Module 17 > Approach to Urethral Obstruction > Flashcards

Approach to Urethral Obstruction Flashcards

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1
Q

what is a nephrectomy

A

removal of a kidney

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2
Q

what is a cystotomy

A

incising into the bladder

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3
Q

what is a urethrotomy

A

incising into the urethra

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4
Q

what is a urethrostomy

A

creating a permanent urethral stoma

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5
Q

where are potential urethrotomy/urethrostomy locations

A

perineal, scrotal, prescrotal

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6
Q

what are signs of urethral obstruction

A

dysuria

stranguria

pollakiuria

urine dripping from penis

persistent straining to urinate

prolonged time in litter tray

inappropriate urination (small volumes freq)

abdominal discomfort

malaise

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7
Q

what are consequences of urethral obstruction (4)

A
  1. post renal azotemia
  2. hyperkalemia
  3. hydronephrosis
  4. bladder damage
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8
Q

what can cause urethral obstruction in dogs (6)

A
  1. urolithiaisis
  2. prostatomegaly
  3. urethritis
  4. bladder neck/urethral neoplasia
  5. perineal hernia (retroflexed bladder)
  6. functional obstruction (ex spasm)
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9
Q

what can cause urethral obstructions in cats (4)

A
  1. feline lower urinary tract disease (FLUTD) with obstruction (urethral spasm, urethral plugs, urolithiasis)
  2. bladder neck/urethral neoplasia
  3. prostate disease
  4. penile neoplasia
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10
Q

how do you manage an urethral obstruction initially (2)

A
  1. manage post renal failure: IV fluid therapy, manage hyperkalemia
  2. relieve obstruction: urethral catheterization, cystocentesis, +/- surgery
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11
Q

how do you investigate a urethral obstruction (5)

A
  1. history
  2. physical exam
  3. collect urine by cystocentesis
  4. assess renal function
  5. image to establish cause of obstruction
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12
Q

what in the history could indicate a urethral obstruction (3)

A
  1. prev history of urinary tract signs
  2. pattern of urination
  3. neuter status
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13
Q

what should you make sure to do in your physical exam with a urethral obstruction patient (3)

A
  1. penile evaluation
  2. rectal exam
  3. caution with abdominal palpation (rupture)
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14
Q

what is crystalluria

A

cyrstals in urine may be normal

indicates urine is supersaturated with mineral

may be at increased risk of developing stones

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15
Q

what are uroliths

A

stones in urine are always abnormal

kidney, ureter, bladder, urethra

bladder and urethral stones cause urethral obstruction

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16
Q

which types of cyrstals are normal in stored urine (3)

A
  1. struvite
  2. amorphous phosphate
  3. calcium oxalate
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17
Q

which crystals are abnormal in the urine

A
  1. cystine
  2. xanthine
  3. urate
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18
Q

what does supersaturation of the urine depend on

A
  1. urine pH
  2. urine concentration
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19
Q

what stone does alkaline urine favour the production of

A

struvate

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20
Q

what stone does acidic urine favour the production of

A

calcium oxalate

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21
Q

what uroliths are common in dogs and cats (3)

A
  1. struvite
  2. oxalate
  3. purine (including urate)
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22
Q

which uroliths are uncommon in cats and dogs (5)

A
  1. cystine
  2. compound
  3. mixed
  4. calcium phosphate
  5. silica
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23
Q

why is struvite associated with bacterial infection

A

associated with urease producing bacteria

urease breaks urea into ammonia and bicarbonate

ammonia forms complexes with Mg and PO4 and damages GAG layer

bicarb increases urine pH which reduces struvite solubility and increases dissolved PO4

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24
Q

what are urease producing bacteria

A

staphylococcus

proteus

e coli

pseudomonas

klebsiella

mycoplasma

enterococcus

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25
is the solubility of calcium oxalate influenced by urine pH
no
26
are males or females at a greater risk of forming calcium oxalate uroliths
males greater risk
27
what increase the risk factors of forming calcium oxalate uroliths (2)
1. chronic kidney disease (cats) 2. hypercalcemia
28
what are purine uroliths
uric acid urate xanthine uroliths
29
how do purine uroliths form
protein/nucleic acid degradation releases purines purines degraded to uric acid --\> converted to soluble allantoin in liver
30
what causes purine uroliths
1. liver dysfunction 2. congenital cases (disrupted uric acid metabolism)
31
what dog breeds have genetic predisposition of purine uroliths
dalmation bulldog russian terrier
32
what cat breeds have a genetic disposition of purine uroliths
siamese egyptian mau birman
33
how do you relieve obstruction of canine urolithiasis (5)
1. catheterization 2. surgery 3. push stones into bladder 4. remove stones from urethra 5. create new stoma into urethra above obstruction
34
how do you prevent recurrence of canine urolithiasis (4)
1. dietary modification 2. +/- stone removal 3. +/- medical dissolution 4. +/- medical prevention
35
how would you push uroliths into the bladder
retrograde hydropulsion
36
how would you perform retrograde hydropulsion
catheterize urethra to obstruction occlude urethra proximally flush high volume/pressure release finger in pulsatile fashion lift mucosa off urethra and build pressure up to push it forward
37
what should you do following retrograde hydropulsion
cystotomy to remove stones medical dissolution
38
how do you perform a cystotomy (14)
1. isolate bladder from abdomen 2. place stay suture in apex 3. select cystotomy site 4. ventral cystotomy (dorsal can also be considered) 5. prior to incision perform cystocentesis to reduce spillage 6. stab incision 7. extend with metzenbaums 8. additional stay sutures as required 9. longitudinal incision: apex towards trigone 10. remove clots beofre closure 11. one layer or two layers 12. appositional or inverting 13. one layer, simple, continuous 14. omental wrap
39
what should you do after a cystotomy (4)
1. repeat radiographs +/- double contrast 2. rectal palpation 3. quantitative analysis minnesota 4. culture urolith
40
how do you perform a urethrotomy (5)
1. create temporary hole into urethra 2. remove stones 3. suture closed urethrotomy 4. most stones lodge at os penis 5. incision directly over obstruction
41
how do you perform a prescrotal urethrotomy (5)
1. place urinary catheter 2. incise skin behind os penis 3. reflect retractor peni muscle 4. incise urethra 5. flush to ensure all stones removed
42
when would you perform a urethrostomy (3)
1. can't dislodge stones 2. stricture has formed 3. repeated obstructions
43
what is the best area to perform a permanent canine urethrostomy
scrotal
44
what are the complications of urethrostomy (4)
1. hematuria 2. stenosis 3. incontinence 4. urinary tract infection
45
what can cause feline lower urinary tract disease (6)
1. feline idiopathic cystitis (2/3 of cases) 2. urethral plugs 3. urethral spasm 4. urolithiasis 5. bacterial urinary tract infection 6. bladder neck/urethral neoplasia
46
what are risk factors to feline idiopathic cystitis (3)
1. low water intake (dry food) 2. lazy, overweight, indoor, multiple cat households 3. stress: pyschological, physical
47
what are the presentations of FLUTD
dysuria, stranguria, pollakiuria, hematuria
48
what are the types of presentations of FLUTD (3)
1. acute, non-obstructed severe episodes 2. chronic, non-obstructed, lower grade presentation 3. acute urethral obstruction (males)
49
what are the most common causes of acute urethral obstructions
1. urethral spasm 2. urethral plugs
50
how do you manage acute non-obstructed FLUTD
not curable generally self-limiting (improve in 2-4d, normal in 1 week) provide analgesia during episde (oral buprenorphine or NSAIDs) warn clients it tends to recur no indication for antibiotics unless confirm bacteria in urine
51
how do you manage chronic or recurrent non-obstructive FLUTD
confirm diagnosis (exclude other conditions) minimize cats clinical signs increase disease free interval
52
95) how would you chronically manage feline idiopathic cystitis
**1. multimodal environemtal modification (MEMO):** reduce stress (members of household, litter trays, feeding, play/rest, activity, changes in household) **2. dietary modification:** multipurpose therapeutic urinary food, increased water intake (switching to wet food), control food intake (often overweight), change diet gradually **3. pheromones** **4. GAG replacers** **5. behaviour modifying drugs**
53
what pheromones can be used to manage FIC
feliway: synthetic analogue of feline facial pheromone tred towards fewer days exhibiting clinical signs use with MEMO
54
what behaviour modifying drugs can be used to manage chronic FIC
tricyclic antidepressants amytriptylline and clomipramine
55
what are the differences between dogs and cat urethral obstructions
1. FLUTD with obstruction most prevalent cause of obstruction in cats urethral plugs common in cats urolithiasis urethral spasm recurrent signs of cystitis very common 2. penile anatomy: very different limiting surgical options
56
what are the key differences in feline penile anatomy
1. backward pointing penis 2. scrotum either side of penis
57
why is the feline peline anatomy relevant
cannot perform urethrotomy can only consider perineal urethrostomy
58
what uroliths is medical dissolution possible
struvite and urate
59
when is medical dissolution of uroliths contraindicated (3)
1. compound or mixed uroliths suspected 2. obstruction to urine flow or high risk of obstruction 3. patient uncomfortable
60
what must the USG be for medical dissolution in dogs and cats
dogs: 1.020 cats: 1.025
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