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© 2008 Delmar Cengage Learning. CHAPTER 20 Genitourinary Surgery
© 2008 Delmar Cengage Learning. 2 Anatomy Suprarenal glands Kidneys Ureters Urinary bladder
© 2008 Delmar Cengage Learning. 3 Supradrenal Glands On top of kidneys Endocrine glands Cortex –Secretes steroid- type hormones –Control fluid and electrolyte balance Medulla –Secretes epinephrine –Norepinephrine
© 2008 Delmar Cengage Learning. 4 Kidneys Differ in location and size –Left is normally larger Nephron is the functional unit –Renal corpuscle –Renal tubule Filters blood Excrete waste
© 2008 Delmar Cengage Learning. 5 Ureters Conduct urine from the kidney to the bladder Muscular tubes Small lumen “S” shaped
© 2008 Delmar Cengage Learning. 6 Kidney/Ureter
© 2008 Delmar Cengage Learning. 7 Urinary Bladder Collects urine Lies in the anterior half of the pelvis Male –Lies on and is attached to the base of the prostate gland Female –Lies on the pelvic diaphragm
© 2008 Delmar Cengage Learning. 8 Urinary Bladder Trigone –Ureteral openings –Urethral opening –Base of the bladder
© 2008 Delmar Cengage Learning. 9 Bladder Tumors Present with hematuria Single growth or multiple present Benign (papillomas) occur in young adults Malignant neoplasms usually occur in men over 50 Early removal transurethrally
© 2008 Delmar Cengage Learning. 10 Urinary Calculi Small solid particles Form in one or both kidneys Travel through the urinary system Partial or total obstruction
© 2008 Delmar Cengage Learning. 11 Urinary Calculi Calculi symptoms –Dysuria –Polyuria –Passage of small amounts of urine –Flank pain –Nausea and vomiting
© 2008 Delmar Cengage Learning. 12 Male Reproductive System Penis Testes Ductus Deferens Seminal vesicles Ejaculatory ducts Prostate gland
© 2008 Delmar Cengage Learning. 13 Penis Superficial structure Cylindrical masses of cavernous tissue –Two corpora cavernosa Dorsal –Corpus spongiosum Midline
© 2008 Delmar Cengage Learning. 14 Penis Glans penis Prepuce –Foreskin Covers the glans penis
© 2008 Delmar Cengage Learning. 15 Male Urethra Passes through the prostate gland Divided into three parts –Prostatic –Membranous –Spongy
© 2008 Delmar Cengage Learning. 16 Female Urethra Only 4 cm long Passes in front of the lower half of the vagina Skene’s glands provide lubrication
© 2008 Delmar Cengage Learning. 17 Testes Paired Lie in the scrotum Tunica vaginalis covers most of the testis, epididymis, and lower end of spermatic cord Seminiferous tubules Epididymis –Maturation site
© 2008 Delmar Cengage Learning. 18 Testis
© 2008 Delmar Cengage Learning. 19 Ductus Deferens Arises from the epididymis Also known as the “vas deferens” Ascends through the inguinal canal Delivers semen to the prostatic urethra
© 2008 Delmar Cengage Learning. 20 Prostate Gland Accessory gland Lobulated gland (50 lobules) Secrete prostatic fluid
© 2008 Delmar Cengage Learning. 21 Pathology Adrenal Glands –Cushing’s syndrome Overproduction of cortisol –Addison’s disease Complication of certain illnesses – TB and AIDS Renal insufficiency
© 2008 Delmar Cengage Learning. 22 Pathology Adrenal Glands –Pheochromocytoma Tumor affecting the medulla Overproduction of adrenaline
© 2008 Delmar Cengage Learning. 23 Pathology Urinary System –Bladder tumors –Urinary calculi –Kidney disorders
© 2008 Delmar Cengage Learning. 24 Kidney Disorders Polycystic Kidney Disease –Occurs when the parenchyma of the kidney is replaced by multiple fluid filled benign cysts –Autosomal dominant Inherited Symptomatic between the age of 30 and 40 90% of PKD fall under this category
© 2008 Delmar Cengage Learning. 25 Kidney Disorders Polycystic Kidney Disease –Autosomal recessive Inherited Extremely rare Affects young children –Acquired Develops in patients with long term kidney disease
© 2008 Delmar Cengage Learning. 26 Kidney Disorders Diabetic Nephropathy –Sclerosis –Kimmelstiel-Wilson disease –Diabetic glomerulosclerosis –Caused by uncontrolled diabetes mellitus
© 2008 Delmar Cengage Learning. 27 Kidney Disorders End-Stage Renal Disease (ESRD) –Kidney failure –Kidneys functioning under 10% –Half the population with ESRD is diabetic –Dialysis –Kidney transplant
© 2008 Delmar Cengage Learning. 28 Kidney Disorders Renal Cell Carcinoma –Adenocarcinoma –Most common type of kidney cancer –8,000 deaths per year in the U.S. –Affects men twice as often –Usually appears between 50-60 years old –Directly linked to cigarette smoking
© 2008 Delmar Cengage Learning. 29 Kidney Disorders Congenital Nephroblastoma –Wilms’ tumor –Malignant –Occurs primarily in children between 3-4 years –Surgical removal is recommended –Followed by radiation and chemotherapy
© 2008 Delmar Cengage Learning. 30 Pathology Affecting the Male Reproductive System Phimosis Hypospadias/Epispadias Benign Prostatic Hypertrophy (BPH) Cancer Cryptorchidism Testicular Torsion
© 2008 Delmar Cengage Learning. 31 Diagnostic Procedures History and physical Hematology Urinalysis Regular X-ray KUB (kidney, ureter, bladder)
© 2008 Delmar Cengage Learning. 32 Diagnostic Procedures IVU Retrograde urogram MIBG Biopsy Endoscopy
© 2008 Delmar Cengage Learning. 33 Special Considerations Transurethral procedures Specially equipped room –Built-in table –Radiographic equipment –Darkroom –Drainage system
© 2008 Delmar Cengage Learning. 34 Special Considerations General instruments Kidney instruments –Rib instruments
© 2008 Delmar Cengage Learning. 35 Cystoscope Flexible Cystoscope Rigid Cystoscope
© 2008 Delmar Cengage Learning. 36 Flexible Ureteroscope
© 2008 Delmar Cengage Learning. 37 Incisional Options Inguinal –Access the scrotal contents of an adult or child Scrotal –Access scrotal contents Abdominal
© 2008 Delmar Cengage Learning. 38 Incisional Options Gibson –Extraperitoneal abdominal approach –Access the lower ureter Flank Lumbar –Adrenalectomy, renal biopsy, removal of low lying kidney
© 2008 Delmar Cengage Learning. 39 Common Procedures Nephrectomy Adrenalectomy Renal transplant ESWL Cystectomy
© 2008 Delmar Cengage Learning. 40 Common Procedures Marshall-Marchetti-Krantz (MMK) Circumcision Orchiopexy TURP Prostatectomy
© 2008 Delmar Cengage Learning. 41 Nephrectomy Subtotal removal –Upper or lower pole of the kidney Total removal –Simple Small malignancies –Chronic obstructive disorders –Benign tumors –Transplant
© 2008 Delmar Cengage Learning. 42 Open Cystotomy Alternate method of catheterizing the bladder for drainage Percutaneous Open Acute urinary retention –Enlarged prostate
© 2008 Delmar Cengage Learning. 43 Open Cystotomy
© 2008 Delmar Cengage Learning. 44 Stress Incontinence in Women Restore posterior urethrovesical angle Elevate base of bladder MMK procedure –Suprapubic suspension Stamey procedure –Endoscopic suspension –Stamey needle
© 2008 Delmar Cengage Learning. 45 MMK
© 2008 Delmar Cengage Learning. 46 Stamey Needle Placement
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