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Genitourinary Surgery

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Presentation on theme: "Genitourinary Surgery"— Presentation transcript:

1 Genitourinary Surgery
CHAPTER 20 Genitourinary Surgery

2 Anatomy Suprarenal glands Kidneys Ureters Urinary bladder

3 Supradrenal Glands On top of kidneys Endocrine glands Cortex Medulla
Secretes steroid- type hormones Control fluid and electrolyte balance Medulla Secretes epinephrine Norepinephrine

4 Kidneys Differ in location and size Nephron is the functional unit
Left is normally larger Nephron is the functional unit Renal corpuscle Renal tubule Filters blood Excrete waste

5 Ureters Conduct urine from the kidney to the bladder Muscular tubes
Small lumen “S” shaped

6 Kidney/Ureter

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 Urinary Bladder Trigone Ureteral openings Urethral opening
Base of the bladder

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 Urinary Calculi Small solid particles Form in one or both kidneys
Travel through the urinary system Partial or total obstruction

11 Urinary Calculi Calculi symptoms Dysuria Polyuria
Passage of small amounts of urine Flank pain Nausea and vomiting

12 Male Reproductive System
Penis Testes Ductus Deferens Seminal vesicles Ejaculatory ducts Prostate gland

13 Penis Superficial structure Cylindrical masses of cavernous tissue
Two corpora cavernosa Dorsal Corpus spongiosum Midline

14 Penis Glans penis Prepuce Foreskin Covers the glans penis

15 Male Urethra Passes through the prostate gland
Divided into three parts Prostatic Membranous Spongy

16 Female Urethra Only 4 cm long
Passes in front of the lower half of the vagina Skene’s glands provide lubrication

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 Testis

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 Prostate Gland Accessory gland Lobulated gland (50 lobules)
Secrete prostatic fluid

21 Pathology Adrenal Glands Cushing’s syndrome Addison’s disease
Overproduction of cortisol Addison’s disease Complication of certain illnesses – TB and AIDS Renal insufficiency

22 Pathology Adrenal Glands Pheochromocytoma Tumor affecting the medulla
Overproduction of adrenaline

23 Pathology Urinary System Bladder tumors Urinary calculi
Kidney disorders

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 Kidney Disorders Polycystic Kidney Disease Autosomal recessive
Inherited Extremely rare Affects young children Acquired Develops in patients with long term kidney disease

26 Kidney Disorders Diabetic Nephropathy Sclerosis
Kimmelstiel-Wilson disease Diabetic glomerulosclerosis Caused by uncontrolled diabetes mellitus

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 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 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 Pathology Affecting the Male Reproductive System
Phimosis Hypospadias/Epispadias Benign Prostatic Hypertrophy (BPH) Cancer Cryptorchidism Testicular Torsion

31 Diagnostic Procedures
History and physical Hematology Urinalysis Regular X-ray KUB (kidney, ureter, bladder)

32 Diagnostic Procedures
IVU Retrograde urogram MIBG Biopsy Endoscopy

33 Special Considerations
Transurethral procedures Specially equipped room Built-in table Radiographic equipment Darkroom Drainage system

34 Special Considerations
General instruments Kidney instruments Rib instruments

35 Cystoscope Flexible Cystoscope Rigid Cystoscope

36 Flexible Ureteroscope

37 Incisional Options Inguinal Scrotal Abdominal
Access the scrotal contents of an adult or child Scrotal Access scrotal contents Abdominal

38 Incisional Options Gibson Flank Lumbar
Extraperitoneal abdominal approach Access the lower ureter Flank Lumbar Adrenalectomy, renal biopsy, removal of low lying kidney

39 Common Procedures Nephrectomy Adrenalectomy Renal transplant ESWL

40 Common Procedures Marshall-Marchetti-Krantz (MMK) Circumcision
Orchiopexy TURP Prostatectomy

41 Nephrectomy Subtotal removal Total removal
Upper or lower pole of the kidney Total removal Simple Small malignancies Chronic obstructive disorders Benign tumors Transplant

42 Open Cystotomy Alternate method of catheterizing the bladder for drainage Percutaneous Open Acute urinary retention Enlarged prostate

43 Open Cystotomy

44 Stress Incontinence in Women
Restore posterior urethrovesical angle Elevate base of bladder MMK procedure Suprapubic suspension Stamey procedure Endoscopic suspension Stamey needle

45 MMK

46 Stamey Needle Placement

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