Bladder Flashcards
Where do the lateral ligaments attach?
What structures run within them?
- Attach to the pelvic walls
- Distal ureter and umbilical artery on each side
Where is the trigone?
Internal region of the bladder between the ureteral opening and the urethral opening at the bladder neck
What is responsible for voluntary control of micturition?
- Pudendal nerve control of striated urethral muscle
- Direct cortical innervation of the pontine micturition centre
How long does it take for bladder mucosa to heal?
How long for full-thickness defects to reach full strength?
- Mucosa fully heads in 5 days
- Full thickness strength in 14-21 days
What suture materials are most appropriate for use in the bladder?
What organism disintegrated all tested sutures by day 7?
- Polydioxanone and polyglyconate
- Proteus mirabilis
What ABx are a reasonable choice for periop antibiosis in the face of a UTI?
- Amoxiclav
- 3rd gen cephalosporin
- Enrofloxacin
What effects does azotaemia have on anaesthesia and surgery?
- Significant impact on animals ability to tolerate anaesthesia due to alterations of pharmacokinetics of, and sensitivty to, drugs
- Interferes with platelet function
What are the effects of hyperkalaemia?
- Bradycardia
- Arrhythmias
- Potentiates the cardiodepressant effects of anaesthetic drugs
List some factors which may help to predict what type or urolith is present
List the options for contrast radiographs for the work-up of suspected urolithiasis
- Cystogram
- Retrograde cystourethrogram
- Double contract cystogram
- Intravenous urogram
What is the reported rate or uroabdomen after cystotomy?
less than 1.5%
Haematuria and dysuria in 37-50%
What cause bladder regeneration after cystectomy?
- Mucosal regeneration, synthesis and remodelling of scar tissue
- Hypertrophy and proliferation of smooth muscle
- Distention of remaining bladder wall
Regenerating cells arise from the epithelium of the terminal ureters and urethra (trigone)
How much bladder can be removed in dogs?
- 30-40% - all dogs regained baseline bladder capacity by 10m
- More than 90% - Still had 72% decrease in capacity by 9m
- 40-70% excised in 11 dogs, 2 had persistant pollakiuria
List options for reconstructions when most or all of the bladder required excision
- Seromuscular colonic augmentation
- Ileocystoplasty
- Total cystectomy with urinary diversion to colon (not recommended, high morbidity)
- TOtal cystectomy with diversion to prepuce or vagina
- Porcine SIS
What approaches can be used for cystostomy tube placement?
- Ventral midline
- Minimally invasive inguinal approach
- Laparoscopic
What % of patients with cystostomy tubes develop complications?
49%
Inadvertnent removal, displacement, chewing, breakage of mushroom tip on removal, fistula formation, urine leakage, rectal prolapse etc
List the 2 broad options for cystopexy
- Tube cystostomy
- Incisional cystopexy (3 rows of 6 simple interrupted sutures with 3-0 polypropylene)
What is a patent urachus?
Foetal communication between urinary bladder and allantoic cas persists, resulting in urine being discharged through urachal tube and exiting abdomen at the umbilicus
What is a congenital vesicourachal diverticulum?
The external opening of the urachus closes but a blind-ending diverticulum remains at the bladder apex
What are the physiologic effects of uroabdomen?
- Azotaemia
- Dehydration
- Metabolic acidosis
- Hyperkalaemia
- Death within 47-90hr
How can you perform peritoneal dialysis in a patient with uroabdomen?
- Place an indwelling abdominal drain
- Instill 20ml/kg warmed isotonic fluid
- Leave in situ for 45 minutes and then drain
- Can be repeated hourly
What are the most common calculi in dogs and cats?
- Struvite (magnesium ammonium phosphate)
- Calcium oxalate
What % of dogs with a negative urine culture will have a positive culture from the urolith, mucosal biopsy or both?
24%
Which uroliths are not amenable to dissolution and therefore requir removal?
- Calcium oxalate
- Silicate
