urologic procedures

Question 1

what makes up the upper urinary tract

Answer 1

ureter and kidney

Question 2

what makes up the lower urinary tract

Answer 2

bladder, prostate, urethra

Question 3

how does CP nerve injury happen

Answer 3

compression of fibular head on leg brace

Question 4

how does saphenous nerve injury happen

Answer 4

compression of medial tibial condyle

Question 5

how does sciatic nerve injury happen

Answer 5

excessive external rotation of legs, excessive extension of the knees

Question 6

what spinal level is needed for cystoscopy

Answer 6

T9-T10/ T8 for ureters

Question 7

indications for cysto

Answer 7

retrograde ureteral cauterization, to visualize the ureter and kidney, to place stents, to drain obstructions, to remove renal calculi

Question 8

TURBT stands for

Answer 8

transurethral resection of the bladder

Question 9

TURBT indicated for

Answer 9

resection and electrodesication are used to treat superficial bladder tumors

Question 10

how does the risk of perforation increase when doing a TURBT under regional

Answer 10

the bladder becomes atonic and may become thinner when distended, increasing the risk of perf

Question 11

how does bladder perf present in the awake patient

Answer 11

shoulder discomfort, nausea, vom, suprapubic fullness, abd spasm and pain

Question 12

bladder perf consequences

Answer 12

blood loss, hypothermia, bacteremia, spreading high grade malignancy into the peritoneum

Question 13

bladder perf cv signs

Answer 13

htn and tachycardia are early signs, followed by severe hypotension

Question 14

bladder perf : cool irrigation causes vaso___, give what to decrease the risk

Answer 14

constriction, give warm fluids

Question 15

bladder perf causes what clotting abnormality

Answer 15

DIC triggered by release of prostatic thrombogenic substances - esp with cancer of prostate.

Question 16

what spinal level do you need for TURP

Answer 16

T10

Question 17

obturator reflex

Answer 17

bladder rupture/ injury secondary to adductor muscle contraction from obturator nerve stimulation from electrocautery

Question 18

blood loss estimation in TURP

Answer 18

2-5ml of resection time

Question 19

early signs of TURP

Answer 19

hypertension and tachycardia - think fluid overload

Question 20

absorbed volume estimate in TURP

Answer 20

10-30ml of resection time

Question 21

TURP resection time should be limited to

Answer 21

1h

Question 22

height of TURP solution should be kept no more than ___cm above the OR table in the beginning of the case and no more than ___ above the OR table towards the end

Answer 22

30, 15

Question 23

sorbitol causes

Answer 23

hyperglycemia and lactic acidosis

Question 24

mannitol causes

Answer 24

nonmetabolized, osmotic diuresis causing hypervolemia [fluid overload, CHF]

Question 25

first sign of TURP syndrome may be

Answer 25

change in mental status d/t hyponatremia

Question 26

turp syndrome circulatory overload symptoms

Answer 26

htn, reflex brady, CHF, pulm edema, dysrhythmias, MI

Question 27

classic triad TURP syndrome

Answer 27

htn (with increased pulse pressure, bradycardia (reflex), AMS

Question 28

hypervolemia and hyponatremia is treated with

Answer 28

fluid restriction and diuretics (lasix 10-20mg)

Question 29

postpone procedure if sodium is

Answer 29

125

Question 30

open prostate - radical prostatectomy - more hemorrhage occurs with ____ approach

Answer 30

retropubic

Question 31

methylene blue 1% can cause

Answer 31

hypotension

Question 32

indigo carmine dye 0.8% has an ____ effect

Answer 32

alpha sympathomimetic , increases BP

Question 33

pulse ox for dyes

Answer 33

65% (false low)

Question 34

methyl blue has a ____ effect than indigo

Answer 34

greater

Question 35

nephrectomy - use lateral-flex table and kidney bar - concerns

Answer 35

vena cava compression and hypotension (d/t decreased venous return)

Question 36

what conditions are common in pt needing kidney transplant

Answer 36

anemia, hyperK, metabolic acidosis, hypocalc

Question 37

why would regional be contraindicated in renal transplant patient

Answer 37

preexisting coagulopathy and or immunosuppression

Question 38

complications of renal transplant

Answer 38

hyperkalemia, delayed renal function, graft failure

Question 39

temp for kidney preservation

Answer 39

4 degrees C

Question 40

preservation of kidney with renal perfusion:

Answer 40

72 hours

Question 41

preservation of kidney with cold storage

Answer 41

48 hours before necrosis jeopardizes graft survival

Question 42

radical cystectomy is done in what position

Answer 42

supine

Question 43

what is the main concern with radical cystectomy

Answer 43

fluid shifting - need CVP

Question 44

radical cystectomy complications

Answer 44

hypothermia, inadequate fluid replacement, need for post op ventilation

Question 45

what position for orchiopexy

Answer 45

supine or lithotomy

Question 46

what sensory level block needed for orchiopexy

Answer 46

T9

Question 47

position for AV fistula/ shunts

Answer 47

supine with arm extended

Question 48

ESWL - pulse wave is timed to the ___ wave

Answer 48

R

Question 49

absolute contraindications to ESWL

Answer 49

pregnancy, risk of bleeding