g. Two small bodies called Cowper's glands are situated on either side of the
membranous portion of the urethra inferior to the prostate. Each gland via its duct
empties mucous secretions into the urethra.
h. The penis is a pendulous organ suspended by the fascial attachments of the
pubis arch and supported by the suspensory ligaments. The penis contains three
distinct vascular sponge-like bodies: the two upper bodies are called the right and left
corpus cavernosum and the lower body, the corpus spongiosum urethras. The tissue
contains a network of vascular channels that fill with blood on erection. At the distal end
of the penis, the skin is doubly folded to form the so-called prepuce, or foreskin, which
serves as a covering for the glans penis. The glans penis contains the urethral orifice.
The adrenal glands lie retroperitoneally beneath the diaphragm at the medial
aspect of the superior pole of each kidney. On the right side, the gland is adjacent to
the inferior vena cava; on the left side, the gland is posterior to the stomach and
pancreas. Each adrenal gland has a medulla, which secretes adrenaline, and a cortex
which secretes steroids and other hormones. The glands are freely supplied with
arterial branches from the phrenic and renal arteries and from the aorta. The venous
drainage is accomplished on the right by the inferior vena cava; on the left, by the left
Section II. GENERAL CONSIDERATIONS IN GENITOURINARY SURGERY
a. Operating room personnel must have a good understanding of the procedure
that is planned in order to properly prepare the patient, room, equipment, and supplies.
Safety is the prime consideration since the patient is positioned in a lateral, prone, or
lithotomy position. These positions are frequently exaggerated to give better access to
the organs involved, as for a radical operation on the prostate and bladder. Care must
be taken to avoid displacement of the joints in lithotomy as the anesthetized patient is
positioned. This is especially true in aged or debilitated patients.
b. In positioning a patient laterally for kidney surgery, the spine is extended to
give more access to the retroperitoneal space. This patient should have padding and
stabilizing support from rubber-covered pillows, sandbags, and straps. If the
electrocautery unit is to be used, care must also be taken to see that no part of the
patient touches metal equipment other than the indifferent electrode plate attached to
the cautery unit.
c. In some procedures involving stones of the kidneys or ureters, it may be
necessary to make X-ray examinations during the procedure. A cassette holder must
be placed under the patient who is in the supine, prone, or lithotomy position. The
patient positioned laterally will be X-rayed by a cassette held in a sterile wrap.