Transcript Genitourinary Surgery

Genitourinary Surgery
Chapter 20
Anatomy
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Suprarenal Glands (Adrenal
Glands)
Situated on the superior/medial
portion of the kidney.
 Outer Cortex secretes steroidal
hormones
 Inner Medulla secrete epinephrine
and norepinephrine.
 Highly vascular.
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Anatomy
Anatomy
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Kidneys (2)
 Two bean shaped organs located in
the retroperitoneal space.
 Medial indention is known as the
hilum.
 Lie in a bed of fatty and fibrous
connective tissue.
 Surrounded by a smooth fibrous
capsule.
 Gerota’s Fascia
 Right kidney is smaller and lower.
 Left kidney is larger and higher.
Genitourinary Surgery
Anatomy
Anatomy
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Kidneys
Outer portion – Cortex
 Inner portion - Medulla
 Comprised of millions of Nephrons
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Divided into two units
 Renal corpuscle
 Renal tubule
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Responsible for filtration, reabsorbtion, and secretion.
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Renal arteries
Anatomy
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Renal corpuscle
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Consists of a network of capillaries
called the glomerulus.
Contained within the Bowman’s
Capsule.
 Responsible for filtration.
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Anatomy
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Renal tubules
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Consists of 3 units
Proximal convoluted tubule
 Loop of Henle
 Distal convoluted tubule
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Responsible for reabsorbtion and
secretion.
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Most of the reabsorbtion happens in
the Proximal tube.
Anatomy
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Kidneys
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As urine is produced, it flows inward
from the:
Renal pyramids
 Renal papillae
 Minor calyces
 Major calyces
 Renal pelvis
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The renal pelvis forms a funnel like
upper end of the ureters.
Anatomy
Anatomy
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Ureters
Two tubes conducting urine from
each kidney to the bladder.
 Uses wave like muscular
contraction to move urine to the
bladder.
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Anatomy
Anatomy
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Urinary bladder
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Elastic sac-like organ that stores urine,
until it is eliminated out of the body
through the urethra.
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Located in the pelvis surrounded:
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Holds up to 600ml on average
Levator ani – Inferior
Obturator internus – Superior
Rectum – Posterior
Abdominal wall – Anterior
Blood supply – Vesical arteries
Anatomy
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Urinary bladder
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Lined with a folded mucous
membrane that will stretch when
distended.
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Trigone
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Triangular smooth area from the
ureteral openings to the urethral
opening.
Anatomy
Anatomy
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Urethra
Tube conducting urine from the
bladder to the urethral meatus to
be expelled from the body.
 Portion of the male urinary and
reproductive system.
 Divided into 3 portions
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Prostatic (proximal)
 Membranous
 Spongy (distal)
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Male Reproductive System
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Testis
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Tunica abuginea
Seminiferious tubules
Septum
Epididymis
Ductus (Vas) Deferens
Seminal Vesicles
Ejaculatory ducts
Prostate Gland
Penis
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Prepuce
Pathology Affecting the
Adrenal Glands
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Cushing’s Syndrome
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Addison’s Disease
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Over production of cortisol due to
tumor of the adrenals or pituitary.
Under production of adrenal
hormones. Treated medically.
Pheochromocytoma
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Tumor of the medulla, resulting in
overproduction of adrenaline.
Pathology Affecting the
Urinary System
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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.
 Cancer of the bladder may recur.
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Pathology Affecting the
Urinary System
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Urinary Calculi
Small solid particles
 Form in one or both kidneys
 Travel through the urinary
system
 Partial or total obstruction
 The size and location will
determine the signs and
symptoms.
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Pathology Affecting the
Urinary System
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Calculi symptoms
Dysuria
 Polyuria
 Passage of small amounts of
urine
 Flank pain
 Nausea and vomiting
 Urinary tract infection
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Pathology Affecting the
Urinary System
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Kidney disorders
Polycystic Kidney Disease
 Diabetic Nephropathy
 End-Stage Renal Disease
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Hemodialysis
 Peritoneal Dialysis
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Renal Cell Carcinoma
 Congenital Nephroblastoma
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Pathology Affecting the Male
Reproductive System
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Phimosis
Hypospadias/Epispadias
Benign Prostatic Hypertrophy
Cancer of the Prostate
Cryptorchidism
Testicular Torsion
Testicular Cancer
Diagnostic Procedures
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Hemotology
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Urinalysis
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PSA
Simple Void
Clean-catch
Catheterized
24 hour urine
KUB
IVU/IVP
Retrograde Urogram
Instrumentation
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General
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Kidney
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Major, Long
Stone Forceps
Thoracic
Rib retractors
 Elevators
 Rib shears/approximator
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Instrumentation
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Urethral
sounds/dilators
Resectoscope
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Ellik evacuator
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Working element
Removes tumor
segments
Flexible endoscopes
Rigid endoscopes
Resectoscope
Resectoscope
Resectoscope
Incisions
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Inguinal
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Scrotal
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Lower portion of the
ureter
Flank
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Vasectomy
Abdominal
Gibson
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Radical Orchietomy
Lateral Position
Lumbar
Common Procedures
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Nephrectomy
MMK
Circumcision
Orchiopexy
Vasectomy/Vasovasotomy
TURP
Suprapubic prostatectomy
Genitourinary Surgery
Genitourinary Surgery
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CIRCUMCISION
Genitourinary Surgery
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ORCHIECTOMY
Genitourinary Surgery
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VASECTOMY
Genitourinary Surgery
QUESTIONS?