Question 1

High-intensity focused ultrasound (HIFU) is a noninvasive technique used in the treatment of prostate cancer. HIFU is a targeted therapy that is highly focused into a small area without causing collateral tissue damage. Aside from primary therapy, HIFU can be used as salvage therapy, primarily after radiation. HIFU can be performed as an outpatient procedure, often with an epidural anesthetic. The HIFU-directed energy modality is best described as:

A)high-temperature nonionizing thermal energy.
B)cavitation of the prostate cell cytoplasm by the implosion of microscopic bubbles.
C)mechanical shearing force of ultrasonic waves.
D)radiofrequency coagulation of prostatic cell nuclei.

Accepted Answer

HIFU is highly focused into a small area, creating intense heat of 80° to 100° C, which is lethal to prostate cancer tissue. HIFU destroys tissue by heat, rather than by cavitation or mechanical shearing. Since ultrasound is nonionizing, there is no collateral tissue damage.
For the majority of patients, HIFU is indicated as a curative therapy. The best candidates are clinical/pathologic stages T1c to T3. Because of the limited focal length of HIFU, gland volume cannot be 40 ml or larger. Aside from primary therapy, HIFU can be used as salvage therapy, primarily after radiation. HIFU can also be repeated without any increase in risk or complications.

Question 2

The PSA test is a serum lab test for prostate-specific antigen. If the test value is elevated, the patient is at risk for carcinoma of the prostate; a PSA value greater than 10 ng/ml is highly suggestive of prostatic carcinoma. Tissue from a transrectal prostate biopsy provides the cellular information to confirm the diagnosis. The American Urological Association (AUA) prostate cancer staging tool essentially provides what important information about the tissue specimen?

A)Prostate cancer stages of severity
B)Indications for selecting appropriate intervention
C)Prognosis and potential for recovery
D)All of the options define the AUA score system.

Accepted Answer

The American Urological Association (AUA) recommends that starting at age 40 the prostate-specific antigen (PSA) test and digital rectal examination (DRE) be offered to men at average risk. Clinical evaluation and an elevated PSA usually indicate the need for a transrectal ultrasound needle biopsy to confirm the diagnosis. When the results of the biopsy are positive for cancer, the AUA score measures the severity of the cancer: stage A = clinically unsuspected disease; stage B = tumor confined to the prostate gland; stage C = tumor localized to the periprostatic area; stage D = metastatic prostate cancer.

Question 3

A kidney transplant entails transplantation of a living-related or cadaveric donor kidney into the recipient's iliac fossa. It is performed in an effort to restore renal function and maintain life in a patient who has end-stage renal disease. Select the statement that best reflects the ideal living-related donor candidate.

A)An identical twin or spouse, young, ABO and Rh factor compatibility
B)An identical twin or parent, good health, and large right kidney
C)An identical twin or sibling, no family history of diabetes, Rh factor compatibility
D)An identical twin or sibling or parent, ABO and HLA compatibility, good health

Accepted Answer

The kidney donor must be in good health. ABO (blood typing) and histocompatibility (human leukocyte antigen [HLA] tissue typing) along with a negative white cell (lymphocyte) crossmatch determine donor-recipient compatibility. It is not necessary to match the Rh factor. If there is a family history of diabetes, a 5-hour glucose tolerance test is also performed. The ideal living donor is an identical twin, although any immediate family member (usually a sibling or parent) may be a donor. Usually the right kidney is chosen for removal because of its smaller size, leaving the donor patient with the left and larger kidney.

Question 4

The flexible cystoscope is a delicate and valuable endoscopic instrument indicated for diagnostic bladder evaluation for patients with obstructive symptoms from prostatic hyperplasia and a rigid prostatic urethra. It has valuable benefits because of its small diameter and flexibility. Select all of the benefits from the list below that support the use of flexible endoscopy in the outpatient setting.

A)It may be accomplished using a local anesthetic.
B)It can be used for patients unable to assume the lithotomy position.
C)It can be performed on the patient's bed on the nursing unit.
D)The cystoscope can be processed between patients without manual cleaning and disinfection.

Accepted Answer

The flexible cystoscope (Figure 6-25) is used for patients with obstructive symptoms resulting from prostatic hyperplasia and a rigid prostatic urethra. In addition, the flexible cystoscope can be used for patients who cannot assume a lithotomy position, such as those with spinal cord injuries or severe arthritis. Flexible cystoscopy may be accomplished with the use of a local anesthetic. It affords the patient a higher degree of comfort, is less traumatic to the urethra, and can be performed in the patient’s bed on the nursing unit. The flexible cystoscope must be reprocessed with manual cleaning and high-level disinfection or sterilization.

Question 5

Select the statement about the prostate that best reflects its location, size, and weight.&#10;A) The prostate sits adjacent to the urethra, is 2 to 4 cm in depth, and weighs about 25 g.&#10;B) The prostate sits below the urethra, is 2 to 3 cm in depth, and weighs 25 to 30 g.&#10;C) The prostate sits below the bladder, is 2 cm in depth, and weighs about 25 to 40 g.&#10;D) The prostate sits below the base of the bladder, is 4 cm at the base, and weighs 20 to 30 g.

Accepted Answer

The prostate gland is a donut-shaped organ composed of fibromuscular and glandular components. It is located at the base of the bladder neck and completely surrounds the urethra. The gland is about 4 cm at the base, is about 2 cm in depth, and normally weighs 20 to 30 g (see Figures 6-5 and 6-7).

Question 6

Patients having genitourinary surgery are at risk for impaired urinary elimination. Select the statement that best reflects a desired outcome for an adult patient.&#10;A)The patient will be able to urinate before the bladder exceeds 350 ml of fullness.&#10;B)The patient will regain his or her normal pattern of urinary elimination.&#10;C)The patient will excrete 50 ml of urine per hour.&#10;D)All of the options are desired outcomes.

Accepted Answer

The patient outcome related to the risk for urinary retention could be stated as follows: The patient will demonstrate or regain a normal pattern of urinary elimination. Normal urinary output for an adult is 0.5 to 1 ml/kg body weight/hour. Full bladder capacity is 350 to 700 ml.

Question 7

Which action best reflects the movement of urine from the renal pelvis to the bladder?&#10;A)Normal intra-abdominal positive pressure promotes renal drainage.&#10;B)Slight distention of the renal pelvis initiates a wave of peristaltic contractions.&#10;C)Distention of the proximal ureter facilitates gravity drainage through signaling channels.&#10;D)Urine is propelled into the bladder when adrenal hormones bind with ureteral receptor sites.

Accepted Answer

As urine accumulates in the renal pelvis, slight distention initiates a wave of muscular contractions. This peristaltic activity continues down the ureter, propelling urine into the bladder.

Question 8

Although each potential kidney transplant recipient is judged individually as a candidate, which condition from the list below would most likely eliminate a patient as a candidate for kidney transplant?

A)Systemic disease
B)Cardiovascular disease
C)Post-treatment cancer in remission
D)Active cancer

Accepted Answer

Each potential recipient is judged individually in regard to kidney transplantation. Most persons younger than 55 years are acceptable; older patients are less tolerant of postoperative complications. The following are contraindications for renal transplantation: systemic disease that precludes major surgery, oxalosis (a metabolic disorder), a positive HLA cytotoxic antibody screen, untreatable cardiovascular disease, active cancer, and noncompliance.

Question 9

The adrenal glands lie retroperitoneally beneath the diaphragm, capping the medial aspects of the superior pole of each kidney. The adrenal medulla secretes ______________ while the adrenal cortex secretes ____________ and ____________.

A)epinephrine; steroids and hormones
B)steroids; adrenaline and hormones
C)epinephrine; pituitary-stimulating hormone and adrenaline
D)pituitary hormones; cortisol and norepinephrine

Accepted Answer

Each adrenal gland has a medulla, which secretes epinephrine (adrenaline), and a cortex, which secretes steroids and hormones. Secretions from the adrenal cortex are influenced by the activity of the pituitary gland.

Question 10

During urologic surgery, large quantities of irrigating fluids are infused intraoperatively. Which of the following is appropriate?&#10;A)monitoring and recording the volume of IV and irrigating fluids instilled.&#10;B)maintaining a closed urinary drainage system.&#10;C)providing the patient with information on preventing recurrent urinary tract infections.&#10;D)monitoring blood loss and volume replacement.

Accepted Answer

Large amounts of irrigating fluids are often used during urologic procedures, which may impact the patient's electrolyte status. Irrigating fluids should be monitored both for fluid infused and for fluid returned. Thorough knowledge of the potential hazards encountered intraoperatively is extremely important and close observation is essential. A sudden change in signs and symptoms may be suggestive of TURP syndrome, a severe hyponatremia caused by systemic absorption of irrigating fluid used during surgery. Minimum amounts of fluids should be given and urine output carefully monitored. Irrigation fluid should be under as little pressure as possible and the bladder emptied before it reaches full capacity to prevent intravesical pressure.

Question 11

The renal artery and vein enter and exit the kidney on the medial side of the organ through a concave area known as the:&#10;A)calyces.&#10;B)pedicle.&#10;C)hilum.&#10;D)renal pelvis.

Accepted Answer

The answer of The renal artery and vein enter and...

Question 12

In transurethral resection of the prostate gland (TURP), the surgeon passes a resectoscope into the bladder through the urethra and resects successive pieces of tissue from around the bladder neck and the lobes of the prostate gland, leaving the capsule intact. TURP is traditionally indicated for patients with benign obstructive disease of the prostate. A TURP would be indicated for a patient with malignant prostatic disease under which of the following conditions?

A)For palliative relief of obstruction for end-stage disease
B)For symptom relief of obstruction before initiating other treatments
C)For specimen retrieval for diagnostic cancer staging
D)For men who cannot tolerate, or who are not candidates for, high-intensity focused ultrasound

Accepted Answer

The answer of In transurethral resection of the prostate gland...

Question 13

A wide variety of ureteral and urethral drains, stents, and other catheters are designed and used for specific urologic procedures. A commonly used catheter is described by its tip. What catheter type is described as open-ended tip, whistle tip, cone tip, and olive tip?

A)Irrigation catheter
B)Urethral catheter
C)Ureteral catheter
D)Pigtail catheter

Accepted Answer

The answer of A wide variety of ureteral and urethral...

Question 14

The kidneys are highly vascular organs. Approximately how much of the entire circulating blood volume do the kidneys process at any one time?&#10;A)One fifth&#10;B)1 ml per kg body weight&#10;C)One third&#10;D)30 ml per hour

Accepted Answer

The answer of The kidneys are highly vascular organs. Approximately...

Question 15

An orthotopic neobladder is surgically created as a bladder substitute after a cystectomy, prostatectomy, or hysterectomy is performed for bladder cancer. Bladder substitution relies on meticulous dissection with preservation of the urinary sphincter and neurovascular bundles, as well as a watertight urethral anastomosis. Also termed the "Le Bag continent diversion," what segments of the bowel and/or small intestine are used in this technique to create the neobladder?

A)Segment of sigmoid colon
B)Right colon and ileum
C)Proximal right colon segment with cecum
D)Transverse colon

Accepted Answer

The answer of An orthotopic neobladder is surgically created as...

Question 16

TURP syndrome is a state of severe hyponatremia, caused by systemic absorption of irrigating fluid during the procedure. Select the sign/symptom that the anesthesia provider would report in a patient experiencing TURP syndrome.

A)Hypertension
B)Hyperthermia
C)Hypernatremia
D)Hypokalemia

Accepted Answer

The answer of TURP syndrome is a state of severe...

Deck 6: Genitourinary Surgery