chapter 20

©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 1©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied,

duplicated, or posted to a publicly accessible website, in whole or in part.

©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 2©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.

CHAPTER 20

Genitourinary Surgery

©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 3

Objectives• After studying this chapter, you will be able

to:– Recognize the relevant anatomy of the

genitourinary system– Recognize the pathology that prompts

genitourinary system surgical intervention and the related terminology

– Assess any special preoperative genitourinary diagnostic procedures/tests


Objectives (cont’d.)– Assess any special preoperative genitourinary

preparation procedures– Indicate the names and uses of genitourinary

instruments, supplies, and specialty equipment

– Determine the intraoperative preparation of the patient undergoing the genitourinary procedure

– Summarize the steps of the genitourinary procedures


Objectives (cont’d.)– Determine the purpose and expected

outcomes of the genitourinary procedures– Assess the immediate postoperative care and

possible complications of the genitourinary procedure

– Recognize any specific variations related to the preoperative, intraoperative, and postoperative care of the genitourinary patient


Introduction• Genitourinary (GU) surgery

– Surgical subspecialty • Addresses a wide spectrum of diseases involving

the male and female GU systems and the male reproductive system

• Urologists– Medical professionals: specialize in urology

• Diagnose, treat, and manage diseases ranging from GU malignancies and renal calculi to congenital GU defects


Diagnostic Procedures and Tests• Disorders of the GU tract

– Diagnosed through many standard procedures

• History and physical– Detailed history – Routine testicular self-examination– Digital rectal examination for men over 40


Laboratory Findings• Microscopic examination

– Accurate method for determining blood and urine composition

• Chemical reagent strips– Available for fast general results for some

tests• Home/office test strips

– Not highly accurate


Laboratory Findings (cont’d.)• Hematology findings

– Specific hematologic examinations will require a patient to comply with certain prerequisites

– Refer to Tables 20-1 and 20-2• Urinalysis

– Most important laboratory examination used in diagnosing problems affecting the urinary tract

– Refer to Tables 20-3 and 20-4


Radiologic Findings• Regular X-rays, ultrasound, CT scan, and

MRI– Important tools in diagnosing tumors and

obstructions of the GU tract• KUB: kidney, ureters, and bladder

– An AP (anterior-to-posterior [anteroposterior]) radiographic view of the urinary system


Radiologic Findings (cont’d.)• IVU

– Enhancement of the KUB – Involves injection of a contrast medium into

the patient’s vein• Retrograde urogram

– Serves same purpose as IVU– Contrast medium must be injected into the

ureters with the use of a cystoscope


Biopsy• Only accurate way to determine the

presence of malignancy and the exact cell type– Tissue samples are obtained using

percutaneous, endoscopic, and open methods


Endoscopy• Allows for visualization of the affected

structures– Tissue and fluid samples may be collected at

the same time, and/or additional tests– Laparoscopic procedures may also be

performed to diagnose and treat conditions of the GU system


Instrumentation, Routine Equipment, and Supplies

• Routine instrumentation, equipment, and supplies for GU surgery – Similar to those for general surgery with the

exception of specialty items needed for kidney, ureter, and prostate surgery


Instrumentation, Routine Equipment, and Supplies (cont’d.)

• General– Laparotomy instrument set– Long instrumentation set– Self-retaining abdominal retractor– Mixter right angles– Potts scissors– Vascular instruments– Hemoclip appliers, various sizes– Bladder and prostate retractors



• Kidney– Pedicle clamps and stone/lithotomy forceps

• Thoracic (rib resection)– Self-retaining rib retractor (Finochietto)– Alexander periosteotome– Doyen rib elevator and raspatory– Rib shears– Sauerbruch rongeur– Bailey rib contractor (approximator)



• Transurethral procedures – More complex and unique to GU surgery – Refer to Table 20-5

• Equipment– Cysto room: contains specialty equipment – GU procedures: similar to general surgery

• Supplies– Depend on procedure


Incisional Options • Inguinal incision

– Often used to access the scrotal contents of an adult or child

• Scrotal incisions – Performed to access the scrotal contents

• Abdominal incisions– Refer to Chapter 14


Incisional Options (cont’d.)• Gibson incision

– Extraperitoneal abdominal approach – Designed for access to the lower portion of

the ureter – Refer to Figure 20-7

• Flank incision– Provides direct access to the adrenal gland,

kidney, and proximal ureter– May be subcostal, transcostal, or intercostal


Incisional Options (cont’d.)• Lumbar incision

– Provides limited exposure – Used for adrenalectomy, renal biopsy, or

removal of a small low-lying kidney– May be done with the patient in lateral or

prone position


Kidney, Ureter, and Bladder Surgical Procedures

• Several procedures are used – Wilms’ tumor excision– Nephrectomy

• Partial or radical• Open simple nephrectomy• Laparoscopic simple nephrectomy

– Kidney transplant


Kidney, Ureter, and Bladder Surgical Procedures (cont’d.)

– GU endoscopy• Ureteroscopy• Pyelolithotomy• Cystoscopy with overview of TURBT

– Cystectomy • Partial or segmental• Radical cystectomy with ileal conduit—male

patient surgical anatomy and pathology


Procedures for Stress Incontinence Affecting Women

• Objectives – Restore the posterior urethrovesical angle

and elevate the bladder base• May have been distorted during childbirth or as the

natural result of aging

• Mild stress incontinence – May be reduced following an anterior

colporrhaphy


Procedures for Stress Incontinence Affecting Women (cont’d.)

• Significant incontinent episodes – May be eliminated with suprapubic

vesicourethral suspension (Marshall-Marchetti-Krantz [MMK] procedure)

• Procedure: refer to text

• Suburethral sling (pubovaginal sling)– May be recommended to women who have

been unsuccessfully treated via surgical elevation and stabilization techniques


Prostate Surgery• Prostatectomy

– Surgical removal of all or part of the prostate– May be accomplished transurethrally or may

require an open procedure• Procedures

– Transurethral resection of the prostate (TURP)

– Laparoscopic prostatectomy with robot– Suprapubic prostatectomy


Prostate Surgery (cont’d.)• Percutaneous implantation of radioactive

seeds in the prostate gland– Allows for a focused release of high doses of

radiotherapy as compared to external radiotherapy

– Due to the focused nature of the radiation release, adjacent organs are not affected

• Procedure: refer to text


Testicular Surgery• Large percentage of testicular surgical

procedures are performed on pediatric patients– Adult males may undergo procedures as an

adjunct • Procedures

– Hydrocelectomy– Orchiopexy– Simple orchiectomy


Penile Surgical Procedures• Performed to treat congenital defects,

disorders, and cancer• Procedures

– Circumcision– Hypospadias repair– Epispadias repair– Insertion of Inflatable penile prosthesis– Penectomy


Summary• This chapter reviewed:

– Anatomy of the GU system– The pathology that prompts GU system

surgical intervention– GU diagnostic procedures and tests– GU instruments, supplies, and specialty

equipment– GU surgical procedures

chapter 20

Documents

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genitourinary patient

genitourinary proceduresassess

genitourinary systemrecognize

genitourinary instruments

gu malignancies

gu tract