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urology > Surgery and procedures > Flashcards

Surgery and procedures Flashcards

1
Q

Indications for circumcision (9)

A

pathological Phimosis
paraphimosis
Recurrent balanoposthitis (infec glans and prepuce)
Carcinoma of penis
Condylomata acuminata (multiple penile warts under foreskin)
Foreskin trauma eg zipper
Religion (Jewish, Islam), (culture)
Recurrent UTIs (esp in infants and in association with other urinary abnormalities)
Balanitis xerotica obliterans and other chronic inflammatory conditions
Inadequate previous circumcision eg iatrogenic phimosis
Hygiene eg mentally impaired
(Prevent HIV)
Urisheath/condom catheter application
(Psychological)

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2
Q

Where is resistance felt on catheter insertion in males

A

External urethral sphincter

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3
Q

Instrument used to view bladder and urethra

A

Cystoscope

NB in bladder cancer

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4
Q

Name 5 contraindications to circumcision

A
  • neonatal prematurity
  • neonatal illness, unstable
  • neonatal blood dyscrasia
  • family history bleeding disorder
  • congenital penniless abnormalities (may be needed later for reconstruction): hypospadias, chordee, buried penis, webbed penis, epispadias
  • Poor hygiene = relative
  • fashion and requests = relative
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5
Q

Name 5 early complications of circumcision

A
  • bleeding most common, most minor + self-limiting
  • infection
  • glans injury: esp associated with clamp procedures, iatrogenic hypospadias/epispadias
  • amputation
  • slippage of circumcision device
  • rarely death
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6
Q

Name 10 late complications of circumcision

A
  • redundant foreskin
  • cosmetic issues eg scar
  • inclusion cysts in suture line (implantation smegma/ surgical “rolling in” of epidermis)
  • adhesions/skin bridges between shaft + glans
  • suture sinus tracts
  • ventral curvature/chordee
  • secondary buried penis
  • phimosis
  • urethrocutaneous fistula
  • meatal stenosis after meatal ulcer due to exposure to ammonia in urine soaked nappies
  • rarely necrosis (due to diathermy + clamping, adrenaline use, tourniquet, tight dressing)
  • urinary retention / bladder rupture very rare
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7
Q

Name 6 indications suprapubic catheter

A
  • Urinary retention: failed urethral catheterisation ey due to stricture, bladder neck contracture
  • suspected traumatic urethral. injury
  • necrotising fasciitis of perineum (Fournier’s gangrene)
  • temporary urinary diversion after urological surgery
  • selected patients with neuropathic bladder, unsuitable for CISC
  • patients with transurethral catheter and acute epididymitis
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8
Q

Name 5 contraindications suprapubic catheter

A

• Bladder not distended, not easily palpable, empty or small capacity, can’t be localised with US
• previous lower abdominal surgery: possibility adhesions between bowel and bladder risk bowel injury
. History bladder cancer, macroscopic haematuria
• skin disease in suprapubic area
• gross obesity
Relative: coagulopathy, pelvic cancer, orthopedic hardware for pelvic fracture repair

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9
Q

How insert suprapubic catheter? (11)

A

1 local anaesthetic ( 10 ml of 1 % lignocaine) 1-2 cm above symphysis pubis in midline after cleaning and ensuring sterility
2. When needle give way in bladder, aspirate until urine obtained.
3. Pull back syringe and needle as unit and measure how deep needle was in abdo to guide depth of trocar.
4 make 1cm incision with disposable scalpel deep enough to incise rectus sheath
5. Insert trocar and sheath ( introducer): will feel “giving way “ when passing through rectus. sheath first, then again through bladder wall - will see stream of urine
6. Push in 5mm more to make space for balloon inflation in case of bladder wall thickness
7. Remove trocar and place thumb over sheath to prevent mess.
8. Insert Foley catheter already attached to urine bag
9. inflate balloon with 5 -7 ml
10. Remove sheath then peel and pull tab to remove sheath away from catheter
11. Secure with nylon skin suture and plaster

Never cover penis with sheets! If pt void, stop procedure.

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10
Q

Name 10 complication suprapubic cystostomy

A
  • haematuria: common but usually transient
  • migration (dislodgement) of catheter extravesically
  • bowel injury eg perforation : rare
  • rectal injury and injury to iliac vessels: rare
  • catheter occlusion eg by blood, mucus, kinking
  • UTI
  • uro sepsis
  • bladder stones
  • bladder cancer
  • fistula
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11
Q

Name the equipment needed for a suprapubic cystostomy (13)

A
  • Sterile gloves
  • sterile drapes
  • marking pen
  • 10 ml 1% lignocaine
  • needle
  • disposable scalpel
  • 5-10ml sterile water or saline in syringe to inflate balloon
  • skin tape
  • 3-0 nylon suture on curved needle
  • tissue forceps
  • needle holder
  • urine bag
  • suprapubic catheter kit including peel-away sheath introducer with trochar and Foley catheter
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12
Q

Catheter size in men?

A

16-18 F

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13
Q

Catheter size in women?

A

14-16 F

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14
Q

Catheter size if macroscopic haematuria?

A

22-24 F foley catheter or 3 way irrigation catheter 20-30 F

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15
Q

Which catheter is preferred in patients needing long term catheter eg spinal patient?

A

Silicone catheter- less urethral damage, can remain indwelling up to 3 months

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16
Q

Which catheter is used post-op short term?

A

Foley latex catheter. Don’t leave in > 1 week- forms encrustations, unethical irritability, risk allergy

17
Q

Which catheter is used post-op short term?

A

Foley latex catheter. Don’t leave in > 1 week- forms encrustations, unethical irritability, risk allergy

18
Q

What type of catheter is used for prostate obstruction?

A

Coudé tip catheter 18 F

19
Q

What type of catheter is used for neonates?

A

Younger than 6 months: feeding tube 5f with tape

20
Q

How determine foley catheter size for children?

A

Age ÷2 + 8

21
Q

Name 7 indications continuous urethral catheterisation

A
  • Accurate monitoring urine output
  • relief urinary retention due to medication, neurogenic bladder or intravesical obstruction
  • temporary therapy urinary incontinence
  • perineal wounds
  • clot prevention (22-24f) for CBI (continuous bladder irrigation)
  • intra and post op
  • comfort for end of life
22
Q

Name 4 contraindications urethral catheter

A
  • Blood at urinary meatus
  • scrotal haematoma
  • pelvic #
  • high riding prostate
23
Q

What is a radical prostatectomy?

A

Prostate , prostatic capsule and seminal vesicles and their vessels removed
Can be done retro pubic, perineal or laparoscopic
Internal iliac and obturator lymph nodes may be dissected and sent for pathology

24
Q

Name 3 intraoperative complications radical prostatectomy

A
  • blood loss haemorrhage
  • rectal injury very rare
  • ureteral injury very rare
25
Q

Name 3 peri operative complications radical prostatectomy

A
  • Lymphocoele formation if concurrent pelvic lymphadenectomy performed
  • blood loss
  • urine leak from anastomosis
26
Q

Name 2 late complications radical prostatectomy

A
  • Moderate to severe stress urinary incontinence 3-10%, mild 20%
  • ED! About 50%
27
Q

What is TURP?

A

Partially resect periurethral transition zone of prostate to decrease symptoms of urinary tract obstruction accomplished via transurethral (cystoscopic) approach using electrocautery loop, irrigation (glycine) and illumination.

28
Q

Name 6 indications TURP

A

• Obstructive uropathy (large bladder diverticula, renal insufficiency)
• refractory urinary retention
• recurrent UTI
• recurrent gross haematuria
• bladder stones
• intolerance or failure medical therapy
To relieve symptoms urinary tract obstruction

29
Q

Name 8 acute complications TURP

A

• intra or extra-peritoneal rupture of bladder
•Rectal perforation
• incontinence
• incision ureteral orifice with subsequent reflux or stricture
• hemorrhage
• epididymitis
• sepsis
• transurethral resection or post-turp syndrome
-Caused by absorption large volume of hypotonic irrigation solution, usually through perforated venous sinusoids, causing hyperVolemic hyponatraemia
- dilutional hyponatraemia, confusion, nausea and vomit, ht, bradycardia, visual disturb, CHF, pulmonary oedema
- treat with diuresis. If severe, administer hypertonic saline.

30
Q

Name 5 chronic complications TURP

A
  • Retrograde ejaculation! > 75%
  • ED
  • incontinece rare
  • urethral stricture
  • bladder neck contracture
31
Q

Name 6 complications bilateral orchidectomy

A 
• hot flushes
• ED
• osteoporosis, muscle loss, weight gain
• bleeding
• wound sepsis
. Psychological trauma of castration
32
Q

How perform vasectomy? (9)

A
  • Identify vas deferens by palpation and manipulate to superficial position under scrotal skin ( feel like cooked macaroni)
  • inject local anaesthesia within perivesical sheath
  • vas fixation through skin with clamp on either side
  • access by scalpel or sharp curved hemostat
  • dissect vas face from other structures, tubular structure.
  • Resect 1 cm segment and send for pathology
  • crush and occlude free ends: suture ligation, intraluminal electrocautery and tie off ( thus occlude 3 times)
  • fascial interposition into dartos
  • Close with absorbable chromic sutures

Do semenalysis 3 month later to confirm success

33
Q

Name 5 complications vasectomy

A
  • Mild pain
  • dartos /scrotal haematoma, haematospermia
  • infection
  • post vasectomy pain syndrome: pain > 3 months , nsaids
  • recannulanisation → failure, antisperm antibodies, sperm granuloma
34
Q

Name 7 indications penile ring block

A
  • Most circumcisions
  • dorsal slit procedure
  • paraphimosis reduction
  • repair penile laceration
  • release trapped penile skin (zipper injuries)
  • biopsy or lesion excision
  • frenulectomy/plasty
35
Q

How perform penile ring block?

A
  • Clean skin at base and around penis, aseptic technique
  • blue/ black needle with 10 ml lignocaine without adrenaline, insert midline where dorsal penis joins ventral body and inject 4cc one way, 4 cc other way.
  • then insert at ventral base of penis and inject 1 cc one way, 1 cc other way.
36
Q

Which method of circumcision is contraindicated in older children?

A

Clamp methods: children >5 kg increased risk bleeding, great for infants

37
Q

Name 5 complications intracavernous injection

A
  • If using for ED (alprostadil), priapism
  • penile fibrosis
  • injection site haematoma
  • injection site echymosis
  • penile rash
  • penile reclaim

urology (18 decks)

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