Ch 115 - Ureters Flashcards

1
Q

What % of felines have circumcaval ureters?

A
  • Right 30.6%
  • Left 1.3%
  • Bilateral 3.3%

7% have a double cava

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2
Q

List the layers or the ureter

A
  • Outer adventitial layer
  • Central muscular layer
  • Inner mucosal layer (lamina propria and transitional epithelium)
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3
Q

What is the response in terms of ureteral pressure in response to acute ligation?

A

Ureteral pressures increase and peak by 5 hours and then lessen but remain elevated for 12-24hr

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4
Q

What is the response of renal blood flow after acute ureteral ligation?

A
  • 24hr - 40% of normal
  • 2 weeks - 20% of normal

Results in a decreased GFR and a compensatory increased GFR in the contralateral kidney

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5
Q

What cellular response is seen in response to acute ureteral ligation?

A
  • Influx of macrophages and T-lymphocytes
  • Macrocyte proteolytic enzymes and cytokines resilt in fibroblast recruitment and activation
  • Interstitial fibrosis or glomerulosclerosis
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6
Q

What is the expected return of GFR after ureteral obstruction in previouslt healthy kidneys?

A
  • 1 week obstruction - 65% of normal GFR over 5wk
  • 2 week obstruction - 46% of normal over 4m

Slight, moderate and severe fibrosis occurs over 1, 2 and 3 weeks respectively

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7
Q

List important points to discuss with the owner in a cat with ureteral obstruction

A
  • Cannot predict how long the obstruction has been presetn and how well the cat will recover
  • Most have some degree of chronic interstitial nephritis which will progress despite surgery
  • If azotaemic with unilateral obstruction, cat has bilateral kidney disease
  • Significant risk of complications - overall mortality 18-21%
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8
Q

List options for surgical management of ureteral obstruction

A
  • Ureteral resection with reimplantation
  • Ureterotomy
  • Double-pigtail ureteral stent
  • SUB
  • Ureteral resection and anastomosis
  • Lithotripsy
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9
Q

What % of cats need removal or replacement of a double pigtail stent?

A

27% - stent occlusion or dysuria

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10
Q

List complications associated with a SUB

A
  • Urolith occlusion 13%
  • Occlusion with blood clot under 3%
  • Kinking 3%
  • Urine leakage - rare
  • Infection
  • Migration into intestines
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11
Q

What is the % of reported urine leakage after a ureterotomy?

A

6-12%

May heal on its own with draining from an abdominal or nephrostomy drain

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12
Q

What are the most common ureteroliths in dogs?

A
  • Struvite and calcium oxalate
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13
Q

What is the most common primary ureteral neoplasia in dogs?

A

Benign fibroepithelial polyps

DDx: leimyoma, TCC, sarcoma, MCT

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14
Q

Where are congenital ureteral strictures most commonly located?

A

Ureteropelvic junction

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15
Q

What is a urinoma?
What is the treatment?

A

A collection of urine within the retroperitoneal space that causes fat necrosis and subsequent reactive fibrosis

Tx: ureteronephrectomy with ablation or omentalisation of the urinoma cavity

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16
Q

What breeds and sex are overrepresented for ectopic ureters?

A
  • Skye terriers
  • Golden retrievers
  • Labs
  • Huskies
  • Newfies
  • Bulldogs
  • WHWT
  • Fox terriers
  • min and toy Poodles

Females are 20x more likely

17
Q

What is the sensitivity and specificity of CT for diagnosing ectopic ureters?

What other imaging technique is highly valuable?

A
  • 91 and 100%
  • Endoscopy of the vagina, urethra and bladder
18
Q

What is the prognosis after surgical repair of ectopic ureters?

A
  • Continence in 22-72%
  • Additional 7-28% become continent with medical management

Those with continued incontinence likely have a functional abnormality of the bladder neck and urethra

19
Q

List the treatment options for ectopic ureters

A

Neoureterocystostomy (extramural)
- End-to-side intravesicular or extravesicular
- Side-to-side

Cystoscopic guided laser ablation (intramural)

20
Q

How does the prognosis of ectopic ureters differ for males as apposed to females

A

Males seem to have a better outcome
- 5/5 and 9/11 continent after neoureterocystostomy
- 4/4 continent with laser ablation
- Longer urethra, increased pressure within prostatic urethra

21
Q

What is the major difference regarding ectopic ureters in cats vs dogs

A

Majority of cats are extramural

22
Q

What is a ureterocoele?
What are the subtypes?
Treatment?

A

Dilatation assoc with the distal ureter or ureteral orifice that occurs as a faulty embryonic development (Chwalla membrane fails to regress)
- Orthotopic/intravesicular - Ureteral orifice in normal positionand entire ureterocoele is within the bladder
- Ectopic - If any portion of ureterocoele is within the bladder neck or urethra

Treatment: Resection of the ureterocoele (ureterocoelectomy) +/- neoureterocystostomy (if ectopic)

23
Q

What is used as a temporary stent when suturing a ureterotomy site?

A

2-0 to 4-0 suture material

24
Q

What are the 2 options for end-to-side neoureterocystostomy?

A
  • Intravesicular - vental cystotomy performed to pull ureter from outside in and suture mucosa to mucosa after spatulating the ureter
  • Extravesicular - no cystotomy required, sutured to mucose with knows external

Cats with contralateral nephrectomy had creatinine concentrations reduce more rapidly with extravesicular technique

25
Q

List options for tension reduction for a neoureterocystostomy

A
  • Renal descensus
  • Pexy apex of bladder to caudal pole of kidney
  • Pexy apex of bladder to iliopsoas muscle (psos cystopexy)
26
Q

What is the prognosis for reimplantation vs ureterotomy

A
  • Similar rates of uroabdomen (15% reimplantation vs 16% ureterotomy)
  • Persistent obstruction more common after reimplantation (11% vs 3%)
27
Q

What is the reported reduction in GFR after a nephrotomy in feline kidneys?

A
  • 10-20% reduction over 78 weeks