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CHAPTER 20

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CHAPTER 20

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  1. CHAPTER 20 Genitourinary Surgery

  2. Anatomy • Suprarenal glands • Kidneys • Ureters • Urinary bladder

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

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

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

  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 • 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 50-60 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 • Access the scrotal contents of an adult or child • Scrotal • Access scrotal contents • Abdominal

  38. Incisional Options • Gibson • 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 • Cystectomy

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

  41. Nephrectomy • Subtotal 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