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Urogenital system > Bladder > Flashcards

Bladder Flashcards

1
Q

According to Cruciani in Vet Surg 2020 what was the minor complication rate following PCCL in dogs and cats? In what percentage of cases did stones recur?

A

24% (lower urinary tract signs).
Long term stone recurrence occurred in 21% of cases.

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2
Q

According to Visser 2020 in Vet Surg, what was the rate of resolution of lower urinary tract signs in patients undergoing partial cystectomy for urachal remnant removal?

A

64%

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3
Q

According to Adair 2022 in Vet Surg, what was the main benefit of PCCL compared to open cystotomy? Was there any difference in the incidence of incomplete urolith removal?

A

Significantly reduced lower urinary tract signs with PCCL.
No difference in incomplete urolith removal.

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4
Q

In a study by Shimizu 2021 in JSAP, what technique was successfully used for urinary bladder biopsy in instances where urethral size precluded endoscopic guided biopsy?

A

Ultrasound guided transurethral biopsy using endoscopic biopsy forceps (could be used in urethras down to 1.8mm in size).

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5
Q

In a study by DeBow 2023 in VRU, were urate and cystine uroliths >1mm able to be visualized on digital radiography?

A

Yes

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6
Q

In a study by Buote 2022 in JFMS, what was the odds of cats undergoing open v. MIS cystotomy in experiencing a composite outcome (comprised of pain scores >2 at 6 or 12 hrs post-op, failure to remove all stones, and postoperative complications requiring an additional visit to the hospital)?

A

Cats undergoing open cystotomy had an 8x higher chance of experiencing the composite outcome score (21% v 71% in the MIS group).

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7
Q

In a study by Muehlbauer 2023 in JVECC, what technique was successfully used for detection of bladder rupture in cadaveric dogs

A

Agitated saline contrast enhanced cystosonography

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8
Q

In a study by Job 2022 in JVIM, was there a difference in surgical and anesthesia times for dogs/cats undergoing PCCL as compared to open cystotomy? In what percentage of patients was complete urolith removal achieved in both groups?

A

No difference in surgery or anesthesia times for either group. Hospitalization was shorter in dogs undergoing PCCL, but not cats.

Complete urolith removal was achieved in 98% of cases.

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9
Q

The ventral median ligament of the bladder is the remnant of which embryonic structure?

A

Urachus

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10
Q

What is the difference between bladder position in dogs and cats?

A

In cats the bladder remains completely abdominal, even when empty.

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11
Q

What are the anatomic boundaries of the trigone of the bladder?

A

Ureteral openings in the dorsal bladder wall and the proximal urethral opening at the bladder neck.

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12
Q

What are the layers of the bladder?

A

Mucosa, submucosa, muscularis (detrusor), serosa.

The detrusor muscle is composed of oblique interdigitating muscle fibers that are continuous with the smooth muscle of the urethra (no anatomically distinct internal urethral sphincter).

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13
Q

Describe control of micturition as it relates to the innervation of the bladder.

A
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14
Q

From which spinal cord segments do the nerves that innervate the bladder originate?

A

Hypogastric (sympathetic): thoracolumbar.
Pelvic (parasympathetic): S1-S3
Pudendal (somatic): S1-S3.

All the nerves merge together at the pelvic plexus before entering the dorsal surface of the bladder in the region of the bladder neck.

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15
Q

What is the effect of prolonged bladder distension on urinary bladder innervation?

A

Loss of excitation contraction coupling within the bladder (not all detrusor muscle cells are innervated and they rely on this coupling for transmission of signals throughout the bladder).

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16
Q

What is the vascular supply to the bladder?

A

Caudal vesical artery via the prostatic (males) or vaginal (female) arteries. Both are branches of the internal pudendal.

If the umbilical artery remains patent into adulthood a cranial vesical artery may also contribute.

Bladder drainage is into the internal pudendal veins.

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17
Q

What is the lymphatic drainage of the bladder?

A

Hypogastric and sublumbar lymph nodes.

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18
Q

Full thickness bladder defects regain 100% of strength by how many days post-operative?

A

14-21 days (mucosal defects heal within 5 days).

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19
Q

What suture patterns are recommended for closure of the bladder?

A
  1. Single-layer, full-thickness, simple continuous or interrupted.
  2. Two-layer inverting pattern.

Neither has been shown to be inferior.

Experimental studies have shown that poliglecaparone 25 may not have sufficient tensile strength during the critical phase of bladder healing. PDS and polyglyconate were appropriate, but also rapidly lost strength when immersed in Proteus infected urine.

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20
Q

What is the infection rate for clean contaminated surgeries (including the bladder)?

A

5%

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21
Q

What are suitable empirical antimicrobial choices for common urinary tract pathogens (E.coli, proteus, staph)?

A

Amoxy-clav, enrofloxacin, third generation cephalosporin.

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22
Q

What is the cardiovascular effect of hyperkalemia? How can it be medically treated beside urinary unobstruction?

A

Bradycardia and cardiac arrhythmias.

Medical management options include calcium gluconate, glucose and insulin, or sodium bicarbonate administration.

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23
Q

What is the effect of azotemia on BMBT?

A

Uremia can prolong BMBT through platelet dysfunction.

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24
Q

What is the rate of normal urine production?

A

1-2 ml/kg/hr

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25
Q

Describe the factors that may help predict the composition of common urolith types?

A
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26
Q

What are some diagnostic techniques recommended for the work-up of bladder disease?

A
  1. Cystocentesis.
  2. Ultrasound +/- guided catheter biopsy of masses.
  3. Radiography +/- contrast (positive contrast cystogram or cystourethrogram, double contrast cystogram, intravenous urogram).
  4. Cystoscopy.
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27
Q

When might double contrast cystogram of the bladder be useful?

A

Produces enhanced mucosal detail and is recommended for highlighting bladder wall lesions, intraluminal masses, and cystic calculi.

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28
Q

What are methods of cystoscopy in female and male dogs?

A

Female: rigid cystoscopy, laparoscopic assisted (PCCL).

Male: percutaneous prepubic rigid cystoscopy, flexible cystoscopy, laparoscopic assisted (PCCL).

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29
Q

In what percentage of cystotomy procedures does uroabdomen occur?

A

<1.5%. More common complications are hematuria (37%) and dysuria (50%).

30
Q

What are the mechanisms by which bladder capacity restores following partial cystectomy?

A

Mucosal regeneration, synthesis and remodelling of scar tissue; hypertrophy and proliferation of smooth muscle; distension of the remaining bladder wall.

31
Q

How much bladder can be resected without causing long-term pollakiuria?

A

35-40% seems to be tolerated experimentally (return to baseline capacity by 10-months). 90% resection resulted in ongoing 72% reduction in baseline at 9-months.

Clinical removal of 30-70% of the bladder resulted in no long-term incontinence, but pollakiuria was present in some instances.

32
Q

What are options for bladder reconstruction in instances of extensive partial or total cystectomy?

A
  1. Excision and closure over a Foley catheter for decompression.
  2. Seromuscular colonic augmentation.
  3. Ileocystoplasty.
  4. Rectus abdominus muscle flap.
  5. Total cystectomy with urinary diversion to the colon (not recommended due to morbidity).
  6. Total cystectomy with urinary diversion to the prepuce or vagina.
  7. Augmentation of cystectomy with porcine SIS (successful in 40% but not 90% cystectomy model).
33
Q

When might cystostomy tubes be used?

A

Obstructive bladder neck or urethral neoplasia, neurogenic bladder atony.

34
Q

How long must a cystostomy tube remain in place for a stoma to form?

A

7-days

35
Q

What percentage of dogs with cystostomy tubes develop complications?

A

50%

36
Q

What is the most common complication associated with long term use of cystostomy tubes?

A

Recurrent urinary tract infection, with E.coli the most common isolate.

37
Q

What are some tube options for use on cystostomy tube placement?

A

Foley catheter: not recommended long-term due to deflation of the balloon over time.

Mushroom tip (de Pezzer).

Low profile.

38
Q

How is cystopexy performed?

A

Either via cystostomy tube placement or incisional cystopexy.

Incisional cystopexy is performed via abrasion of the bladder and abdominal wall with a gauze square. Three longitudinal rows of suture are placed engaging the submucosal layers of the bladder wall and transversus abdominus. Lap-assisted is also described.

39
Q

If performing a right sided cystopexy care should be taken to avoid which structure?

A

Deep circumflex iliac artery.

40
Q

What are some congenital bladder abnormalities?

A

Vesicourachal diverticula, patent urachus, bladder hypoplasia, genitourinary dysplasia (cats).

41
Q

How are congenital bladder abnormalities typically diagnosed?

A

Contrast cystography.

42
Q

What is the treatment for bladder hypoplasia?

A

Typically occurs in conjunction with ectopic ureters and USMI. Often resolves once these underlying conditions are corrected.

43
Q

What are the typical biochemical abnormalities associated with bladder rupture? How soon after bladder rupture does death result?

A

Hyperkalemia, azotemia, dehydration and metabolic acidosis.

Death results within 47-90 hours.

44
Q

If uroabdomen is diagnosed, how is the source of urinary tract rupture identified?

A

If the fluid is intraperitoneal a retrograde urethrocystogram usually identified a urethral or bladder rupture.

If the fluid is retroperitoneal an excretory urogram/intravenous pyelogram may be required to assess the ureters and kidneys.

45
Q

How can temporary urine diversion be achieved in patients with urinary tract rupture?

A

Urinary catheter, cystostomy tube +/- abdominal drainage.
Peritoneal dialysis can be performed if patients are refractory to simple drainage (infusion of 20 ml/kg of fluid with drainage after 45 minutes, repeated hourly).

46
Q

In what percentage of recurrent canine and feline cystoliths has suture been identified as a nidus?

A

Canine: 9.4%
Feline: 4%

47
Q

What are the most common compositions of canine and feline calculi?

A

Struvite and calcium oxalate (50/50).

48
Q

What size calcium oxalate and struvite uroliths are identifiable on radiography?

A

> 1mm

49
Q

What percentage of urate, cystine and calcium phosphate uroliths are unable to be detected on radiographs?

A

25%

50
Q

In what percentage of dogs were urinary tract infections diagnosed in conjunction with cystic calculi?

A

76%

(24% of dogs with negative urine culture results pre-op also had positive culture results based off bladder mucosal biopsy, urolith, or both).

51
Q

What are the most sensitive imaging techniques for detection of bladder calculi?

A

Pneumocystography, double contrast cystography, ultrasound (accurate count obtained in 50% of cases with these techniques).

CT may also be useful and can differentiate between mineral content of some uroliths.

52
Q

Which uroliths may be able to be medically dissolved?

A

Urate, struvite, cystine.

Calcium oxalate and silicate cystoliths cannot be medically dissolved and require removal.

53
Q

What are methods of retrieval of calculi from the bladder?

A
  1. Catheter assisted.
  2. Transurethral cystoscopic.
  3. Voiding hydropulsion.
  4. Lithotripsy (Ho:YAG laser).
  5. Lap-assisted or PCCL.
  6. Surgical cystotomy.
54
Q

What are some reasons for failure of lithotripsy for urolith retrieval?

A

Small urethral diameter, rupture of the bladder during voiding hydropulsion, excessive or undetected residual urolith fragments.

Female dogs with urethroliths are the easiest to treat successfully.

55
Q

Is cystotomy or laser lithotripsy considered more successful in the removal of uroliths?

A

No difference. Laser lithotripsy associated with longer procedure but shorter hospitalization periods. No difference in complications.

56
Q

In what percentage of dogs is incomplete cystolith removal documented following cystotomy?

A

20%

57
Q

What is the benefit of lap-assisted cystotomy over open cystotomy?

A

Decreased requirement for post-operative analgesia. However also more expensive, the procedure is longer, and no differences in incomplete cystolith removal or hospitalization times.

58
Q

What are the recommended medical management options to prevent calculi recurrence following removal?

A
  1. Struvite (recurrence in 21% dogs, 3% cats); controlling UTIs, acidifying diet.
  2. Calcium oxalate (recurrence 50% in dogs, 7% in cats): non-acidifying, high-moisture diet without excessive protein. Correction of hypercalcemia.
  3. Urate (recurrence in 33% dogs, 13% cats): high-moisture, protein restricted, alkalinizing diet. Allupurinol is not recommended due to risk of xanthine urolith formation.
  4. Cystine (recurrence 47% of dogs): dietary changes, 2-MPG (prevented recurrence in 86% of dogs).
59
Q

Where are polypoid lesion normally located within the bladder?

A

Cranioventrally. Typically affects female dogs.

60
Q

What is the cause of polypoid cystitis?

A

Unknown, but could be related to recurrent UTIs, cystic calculi, or both.

61
Q

What is the most common presenting sign associated with polypoid cystitis?

A

Hematuria.

62
Q

What imaging techniques can be used to diagnose polypoid cystitis?

A

Ultrasound, cystoscopy, contrast radiography. Biopsy is needed to confirm the diagnosis (either surgically or via cystoscopy).

63
Q

What treatment is recommended for polypoid cystitis?

A

Surgical excision with concurrent management of UTI.

Surgical excision techniques include:
1. Partial cystectomy.
2. Submucosal resection.
3. Excisional mucosal biopsy with clamp at base.
4. Lap-assisted cystoscopy and resection.

64
Q

What is the most commonly reported bladder neoplasia?

A

Transitional cell carcinoma.

65
Q

What are some potential risk factors for development of bladder TCC?

A

Neutering, male cats, female dogs, obesity, use of older topical insecticides, exposure to phenoxy herbicides, nitrosamine exposure, cyclophosphamide exposure, living in an area with high industrial activity.

66
Q

How is TCC of the bladder diagnosed?

A
  1. Urine cytology: not very sensitive or specific.
  2. Urine antigen tests: lack specificity (but very sensitive, so may be useful to rule out TCC).
  3. Ultrasound or double contrast cystography +/- excretory urogram or retrograde urethrocystogram to the assess the ureters or urethra.
  4. CT scan can assess for metastatic disease (including vertebral and pelvic masses).
  5. Cystoscopy +/- transurethral biopsy (can also be collected under ultrasound guidance, or blind).
67
Q

Why is FNA or biopsy of suspected bladder TCC not recommend?

A

High risk of abdominal wall seeding.

68
Q

In what percentage of dogs with bladder TCC were lymph node and pulmonary metastases detected?

A

Lymph node: 16% at diagnosis, 40% at death.

Pulmonary: 14% at diagnosis, 49% at death.

69
Q

Does bladder TCC grade correlate with tumor progression and survival?

A

Yes

70
Q

What are the treatment options available for bladder TCC?

A
  1. Chemotherapy +/- NSAIDs (piroxicam).
  2. Total cystectomy.
  3. Cystostomy tube placement.
  4. Urethral stenting.
  5. Partial cystectomy (long survival times have been reported if tumour confined to the mucosa).
  6. Transurethral cystoscopic laser ablation.
71
Q

What are the potential complications associated with urethral stenting for bladder TCC?

A

Urinary incontinence (26-39%), stent migration and reobstruction due to tumour growth.

72
Q

What was the MST for bladder TCC following stenting?

A

78 days.

Urogenital system (11 decks)

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