Surgery

Published on 05/05/2017 by admin

Last modified 05/05/2017

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FIG. 7.12 Organization of the male reproductive organs. Sagittal section of pelvis showing placement of male reproductive organs. (From Patton KT, Thibodeau GA: The human body in health & disease, ed 6, St Louis, 2014, Mosby.)

Surgical Mapping

Cystoscopic TURP (transurethral prostatectomy)

Instruments	Important Anatomy Involved	Pathophysiology
Cystoscopy instrumentation: Irrigation, tubing & pump Camera Light source & cable Resectoscope Three-way Foley catheter Ellik evacuator Van Buren sounds Electrocautery	Urethra Prostate Bladder	BPH (benign prostatic hypertrophy)

Microbiology/Wound Classification	Skin Prep/Incision/Patient position	Pharmacology
Indigenous microorganisms concentrated in the external urethral orifice and navicular fossa, basically consisting of gram-positive aerobic bacteria Class II (clean contaminated)	Prep: perineal prep & drape Position: lithotomy or low lithotomy Incision: none	Spinal/general anesthesia Omniopaque/Renografin (radiopaque solutions for KUB x-ray series)

FIG. 7.13 Urinary bladder. Male bladder cut to show the interior. In the male, a large prostate gland surrounds the urethra as it exits from the bladder. (From Patton KT, Thibodeau GA: The human body in health & disease, ed 6, St Louis, 2014, Mosby.)

Surgical Mapping

Ureteroscopy

Instruments	Important Anatomy Involved	Pathophysiology
Ureteroscopy instrumentation irrigation, tubing & Pump Camera Light source & cable Three-way Foley catheter Ureteral stent Van Buren sounds Electrocautery Laser	Urethra Bladder Ureter Kidney	Urinary calculi

Microbiology/Wound Classification	Skin Prep/Incision/Patient position	Pharmacology
Indigenous microorganisms concentrated in the external urethral orifice and navicular fossa, basically consisting of gram-positive aerobic bacteria Class II (clean contaminated)	Prep: perineal prep & drape Position: lithotomy	Spinal/general anesthesia Omnipaque/Renografin (radiopaque solutions for KUB x-ray series)

Go ahead and use the template available on the Evolve Resources site to try mapping the remaining procedures:

• Cystoscopy

• Cystoscopy TURBT (transurethral resection of bladder tumor)

• Urethrotomy

Penile and Testicular Procedures

Procedures

• Hydrocelectomy

• Orchiopexy

• Circumcision (Fig. 7.14)

• Orchiectomy

• Hypospadias and epispadias repair

• Penile prosthesis placement

• Vasvasotomy

• Vasectomy

• Varicocelectomy

Basic Equipment Required

• Genitourinary minor instrument set

• Electrocautery (needle tip)

• Two #15 knife blades

Additional Facts to Remember

• Repair of hypospadias, in which the urethral opening of the penis is on the underside rather than at the tip, may require multiple procedures performed in stages.

• In epispadias, the urethra ends in an opening on the upper aspect (dorsum) of the penis.

• Because of the importance of preserving skin for use as grafts in repair procedures, circumcision is not performed in infants with defects.

• Hypospadias repair also involves the release of chordee to straighten the penis.

FIG. 7.14 Circumcision. A, Initial incision made in the shaft. B, Second incision made in subcoronal sulcus. C, Amount of tissue to be removed. D, Removal of tissue. E, Shaft skin sutured to subcoronal skin. (From Holcomb GW, Murphy JP: Pediatric surgery, ed 5, Philadelphia, 2010, Saunders.)

• Urethral catheters of 10 to 12 Ch/F for adult women and 10 to 16 Ch/F for adult men are generally chosen; hence, any size smaller than 8F is used for pediatric patients when avoiding damage to the urethra is of major concern.

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