Basic Urinary Tract Sx - SA

Question 1

What are the indications for a renal biopsy?

Answer 1

Neoplasia, nephrotic syndromes, renal cortical dz (protein losing glomerulonephropathy), acute progressive renal failure with unknown underlying cause

Question 2

What are the contraindications for a renal biopsy?

Answer 2

Uncontrolled coagulopathy or hypertension, large or multiple renal abscesses or cysts, extensive pyelonephritis, ureteral obstruction, severe hydronephrosis; AVOID if unlikely to alter course of therapy or prognosis

Question 3

T or F: when taking a renal biopsy, you should do so by going perpendicular to the capsule, all the way through the medulla

Answer 3

False; your biopsy should be tangiential to the capsule, only sampling from the cortex

Question 4

What are the indication for a nephrotomy?

Answer 4

Chronic infection, presence of renal calculi, persistent hematuria of renal origin, persistent hydronephrosis

Question 5

What are the indications for a nephrectomy/nephroureterectomy?

Answer 5

Irreparable trauma, persistent infection, renomegaly, obstructive calculi with persistent hydronephrosis, renal or perirenal masses, harvest for kidney donation

Question 6

What are the contraindications for a nephrectomy/nephroureterectomy?

Answer 6

Precipitation or progression of pre-existing kidney dz, acute kidney failure, failure to resolve underlying clinical signs, inadvertent damage to other abd organs; risk of leaving kidney should be GREATER than taking the kidney

Question 7

What are some options for procedures to perform when a patient has a ureteral obstruction?

Answer 7

Ureteral resection and preimplantation, ureterotomy, ureteral stunting, subcutaneous ureteral bypass (SUB)

Question 8

Ureteral trauma and obstruction is often secondary to what?

Answer 8

Iatrogenic injury during overiohysterectomy

Question 9

How do you treat ureteral transaction/rupture?

Answer 9

Treat with ureteral reimplantation for mid to distal ureteral injury and nephroureterectomy for proximal injury

Question 10

What is the upside to performing bladder surgery?

Answer 10

The bladder heals very quickly, mucosal defects heal within 5 days and full thickness defects regain 100% strength in 14-21 d

Question 11

What are things to make sure you do when performing bladder surgery?

Answer 11

Pack off, minimize handling, use monofilament absorbable suture, and make sharp incisions; close with a single layer absorbable appositional pattern

Question 12

How long does it take urethral mucosa to regenerate?

Answer 12

7 days

Question 13

How might you manage a minor urethral injury vs. a major injury?

Answer 13

Minor - conservative management as long as strip of mucosa is intact (indwelling catheter to allow healing); Major - require surgery; anastomosis, urethrotomy, urethrostomy