
Pezzer, Malecot, Foley, Bonanno
cystoscopy
endoscopic examination of the bladder
indications for cysto
hematuria
retention
UTI
cystitis
stones
why is cysto class 2
outside world
disinfection vs. sterilization
peri-urethral-transurethral collagen injection
intrinsic sphincter deficiency (F)
after prostatectomy (M)
helps hold pee
transurethral ureteropyeloscopy
exam of ureters and renal pelvis
diagnose/remove stones
urethral meatotomy
enlargement of urethral meatus to relieve stenosis
urethral dilation and urethrotomy
dilation of urethra to open stricture
phillips filiforms and followers, van buren sounds, McCarthy sounds, otis urethrotome
urethral dilation and internal urethrotomy for stricture
urethroplasty
reconstruction of the urethra
stricture, fracture, narrow segments
penectomy
partial or total removal of cancerous penis
deep dosral and emissary vein ligation
ligation of deep dorsal vein of penis
vascular compromised impotence
hydrocele
accumulation of fluid in scrotum
excision of tunica vaginalis
varicocele
high ligation of gonadal veins to reduce backflow
spermatocele
lobulated intrascrotal mass on head of epididymides
vasectomy
remove a section of vas deferens for sterilization
no scalpel vasectomy
fixation w/o entering scrotal sac
what reverses vasectomy
vasovasostomy
orchiectomy
removal of testicles
unilateral orchiectomy
cancer
trauma
infection
bilateral orchiectomy
metastatic carcinoma of prostate
TURP
endoscopic resectoscope
leaves capsule intact removes hyperplastic inner tissue
why TURP
BPH
TURP for malignancy?
no
why 30cc 3 way foley
stop bleeding
empty bladder
irrigation
hematuria catheter
3 way foley for blood clots
reinforced for vigorous aspiration
simple suprapubic prostatectomy
removal of prostate transvesically
pros and cons of suprapubic prostatectomy
surgical correction of bladder at same time
hemorrhage
suprapubic prostatectomy for malignancy?
no it would seed the bladder
self retaining bladder retractor for suprapubic prostatectomy
omni tract
simple retropubic prostatectomy
remova all hypertrophic prostate through anterior prostatic capsule by extravesical approach
pros of simple retropubic prostatectomy
excellent exposure of prostate and bladder neck
controllable bleeding
retropubic prostatectomy for malignancy?
yes
simple perineal prostatectomy
removal of prostatic adenoma through perineum
biopsy and radical excision to follow
pros and cons of perineal prostatectomy
good anastomosis and bleeding control
preservation of bladder neck
can make fistulas and can’t biopsy iliac and obturator nodes
perineal prostatectomy for malignancy?
yes
nerve sparing radical retropubic prostatectomy
removal of entire gland, capsule, and seminal vesicles
pros of nerve sparing retropubic prostatectomy
spare neurovascular bundles to preserve potency
2 self retaining abdominal retractors for retropubic prostatectomy
bookwalter
wishbone
radical perineal prostatectomy
same as simple w/ lymph nodes through separate incision
what accompanies radial perineal prostatectomy
laparoscopic or low abdominal lymph node dissection
2 self retainers for perineal prostatectomy
thompson
omnitract wishbone 2150
TURBT
removal of bladder tumor w/ resectoscope
sterile water to burst cancer cells
suprapubic cystostomy
opening into bladder through a low abdominal incision for drain tubes
suprapubic cystolithotomy
removal of bladder stones
vesicourethral suspension
correction of stress incontinence caused by abnormal urethrovesical angle
Marshall-Marchetti-Krantz procedure
bladder and urethra into pelvis by suturing vaginal tissue to back of symphysis pubis
Burch procedure
nonabsorbable 0 suture into cooper ligament on each side of bladder neck
transvaginal bladder neck suspension Pereyra
neck elevated from anterior rectus sheath passed blindly down retropubic space out vagina
transvaginal bladder neck suspension Stamey
suture placed urethrovesical junction of ant. rectus fascia to vagina
2 types of transvaginal suspensions
TVT sling, TVT sling w/ bone anchor
TVT sling
tension free vaginal tape
hypermobility
intrinsic sphincter deficiency
stress incontinence
graft for TVT sling
polypropylene mesh tape
bladder augmentation enterocystoplasty
enlarge bladder with bowel
reflux incontinence
detrusor hyperactivity
chronic contracted bladder
neuropathic bladder
radical cystectomy
remove bladder and pelvic nodes
malignancy or papillary tumors
bladder substitution
creation of new bladder
after cystectomy for carcinoma
5 bladder substitutions
right colocytoplasty
sigmoidocystopasty
orthotopic ileocolic neobladder
ileocecal bladder
ileoascending
ileal conduit
urine flow diverted to an isolated bowel
incontinent division
continent urinary division
control of urination
4 continent divisions
Kock pouch
Indiana pouch
Camey ileocystoplasty
Meriz
3 incisional approaches to the kidney
CHECK
percutaneous nephrolithotomy
break kidney stones with nephroscope
litholapaxy
crushing stones in bladder
Hendrickson-Bigelow lithotrite in litholapaxy
pass in urethra to bladder to crush stone
extracorporeal shock wave lithotripsy
noninvasive externally applied acoustic pulse
urolithiasis
kidney stones
nephroureterectomy
remove kidney + ureter
tumors
hydroureteronephrosis
heminephrectomy
remove portion of kidney
upper or lower pole condition
nephrectomy
removal of a kidney
UPJ with hydronephrosis
position for nephrectomy
lateral
when do laparoscopic nephrectomy
benign disease
2 laparoscopic approaches for nephrectomy
transabdominal
extraperitoneal
intraperitoneal
radical nephrectomy
remove kidney, perirenal fat, adrenal gland, gerota’s capsule, periaortic nodes
why do radical nephrectomy
parenchymal neoplasm
radical vs regular nephrectomy
renal pedicle ligated before mobilizing kidney
gerota’s capsule removed en bloc w/ kidney
adrenalectomy
removal of 1 or both adrenal glands
4 indications for adrenalectomy
hypersecretion
neoplasm
carcinoma of prostate or breast
3 positions for adrenalectomy
lateral
supine
prone
kidney transplant
living-relative or cadaveric donor into iliac fossa
why do renal transplant
restore function to maintain life in end-stage renal disease
position for donor kidney
left lateral
position for recipient kidney
supine
where is kidney placed
right renal/iliac fossa
where are renal blood vessels anastomosed
renal vein to iliac vein
renal artery to internal iliac artery
solutions to preserve kidney
cold saline
lactated ringers
renal dialysis
extracorporeal removal of waste from blood
peritoneal dialysis
peritoneum filters blood
abdominal catheter for peritoneal dialysis
Tenckhoff
CAPD
ureterostomy
opening into ureter for drainage to another point
ureterectomy
remove a ureter
ureterneocystostomy
division of distal ureter from blader to reimplant w/ submucosal tunnel
ureterolithotomy
incision into ureter to remove a stone
nephrostomy
opening into kidney for temp or permanent urine drainage
nephrotomy
incision into kidney over collecting system with a calculus
pyelolithotomy
removal of stone through renal pelvis
pyelostomy
opening into renal pelvis to remove stones or for collecting
circumcision
removing foreskin from glans
3 common indications for circ
phimosis
balanoposthitis
papaphimosis
orchiopexy/orchidopexy
move undescended testicles into scrotum
why perform orchiopexy
cryptorchidism
cryptorchidism
undescended testicles
3 devices for circ
gomio clamp
hollister
plastibell
retractile testes
testicle can move between scrotum and groin
age for orchiopexy
5-6
hypospadius
meatus on underside of penis or perineum
epispadius
meatus of upper penis/dorsum
chordee
downward curvature of penis
hypospadius and epispadius repair
move meatus to the apex of the glans
methods of hypo/epispadius repair
meatoplasty
glanuloplasty
orthoplasty-release chordee
urethroplasty
skin cover
scrotoplasty
