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Tobias ECVS - Krizia > Ch 116 - Bladder > Flashcards

Ch 116 - Bladder Flashcards

1
Q

Where do the lateral ligaments attach?
What structures run within them?

A
  • Attach to the pelvic walls
  • Distal ureter and umbilical artery on each side
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2
Q

Where is the trigone?

A

Internal region of the bladder between the ureteral opening and the urethral opening at the bladder neck

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3
Q

What is responsible for voluntary control of micturition?

A
  • Pudendal nerve control of striated urethral muscle
  • Direct cortical innervation of the pontine micturition centre
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4
Q

How long does it take for bladder mucosa to heal?
How long for full-thickness defects to reach full strength?

A
  • Mucosa fully heads in 5 days
  • Full thickness strength in 14-21 days
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5
Q

What suture materials are most appropriate for use in the bladder?
What organism disintegrated all tested sutures by day 7?

A
  • Polydioxanone and polyglyconate
  • Proteus mirabilis
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6
Q

What ABx are a reasonable choice for periop antibiosis in the face of a UTI?

A
  • Amoxiclav
  • 3rd gen cephalosporin
  • Enrofloxacin
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7
Q

What effects does azotaemia have on anaesthesia and surgery?

A
  • Significant impact on animals ability to tolerate anaesthesia due to alterations of pharmacokinetics of, and sensitivty to, drugs
  • Interferes with platelet function
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8
Q

What are the effects of hyperkalaemia?

A
  • Bradycardia
  • Arrhythmias
  • Potentiates the cardiodepressant effects of anaesthetic drugs
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9
Q

List some factors which may help to predict what type or urolith is present

A
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10
Q

List the options for contrast radiographs for the work-up of suspected urolithiasis

A
  • Cystogram
  • Retrograde cystourethrogram
  • Double contract cystogram
  • Intravenous urogram
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11
Q

What is the reported rate or uroabdomen after cystotomy?

A

less than 1.5%

Haematuria and dysuria in 37-50%

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12
Q

What cause bladder regeneration after cystectomy?

A
  • 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)

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13
Q

How much bladder can be removed in dogs?

A
  • 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
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14
Q

List options for reconstructions when most or all of the bladder required excision

A
  • 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
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15
Q

What approaches can be used for cystostomy tube placement?

A
  • Ventral midline
  • Minimally invasive inguinal approach
  • Laparoscopic
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16
Q

What % of patients with cystostomy tubes develop complications?

A

49%
Inadvertnent removal, displacement, chewing, breakage of mushroom tip on removal, fistula formation, urine leakage, rectal prolapse etc

17
Q

List the 2 broad options for cystopexy

A
  • Tube cystostomy
  • Incisional cystopexy (3 rows of 6 simple interrupted sutures with 3-0 polypropylene)
18
Q

What is a patent urachus?

A

Foetal communication between urinary bladder and allantoic cas persists, resulting in urine being discharged through urachal tube and exiting abdomen at the umbilicus

19
Q

What is a congenital vesicourachal diverticulum?

A

The external opening of the urachus closes but a blind-ending diverticulum remains at the bladder apex

20
Q

What are the physiologic effects of uroabdomen?

A
  • Azotaemia
  • Dehydration
  • Metabolic acidosis
  • Hyperkalaemia
  • Death within 47-90hr
21
Q

How can you perform peritoneal dialysis in a patient with uroabdomen?

A
  • Place an indwelling abdominal drain
  • Instill 20ml/kg warmed isotonic fluid
  • Leave in situ for 45 minutes and then drain
  • Can be repeated hourly
22
Q

What are the most common calculi in dogs and cats?

A
  • Struvite (magnesium ammonium phosphate)
  • Calcium oxalate
23
Q

What % of dogs with a negative urine culture will have a positive culture from the urolith, mucosal biopsy or both?

A

24%

24
Q

Which uroliths are not amenable to dissolution and therefore require removal?

A
  • Calcium oxalate
  • Silicate
25
Q

List methods for retrieval of uroliths

A
  • Catheter-assisted retrieval
  • Transurethral cystoscopic retrieval
  • Voiding hydropulsion (fully voided in 15/21)
  • Lithotripsy (Ho:YAG)
  • Laparoscopic assisted or percutaneous cystotomy
  • Surgical cystotomy
26
Q

What is the rate of incomplete removal of cystoliths at cystotomy?

A

20%

27
Q

What minimises urine spillage during a minimally invasive laparoscope-assisted cystotomy?

A
  • Packing swabs around the bladder
  • Using a purse string suture
  • Trochar with a diaphragm
28
Q

What recommendations can be made to reduce recurrence?

A
  • Increased water intake
  • Elimination of obesity
  • Appropriate diet or medical therapy
29
Q

What are the recurrence rates of various uroliths?

A

Struvite
- 21% dogs
- 2.7% cats
- UTI management, acidifying diet

Calcium oxalate
- 50% in dogs within 3 yr
- 7% cats

Urate
- 33% dogs
- 13% cats

Cysteine
- 47% dogs
- diet, 2-MPG

Silicate
- 12% dogs

30
Q

What is polypoid cystitis?
What disease can it resemble?

A
  • An uncommon nonneoplastic inflammatory disease
  • Can resemble TCC but is typically located in cranioventral aspect of bladder
31
Q

List surgical options for polypoid cystitis

A
  • Partial cystectomy
  • Submucosal resection
  • Excisional mucosal biopsy using a clamp placed across the base
  • Resection using laparoscope-assisted cystoscopy
32
Q

What is the most common bladder neoplasia in dogs and cats?
What breeds are overrepresented?

A

TCC
Overrepresented:
- Airedale terriers
- Beagles
- Shelties
- Collies
- Scottish terriers

33
Q

List factors which may be associated with the development of TCC

A
  • Female
  • Obesity
  • Older topical insecticides
  • Phenoxy herbicides
  • Nitrosamine exposure
  • Cyclophosphamide
  • Living in highly industrial area
34
Q

In what % of cases does it effect both the bladder and urethra?
Prostate?

A
  • Bladder and urethra in 56%
  • Prostate in 29% of male dogs
35
Q

What % of TCC will have metastatised to the LNs and to the lungs?

A
  • LN 16% at diagnosis, 40% at necropsy
  • Thoracic: 14% at diagnosis, 49% at necropsy
36
Q

What Tx is associated with the best results for TCC?

A

Recieving multiple different treatment protocols over the course of their disease (leads to control of TCC growth in 75% with a MST of 1yr)
- Response monitored every 4-8 weeks
- Different treatment instituted if cancer progresses or unacceptable toxicity occurs

37
Q

What % of stents will relieve urinary obstruction in the face of TCC?
And cause urinary incontinence?

A
  • over 95% relieve obstruction
  • 26-39% urinary incontinence
  • MST 78d

Tobias ECVS - Krizia (110 decks)

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