Chapter 20: Genitourinary Surgery

Which cutting instruments should the surgical technologist have ready for anastomosis of the renal vessels into the recipient?

Select one:

- #15 blade and Knight scissors

- #11 blade and 45° angle Potts scissors

- #12 blade and straight tenotomy scissors

- #10 blade and curved Mayo scissors

#11 blade and 45° angle Potts scissors

Diabetes, vascular disorder, nerve damage, and trauma are all possible causes of:

Select one:

hypospadias

prostate cancer

impotence

epispadias

Impotence

Which structure is ligated and transsected first in a radical nephrectomy or laparoscopic simple nephrectomy, following isolation of the vessels and ureter?

Select one:

Gerota's fascia

renal vein

renal artery

proximal ureter

Renal Artery

What structure of male anatomy is divided into three sections: prostatic, membranous, and spongy?

Select one:

urethra

spermatic cord

ureter

ejaculatory duct

Urethra

What is the medical term for the procedure of connecting a donor ureter to a recipient bladder?

Select one:

reimplantation

ureteroscopy

ureteroneocystostomy

suprapubic cystostomy

Ureteroneocystostomy

How is the anesthetic jelly that is inserted into the male urethra prior to cystoscopy kept from leaking out?

Select one:

- A cotton-tipped applicator is inserted into the external meatus.

- A sterile tight-fitting condom is applied to the penis.

- A flexible penile clamp is applied to the head of the penis.

- A gloved finger is held firmly against the head of the penis.

A flexible penile clamp is applied to the head of the penis.

Which of the following is used to ensure patency of the ureters or allow for drainage of urine from the kidneys?

Select one:

suprapubic catheter

double-J or pigtail stent

Foley catheter

Jackson-Pratt drain

Double-J or pigtail stent

Cystoscopy and ureteroscopy procedures are performed in which position?

Select one:

lateral

Trendelenburg

supine

low-lithotomy

Low-lithotomy

Adenocarcinoma has a direct correlation to each of the following EXCEPT:

Select one:

end-stage renal disease

tobacco use

liver cirrhosis

genetic predisposition

Liver Cirrhosis

What might the donor kidney be placed into to reduce possibility of injury during handling and transplantation?

Select one:

lahey intestinal bag

woven stockinette

plastic incise drape

laparoscopic entrapment sack

Woven Stockinette

Simple nephrectomy is routinely performed in which position?

Select one:

low-lithotomy

lateral

prone

supine

Lateral

Approximately how many lobules comprise the average prostate gland?

Select one:

4

20

50

2

50

In which surgical approach would the latissimus dorsi, internal and external oblique muscles be transected for access to the operative site?

Select one:

inguinal oblique

subcostal flank

transverse abdominal

suprapubic

Subcostal Flank

What is the term for an abnormal accumulation of serous fluid around the testis contained within the tunica vaginalis?

Select one:

omphalocele

hydrocele

cystocele

ectoceler

Hydrocele

Which of the following is given IV after the donor kidney is removed to reverse the heparinization?

Select one:

Ringer's lactate

furosemide

thrombin

protamine sulfate

Protamine Sulfate

What is the MOST serious post-op complication of penile implant surgery?

Select one:

edema

surgical site infection

premature ejaculation

impotence

Surgical Site Infection

What does specialized tissue within the seminiferous tubules produce?

Select one:

mucus

urine

testosterone

sperm

Sperm

An elevated serum PSA exam might prompt the additional investigation of a(n):

Select one:

intravenous urogram

urinalysis

prostate biopsy

PAP smear

Prostate Biopsy

Which of the following is NOT a type of pubovaginal or suburethral sling?

Select one:

allograft fascia lata

autograft fascia lata

radiopaque vaginal packing

polypropylene mesh tape

Radiopaque Vaginal Packing

What does the adrenal medulla secrete?

Select one:

catecholamines

insulin

testosterone

urine

Catecholamines

Just before the surgeon clamps the renal vessels of the donor's kidney, what does the anesthesia provider put in the IV?

Select one:

protamine sulfate

furosemide

Ringer's lactate

heparin and mannitol

Heparin and Mannitol

What is the name of the connective tissue that forms the umbilical ligament and is used for traction in radical cystectomy?

Select one:

urachus

vas deferens

diastasis recti

symphysis

Urachus

Many hospitals allow use of only sterile gloves to set up the back table for cystoscopy procedures.

Select one:

True

False

True

When is a patient classified as being in end-stage renal failure?

Select one:

- when both kidneys are functioning at or below 10% of normal

- when one kidney is normal and the other if functioning at or below 10% of normal

- when one kidney is normal and the other is functioning at or below 25% of normal

- when both kidneys are functioning at or below 25% of normal

When both kidneys are functioning at or below 10% of normal

Bonanno, Malecot, and Pezzer are types of :

Select one:

suprapubic catheters

active wound drains

passive wound drains

urethral catheters

Suprapubic Catheters

Flank, Gibson, inguinal, and scrotal are examples of:

Select one:

wound drains

post-op dressings

drape sheets

operative approaches

Operative Approaches

What anatomical structure is the bladder attached to in males?

Select one:

scrotum

symphysis pubis

prostate

rectum

Prostate

Which of the following comparisons of normal or typical kidney anatomy is CORRECT?

Select one:

- The left kidney is smaller and slightly lower than the right.

- The left kidney is larger and slightly higher than the right.

- The right kidney is smaller and slightly higher than the left.

- The right kidney is larger and slightly lower than the left.

The left kidney is larger and slightly higher than the right

Radical nephrectomy is usually performed with the patient in which position?

Select one:

low-lithotomy

prone

lateral

supine

Supine

What is done with the edge of the ilium that is brought out through the abdominal wall for stoma creation?

Select one:

- A Penrose drain is inserted and pulled over the edge.

- It is cut into four sections and tacked to the skin.

- A purse-string suture is placed to cinch it shut.

- The edges are everted and affixed to the skin.

The edges are everted and affixed to the skin.

Which suture configuration is used to anastomose vessels in transplants?

Select one:

- fine, nonabsorbable, double-armed

- heavy, nonabsorbable, double-armed

- heavy, absorbable, single-armed

- fine, absorbable, single-armed

Fine, nonabsorbable, double-armed

Which of the following procedures could be done in either a male or female patient?

Select one:

hydrocelectomy

TURP

TURBT

orchiectomy

TURBT

What type of light is used for illumination in endoscopic equipment?

Select one:

fluorescent

incandescent

fiber-optic

ultraviolet

Fiber-Optic

What procedure is performed to remove a calculus lodged in the area of the hilum?

Select one:

cystoscopy

pyelolithotomy

orchiectomy

urethrotomy

Pyelolithotomy

At approximately what age or period would a patient MOST likely be diagnosed with a Wilms' tumor?

Select one:

over age 60

onset of puberty

second trimester of gestation

between ages 3 and 8 years

Between ages 3 and 8 years

Dialysis and kidney transplant are the only two treatments for which of the following?

Select one:

testicular carcinoma

type I diabetes mellitus

end-stage renal disease

Wilms' tumor

End-stage renal disease

Surgical technologists are not required to be proficient in endoscopic genitourinary procedures, only open cases because there are cystoscopy specialists who will do them.

Select one:

True

False

False

Which of the following structures encloses the kidneys and suprarenal glands?

Select one:

tunica vaginalis

costal periosteum

Gerota's fascia

peritoneal sac

Gerota's Fascia

What is the name of a continent urinary reservoir that may be performed following cystectomy?

Select one:

ileal conduit

orchiopexy

Koch pouch

hydrocele

Koch Pouch

What is the medical term for the free fold of skin that covers the glans penis?

Select one:

tunica

scrotum

prepuce

epididymis

Prepuce

Which type of catheter is placed postoperatively following TURP?

Select one:

a. 2-way 16 Fr. Foley with 5 mL balloon

b. 2-way 22 Fr. Foley with 30 mL balloon

c. 3-way 22 Fr. Foley with 30 mL balloon

d. 3-way 16 Fr. Foley with 5 mL balloon

3-way 22 Fr. Foley with 30 mL balloon

What is the name of the basic structure composed of renal corpuscles and tubules and numbers over a million?

Select one:

psoas

hilum

adrenal

nephron

Nephron

Suprarenal glands are more commonly known as:

Select one:

thymus

adrenal

parotid

prostate

Prostate

Cryptorchidism is more commonly known as:

Select one:

nocturnal bedwetting

kidney stones

undescended testicles

urinary tract infection

Undescended Testicles

Which signal should alert the surgical team that prostate capsule perforation is imminent and may conclude the procedure?

Select one:

groaning

leg jerking

flatulence

coughing

Leg jerking

What device is used through the ureteroscope to capture an intact calculus or fragments if fractured by laser?

Select one:

Babcock forceps

entrapment sack

basket stone forceps

vessel loops

Basket Stone Forceps

Which distention fluid is nonelectrolytic and will lyse malignant tumor cells because of cellular uptake?

Select one:

water

glycine

sorbitol

saline

Water

Which dilating instrument is used to dilate the corpora for placement of penile prosthesis?

Select one:

Walther

Van Buren

Hegar

Bougie

Hegar

How many suture ligatures or free ties should the surgical technologist have prepared for ligation of the renal artery and vein prior to transsection and removal?

Select one:

one

three

seven

five

Three

In what position is the patient placed for proximal pyelolithotomy?

Select one:

prone

Trendelenburg

lateral

lithotomy

Lateral

What is the morcellator used for in a laparoscopic simple nephrectomy?

Select one:

- excising Gerota's fascia from around the kidney

- insufflating the peritoneal cavity after initial port placement

- cutting between the ligaclips placed on the renal vessels

- chopping the kidney and ureter into small pieces for suctioning

chopping the kidney and ureter into small pieces for suctioning

In radical cystectomy with ileal conduit on a male patient, what tissue will be sent for frozen section to verify clear margins?

Select one:

lateral edges of the tunica vaginalis

segments of bilateral ureters

distal segments of the seminal vesicles

sections of both testicles

Segments of bilateral ureters

Which of the following is a glass or plastic evacuator used to remove tissue and debris during TURP?

Select one:

Ellik

Toomey

Pezzer

Malecot

Ellik

Which instrument is used in TURP or TURBT and includes the sheath, obturator, working element, and ESU loops?

Select one:

nephroscope

cystoscope

resectoscope

ureteroscope

Resectoscope

What is the medical term for excision of the urinary bladder?

Select one:

ystectomy

corpectomy

colporrhaphy

cystostomy

Cystectomy

Which part of the kidney becomes the proximal ureter?

Select one:

medulla

cortex

Bowman's capsule

renal pelvis

Renal Pelvis

The anatomical structures excised during radical cystectomy are different between male and female patients.

Select one:

True

False

True

Which component of the rigid endoscopic system for cystoscopy is blunt ended and minimizes mucosal trauma during insertion?

Select one:

telescoping bridge

deflecting mechanism

sheath

obturator

Obturator

Which of the following are male urethral dilators or sounds?

Select one:

Pratt

Hanks

Van Buren

Walther

Van Buren

What procedure is performed for penile carcinoma resistant to chemotherapy or radiation?

Select one:

hydrocelectomy

vasectomy

penectomy

orchiectomy

Penectomy

Which of the following studies is a radiologic procedure in which contrast media is injected through a cystoscope?

Select one:

IV urogram

retrograde urogram

PSA

KUB

Retrograde Urogram

Which procedure is performed for testicular cancer, trauma, or necrosis secondary to torsion?

Select one:

penectomy

circumcision

orchiectomy

hydrocelectomy

Orchiectomy

Where in the genitourinary system do calculi originate?

Select one:

testicles

bladder

kidney

prostate

Kidney

Marshall-Marchetti-Krantz (MMK) is a traditional version of which general type of procedure?

Select one:

repair of cystocele and rectocele

shock wave destruction of calculi

inguinal hernia repair

suprapubic vesicourethral suspension

Suprapubic Vesicourethral Suspension

Which irrigation or distention fluid would be contraindicated during cystoscopy for fulguration of bladder tumor?

Select one:

saline

glycine

water

sorbitol

Saline

Which of the following is responsible for emptying of the bladder and closure of the bladder orifice?

Select one:

urogenital diaphragm

external sphincter

vesical trigone

detrusor muscle

Detrusor Muscle

What is used to resect the prostate gland tissue through the resectoscope?

Select one:

wire loop snare

ESU loop electrode

endoshears

#11 blade on #7 handle

ESU loop electrode

What is the more common name for ureteroileocutaneous diversion?

Select one:

ileal conduit

colostomy

pubovaginal sling

bladder prolapse

Ileal Conduit

Procedures for female urinary incontinence may be performed by gynecologists, urologists, or urogynocologists.

Select one:

True

False

True

What measure is taken to reduce the metabolic needs and prevents tubular necrosis of a kidney removed for transplant?

Select one:

- infusion with warmed lactated Ringer's solution

- spraying with reconstituted topical thrombin

- cooling with Collins solution or ice slush

- warming with sterile isotonic saline solution

Cooling with Collins solution or ice slush

Vesicourethral suspension and pubovaginal slings are performed to mainly treat moderate to severe:

Select one:

stress incontinence

urinary tract infections

vaginal dryness

uterine prolapse

Stress Incontinence

What is a unique feature of the OR table in a cystoscopy suite?

Select one:

It can be adjusted for fluoroscopic exams.

It has a mesh drain attachment.

Stirrups can be attached to rails.

It is radiolucent.

It has mesh drain attachment

Omnipaque, Renografin, and Isovue are used in cystoscopy as:

Select one:

contrast media

antibiotics

distention fluids

topical analgesics

Contrast Media

Every instrument or catheter placed into the urethra should be lubricated to minimize mucosal injury or irritation.

Select one:

True

False

True

What is the common diagnosis of a patient undergoing transurethral resection of the prostate?

Select one:

carcinoma of the prostate

benign prostatic hypertrophy

stress incontinence

erectile dysfunction

Benign Prostatic Hypertrophy

Which of the following is the term for the inability to retract the foreskin of the penis?

Select one:

sclerosis

balanitis

hypospadias

phimosis

Phimosis

The vesical arteries that supply the bladder arise from the:

Select one:

internal iliac artery

ascending aorta

renal arteries

external iliac artery

Internal Iliac Artery

What is one of the main objectives of procedures for female stress incontinence?

Select one:

- increase overall bladder capacity

- tighten and enhance bladder sphincter tone

- reduce bladder spasms and irritability

- restore the posterior urethrovesical angle

Restore the posterior urethrovesical angle

Baumrucker, Iglesias, Stern-McCarthy, and Nesbit are types of:

Select one:

resectoscopes

evacuators

incisions

catheters

Resectoscopes

Which self-retaining retractor is used for open suprapubic prostatectomy?

Select one:

Adson-Beckman

Gelpi

O'Sullivan-O'Connor

Judd-Mason

Judd-Mason

Which of the following items would likely be needed if the pleural cavity is unintentionally entered during nephrectomy?

Select one:

flexible bronchoscope

chest tube with drainage system

1-inch Penrose drain

fibrin glue

Chest tube with drainage system

Where is the hilum of the kidney located?

Select one:

inferior pole

medial midsection

superior pole

lateral midsection

Medial Midsection

Which of the following is NOT a form of polycystic kidney disease?

Select one:

autosomal dominant

autosomal recessive

acquired

traumatic

Traumatic

Into which anatomical area of the abdomen will a transplated donor kidney be implanted?

Select one:

right upper quadrant

right lower quadrant

left upper quadrant

left lower quadrant

Right Lower Quadrant

Which incisional approach is used for access to the lower ureter and may be used for donor kidney implantation?

Select one:

Gibson

scrotal

inguinal

flank

Gibson

Particle detector that measures ionizing radiation levels

Select One:

Geiger counter

Tunica vaginalis

Torsion

Balanitis

Hypospadias

Chordee

Palladium

Hyperplasia

Robotic

Epididymis

Geiger Counter

Serous sac that covers most of the testis, epididymis, and lower spermatic cord

Tunica Vaginalis

Twisting of the spermatic cord, resulting in pain, ischemia, and eventual necrosis; failure of immediate correction may require orchiectomy

Torsion

Inflammation of the glans penis due to poor hygiene

Balanitis

Congenital condition in which the urethral opening is located on the ventral surface of the penis

Hypospadias

Congenital downward bowing of the penis caused by fibrous bands

Chordee

Radioactive seed implants used to treat aggressive prostate cancers in situ; stronger effect, so lower doses can be used

Palladium

Condition of abnormal increase in number of cells in tissues or organs

Hyperplasia

Minimally invasive surgical approach for removal of prostate with fewest post-op complications and quickest recovery time

Robotic

Coiled segment of the spermatic ducts that stores sperm and is attached to the superior surface of the testis

Epididymis