CUA Surgical Procedures & Perioperative Care 2 — Questions and Answers
Question 1: During laparoscopic urologic surgery, what is the standard intraabdominal CO2 insufflation pressure maintained?
- 5–8 mmHg
- 10–15 mmHg (Correct answer)
- 18–20 mmHg
- 20–25 mmHg
Correct answer: 10–15 mmHg
Standard pneumoperitoneum is maintained at 10–15 mmHg, providing adequate visualization and working space while minimizing cardiorespiratory compromise from elevated intraabdominal pressure.
Question 2: Which catheter is placed post-operatively after TURP to allow continuous bladder irrigation (CBI)?
- Straight urethral catheter
- Three-way Foley catheter (Correct answer)
- Coude catheter
- Suprapubic catheter
Correct answer: Three-way Foley catheter
A three-way Foley catheter has an extra lumen for continuous saline irrigation, allowing CBI to flush blood and prevent clot retention in the bladder after TURP.
Question 3: During cystoscopy, which intraoperative finding most strongly indicates bladder perforation?
- Gross hematuria
- Decreased irrigant return with sudden patient discomfort (Correct answer)
- Involuntary bladder contractions
- Elevated blood pressure
Correct answer: Decreased irrigant return with sudden patient discomfort
Bladder perforation causes irrigation fluid to extravasate into perivesical or peritoneal space, reducing fluid return while producing abdominal or shoulder pain from fluid accumulation.
Question 4: What is the primary purpose of a double-J ureteral stent placed after ureteroscopy?
- Deliver antibiotics directly to the renal pelvis
- Prevent ureteral obstruction from post-procedure edema (Correct answer)
- Measure ureteral peristaltic pressure
- Prevent vesicoureteral reflux
Correct answer: Prevent ureteral obstruction from post-procedure edema
Double-J stents are placed after ureteroscopy to maintain ureteral patency and allow healing while preventing obstruction from post-procedural mucosal edema.
Question 5: In robotic-assisted radical prostatectomy (RARP), what patient position is used to improve pelvic access?
- Reverse Trendelenburg
- Lateral decubitus
- Steep Trendelenburg (Correct answer)
- Prone with hip flexion
Correct answer: Steep Trendelenburg
Steep Trendelenburg (head-down tilt 25–40°) uses gravity to displace the bowel cephalad, improving surgical access and visualization of the prostate and bladder neck.
Question 6: What is the most common early complication following radical cystectomy with urinary diversion?
- Cardiac arrhythmia
- Paralytic ileus (Correct answer)
- Wound dehiscence
- Pulmonary embolism
Correct answer: Paralytic ileus
Paralytic ileus is the most common early complication after radical cystectomy, occurring because extensive bowel manipulation during urinary diversion disrupts normal intestinal motility.
Question 7: Which pre-operative laboratory value is most critical to assess in a patient on warfarin therapy before urologic surgery?
- Complete blood count
- Prothrombin time/INR (Correct answer)
- Basic metabolic panel
- Serum creatinine
Correct answer: Prothrombin time/INR
PT/INR directly quantifies the degree of anticoagulation from warfarin, determining whether the drug has been held long enough to allow safe surgical hemostasis.
CUA Surgical Procedures & Perioperative Care 2
During laparoscopic urologic surgery, what is the standard intraabdominal CO2 insufflation pressure maintained?