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ACVS Phase I Master Deck *Use This* > Chapter 117: Urethra > Flashcards

Chapter 117: Urethra Flashcards

1
Q

Urethra is innervated by which nerves?

A

hypogastric and pelvic

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2
Q

Urethralis is innervated by which nerve exclusively ?

A

Pudendal nerve

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3
Q

Blood supply by which artery?

A

Internal pudendal artery (prostatic, urethral and penile branches)

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4
Q

Average diameter of male cat urethra?

A

0.7mm

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5
Q

Average diameter of female dogs?

A

0.5cm

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6
Q

MOA of calcium gluconate?

A
  • Increases the threshold for cardiac myocyte depolarization, soley cardioprotective agent, does not alter serum K+ level
  • DOA: 30-60mins
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7
Q

most common site of male urethral obstructions

A

cd os penis

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8
Q

how to improve success of urohydropulsion?

A

LA, lube, coccygeal epidural LA, different sizes of urethral catheter used

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9
Q

animals only show clinical signs when urethral diameter is narrowed over what %?

A

> 60%

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10
Q

urethral mucosa can regenerate in X days

A

7 days

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11
Q

Which urethrostomy is most useful for revision of failed perineal urethrostomies?

A

TPU

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12
Q

Most common complication from scrotal PU in a dog?

A

Persistent haemorrhage, haematuria 3-5 days postop and usually self-limiting

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13
Q

common 2 complications from PU in cats?

A

Stricture and urine extravasation

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14
Q

TPU - how much in mm length and mm in width to remove from cd ischium to expose urethra?

A

12mm in length and 10mm in width

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15
Q

MST is prolonged if what happens prior to SEMS placement (self-expanding metallic stent)?

A

NSAID and chemo

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16
Q

Most significant complication with SEMS?

A

Urinary incontinence 26%
stranguria is 2nd most common
( other complications bladder atony, recurrent obstruction and stent migration)

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17
Q

Tx options for a urethral stricture?

A
  • Urethrostomy proximal to site
  • R and A
  • Balloon dilatation
  • Stent placement
  • experimentally - Urethral replacement
18
Q

What is the most common complication post urethropexy/R and A?

A

Post op haemorrhage 39%

19
Q

List the layers of the urethra:

A
  • Mucosa (transitional epithelium proximally, squamous distally)
  • Submucosa (vascular)
  • Muscularis
20
Q

Describe the muscularis layer of the urethra in the male and female dog and cat:

A

Male dog:
- Inner longitudinal smooth surrounded by outer circumferential striated
- Smooth muscle is in the distal 2/3rds of the urethra
- Striated mostly Type II fast twitch, some Type I slow twitch

Male cats:
- 3 layers of smooth muscle - inner longitudinal, middle circumferential, outer longitudinal

Female dog:
- Three smooth muscle layers as male cats
- Smooth muscle essentially absent in terminal urethra
- Prominent sphincter of striated muscle at external urethral orifice

Female cat:
- Significantly more smooth muscle and significantly less striated urethral sphincter than female dog

21
Q

What is the urethral diameter of male cats at the level of the pre/post prostatic, bulbourethral glands and at the penile urethra?

A

-Pre/Post prostatic both 2mm
- Bulbourethral gland 1.3mm
- Penile urethra 0.7mm

22
Q

How long is the urethra in a male cat?

A

8.5 to 10.5 cm

23
Q

How long is the urethra in a male dog?

A

~25cm in a 25lb dog

24
Q

Urethral length in female dogs and cats?

A

7-10 cm

25
Q

Width of urethral lumen in female dogs?

A

0.5cm

26
Q

What is the theorized mechanism of hypothermia in cats with urethral obstruction?

A
  • Reduction in the thermoregulatory set point in the hypothalamus secondary to uremia
  • Or secondary to volume depletion and shock.
27
Q

What is the time frame for renal decompensation and death in animals with complete urethral obstruction?

A
  • Renal decompensation within 24hr
  • Death 3-6 days
28
Q

What fluid is most efficient for correcting electrolyte derangement with urethral obstruction?

A

Lactated ringer’s solution (LRS) - give at least 15 min of fluids before anesthesia.

29
Q

List options and mode of action of each option for the treatment of hyperkalemia:

A

10% Calcium Gluconate
- Increases threshold for cardiac myocyte depolarization. 0.5-1.5ml/kg IV over 5-10 min, last 30-60min

IV dextrose +/- regular insulin
- Drives K intracellularly by cotransport. Lasts 2-4hr

Sodium Bicarbonate
- Enables H ions to move extracellularly in exchange for K. Only used if severe acidosis

30
Q

What are the critical factors which effect urethral healing?

A
  • Mucosal continuity
  • Urine extravasation

If a strip of mucosa is left intact and urine is diverted, the urethral mucosa can regenerate within 7 days

31
Q

How much narrowing of the urethral lumen can occur before clinical signs appear?

A

60%

32
Q

What can plain abdominal radiographs tell you for urethral lesions? What are they not good at?

A

Abnormal location of bladder, radiopaque calculi

Not good for trauma (need contrast)

33
Q

What is the imaging modality of choice for urethral lesions?

A

Positive-contrast retrograde urethrography
Use fluoro, balloon catheter in distal urethra

34
Q

Negative-contrast (air) urethrography is contraindicated in trauma for what reasons?

A

Rarely shows location of tears
Can cause fatal air embolism

35
Q

Ultrasound of the urethra is limited to the extrapelvic portions, but can add information about what?

A

Wall thickness and mucosal surface contour.

36
Q

What is an emerging method of evaluating the urethra and treating lesions?

A

Cystoscopy/urethroscopy.

-Stricture dilation, laser lithotripsy, laser ablations, submucosal collagen injections

37
Q

What type of suture should you use for the urethra?

A

4-0 or 5-0 Monocryl or PDS if concerned it will take time. Taper needle.

38
Q

What is the prognosis after urethral anastomosis?

A

Guarded - Some degree of stenosis is expected

39
Q

Male dogs most commonly obstruct where?

A

At os penis

40
Q

What type of analgesia can be used to help unobstruct a dog?

A

Coccygeal epidural

ACVS Phase I Master Deck *Use This* (88 decks)

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