Lecture 23 - Clinical Genitourinary Anatomy

Question 1

Most common presentations for a renal mass? What to note?

Answer 1

1. Flank pain
2. Hematuria
3. Abdominal/flank mass

Note: in the real world, you incidentally discover it on imagine and the patient has no symptoms because usually in the parenchyma

Question 2

How would a renal mass cause flank pain?

Answer 2

Renal capsule is affected

Question 3

How would a renal mass cause hematuria?

Answer 3

Collecting system is invaded by the mass

Question 4

3 approaches to nephrectomy?

Answer 4

1. Laparoscopic
2. Robotic
3. Open

Question 5

Arterial blood supply to suprarenal glands? Asymmetry?

Answer 5

1. Superior suprarenal arteries from the inferior phrenic arteries
2. Middle suprarenal artery from the abdominal aorta
3. Inferior suprarenal arteries from the renal arteries

Shorter on the left, longer on the right

Question 6

Which renal artery is longer than the other? Which one arises higher?

Answer 6

Right one is longer

Left one arises higher

Question 7

Venous drainage of suprarenal glands?

Asymmetry?

Answer 7

Single vein leaving hilum of each gland:

• Right one drains into IVC directly and is short
• Left one drains into left renal vein and is longer

Question 8

Which kidney is better for transplants?

Answer 8

Left one because longer vein

Question 9

How many lumbar veins are there?

Answer 9

5

Question 10

Do all lumbar veins drain into the IVC?

Answer 10

NOPE

Only the 3rd and 4th do

5th: drains into iliolumbar vein
1st and 2nd drain into ascending lumbar veins connecting common iliac veins, iliolumbar veins, and lumbar veins with azygos and hemiazygos veins

Question 11

What 5 structures enter/exit the kidney at the renal hilum? Describe their location.

Answer 11

1. Renal vein (superior/anterior)
2. Renal artery (superior/posterior)
3. Renal pelvis (inferior)
4. Lymphatics
5. Nerves

Question 12

What is located anterior to the right suprarenal gland?

Answer 12

1. Right liver lobe

2. IVC

Question 13

What is located anterior to the left suprarenal gland?

Answer 13

1. Stomach
2. Pancreas
3. Sometimes spleen

Question 14

What 5 structures are in contact with the anterior surface of the right kidney? Indicate which ones are separate from kidney by a layer of peritoneum.

Answer 14

1. Right suprarenal gland (small part of the superior pole)
2. ***Liver (a large part of the rest of the upper part)
3. Descending part of the duodenum (hilum)
4. Right colic flexure (inferior pole on lateral side)
5. ***Intraperitoneal small intestine (inferior pole on small intestine)

Question 15

What 6 structures are in contact with the anterior surface of the left kidney? Indicate which ones are separate from kidney by a layer of peritoneum.

Answer 15

1. Left suprarenal gland (small part of the superior pole)
2. ***Stomach and spleen (a large part of the rest of the upper part)
3. Pancreas (hilum)
4. Left colic flexure (middle lateral part)
5. Descending colon (lower lateral part)
6. ***Jejunum (lower medial part)

Question 16

What is in contact with both kidneys on posterior surface? 6 structures. What is posteriorly located but not in direct contact?

Answer 16

1. Diaphragm
2. Ribs (see other flashcard)
3. Psoas major, quadratus lomborum, and transversus abdomonis (medial to lateral)
4. Subcostal VAN
5. Iliohypogastric nerve
6. Ilio-inguinal nerve

+ Costodiaphragmatic recesses

Question 17

Classic presentation for kidney stones?

Answer 17

1. Flank pain radiating
2. Colic quality pain
3. Hematuria

Question 18

What value is very important for patients with kidney stones?

Answer 18

Nitrate/leukocyte esterase negative: no infection, meaning not as bad as an emergency

If it was positive, could cause sepsis

Question 19

4 treatments for 5 mm kidney stone without infection?

Answer 19

1. MET: medical expulsive therapy = hydration + pain control + nausea control +/- alpha blockers
2. ESWL: extracorporeal shock wave lithotripsy to break it down
3. URS: ureteroscypy +/- Laser lithothripsy/Stent(to avoid spasms or more stones obstructing it)/Basket
4. PCNL: percutaneous nephrolithotomy

Question 20

% chance of a 5 mm stone passing?

Answer 20

50%

Question 21

How do we call a study of the collecting system via catheter?

Answer 21

Pyelogram

Question 22

What makes the ureter peristalse?

Answer 22

It has its own pacemaker

Question 23

Ureteral course?

Answer 23

1. Begin posterior to renal artery
2. Continue along anterior edge of psoas (gonadal arteries cross anterior to ureter in this region)
3. Over iliac vessels at bifurcation

Question 24

Patient presents with blood at meatus - where could it be coming from? How to diagnose?

Answer 24

1. Kidney injury
2. UPJ disruption
3. Ureter injury
4. Bladder injury
5. Urethral injury

Diagnosis: retrograde urethrogram with contrast

Question 25

Big distinction for bladder injuries? Which requires surgery?

Answer 25

Whether they are intra or extra peritoneal Intraperitoneal injury requires surgical repair because urine will just continue to dump in it Extraperitoneal injury can be fixed with a Foley catheter

Question 26

Can you fracture your penis? Explain. What is this called?

Answer 26

YUP Corpora cavernosa rupture and sometimes even the corpus spongiosum Eggplant sign if blood is contained within Buck's fascia Butterfly hematoma if the blood is not contained within Buck's fascia, and contained by Colle’s Fascia in perineum, Darto’s fascia in scrotum and penis, Scarpa’s fascia in abdomen

Question 27

Once penis fracture is repaired, can you regain erectile function?

Answer 27

YUP

Question 28

Can you repair a minor rupture to testicule? What about a major one?

Answer 28

Minor: yup Major: need to remove testicle because it would just die and would be very painful

Question 29

What is priapism?

Answer 29

Erect penis does not return to its flaccid state, despite the absence of both physical and psychological stimulation, within four hours => causes corpora cavernosa fibrosis

Question 30

Blood supply of ureters? What to note?

Answer 30

Branches from: 1. Renal arteries (upper end) 2. Abdominal aorta or gonadal arteries or common iliac arteries (middle part) 3. Internal iliac arteries (lower end) => arteries reaching the ureters divide into ascending and descending branches, which form longitudinal anastomoses In the abdomen, blood supply to ureters arrives from their medial side, whereas in the pelvis blood arrives from their lateral side