Week 2 urologic procedures

Question 1

Why is it important to find out a babies gestational age?

Answer 1

Premises Have a higher risk for SIDS and anesthesia complications

Question 2

What is included in upper urinary tract?

Answer 2

Ureter and kidney

Question 3

What is included in the lower urinary tract?

Answer 3

Bladder, prostate, and urethra

Question 4

What are 5 common nerve injuries with urologic procedures?

Answer 4

1. Common peroneal; 2. Saphenous nerve; 3. Sciatic nerve; 4. Obturator nerve; 5. Femoral nerve

Question 5

What position are urologic procedures usually performed in?

Answer 5

Lithotomy

Question 6

How does common peroneal nerve get injured?

Answer 6

Compression of fibular head on leg brace

Question 7

How does saphenous nerve get injured?

Answer 7

Compression of MEDIAL tibial condyle

Question 8

How does sciatic nerve get injured?

Answer 8

Excessive external rotation of legs & excessive extension of the knees

Question 9

How does obturator nerve get injured?

Answer 9

Excessive flexion of the groin

Question 10

How does Femoral nerve get injured?

Answer 10

Excessive flexion of the groin

Question 11

What is the average amount of blood in each leg?

Answer 11

500 mL

Question 12

What is the obturator reflex and what can happen?

Answer 12

Obturator nerve stimulation by electrocautery leads to adductor muscle contraction which can lead to bladder rupture during urologic procedure

Question 13

What procedure has an increased risk of obturator reflex occurring?

Answer 13

Resecting lateral wall tumors with electrosurgical resection

Question 14

What happens during cystoscopy? What type of anesthesia is used?

Answer 14

Passage of rigid scope through the urethra — general or regional anesthesia

Question 15

If using regional anesthesia for cystoscopy, what sensory level must be attained?

Answer 15

T9-T10 or T8 for ureters

Question 16

Where are sympathetic and motor anesthesia levelsin relation to the sensory level?

Answer 16

Sympathetic is 2 levels up and motor is 2 levels down

Question 17

Why should TURBT patients be paralyzed?

Answer 17

Coughing or straining puts that at higher risk for bladder perforation

Question 18

What about regional anesthetisia puts TURBT patient at higher risk of bladder perforation?

Answer 18

Bladder becomes atonic and may be come thinner when distended

Question 19

If bladder perforation occurs what can awake patient experience (3)?

Answer 19

1. Shoulder discomfort; 2. Nausea; 3. Vomiting

Question 20

What is pt at risk for if bladder perforation occurs with malignancy present?

Answer 20

seeding into the peritoneum

Question 21

What are the 3 main things pts are at risk for if bladder perforation occurs?

Answer 21

1. Blood loss; 2. Hypothermia; 3. Bacteremia

Question 22

What are clinical indicators of bladder perforation?

Answer 22

HTN and tachycardia followed by severe hypotension; reduction of irrigation fluid return is early sign

Question 23

What is DIC triggered by during bladder irrigation?

Answer 23

Prostatic throbogenic substances - especially with cancer of prostate

Question 24

What is required with bladder perforation?

Answer 24

Emergent subrapubic cystostomy or possible exploratory lap

Question 25

What are 4 requirements of irrigation solution for TURP?

Answer 25

1. Clear; 2. Nonconductive; 3. Non-hemolytic; 4. Nontoxic

Question 26

What spinal level is needed for TURP?

Answer 26

T10

Question 27

Why is spinal anesthesia preferred for TURP?

Answer 27

1. Bladder will be atonic with large capacity; 2. Post op bladder spasm prevented (homeostasis); 3. Awake pts can supply early detection of complications

Question 28

What are 2 complications of TURP?

Answer 28

1. Blood loss; 2. Venous absorption of irrigation fluid

Question 29

What are 2 early signs of TURP syndrome?

Answer 29

Hypertension and tachycardia

Question 30

How can blood loss be estimated during TURP case?

Answer 30

2-5 mL/min of resection time

Question 31

What may an awake pt complain of if experiencing TURP syndrome?

Answer 31

Dyspnea and nausea

Question 32

Where is irrigation fluid absorbed into body during TURP?

Answer 32

Open venous sinuses of prostate