Ch 116 - 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 require removal?
- Calcium oxalate
- Silicate
List methods for retrieval of uroliths
- Catheter-assisted retrieval
- Transurethral cystoscopic retrieval
- Voiding hydropulsion (fully voided in 15/21)
- Lithotripsy (Ho:YAG)
- Laparoscopic assisted or percutaneous cystotomy
- Surgical cystotomy
What is the rate of incomplete removal of cystoliths at cystotomy?
20%
What minimises urine spillage during a minimally invasive laparoscope-assisted cystotomy?
- Packing swabs around the bladder
- Using a purse string suture
- Trochar with a diaphragm
What recommendations can be made to reduce recurrence?
- Increased water intake
- Elimination of obesity
- Appropriate diet or medical therapy
What are the recurrence rates of various uroliths?
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
What is polypoid cystitis?
What disease can it resemble?
- An uncommon nonneoplastic inflammatory disease
- Can resemble TCC but is typically located in cranioventral aspect of bladder
List surgical options for polypoid cystitis
- Partial cystectomy
- Submucosal resection
- Excisional mucosal biopsy using a clamp placed across the base
- Resection using laparoscope-assisted cystoscopy
What is the most common bladder neoplasia in dogs and cats?
What breeds are overrepresented?
TCC
Overrepresented:
- Airedale terriers
- Beagles
- Shelties
- Collies
- Scottish terriers
List factors which may be associated with the development of TCC
- Female
- Obesity
- Older topical insecticides
- Phenoxy herbicides
- Nitrosamine exposure
- Cyclophosphamide
- Living in highly industrial area
In what % of cases does it effect both the bladder and urethra?
Prostate?
- Bladder and urethra in 56%
- Prostate in 29% of male dogs
What % of TCC will have metastatised to the LNs and to the lungs?
- LN 16% at diagnosis, 40% at necropsy
- Thoracic: 14% at diagnosis, 49% at necropsy
What Tx is associated with the best results for TCC?
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
What % of stents will relieve urinary obstruction in the face of TCC?
And cause urinary incontinence?
- over 95% relieve obstruction
- 26-39% urinary incontinence
- MST 78d
