Principles 2 Fall 2025 > GU Procedures > Flashcards

GU Procedures Flashcards

FINAL (88 cards)

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1
Q

Urological surgery allows direct visualization of _________ (4). What are indications for this? (6)

A
  1. Urethra
  2. Bladder
  3. Ureter
  4. Kidney

Indications:
1. Biopsies
2. Evaluate bleeding
3. Laser/retrieve stones
4. Remove/treat stricture
5. Resect masses
6. Retrograde pyelography

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2
Q

What is the positioning with Urological surgery? What risk associated with this? (6)

A

Lithotomy

  1. Femoral/peroneal nerve injury
  2. Skin breakdown dt stirrups
  3. Hip dislocation
  4. Back strain
  5. Vessel compression (DVT, Venous pooling)
  6. Compartment syndrome
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3
Q

The Measure of glomerular function is _______. you are asymptomatic until a ______ decrease. What’s the difference between moderate and severe insufficiency of glomerular function?

A

GFR

50%

Moderate: increased BUN/Creat, anemia, decreased energy

Severe: profound uremia, acidemia, volume overload

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4
Q

Normal value: GFR

A

125 ml/min

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5
Q

Normal value: BUN

A

8 - 18 mg/dL

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6
Q

BUN is influenced by ___________ (3) and it’s more influenced by _____ early on. It is not elevated and kidney disease until GFR is _____ %of normal

A
  1. Exercise
  2. Steroids
  3. Dehydration

Acute things

75%

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7
Q

Normal value: creatinine

A

0.8 - 1.2 mg/dL

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8
Q

T/F: there’s no variation in creatinine

A

F

It varies with age & sex

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9
Q

What consideration should we have in the preop eval with chronic renal failure? (10)

A
  1. Hypervolemia
  2. Hypernatremia
  3. Acidosis
  4. Decreased ammonium
  5. Hyperkalemia
  6. HTN
  7. Cardiac/pulmonary dysfunction
  8. Iron deficient anemia
  9. Abnormal platelet aggregation
  10. Abnormal Prothrombin consumption
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10
Q

Drugs of concern w/ renal insufficiency are ______ & eliminated ________ in the urine. What are they? (6)

A

Highly ionized

Unchanged

  1. Muscle relaxant
  2. Cholinesterase inhibitors
  3. Thiazise diuretics
  4. Digoxin
  5. Many Abx
  6. Metabolites of opioids (morphine/meperidine)
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11
Q

Most drugs are _____ in non-ionized state. Why is this beneficial to patient with renal insufficiency?

A

Lipid soluble

  1. Termination doesn’t depend on renal excretion
  2. Use redistribution and metabolism
  3. Excreted as water soluble compounds
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12
Q

Urological scope procedure name: urethra

A

Urethroscopy

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13
Q

Urological scope procedure name: bladder

A

Cystoscopy

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14
Q

Urological scope procedure name: ureteral orifice

A

ureteroscopy

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15
Q

Urological procedures are endoscopic evaluation of the _________. how is this done?

A

Lower urinary tract

Through a flexible or rigid scope hooked to a irrigating system –> guide wire inserted through scope –> catheter/instruments placed over wire –> radiopaque die injected through catheter

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16
Q

What are indications for urethroscopy/cystoscopy? (2)

A
  1. Visualize the urethra/bladder dt urinary symptoms
  2. Dx lesions, strictures
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17
Q

Ureteroscopy the procedure of choice for _________ and can incorporate ______. there is a __% chance in men & ___% in women and a recurrent percent of ___%. What do they contain? What is this cause?

A

Mid/distal ureter or bilateral stones

Laser technology

10%

5%

50%

The stones contain calcium which causes them to be radiopaque

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18
Q

How are ureter/kidney stones Dx? (3)

A
  1. CT
  2. KUB
  3. IVP
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19
Q

What is the medical Tx for stones? (5)

A
  1. Medical expulsive therapy (MET)
  2. NSAIDs
  3. Aggressive fluid administration
  4. CCB
  5. Alpha blockers

Last –> Sx

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20
Q

What are the different types of Sx for stone removal? (3)

A
  1. Stone basket/laser
  2. Shockwave lithotripsy
  3. Perc nephrolithotomy
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21
Q

Shockwave lithotripsy is best suited for __________. what are the risk associated with this? (2) how is this done?

A

Small/medium intranephric stones

Risks:
1. Kidney injury
2. Sub – capsular hematoma

How:
Water filled coupler device –> tightly focus beam –> low pressure pulse –> has decreased pain

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22
Q

What are absolute contraindications to Shockwave lithotripsy? (3)

A
  1. Bleeding disorder
  2. Anticoagulation
  3. Pregnancy
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23
Q

What are relative contraindications to Shockwave lithotripsy? (5)

A
  1. Large calcified aortic/renal aneurysms
  2. Untreated UTI – sepsis risk
  3. Obstruction distal to the renal calculi
  4. Pacemaker, ICD, neurostimulator - may mimic trigger
  5. Morbid obesity
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24
Q

What are IMPORTANT anesthesia considerations with Shockwave lithotripsy? (7)

A
  1. Iodine allergy?
  2. GA – this is painful and they’re hitting on your kidney, don’t do local you don’t want them awake
  3. LMA is appropriate, but I’ll never argue with the ETT
  4. Minimal narcotics
  5. PONV
  6. Eye covering if laser used
  7. Lead for providers
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25
Percutaneous nephrolithotomy is useful for ___________. what is required first with this? What does this require?
Large intranephric stones. **Requires initial placement of urethral stents** to prevent obstruction as fragments pass This requires large amounts of fluoroscopy/radiation
26
_______ syndrome is a possibility with Percutaneous nephrolithotomy.
Transurethral resection syndrome (TUR)
27
What are IMPORTANT anesthesia considerations with Percutaneous nephrolithotomy? (4)
1. GA 2. ETT 3. Lead/eye if laser 4. short acting NMB - roc is fine
28
What position is for Percutaneous nephrolithotomy?
Lateral
29
What are the scrotal operations? (3) describe them
1. Orchiectomy -almost always bilateral -spermatic cord is clamped, cut, suture -dt metastatic prostate cancer 2. Hydrocelectomy -wall of hydrocele excised and edge suture to prevent recurrence 3. Testicular torsion -must be performed within 6 hours to prevent irreversible ischemic damage
30
What are the penile operations? (4) describe them
1. Circumcision -dt phimosis, penile/prostate cancer 2. Hypospadius repair 3. Penectomy -may include inguinal lymph node -dt squamous cell carcinoma 4. Penile prosthesis -dt DM, spinal cord injury
31
What are IMPORTANT anesthesia implications with scrotal/penile operations? (5)
1. Preop anxiolytics 2. GA, Spinal, epidural 3. ETT/LMA 4. SCIP Abx 5. Manipulation of genitals --> bradycardia
32
What is a position for scrotal/penile operations?
Supine
33
You can use a ______ block for scrotal/penile operations which affect the ______ nerve for _______.
Penile block Pudendal nerve S2 - S4
34
What are indications for Cystectomy? (4)
Simple benign conditions: 1. Hemorrhagic cystitis 2. Radiation cystitis Radical malignant conditions: 3. Invasive bladder cancer 4. Cancers involving the uterus, prostate, ovaries
35
What does Cystectomy require? (2)
1. Ileal conduit or 2. Bladder substitution
36
What are preop considerations for Cystectomy? (6)
1. Bowl prep used 2. Anticoagulant? 3. Need EKG 4. Risk factors for CAD/pulmonary disease 5. Type in crossmatch blood - massive blood loss risk 6. 1-2 IV
37
What are intraop considerations for Cystectomy? (6)
1. GETA 2. Spinal/epidural 3. SCIP 4. Blood loss up to 3 L 5. Massive fluid shifts 6. Hypothermia - warm patient
38
What position is for Cystectomy?
Supine
39
The gold standard for a BPH is _________. when would you do this?
Transurethral resection of prostate (TURP) After a failure of medical therapy & recurrent symptoms
40
With Transurethral resection of prostate (TURP), it is common in _______ & you use ________ in this procedure. Blood loss is expected to be ______.
Elderly Electrocautery/laser 2-4ml/min
41
What are the risk factors associated with needing a Transurethral resection of prostate (TURP)? (7)
1. Male 2. Older (30-50) 3. Obese 4. HTN 5. Hyperthyroidism 6. CRI (chronic renal injury?) 7. Paraplegic
42
What are preop & intraop considerations with Transurethral resection of prostate (TURP)? (4-3)
Pre-op: 1. Comorbidities 2. Anticoagulants? 3. Type & screen 4. Large bore IV Intraop: 1. GA/Spinal 2. May need transfusion 3. TUR syndrome
43
What position is for Transurethral resection of prostate (TURP)?
Lithotomy
44
You are in the _______ position for robotic prostatectomy. What do you need for this? (3)
Lithotomy, steep trendelenburg 1. A line 2. Neo drip 3. Limit IV fluid -- prevent facial/airway edema
45
What is TUR syndrome?
Symptoms rt hypovolemic water intoxication Excessive volume --> hyponatremia
46
TUR syndrome symptoms: 120 Na
CNS: confusion, restlessness ECG: widening of QRS
47
TUR syndrome symptoms: 115 Na
CNS: Somnolence, nausea ECG: elevated ST segment, widen QRS
48
TUR syndrome symptoms: 110 Na
CNS: seizures, coma ECG: VTach/Vfib
49
What should we be aware of with TUR syndrome?
Under GA you wont be able to recognize most of the CNS symptoms.
50
What are the differen types of irrigants? (4) Describe them
1. Saline -volume overload -current dispersion w/ monopolar cautery --> need to increase energy used w/ cautery 2. Glycine -metabolize in liver to ammonia -- bad w/ liver pts 3. Water -intravascular hemolysis -electrolyte shifts 4. Sorbitol -metabolized to CO2 & fructose -volume overload
51
Irrigation rates of ______ will have an absorption rate of ________. For TUR syndrome _____ of absorption is usually required
300ml/min 20ml/min - 200ml/min >2L
52
How do you **PREVENT** TUR syndrome? (3)
1. Limit resection time to 1 hour 2. Suspend the irrigating fluid LESS THAN 30cm above table 3. Tx hypotension for SAB/spinal with vasopressors NOT fluids
53
How do you **TREAT** TUR syndrome? (6)
1. ABC's 2. Terminate procedure 3. Invasive lines -- for cardiovascular instability Mild symptoms (Na >120): 4. Fluid restriction 5. Loop diuretics Severe symptoms (Na <120): 6. 3% saline
54
What are 20% of post complications of Nephrectomies? (7)
1. Mortality 2. Peritonitis 3. Acute renal failure 4. Hernia 5. Visceral injury 6. Hemorrhage 7. Pneumothorax
55
What are the different types of nephrectomies? (3) briefly describe them
1. Simple -dt irreversible non-malignant disease (autoimmune), trauma, congenital disease (polycystic kidney disease-PKD) 2. Radical: include adrenal glands -dt renal cell carcinoma 3. Donor
56
What consideration should we have with radical nephrectomy?
Includes adrenal glands --> may have issues with BP
57
What is the positioning for nephrectomy?
Lateral decubitus
58
Pts needing Nephrectomies are commonly associated w/ ________ (3)
1. CAD 2. CRI/ESRD 3. HTN
59
What are preop considerations with Nephrectomies? (4)
1. Anxiolytics 2. SCIP 3. Type&cross 4. 2 large bore IV
60
What's the difference between type&screen and type&cross?
Type & Screen = Check and prepare. Type & Cross = Check, match, and reserve blood.
61
What are IMPORTANT intraop considerations with Nephrectomies? (6)
1. GETA 2. **Avoid nitrous** 3. Consider A-line 4. Consider central line - ipsilateral to surgical site 5. Regional for postop pain (ESP) 6. Have colloids, blood, rapid transfusion, mannitol, lasix at ready
62
Where is the transplanted kidney put at?
Closer to the bladder, down in the abd
63
_____ of all renal nephrectomies are from living donors
1/3
64
What are exclusions for kidney donations, whether they're living or after death? (4)
1. DM 2. HIV 3. Liver disease 4. Cancer
65
What are benefits of using a living donor for an nephrectomy? (2)
1. Avoid waiting times 2. Decrease cold ischemic time
66
What are the anesthesia considerations for the **living donor** during a nephrectomy?
1. Similar to simple nephrectomy 2. Aggressive isotonic hydration (10-20ml/kg/hr) 3. Low level anticoagulation 4. Diuresis 5. Protamine for heparin reversal
67
Which kidney is preferred when donating a kidney from a living donor?
Left
68
For the person donating a kidney, how much fluid do you want to give them? How much do you want their UO to be?
Input: 10-20 ml/kg/hr Output: 2ml/kg/hr
69
What are the physiological differences for DBD Nephrectomies? (4)
1. Neurologic instability -**Cushing sign**: HTN, bradycardia, wide PP -IICP 2. Cardiac instability -massive release of catecholamines -acute MI common -cardiovascular collapse 3. Pulmonary instability -neurogenic pulmonary edema -SIRS 4. Metabolic instability -dt dysfunction of hypothalamus and pituitary systems -thermal regulation, hormones, insulin, electrolytes, DIC
70
What are anesthesia considerations for DBD nephrectomy? (7)
1. Stabilization > anesthesia 2. Vasoactive management for hemodynamic support 3. Bradycardia not responsive to anticholinergics -- use isuprel 4. Fluid resuscitation with crystalloids & PRBCs 5. Avoid glucose containing solution solutions 6. Normal peep & Vt (5-10 & 6-8ml/kg IBW) 7. **Steroids to attenuate immune response in recipient**
71
We need to use _______ medications to decrease BP in DBD nephrectomy. What are they? (3)
Short acting 1. Cardene 2. Esmolol 3. VA
72
What are the vasopressors of choice in DBD nephrectomy? (5)
1. Vasopressin 2. NE 3. Neo 4. Dopamine 5. Dobutamine
73
_______ is the NMB that we should use in DBD nephrectomy
Cisatracurium
74
Nephrectomy donor management goals: CVP (heart/lungs)
Heart: 4 - 10 lungs: 6 - 8
75
Nephrectomy donor management goals: MAP
60 - 120 mmHg
76
Nephrectomy donor management goals: PaO2
>300 on 5cm PEEP & 100% O2
77
Nephrectomy donor management goals: PaCO2
35 - 45 mmHg
78
Nephrectomy donor management goals: ABG pH
7.3 - 7.45
79
Nephrectomy donor management goals: UO
>1ml/kg/hr
80
Nephrectomy donor management goals: Na
135 - 160
81
Nephrectomy donor management goals: Glucose
<150
82
Nephrectomy donor management goals: EF
>50%
83
Nephrectomy donor management goals: Hgb
>9
84
Nephrectomy donor management goals: Pressors
1 & low dose
85
The ischemic time for kidneys is _________. What happens during this time? (4)
48 - 72 hrs 1. Lack of O2 2. Depletion of ATP/glycogen 3. Failure of Na/K pump 4. Increase intracellular Na --> edema
86
What are preop considerations we should have with Nephrectomies? (4)
1. Last dialysis -- K? 2. DM? 3. CAD/HTN 4. EKG
87
What are intraop considerations we should have with Nephrectomies? (7)
1. GETA 2. Use Succ & cisatracurium 3. Careful of AV fistula 4. CVP 5. A line 6. Steroids, mannitol, lasix, bumex, albumin, antithymocyte 7. EXTUBATE ON THE OR TABLE!!!
88
Antithymocyte is a _______ medication that is an infusion of ______ antibodies.
Anti-rejection Rabbit-derived
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