Chapter 66 - Bladder

Question 1

What is the bladder’s capacity in a 500-kg horse, and how does its position change when empty or full?

Answer 1

The bladder can hold** 4 L or more of urin**e in a 500-kg horse. When empty, it may lie entirely in the pelvic canal, and when full, it drops over the pelvic brim to extend to the level of the umbilicus.

Question 2

What are the round ligaments of the bladder, and what is their origin?

Answer 2

The round ligaments of the bladder are the cranial free edges of the lateral ligaments, remnants of the umbilical arteries.

Question 3

How is the bladder covered anatomically, both cranially and in the remainder of the retroperitoneal space?

Answer 3

Cranially at the apex, the bladder is covered with peritoneum, and in the remainder of the retroperitoneal space, it is covered with adventitial tissue.

Question 4

What are the two muscle layers in the bladder wall, and how are they arranged anatomically?

Answer 4

Bladder wall contains an** outer layer of longitudinal** to obliquely arranged muscle fibers
**inner layer of transversely **or **circularly arranged **muscle fibers.

They are partly interwoven but become external to each other at the dorsal aspect.

Question 5

Why is the dorsal wall of the bladder considered inherently weak, and what is the potential consequence of excessive bladder distention?

Answer 5

The** dorsal wall** is considered** weak** due to the anatomical arrangement of muscle fibers. Excessive bladder distention may lead to rupture, particularly at the dorsal wall.

Question 6

What muscles form the urethral sphincter, and how are they arranged around the pelvic urethra?

Answer 6

The urethral sphincter is formed by an outer longitudinal and an inner circular layer of smooth muscle surrounding the pelvic urethra.

Question 7

What is the lining of the bladder, and what allows the bladder to stretch considerably during filling?

Answer 7

the bladder is lined with transitional epithelium overlying a thick submucosa that allows considerable stretching.

Question 8

How is sympathetic innervation provided to the bladder, and what receptors do the fibers supply in the bladder and proximal urethra?

Answer 8

Sympathetic innervation is provided via the hypogastric nerve, with fibers supplying the** bladder** (β2-adrenergic receptors) and proximal urethra (primarily α1- and some α2-adrenergic receptors).

Question 9

What is the origin of parasympathetic innervation for the bladder, and how is somatic innervation primarily directed to the lower urinary tract?

Answer 9

Parasympathetic innervation originates in the sacral segments of the spinal cord, forming the pelvic nerve.

Somatic innervation is primarily directed to the lower urinary tract via a branch of the pudendal nerve.

Question 10

What is the detrusor muscle, and how is it innervated in the bladder wall?

Answer 10

The detrusor muscle is the smooth muscle of the bladder wall. It is innervated by the parasympathetic pelvic nerve and β2-adrenergic postganglionic fibers.

Question 11

Describe the filling/storage phase of the bladder, and what is the role of sympathetic nerve activity during this phase?

Answer 11

During filling/storage, there is an increase in tone of the urethral sphincter muscles. Sympathetic nerve activity is dominant, leading to relaxation of the detrusor muscle

Question 12

What receptors mediate the relaxation of the detrusor muscle during the filling/storage phase?

Answer 12

Relaxation of the detrusor muscle during filling/storage is mediated by α-receptor–mediated inhibition of pelvic nerve afferents and stimulation of sympathetic β2 receptors in the smooth muscle of the bladder.

Question 13

How is the detrusor muscle reflexively relaxed during bladder filling, and what triggers detrusor contraction during the elimination phase?

Answer 13

the detrusor muscle reflexively **relaxes during bladder filling due to sensory input from bladder stretch and pressure receptors**. Detrusor contraction is triggered by signals for voluntary micturition during the elimination phase.

Question 14

What is the role of brainstem upper motor neurons in micturition, and what triggers the end of micturition?

Answer 14

Brainstem upper motor neurons transmit signals to trigger detrusor contraction during micturition. Micturition ends when detrusor stretch receptors cease firing, and pelvic nerve efferent activity stops.

Question 15

How is sympathetic nerve and pudendal nerve activity involved in the post-micturition storage/filling phase?

Answer 15

Sympathetic nerve and pudendal nerve activity resumes for the next storage/filling phase after micturition.

Question 16

What triggers the initiation of voluntary micturition signals, and what muscles are concurrently inhibited during this phase?

Answer 16

Voluntary micturition signals are initiated in the cerebrum, leading to the inhibition of pudendal nerve and hypogastric α- and β2-sympathetic activity, allowing relaxation of the urethral sphincter and facilitating detrusor muscle contraction.

Question 17

How does sympathetic innervation contribute to the relaxation of the detrusor muscle during the filling/storage phase?

Answer 17

Sympathetic innervation leads to the relaxation of the detrusor muscle during the filling/storage phase by inhibiting pelvic nerve afferents and stimulating sympathetic β2 receptors in the smooth muscle of the bladder.

Question 18

What are some disorders of the bladder that may necessitate surgery in horses?

Answer 18

Foals:

1. uroperitoneum,
2. patent urachus,

In adult horses,

1. cystolithiasis/urolithiasis
2. prolapse or eversion of bladder
3. neoplasia

Question 19

What is the most common surgical disorder of the bladder in adult horses?

Answer 19

Cystolithiasis

Question 20

What can cause uroperitoneum in foals, and what is the prevalence of uroperitoneum after bladder rupture during parturition in colts?

Answer 20

Uroperitoneum in foals can result from bladder rupture during parturition in colts. The prevalence ranges from 0.5% to 2.5%.

Question 21

What is the commonly accepted explanation for bladder rupture in colts during parturition?

Answer 21

high intravesicular pressure during passage through the pelvic canal and occlusion of the urethra.

Question 22

what is the typical appearance of bladder tears in foals?

Answer 22

Bladder tears are typically** 2 to 5 cm in length** on the dorsal surface, with hemorrhagic and edematous margins.

Question 23

What are the potential causes of bladder distention in stillborn and neonatal foals, and how can bladder distention be confused with uroabdomen?

Answer 23

Potential causes of bladder distention in stillborn and neonatal foals include excessively long umbilical cords and anomalies in bladder-urachus fusion. Bladder distention can be confused with uroabdomen, as seen in cases of enlarged, flaccid bladders.

Question 24

what is the treatment of megavesica in foals

Answer 24

Surgical removal of a large portion of the bladder is the treatment for megavesica with uroabdomen in foals.

Question 24

and what complications may arise after surgical correction?

Answer 24

Complications may include recurrent colic after weaning, as observed in some cases.

Question 25

What electrolyte alterations are commonly found in foals with uroabdomen, and how is uroabdomen confirmed?

Answer 25

**Hyponatremia, hypochloremia, ** and moderate to marked hyperkalemia Uroabdomen is confirmed by measuring a ratio of peritoneal fluid to serum creatinine greater than two.

Question 26

How does bladder rupture in adult horses typically occur?

Answer 26

Bladder rupture in adult horses = less common than in foals Causes: - parturition - urolithiasis - penile hematoma and swelling - blunt abdominal trauma - falling during recovery from anesthesia, or after repair of bladder rupture or treatment of urachal sepsis.

Question 27

What are the clinicopathologic findings in adult horses with bladder rupture, and how do they compare to neonates with uroabdomen?

Answer 27

Clinico pathologic findings in adult horses with bladder rupture include **azotemia** and alterations in **serum electrolyte concentrations**, which are **similar to those found in neonate**s with uroabdomen.

Question 28

Under what circumstances might foals with perinatal asphyxia syndrome (PAS) exhibit bladder distention

Answer 28

Foals with PAS, especially when recumbent, may exhibit bladder distention.

Question 29

how is it managed to prevent rupture?

Answer 29

Temporary use of an indwelling bladder catheter is useful to keep the bladder empty and decrease the risk of rupture.

Question 30

What is the potential complication associated with the temporary use of an indwelling bladder catheter in foals with PAS?

Answer 30

Ascending urinary tract infection

Question 31

In adult horses, what has been observed as a complication following treatment of urachal sepsis as a neonate?

Answer 31

Uroabdomen has been observed as a complication following treatment of urachal sepsis as a neonate in adult horses.

Question 32

What is the suggested cause of bladder tears in foals with smooth margins and no evidence of traumatic disruption?

Answer 32

ay be developmental anomalies rather than ruptures

Question 33

What is the primary cause of lower urinary tract obstruction in male infants, and has it been recognized in horses?

Answer 33

he primary cause of lower urinary tract obstruction in male infants is posterior urethral valves. Although it has not been recognized in horses, bladder rupture, vesicoureteral reflux, and hydronephrosis can result from this condition.

Question 34

Clinical signs of bladder rupture during parturition when does it manifest? what are the signs?

Answer 34

Foals with bladder rupture during parturition initially appear healthy and nurse well for the first 24 to 48 hours. Early signs include a decrease in nursing vigor, lethargy, and progressive abdominal distention, along with intermittent colic signs.

Question 35

From what value must be corrected the hyperkalemia?

Answer 35

K>5.5 mEq/L mm tremors and cardiac arrythmias

Question 36

What is the treatment dosage?

Answer 36

In sever hyperkalemia 50 kgs foal is** 25-50 mL of 23% calcium borogluconat**e added to **1L NaCl 0.9% **and **infused 5-10 minutes** Administer more fluids supplemented with **50% dextrose 4-8 mg/kg/min Drain abdomen go to surgery**

Answer 37

Bloqueio atrioventricular de terceiro grau demonstrando um intervalo R-R irregular sem qualquer relação com as ondas P e um complexo QRS largo (complexo de escape) (seta). O ECG apresenta ondas P regulares que não são seguidas por um QRS e os complexos QRS apresentam uma morfologia larga e bizarra,

Question 38

Answer 38

Figure 66-1. Longitudinal bladder tear in the dorsal aspect of a 3-day-old colt (arrows). This is the typical surgical finding in a foal that develops uroabdomen consequent to bladder rupture sustained during parturition.

Question 39

Answer 39

Figure 66-2. Transabdominal ultrasonographic images at the level of the umbilicus in foals. (A) A large amount of free peritoneal fluid is present in moderate to severe uroabdomen; (B) Only a modest amount of fluid is visible as would be imaged during the early stages of uroabdomen. BL, Bladder; F, free abdominal fluid [urine]; SI, small intestine; UA, umbilical artery.

Question 40

Why do you drain the abdomen?

Answer 40

Essencial to remove large amount of potassium and decrease pressure on diaphragm

Question 41

What can happen if you drain 5L in foal or 50 L in adult??

Answer 41

When a large volume is drained >5 L in foal or 50L in adult}Risk of hemodynamic collaps – administer IV fluids concurrently

Question 42

what is the treatment of choice in uroperitoneum

Answer 42

surgery + AB + NSAID + protector of mucosa

Question 43

What is the urachus, and when does it normally close in equine development?

Answer 43

The urachus is the conduit through which fetal urine passes from the bladder into the allantoic cavity. It normally closes at the time of parturition.

Question 44

Patent urachus is incomplete closure at parturition time is the most common malformation in equine urinary trach. Can be classified in what?

Answer 44

Simple or congenital form from sepsis

Question 45

How can one distinguish between simple or congenital patent urachus and sepsis of the urachus?

Answer 45

Simple or congenital patent urachus is considered a malformation and results in a persistently moist umbilicus Sepsis : considered an acquired patent urachus and may lead to urine leakage from the umbilicus within a few hours to days after birth, often accompanied by more severe illness.

Question 46

What factors have been suggested to cause tension on the umbilical cord attachment, leading to dilatation of the urachus and failure to close at birth?

Answer 46

Greater than **average length** or **partial torsion of the umbilical cord** resulting in dilatation of the urachus and failure to close.

Question 47

What is conservative tx for patent urachus?

Answer 47

Treated with **chemical cauterization with concentrated phenol** or **7% iodine solution** or silver nitrate BID ou QID}These substances can be irritating and predispose to infection In absence of infection dip w/ 0.5% clorhexidine or 0.1% octenidine Large spectrum antibiotics}If after 5-7 days is still leaking or there signs of infection – surgery

Question 48

Why is chemical cauterization contraindicated in cases of local sepsis associated with a patent urachus, and what alternative treatment approach is recommended?

Answer 48

Chemical cauterization is contraindicated in local sepsis cases as it may increase the risk of urachal rupture. Instead, broad-spectrum antibiotic therapy is recommended, and resolution of systemic disease may lead to the closure of the urachus.

Question 49

When might surgical exploration and resection of the urachus and umbilical vessels be indicated in cases of patent urachus?

Answer 49

Surgery if no decrease in urine leakage is observed after 5 to 7 days of medical therapy or US reveals abnormalities of multiple structures in the umbilicus.

Question 50

Answer 50

Urolithiasis

Question 51

what is the primary treatment for equine bladder stones, and how does it differ from the treatment of cystic calculi in small animals?

Answer 51

Surgical removal is the treatment of choice

Question 52

What is the classic presenting complaint for cystolithiasis in horses, and how might affected male horses demonstrate signs of urolithiasis?

Answer 52

**hematuria after exercise.** Affected male horses may demonstrate signs of stranguria by repeatedly dropping the penis and posturing to urinate but voiding little or no urine.

Question 53

What role does urinary tract infection (UTI) play in the development of cystolithiasis in horse

Answer 53

uncertain

Question 54

What are the two basic forms of cystoliths in horses

Answer 54

2 basic forms of cystoliths are: **- yellow-green spiculated **stones (Type I) +++ common -** gray-white smooth stones (Type II).** both are **calcium carbonate crystals**

Question 55

# b

Answer 55

Figure 66-3. Equine cystic calculi. (A) The more common flattened, sphere-shape type of bladder calculus that is highly spiculated. (B) The less-common form of gray, smooth-surfaced calculi that can be more irregular in shape. (A, Courtesy Julie Rossetto, DVM, Alamo Pintado Equine Medical Center, Fenton, Michigan. B, Reproduced from DeBowes RM. Surgical management of urolithiasis. Vet Clin North Am Equine Pract. 1988;4:461, with permission.)

Question 56

How is diagnosis usually made for bladder stones in horses, and what is the importance of endoscopy in further evaluating cystoliths?

Answer 56

Diagnosis is usually made by **rectal palpation**. ** Endoscopy of the urinary bladde**r is important to further evaluate the size, number, and nature of the cystoliths.

Question 57

What is the recommended treatment for sabulous urolithiasis?

Answer 57

Treatment involves repeated bladder lavage and antimicrobial therapy for concurrent UTI.

Question 58

why are affected horses not considered surgical candidates?

Answer 58

**sabulous urolithiasis are not surgical candidates due to the secondary** nature of the problem, which results from bladder paralysis or other disorders interfering with complete bladder emptying.

Question 59

What is the key difference between sabulous urolithiasis and cystolithiasis in terms of bladder size, and how can the diagnosis be confirmed?

Answer 59

**Sabulous urolithiasis **is associated with an e**nlarged bladder** compared to the small bladder typical for cystolithiasis. ** Diagnosis **can be confirmed through careful **rectal palpation,** allowing indentation of the sabulous mass with firm digital pressure.

Question 60

What drugs have been recommended for horses with bladder paresis/paralysis and incontinence?

Answer 60

**Bethanechol and/or phenoxybenzamine** but poor success

Question 61

Answer 61

Initial presentation of the post-partum mare with aneverted bladder. EVE 2020 Segmental ischaemic necrosis of the jejunum in a post-partummare due to two mesenteric avulsionsL. Vilaregut

Question 62

What is the cause of bladder evertion or eventration through tear in the vagina in the mare?

Answer 62

associated w/parturition + collic

Question 63

2 case report revealed jejunal mesentery was avulsed from the intestine and another a small colon was entrapped in the bladder. How was achieved the resolution?

Answer 63

Initial assessment, replacement of the urinary bladder in the normal position did not appear possible. The mare was immediately prepared for C- section. The foal was successfully delivered and resuscitated. Detailed assessment of the bladder during surgery revealed that the small colon had prolapsed through the external urethral opening and **was inside the space formed by the everted bladder.** The urinary bladder was opened. Small colon was replaced into the abdominal cavity; a surgeon gently replaced the small colon through the external urethral sphincter and a second surgeon retrieved the small colon by gentle traction until normally aligned. The bladder was closed and replaced

Question 64

Neoplasia can cause what symptoms and is the most common tumor?

Answer 64

SCC Hematuria, straining, urinary obstruction

Question 65

What are the diagnosis? Prognosis?

Answer 65

Physical exam rectal palpation US endoscopy biopsy Poor prognosis

Question 66

What are the surgical procedures that can be performed in the bladder?

Answer 66

1. CYSTORRHAPHY 2. CYSTOPLASTY 3. CYSTOTOMY 3.1. PARAINGUINAL APPROACH 3.2. PARARECTAL APPROACH 3.3. LAPAROSCOPIC TECHNIQUES 4. LITHOTRIPSY

Question 67

what is the surgical indication of cystorraphy?

Answer 67

Disruption of bladder

Question 68

Describe surgical approach for cystorraphy

Answer 68

ADULTS! Male penis inside prepuce and sutured Adult female mamary gland should be prepped in case incision needs to be extended that far In adult female patient 15-18cm midline incision **caudad from a point 2-5 cm cranial to umbilicus** In the male Skin, subcutaneous layers, of caudal incision directed 2-4cm paramedian to prepuce After peritoneal cavity is entered, fluid is sent for culture and suctioned Bladder exposed by traction on urachus Umbilicalv. ligated and transected ID place and extent of rupture --> need to ID? retrogade injection methylene blue Wound margins are excised Place stay sutures Suture interrupted pattern in 1st layer + continuous inverting pattern !! Avoid penetration of vesicular mucosa (perpetuate calculi w/ alkaline urine) Bladder should be distended w/ saline Urachus is removed if present, abdomen wahsed and closed routinely

Question 69

Answer 69

Figure 66-5. (A) An enlarged bladder filled with a sphere of inspissated sabulous urine sediment at postmortem examination. The mass of urine sediment weighed 5 kg. (B) The sphere of urine sediment could be cut rather easily with a knife. (Reproduced from Schott HC. Urinary incontinence and sabulous urolithiasis: Chicken or egg? Equine Vet Educ. 2006;8:17, with permission.)

Question 70

Answer 70

Figure 66-6. Everted bladder in a postpartum 4-year-old Standardbred mare.

Question 71

Answer 71

Figure 66-7. (A) In male horses or foals, the caudal aspect of the cutaneous midline incision and subcutaneous dissection is directed abaxially to avoid the prepuce and penis. (B) Then the penis and prepuce are retracted laterally so the body wall can be incised on midline.

Question 72

Answer 72

Figure 66-8. After completing the midline incision and mobilizing the umbilicus and urachal remnant from the abdominal wall, the bladder is exposed by careful traction on the umbilicus. When the bladder is exposed, the tissues are retracted caudad.

Question 72

In foals what is advised if is not cystorraphy?

Answer 72

Cystoplasty for bladder rupture and patent or persitent urachus if possible to ressect apex, includes double ligating and** transect both umbilical art.**

Question 73

Answer 73

The external umbilicus should be oversewn if present of the abdomen. Fusiform incision is made around the external umbilicus. The umbilicus and urachus are dissected free from the bodywall. Umbilical vein is double ligated and resected as farcraniad as necessary to remove any portion of abnormal umbilicalvein. Sterile moistened laparotomy sponges to pack the intestines. Ligate umbilical arteries Exposure of the bladder is achieved by traction on the urachus. Stay sutures Isolate urachus in the apex of the bladder Transverse incision to remove urachus

Question 74

Cystotomy is the surgical treatment of choice for?

Answer 74

cystic calculi

Question 75

describe surgery

Answer 75

Figure 66-16. The urolith can be grasped with sponge forceps for expedient removal. When the bladder is exposed, moistened laparotomy sponges are used to pack off the bowel and elevate the bladder in the surgical field. L**arge-diameter stay sutures** can be positioned at the **ventrolateral aspects of the bladder** to facilitate control of the cystotomy incision and to reduce urine spillage. A** transverse incision** is made across the **ventral bladder** to **expose the urolith. **Frequently, the urolith is closely** adherent to the bladder mucosa, **particularly in the case of a** type I urolith. **The mucosal layer of the** bladder must be peeled back from the urolith to permit removal of the calculus (Figure 66-16)**. The **bladder** can be** lavaged in an effort to remove small fragments **of calcular material and blood clots. Irrigation of the bladder by retrograde introduction of sterile saline through the urinary catheter flushes small fragments of the urolith from the neck of the bladder toward the incision, where they can be evacuated by suction. The **cystotomy is sutured with a two-layer closure of monofilament synthetic** absorbable suture material. Continuous inverting suture patterns such as the **Cushing and Lembert patterns **are preferred. The sutures should not penetrate the mucosa of the bladder. After closure of the cystotomy, the bladder may be carefully distended with sterile saline to evaluate the closure for leakage. The abdomen is lavaged with sterile balanced saline solution, which is subsequently suctioned off. The **midline incision** is closed with** USP size 2 or 3 synthetic absorbable** suture material in continuous or interrupted fashion. In very large horses, a suture size of USP size 6 can be used if available. If the caudal limit of the incision was made in a **paramedian location, **the **fascial closure is completed in two layers** by suturing the internal and external layers of the rectus abdominis sheath separately. Of the two layers, the **external rectus sheath** is the more critical to the security of the abdominal closure.The subcutaneous tissues and skin are closed in routine fashion.

Question 76

How would you perform a **parainguinal approach of cysototomy**?

Answer 76

**- 12-14 cm skin incision parallel **and **2 cm axial to external inguinal ring ** - **Blunt dissection** until aponeurosis of external oblique, then incise **12-14cm** - Find** internal oblique **and slip it in direction of fibers Peritoneum entered w/ finger Bladder identified Rest as described before

Question 77

Advantages of parainguinal approach

Answer 77

This approach eliminates the need to reflect the prepuceand reduces the chances of encountering large vessels prior togaining access to the urinary bladder.

Question 78

What is the modified parainguinal approach? Why is advantegous?

Answer 78

A 12-cm ventral midline incision is made at thelevel of the umbilicus. The surgeon’s hand is introduced intothe abdomen and the bladder and calculus are grasped. Basedon the mobility of the bladder the** best location for a parainguinalincision is determined**

Question 79

Transurethral techniques in standing sedate patients where describe in 2 reports. Name them

Answer 79

Direct access to urthra using laparoscopic polyurethane specimen transurethral Pararectal cystotomy

Question 80

Describe pararectal cystotomy landmarks and surgery

Answer 80

- 10-15 cm vertical incision made between right side of anus and right semimembranosus mm - Dissection cranially 15-20cm to expose retroperitoneal aspect of the neck of bladder - Left hand guides through rectum, right hand carries scalpel to make cystotomy incision - Calculus is removed - Can be left to heal by 2nd intention

Question 81

Laparoscopic technique is used as well to repair cystorrhexis, persistent urachus and umbilical infections what are the portals?

Answer 81

DR - insufflation w/ teat cannula or Veress needle, lower insufflation rates -1.5 cm incision 5m lateral to ventral midline - 10-15cm cranial to umbilicus – for laparoscope - Additional portals 8-10cm lateral, 5cm cranial to umbilicus

Question 82

In adults?

Answer 82

Bladder lavage and drained until clear salin Standard umbilical portal mader after insufflation 5 instrument portals

Question 83

What does it mean lithotripsy?

Answer 83

Means of fragmenting urinary calculus into smaller pieces so that fragments can be removed through smaller lumen or incision Manueal crushing associated with high rate recurrence

Question 84

What are the options for lithotripsy?

Answer 84

Laser dye Holmium laser Electrohydraulic shockwave

Question 85

What is the laser lithotripsy pulse dye wavelenght?

Answer 85

504 nm - Causes disruption of calculus, generating acoustic wave greater than tensile strength of crystals

Question 86

If you use Holmium yttrium aluminum garnet wha is the wwavelength?

Answer 86

wavelenght 2100nm}Uses photothermal + photoacoustic effects to fragment urolith

Question 87

How do you perform electrohydraulic shockwave lithotripsy?

Answer 87

- Can be done standing - Fiber is passed thtough working channel, and held in contact w/ calculus - Calculus fragmented until they’re 1 cm in diameter - Described in 21 males, required average 2.15 sessions (1-6 sessions) - Only works if calculus is submerged in fluid

Question 88

What is the aftercare required?

Answer 88

- Antibiotics 48-72h - Urinary catheter 48-72 h - Abdominaldrainage if peritonitis - May require iv fluids and electrolyte supplementation

Question 88

What can you during laparoscopy to increment you vision of the bladder?

Answer 88

Trendelenburg position

Question 89

List the complications postoperative

Answer 89

–– Uroabdomen/extravasation of urine –– Incontinence –– Infection –– Urine scalding –– Stricture/fistula –– Complications related to suture choice andplacement –– Complications related to suture choice andplacement

Question 90

Answer 90

Bernardis et al 2017 Components of the pneumatic lithotripsy equipment. a)Gas regulator, b) Gas line, c) Pneumatic scaler, d) laparoscopicretrieval bags, e) stainless steel lithotrite.

Question 91

Answer 91

Hall and Rodgerson EVE 2020 describe a transurethral intraluminal closure of a caudally located bladder neck tear in standing mare

Question 92

Answer 92

Hall 2020 Endoscopic view of the bladder tear, located caudally inthe region of the neck of the bladder.

Question 93

Describe the surgical procedure of transurethral intraluminal closure

Answer 93

Caudal epidural anesthesia, mepi faeces manually removed, tail tied, Vaginal speculum 31 cm laparosocope 10 mm and needle holder grasping cutting needle Vicryl that was passed in loop simple continuous pattern and grasped with second needle holder and knot was thrown outside of vaginal speculum and slid down

Question 94

What was the medication given to the mare postoperatively?

Answer 94

fluidtherapy with a balanced electrolyte solution infusion (2.5 mL/kg/h) supplemented with 250 mL 23% calcium gluconate(Calnate) Lidocaine administration at0.05 mg/kg/min. She was started on **phenazopyridine Wilma.1988%hydrochloride (Pyridium)10 tablets (4 mg/kg t.i.d. per os).** The morning after surgery she was quiet and her vital signs werewithin normal limits. (She had passed dry, formed manure andhad a poor appetite.) The abdominal drain was removed26 h after surgery following the identification of no free fluidwithin the peritoneal cavity. The urinary catheter was closelymonitored and remained in place for 7 days post-operatively Potassium penicillin G (K-Pen4; 500,000 units/mL i.v. q. 6 h)was administered for 6 days post-operatively, gentamicin(Gentocin2; 6.6 mg/kg bwt i.v. q. 24 h) for 8 days, flunixinmeglumine for 7 days (Banamine5; 1.1 mg/kg i.v., twice aday for 3 days, once a day for the next 4 days).

Question 95

Answer 95

Figure 66-9. The bladder is retroflexed to examine a tear on the dorsocranial wall of the bladder.

Question 96

Answer 96

Figure 66-11. Tissues surrounding a tear in the bladder should be excised before primary repair.

Question 97

Answer 97

Figure 66-12. A two-layer inverting continuous closure is appropriate for repair of a bladder rupture.

Question 98

Answer 98

Figure 66-10. A rupture of the urachus (located at the tip of the hemostatic forceps) is readily apparent on inspection of the cranial bladder.

Question 99

Answer 99

Figure 66-13. After mobilizing and retracting of an umbilical or urachal abscess, the abdomen should be explored for adhesions or additional foci of abscessation.

Question 100

Answer 100

Figure 66-14. Before urachal-umbilical resection, a clamp is applied to prevent spilling urachal contents into the peritoneal cavity. Here, the bladder has been stabilized by stay sutures transfixed as ligatures around the umbilical arteries. The urachus and umbilical tissues are removed by sharp dissection. The bladder is closed by the two-layer inverting continuous suture pattern.