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© 2008 Delmar Cengage Learning. CHAPTER 20 Genitourinary Surgery.

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Presentation on theme: "© 2008 Delmar Cengage Learning. CHAPTER 20 Genitourinary Surgery."— Presentation transcript:

1 © 2008 Delmar Cengage Learning. CHAPTER 20 Genitourinary Surgery

2 © 2008 Delmar Cengage Learning. 2 Anatomy Suprarenal glands Kidneys Ureters Urinary bladder

3 © 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

4 © 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

5 © 2008 Delmar Cengage Learning. 5 Ureters Conduct urine from the kidney to the bladder Muscular tubes Small lumen “S” shaped

6 © 2008 Delmar Cengage Learning. 6 Kidney/Ureter

7 © 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

8 © 2008 Delmar Cengage Learning. 8 Urinary Bladder Trigone –Ureteral openings –Urethral opening –Base of the bladder

9 © 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

10 © 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

11 © 2008 Delmar Cengage Learning. 11 Urinary Calculi Calculi symptoms –Dysuria –Polyuria –Passage of small amounts of urine –Flank pain –Nausea and vomiting

12 © 2008 Delmar Cengage Learning. 12 Male Reproductive System Penis Testes Ductus Deferens Seminal vesicles Ejaculatory ducts Prostate gland

13 © 2008 Delmar Cengage Learning. 13 Penis Superficial structure Cylindrical masses of cavernous tissue –Two corpora cavernosa Dorsal –Corpus spongiosum Midline

14 © 2008 Delmar Cengage Learning. 14 Penis Glans penis Prepuce –Foreskin Covers the glans penis

15 © 2008 Delmar Cengage Learning. 15 Male Urethra Passes through the prostate gland Divided into three parts –Prostatic –Membranous –Spongy

16 © 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

17 © 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

18 © 2008 Delmar Cengage Learning. 18 Testis

19 © 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

20 © 2008 Delmar Cengage Learning. 20 Prostate Gland Accessory gland Lobulated gland (50 lobules) Secrete prostatic fluid

21 © 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

22 © 2008 Delmar Cengage Learning. 22 Pathology Adrenal Glands –Pheochromocytoma Tumor affecting the medulla Overproduction of adrenaline

23 © 2008 Delmar Cengage Learning. 23 Pathology Urinary System –Bladder tumors –Urinary calculi –Kidney disorders

24 © 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

25 © 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

26 © 2008 Delmar Cengage Learning. 26 Kidney Disorders Diabetic Nephropathy –Sclerosis –Kimmelstiel-Wilson disease –Diabetic glomerulosclerosis –Caused by uncontrolled diabetes mellitus

27 © 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

28 © 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 years old –Directly linked to cigarette smoking

29 © 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

30 © 2008 Delmar Cengage Learning. 30 Pathology Affecting the Male Reproductive System Phimosis Hypospadias/Epispadias Benign Prostatic Hypertrophy (BPH) Cancer Cryptorchidism Testicular Torsion

31 © 2008 Delmar Cengage Learning. 31 Diagnostic Procedures History and physical Hematology Urinalysis Regular X-ray KUB (kidney, ureter, bladder)

32 © 2008 Delmar Cengage Learning. 32 Diagnostic Procedures IVU Retrograde urogram MIBG Biopsy Endoscopy

33 © 2008 Delmar Cengage Learning. 33 Special Considerations Transurethral procedures Specially equipped room –Built-in table –Radiographic equipment –Darkroom –Drainage system

34 © 2008 Delmar Cengage Learning. 34 Special Considerations General instruments Kidney instruments –Rib instruments

35 © 2008 Delmar Cengage Learning. 35 Cystoscope Flexible Cystoscope Rigid Cystoscope

36 © 2008 Delmar Cengage Learning. 36 Flexible Ureteroscope

37 © 2008 Delmar Cengage Learning. 37 Incisional Options Inguinal –Access the scrotal contents of an adult or child Scrotal –Access scrotal contents Abdominal

38 © 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

39 © 2008 Delmar Cengage Learning. 39 Common Procedures Nephrectomy Adrenalectomy Renal transplant ESWL Cystectomy

40 © 2008 Delmar Cengage Learning. 40 Common Procedures Marshall-Marchetti-Krantz (MMK) Circumcision Orchiopexy TURP Prostatectomy

41 © 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

42 © 2008 Delmar Cengage Learning. 42 Open Cystotomy Alternate method of catheterizing the bladder for drainage Percutaneous Open Acute urinary retention –Enlarged prostate

43 © 2008 Delmar Cengage Learning. 43 Open Cystotomy

44 © 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

45 © 2008 Delmar Cengage Learning. 45 MMK

46 © 2008 Delmar Cengage Learning. 46 Stamey Needle Placement


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