Genitourinary Surgery

Princess Grace A. Pechon BSN-III

What is Genitourinary Surgery?

Genitourinary (G.U.) surgery involves procedures of the male and female (renal) system. The
organs involved with this specialty consist of the kidney, urinary bladder, urethra, and the
ureters.

Because of the close proximity of the urologic and reproductive structures in the male, it is often
referred to as the Genitourinary System, and includes the male reproductive structures.

Surgical Anatomy Review

The urinary system consists of the kidney, which produce the urine, the ureters, which carry
the urine to the urinary bladder where it is temporarily stored, and the urethra, which
transports the urine to the outside of the body.

THE KIDNEYS

The Kidney are paired reddish-brown organs situated on the posterior wall of the abdominal
activity, one on each side of the verbal column.

Each kidney is capped by an endocrine gland (adrenal gland), and is approximately 11 cm long.

Because of the presence of the liver, the right kidney is generally slightly lower than the left.

THE URETERS
From the renal pelvis in the kidney, urine is transported to the urinary bladder by ureters from
each kidney.

The Urinary Bladder

The urinary bladder is a hollow muscular organ that rest of the floor of the pelvic cavity.
Like other urinary structures, it is retroperitoneal, and the anterior surface lies just behind the
pubic symphysis.

In the male, it is located in front of the rectum, while in the female, it lies anterior to the uterus
and the superior portion of the vagina.

The Urethra

The Urethra is a muscular tube, lined with mucuos membrane, that exits from the inferior
surface of the urinary bladder.

In the female, the urethra is short (approx.4cm), and runs along the anterior surface of the
vagina to an opening (external urinary meatus) located between the clitoris and the vaginal
orifice.

In the male, the urethra is about 20 cm long. It extends to the external urinary meatus at the tip
of the penis, and is divided in to three sections; the prostatic, membranous and spongy urethra
named according to the regions through which it passes.
Procedure: Nephrectomy
The surgical removal of a kidney (Partial or total)

A nephrectomy may be performed for many reasons, including pyelonephritis, renal atrophy,
renal artery stenosis, trauma and tumors of the kidney and ureters.

Positioning: Lateral (Lumbar flank or transthoracic) with affected side up

Incision Site: Flank (posterior axillary line beneath the twelft rib to suprapubic area)

Skin Preparation: Abdomen

The area should include breast line to upper third of thighs

Packs/Drapes:
Laparatomy pack with transverse Lap sheets
Extra drape sheets
Towels (opt.)

Instruments:
Major procedure tray
Kidney Tray
Thoracotomy tray with vascular clamps (opt.)
Hemoclips/ Surgiclips (size varies)
Internal stapling instruments (opt.)

Procedural Overview

A curved incision is made across the flank (for benign disease), and the facia and muscle
tissues are divided with a dissecting scissors and or cautery. Occasionally, a rib must be
sacrificed to gain access to the retroperitoneal space.
The kidney and ureters are mobilized, the ureter is divided and the distal end ligated . For
malignant disease, a radical nephrectomy is perfomed.

Perioperative Nursing Considerations

Have all X-rays in the room

Verify with the blood bank the numbers of available units

Chest tube and drainage unit is needed for a transthoracic approach

A suprapubic catheter and drainage unit may be used if nephrouterectomy is performed

When tow incisions are used, the patient is repositioned, reprepared, and redraped; an
additional instrument tray is necessary