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Surgery final > Basic Urinary Tract Surgery LA (Freeman) > Flashcards

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
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2
Q

Urolithiasis

Bovine

A
  • More common in steers than bulls
  • Feedlot steers-multiple lesions
  • Range steers-single lesion
  • usually found at sigmoid flexure
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3
Q

Urethral obstruction

CS

A
  • abdominal pain
    • stretching
    • treading
    • tail switching
  • rectal
    • distended bladder
      • diagnostic
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4
Q

Ruptured Urethra

CS

A
  • ventral swelling
    • sheath
    • abdomen
  • Rectal exam
    • distended bladder, but not tight
  • Cellulitis
  • uremic smell
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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
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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
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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
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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
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9
Q

Forage based diets in urolithiasis

A
  • allows increased salivation and subsequent excretion in feces instead of urine
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10
Q

High grain diet

urolithiasis

A
  • low roughage diets decrease formation of saliva
  • increases amount of phosphorus in urine
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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​
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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
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13
Q

Goats

advanced clinical signs urolithiasis

A
  • swelling/pain in urethra
  • ventral edema
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14
Q

Goats

Ruptured bladder

A
  • sudden cessation of clinical signs
  • abdominal distention
  • anorexic
  • depression
  • weakness
  • death
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15
Q

Owners may confuse urinary tract obstruction with

A

GI disease

*or sudden improvement with resolution

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16
Q

Diagnosis urolithiasis in goats

A
  • presentation
  • hx
  • PE
  • Blood chem
    • inc BUN
    • inc creatinine
    • inc potassium
  • Rads
    • plain
    • contrast
  • U/S
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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
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18
Q

Medical management

goat urolithiasis

A
  • promotion of urethral relaxation
  • ammonium chloride
  • walpoles solution
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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

Surgery final (9 decks)

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