Basic Urinary Tract Surgery LA (Freeman) Flashcards
1
Q
Topic outline
A
- Bladder, urethra, urachus, ureters
- Urolithiasis: obstruction with calculi/stones: all species
- patent urachus/infected umbilical remnant: equine
- Ruptured bladder: equine
2
Q
Urolithiasis
Bovine
A
- More common in steers than bulls
- Feedlot steers-multiple lesions
- Range steers-single lesion
- usually found at sigmoid flexure
3
Q
Urethral obstruction
CS
A
- abdominal pain
- stretching
- treading
- tail switching
- rectal
- distended bladder
- diagnostic
- distended bladder
4
Q
Ruptured Urethra
CS
A
- ventral swelling
- sheath
- abdomen
- Rectal exam
- distended bladder, but not tight
- Cellulitis
- uremic smell
5
Q
Ruptured bladder
A
- No adbominal pain
- abdominal distention
- symmetric
- Rectal
- bladder can be full
- bladder usually not empty
- Elevated BUN
- Acidotic
- Toxemia
- depression
6
Q
Goals of TX for stones (I think)
A
- steers
- salvage for market
- perineal urethrostomy
- salvage of steers
- epidural anesthesia
- dissect to penis and transect
- salvage of steers
7
Q
Urolithiasis
Pet Goats/Pigs
A
- Typically sporadic metabolic dz
- can be caused by
- environmental, dietary, metabolic, improper husbancry
- importance of anatomy
- treated with sx
- can reobstruct
8
Q
Urolithiasis
diet problems
A
- Concentrate diets
- excess phospherous
- magnesium
- Imbalance in Ca:P ratio
- Lack of water
- inadequate flushing of sediment
- High urine pH
- alkaline urine = struvite, apatite and calcium carbonate uroliths form
9
Q
Forage based diets in urolithiasis
A
- allows increased salivation and subsequent excretion in feces instead of urine
10
Q
High grain diet
urolithiasis
A
- low roughage diets decrease formation of saliva
- increases amount of phosphorus in urine
11
Q
Anatomy of males predisposing to stones
Goats
A
- sigmoid flexure
- urethral process/vermiform appendage
-
narrow urethra
- early castration (<10 weeks)
- testosterone responsible for urethral enlargement
- castration by banding inc necrosis
12
Q
Goat CS urolithiasis
A
- early
- restlessness or anxiety
- tail twitching
- progressive
- excessive vocalization
- stretching/arched back
- forceful urination
- reduced urinary flow
- bloody urine
- crystals on preputial hairs
13
Q
Goats
advanced clinical signs urolithiasis
A
- swelling/pain in urethra
- ventral edema
14
Q
Goats
Ruptured bladder
A
- sudden cessation of clinical signs
- abdominal distention
- anorexic
- depression
- weakness
- death
15
Q
Owners may confuse urinary tract obstruction with
A
GI disease
*or sudden improvement with resolution
16
Q
Diagnosis urolithiasis in goats
A
- presentation
- hx
- PE
- Blood chem
- inc BUN
- inc creatinine
- inc potassium
- Rads
- plain
- contrast
- U/S
17
Q
Initial therapy
Goat urolithiasis
A
- massage/manipulatio of urethral process
- exteriorization of penis
- 0.1-0.5 mg/kg of diazepam
- removal of urethral process
- sedation, lidocaine
- temp fix
- Passage of catheter
- urohydropulsion
- difficult to catheterize
- urethral diverticulum
- traumatic
18
Q
Medical management
goat urolithiasis
A
- promotion of urethral relaxation
- ammonium chloride
- walpoles solution
19
Q
Promotion of urethral relaxation
A
- diazepam (0.1-0.5 mg/kg IV)
- Acepromazine (0.1 mg/kg IV)
-
Avoid xylazine
- promotes diuresis
20
Q
Ammonium chloride
A
- Urinary acidifier
- 0.5-2% of dry matter intake
- 200-300 mg/kg - inconsistent results
- 450 mg/kg - pH < 6.5 > 24 hrs
- unpalatable
21
Q
Walpoles solution
A
- acidifying solution
- supposed to dissolve stones
- appears to work better in TX….?
22
Q
Surgical managment
goat urolithiasis
A
- urethral process amputation
- percutaneous catheter placement
- tube cystostomy
- bladder marsupialization
- perineal urethrostomy
23
Q
Removal of urethral process
A
- always done despite little success
- sedation
- 0.1-0.5 mg/kg diazepam
- be careful in compromised patients
- put in sitting position
- Allis tissue forceps
- Topical lidocaine
- cut with scalpel
24
Q
Percutaneous cather
A
- minimally invasive stabilization overnight
- pigtail catheters
- sedate
- local anesthesia
- U/S guided
- suture in place
- abx
- NSAIDS
25
Q
Tube cystotomy
A
- Most common procedure
- allows urethra to rest
- complete recovery and tube removal may be possible in a few months
- Allows admin of acidifiers to urine
- temp diversion
- must change diet also
26
Q
tube cystotomy
complications
A
- blockage of tube
- failure of balloon
- continued straining
- premature removal of tube
27
Q
Bladder marsupialization
A
- permanent solution after failed tube cystotomy
- minimally invasive technique
- two incision technique
- 4 cm stoma created
- not recommended for young or breeding goats
28
Q
Bladder marsupialization
complications
A
- cystitis
- pyelonephritis
- premature closure
- bladder prolapse
- urine scalding
29
Q
Perineal urethrostomy
A
- generally salvage procedure in ruminants
- high rate of stricture
- newer technice described
- incision ventral to anus
- penile body freed from ishium
- urethral mucosa spatulated
- inc success rate
30
Q
Prevention urolithiasis
A
- avoid grain
- feed diets Ca:P ratio 2:1 not below 1:1
- high Ca reduces P absorption
- don’t add magnesium or phosporous
- Legume hays: alfalfa
- add 4% salt to ration in inc water intake
- Urinary acidifiers
- Walpoles
- ammonium chloride
- ammonium sulfide
- Bio Chlor
- dietary cation anion difference (DCAD)
- palatability
31
Q
Urolithiasis in horses
A
- Males: neck of bladder
- chronic cystitis, incontinence, dysuria, pollakuria, polyuria, hematuria, stranguria
- staining and scalding
- colic
- stiif, stilted hindquarter gate
- usually calcium carbonate
- weight loss
- rectal - diagnostic
32
Q
Subischial urethrotomy
A
- epidural anesthesia
- crush/remove stone
- second intention healing
33
Q
Lithotripsy
A
- long regular slotted scre driver
- grind tip into stone that crushes it
34
Q
Perirectal approach
A
- another option for stone removal
- Dr. Freeman doesn’t do
35
Q
Laparocystotomy
A
- cystotomy under general anesthesia
- equine bladder far back in pelvis
- difficult to assess
36
Q
Hematuria
A
- cystic calculi
- neck of bladder
- easy recalt DX
- urethral defects
- ulcerated mucosa in proximal urethra
- responds to subischial urethrostomy
37
Q
Patent Urachus
about
A
- urachus persists in foals for weeks postpartum
- normally closes after birth
- can resolve without treatment
- not life-threatening
- can uncommonly be caused by infection
- medical tx
- silver nitrate cautery
- avoid aggressive use
- Sx
- umbilical resection
38
Q
Urachus def
A
- urine from fetal bladder to allantoic cavity
- scar at apex of bladder
39
Q
umbilical arteries
A
- on each side of bladder
- drains blood from fetus
- round ligaments of bladder
40
Q
umbilical vein
A
- carries oxygenated blood to fetus
- falciform ligament
41
Q
Omphalophlebitis
A
- Infected umbilical remnants
- CS in first 4 weeks
- septicemia
- fever
- swollen/septic joints (life threatening)
- cause
- can be overzealous iodine application
- If umbilicus is not hot, swollen and draining, U/S is critical
- tells you what structures are infected
42
Q
umbilical vein
A
- usually the size of a pencil or less
- goes all the way to the liver
- unable to access that far up
- marsupialize infected end
43
Q
Uroperitoneum
A
- Ruptured bladder
- Ruptured urachus (internal)
- Ruptured ureter
*fairly common issue in foals
44
Q
Signs uroperitoneum
A
- depression
- abdominal distention
- abnormal urination
45
Q
Uroperitoneum
DX
A
- History and age (= 6 days)
- Males more common, but slightly
- abdominocentesis
- electrolytes
- blood and peritoneal fluid
- U/S
*rarely used: dye studies, contrast studies
46
Q
Electrolytes with uroperitoneum
A
- Sodium will leak into peritoneal cavity
- hyponatremia
- Potassium will leak into blood
- hyperkalemia
- Creatinine in peritoneal cavity and blood
*treat electrolyte abnormalities before sx
47
Q
TX uroperitoneum
A
- treat hyperkalemia
- repair defect
- bladder (dorsal, ventral), urachus, ureter (rare)
*ureter rupture: accumulation urine in retroperitoneum
